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Liz's Urinalysis > Urine Sediments > Flashcards

Urine Sediments Flashcards

1
Q

Microscopic UA

- Recommended volume

A

10-15 mL (12mL is preferred)

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2
Q

Microscopic UA

- Centrifugation time

A

5 minutes

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3
Q

Microscopic UA

- Centrifugation speed

A

400-450g (1800 rpm)

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4
Q

Procedure for preparing a specimen for sediment examination

A
  1. Mix specimen and pour aliquot of 10-12 mL into urine urine centrifuge tube
  2. Centrifuge for 5 minutes at 400-450g
  3. After coming to a complete stop, decant the tube
  4. Mix remaining sediment well
  5. Deliver well mixed sediment to the slide using disposable pipet
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5
Q

Proper magnification for enumerating casts

A

Low (10x) but identify at High (40x)

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6
Q

Proper magnification for enumerating mucus

A

Low (10x)

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7
Q

Proper magnification for identifying and enumerating epithelials, WBCs, RBCs, crystals

A

High (40x)

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8
Q

Proper magnification for evaluating the presence of bacteria, sperm, yeast, trichomonas, or other

A

High (40x)

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9
Q

How do RBCs act in hyper/hypotonic urine?

A
  • Hypertonic: crenate

- Hypotonic: swelled, lysed, or ghost cells (includes alkaline urine)

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10
Q

RBCs will lyse in ____ ____

A

Acetic acid

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11
Q

____ indicates damage to the kidney or urinary tract

A

Hematuria

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12
Q

RBCs/RBC casts/protein indicate what?

A

Renal origin, either glomerular or tubular

  • Glomerulonephritis
  • Pyelonephritis
  • Tumors
  • Calculi
  • Trauma
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13
Q

RBCs/no RBC casts/no protein indicate what?

A

Bleeding “below” the kidney (cystitis) or contamination (menstrual or hemorrhoidal)

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14
Q

T/R, hemoglobin levels < 250 RBCs/uL are likely to cause a positive protein

A

False

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15
Q

If RBCs are seen microscopically but not on the strip, what does that mean?

A
  • Expect interference w/ ascorbic acid

- Possible misidentification of RBCs

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16
Q

How do WBCs act in hyper/hypotonic urine?

A
  • Hypertonic: will shrink but won’t crenate

- Hypotonic: will enlarge and may lyse

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17
Q

What do degenerated WBCs look like?

A
  • Lyse

- Bleb formation

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18
Q

If pyuria is seen w/ WBC casts, cellular casts, or granular casts, this indicates what?

A

Upper UTI is suspected; positive protein

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19
Q

If pyuria is seen w/o casts, this indicates what?

A

Lower UTI is suspected; low protein

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20
Q

What does the predominance of eosinophils indicate?

A
  • Drug induced acute interstitial nephritis

- Renal transplant rejection

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21
Q

What does the predominance of lymphs indicate?

A

Early renal transplant rejection

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22
Q

Leukocyte esterase strip detects ____ and ____ WBCs

A

Intact; lysed

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23
Q

What is a glitter cell?

A

Swollen neutrophils in a hypotonic solution

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24
Q

What makes a swollen neutrophil a glitter cell?

A

Their refractile cytoplasmic granules move by Brownian movement and “glitter”

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25
Q

How do you differentiate RBCs from yeast?

A

Yeast varies in size, is not biconcave, and buds

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26
Q

How do you differentiate RBCs from air bubbles/oil droplets?

A

Air bubbles/oil droplets are refractile, vary in size, and have a uniform appearance

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27
Q

How do you differentiate RBCs from calcium oxalate crystals?

A

Calcium oxalate crystals have an envelope shape

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28
Q

How do you differentiate RBCs from starch?

A

Starch is not perfectly round, highly refractile, has a central dimple, maltese cross under polarized light

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29
Q

Squamous epithelial cells

- Appearance

A
  • Flat w/ irregular shapes

- Central round nucleus

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30
Q

Squamous epithelial cells

- Origin

A

Vaginal contamination

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31
Q

Squamous epithelial cells

- Clinical significance

A

Rare diagnostic significance

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32
Q

Transitional epithelial cells

- Appearance

A
  • Round
  • Pear-shaped or tail-like projection
  • Central round nucleus
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33
Q

Transitional epithelial cells

- Origin

A

Originates in renal pelvis, calyces, ureter, urinary bladder, and upper part of urethra in males

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34
Q

Transitional epithelial cells

- Clinical significance

A

Increased numbers: UTI, viral illness, catheterization, malignancy (transitional cell carcinoma)

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35
Q

Sheets of transitional epithelial cells

A

Synctia

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36
Q

Presence of synctia w/o recent catheteriztion indicates what?

A

Transitional cell carcinoma

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37
Q

Renal tubular epithelial cells

- Appearance

A
  • Polyhedral (flat, cuboidal, columnar)
  • Eccentric nucleus
  • BIG nucleus
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38
Q

Renal tubular epithelial cells

- Origin

A

Originate in lining of the renal tubules and collecting ducts

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39
Q

Renal tubular epithelial cells

- Clinical significance

A

MOST SIGNIFICANT EPI
- Pathologic → pyelonephritis, kidney damage from meds or toxins, tubular necrosis, renal transplant rejection, viral infections (Hep B)

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40
Q

Origin of an oval fat body

A

Renal tubular epi cell w/ absorbed lipids

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41
Q

Cholesterol

- Not/birefringent

A

Birefringent

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42
Q 
Neutral fats (triglycerides, fatty acids)
- Not/birefringent
A

Not birefringent

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43
Q

Cholesterol

- Stains

A

Does not stain

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44
Q 
Neutral fats (triglycerides, fatty acids)
- Stains
A

Sudan Red or Oil Red O (identification)

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45
Q

What is the difference b/w oval fat bodies, air bubbles/oil droplets, and starch granules?

