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Blood > Urine - Sediment Exam > Flashcards

Urine - Sediment Exam Flashcards

1
Q

Urine Amount

A
  • Minimum of 6 mL needed
  • 12-15 mL best
  • If below 6 mL, note on report
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2
Q

Normal Cell Amounts

Urine Sediment

A
  • RBCs = <2-3 cells / HPF
  • WBCs = 0-1 cells / HPF
  • Epithelial Cells = occasional / HPF
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3
Q

RBC Appearance / Changes

Urine Sediment

A

Appearance changes based on pH, SG, and time elapsed
* crenation = high SG
* swell or lyse = low SG or alkaline urine
* can be confused with fat or yeast

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4
Q
A

RBCs in Urine Sediment

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5
Q

WBC

Urine Sediment

A
  • Most are neutrophils
  • Larger than RBCs, but smaller than renal epithelial cells
  • Culture if excessive seen, even without bacteria
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6
Q

WBC Appearance / Changes

Urine Sediment

A

Changes based on SG
* shrink = high SG
* swell = low SG

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7
Q
A

WBC in Urine Sediment

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8
Q

Epithelial Cells

Normal Urine Sediment

A
  • Normal = few (older cells sloughing off)
  • Increased = inflammation
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9
Q

Types of Epithelial Cells

A
  • Squamous
  • Transitional
  • Renal
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10
Q

Squamous Epithelial Cells

A
  • Origin of distal urethra, vagina, vulva, prepuce
  • Usually not significant
  • Collected in voided samples
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11
Q

Squamous Epithelial Cell Appearance

A
  • Large, flat, thin cels
  • Straight edges with distinct corners
  • Small, round nucleus
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12
Q
A

Squamous Epithelial Cells

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13
Q

Transitional Epithelial Cells

A
  • Origin in bladder, ureters, renal pelvis, proximal urethra
  • Normal = low (0-1 / HPF)
  • Increased = cystitis or pyelonephritis / catheterization
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14
Q

Transitional Epithelial Cells Appearance

A
  • Round or pear-shaped
  • Granular with small nuclei
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15
Q

Clumping Transitional Epithelial Cells

A
  • Indicative of Transitional Cell Carcinoma (especially if no WBC)
  • Neoplastic
  • Carcinoma can have cells be different size
  • Can be caused by catheterization
  • Chemotherapy and radiation needed for treatment
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16
Q
A

Transitional Epithelial Cells

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17
Q

Renal Epithelial Cells

A
  • Origin in renal tubules
  • Normal = rare, 0-1 / HPF
  • Increased = Kidney disease
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18
Q

Renal Epithelial Cell Appearance

A
  • Smallest
  • Slightly larger than WBCs
  • Round with large nucleus
  • Non-granular to finely granular
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19
Q
A

Renal Epithelial Cells

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20
Q

Casts

Urine Sediment

A
  • Form in lumen or distal/collecting tubules
  • Localize injury to kidney
  • Any seen indicate abnormality - implies some degree of renal damage
  • Dissolve in alkaline urine
  • Number is not indicative of renal disease severity
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21
Q

Casts Appearance

General

A
  • Cylindrical structures
  • Parallel sides
  • Width is same as tubule lumen
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22
Q

Hyaline Casts

A
  • Composed of mucoprotein
  • Seen with mild renal injury and glomerular leakage
  • Easier to identify with staining
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23
Q

Hyaline Casts Appearance

A
  • Clear, colorless, and somewhat transparent
  • Rounded end
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24
Q
A

Hyaline Casts

25
Q

Granular Casts

A
  • Older epithelial cell casts that degenerated and can no longer be identified as individual cells
  • Coarsely = early stage
  • Finely = late stage (form waxy casts)
  • Most common type
26
Q
A

Granular Casts

27
Q

Cellular Casts

A

May be red, white, or epithelial cell in composition
* red = indicate renal hemorrhage or inflammation
* white = indicate renal inflammation
* epithelial = indicate acute tubular degeneration

Increased = severe kidney disease or acute nephritis

28
Q
A

Cellular Casts

29
Q

Waxy Casts

A
  • Indicate chronic tubular degeneration
  • Must be distinguished from hyaline casts
  • Essentially means kidney has shut down
30
Q

Waxy Cast Appearance

A

Wide with square ends when compared to hyaline casts

31
Q
A

Waxy Casts

32
Q

Progression of Casts

Not as Severe - Severe

A
  • Hyaline
  • Cellular
  • Granular
  • Waxy
33
Q

Urinary Crystals

A
  • Form due to their elements secreted into urine by normal renal activity
  • Type depends on pH, concentration, temp, solubility of elements
34
Q

Struvite Crystals

A
  • Also known as triple phosphate (magnesium ammonium phosphate)
  • Form in alkaline urine
  • “Coffin lids”
35
Q
A

Struvite Crystals

36
Q

Calcium Oxalate Crystals

A
  • Can be Dihydrate or Monohydrate
  • Form in acidic or neutral urine
37
Q

Dihydrate Calcium Oxalate Crystals

A
  • Small square crystals
  • Contain an “X” through center
38
Q

Monohydrate Calcium Oxalate Crystals

A
  • Small and dumbbell-shaped or elongated
  • Pointed at end
  • Seen with ethylene glycol toxicity
39
Q
A

Dihydrate Calcium Oxalate Crystals

40
Q
A

Monohydrate Calcium Oxalate Crystals

41
Q

Cystine Crystals

A
  • 6-sided, colorless, and thin
  • Renal tubule dysfunction
  • Inherited metabolic defect
42
Q
A

Cystine Crystals

43
Q

Ammonium Biurate Crystals

A
  • Round with long irregular spikes
  • Brown color
  • See with any pH
  • Common with liver disease
44
Q
A

Ammonium Biurate Crystals

45
Q

Uric Acid Crystals

A
  • Usually diamond or rhomboid shape
  • Yellow or yellow-brown
  • Uncommon, except for in Dalmatians
46
Q
A

Uric Acid Crystals

47
Q

Amorphous Crystalline Material

A

Phosphate
* alkaline urine

Urate
* acidic urine

Both contain granular precipitates

48
Q
A

Amorphous Crystals

49
Q

Leucine Crystals

A
  • Wheel or pin-cushion shaped
  • See with liver disease
50
Q
A

Leucine Crystals

51
Q

Tyrosine Crystals

A
  • Dark with needle-like projections
  • See with liver disease
52
Q
A

Tyrosine Crystals

53
Q

Pathological Crystals

A
  • Cystine
  • Tryocine
  • Leucine
54
Q

Bacteria

A

Only observed with contamination
* Cocci = round shape
* Bacilli = rod shape
* Quantitate on Low Power Field

55
Q

Parasites

A

Urinary parasites or result of fecal contamination
* bladder worm = p. plica
* kidney worm = d. renale

56
Q
A

Bladder worm (p. plica)

57
Q
A

Kidney Worm (d. renale)

58
Q

Mucus Threads

A
  • Twisted ribbon
  • Confused with casts - not well delineated edges
  • Indicate urethral irritation or genital secretion contamination
59
Q
A

Mucus Thread

Blood (11 decks)

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