A
  • Starch: maltese cross pattern under polarized light; under normal light, not spherical, highly refractive, dimple in center
  • Oils: refractive, vary in size, uniform appearance
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46
Q

Clinical significance of sperm found in urine

A
  • Males: recent ejaculation or nocturnal emission

- Females: vaginal contamination

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47
Q

Normal acidic crystals

A
  • Uric acid
  • Amorphous urates
  • Calcium oxalate
  • Hippuric acid
  • Monosodium urate
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48
Q

Abnormal acidic crystals (PATHOLOGIC)

A
  • Tyrosine
  • Leucine
  • Bilirubin
  • Cystine
  • Cholesterol
  • Sulfonamide
  • Radiographic dye
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49
Q

Alkaline crystals (no abnormal crystals in alkaline urine)

A
  • Amorphous phosphates
  • Triple phosphate
  • Calcium carbonate
  • Calcium phosphates
  • Ammonium biurates
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50
Q

Pathologic crystals appear in ____ and ____ pH

A

Acidic; neutral

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51
Q

Usually presented as rhomboid plates but can also be seen as six-sided plates or barrels; when multiple crystals laminate together, they form rosettes or stars; yellow-brownish in color

A

Uric acid crystals

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52
Q

Uric acid crystals

- Clinical significance

A
  • Normal, product from digestion of RNA and DNA
  • Chemotherapy
  • Gout
  • Acute febrile conditions
  • Chronic renal disease
  • Lesch-Nyhan Syndrome
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53
Q

Yellow-brown, pink sediment; precipitation is enhanced on refrigerated specimens

A

Amorphous urates

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54
Q

Amorphous urate

- Clinical significance

A

No clinical significance

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55
Q

Pencile/needle-like prisms; colorless to light yellow

A

Monosodium urate crystals

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56
Q

Monosodium urate crystals

- Clinical significance

A

No clinical significance

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57
Q

Enveloped shape, colorless

A

Dihydrate calcium oxalate

58
Q

Ovoid or dumbbell shape (may resemble RBCs), colorless

A

Monohydrate calcium oxalate

59
Q

Nonpathologic calcium oxalate crystals are seen when?

A

After the ingestion of excess oxalate as seen in ascorbic acid, citrus fruits, and certain vegetables (tomatoes, asparagus, spinach, rhubarb)

60
Q

Pathologic calcium oxalate crystals are seen when?

A

Following the ingestion of ethylene glycol (antifreeze) (usually monohydrate form), severe chronic renal disease, kidney stones

61
Q

Six-sided prisms, needles, diamonds

A

Hippuric acid

62
Q

Hippuric acid crystals are seen when?

A

After the ingestion of vegetables that have been preserved in benzoic acid

63
Q

Hippuric acid

- Clinical significance

A
  • Usually not significant

- May indicate hepatic disease or acute febrile conditions

64
Q

Thin, needle-like, usually in clusters; coloreless to yellow in color; often seen w/ leucine crystals; reagent strip indicates presence of bilirubin as well

A

Tyrosine (pathologic)

65
Q

Tyrosine crystals

- Clinical significance

A
  • Severe liver disorder (viral hepatitis, hepatocellular poisons)
  • Inherited disorder in amino acid metabolism (tyrosinemia)
66
Q

Sphere w/ concentric striations; yellow-brown in color

A

Leucine crystals (pathologic)

67
Q

Leucine crystals

- Clinical significance

A
  • Severe liver disorder
  • Liver disease (viral hepatitis, hepatocellular poisons)
  • Maple Syrup Urine disorder (MSUD)
68
Q

Small clusters of fine needles; yellow-brown

A

Bilirubin crystals (pathologic)

69
Q

Bilirubin crystals

- Clinical significance

A

Correlate w/ reagent strip

Liver disease that leads to jaundice

70
Q

Colorless, thin hexagonal plates; sometimes w/ two sides shorter or longer than the other four sides; may fuse/laminate to form rosettes

A

Cystine crystals (pathologic)

71
Q

Cystine crystals

- Clinical significance

A

Metabolic disorders (cystinosis, cystinuria)

72
Q

Flat plate w/ notched corner (looks like Utah); may form in clusters

A

Cholesterol (pathologic)

73
Q

Cholesterol crystals

- Clinical significance

A
  • Nephrotic syndromes
  • Renal disease
  • Deposition of lipids in the kidneys (chyluria)
74
Q

Brown rosettes or spheres w/ irregular radial striations

A

Sulfamethoxazole (pathologic)

75
Q

Shocks of wheat, needles, fans

A

Sulfadiazine (pathologic)

76
Q

Sulfanomide crystals

- Clinical significance

A
  • Medication

- Crystals may cause renal tubular damage

77
Q

Pleomorphic needles (single or in sheaths) or in long flat rectangular plates; SG is > 1.040 (often > 1.050)

A

Radiographic dye crytals (pathologic)

78
Q

Radiographic dyes

- Clinical significance

A

Patient hx indicates recent administration of radiographic dye

79
Q

Fine, colorless to slightly brown granules; white precipitate when centrifuged

A

Amorphous phosphates

80
Q

Amorphous phosphates

  • Soluble in…
  • Insoluble in…
A
  • Soluble in…acetic acid (good for clearing; but sure to check for RBCs before adding
  • Refrigeration enhances precipitation but heating doesn’t get rid of them
81
Q

Amorphous phosphates

- Clinical significance

A

Alkaline tide after eating

82
Q

Coffin lids, prisms w/ 3-6 sides w/ oblique angles; colorless

A

Triple phosphate

83
Q

Triple phosphate

- Clinical significance

A
  • Normal
  • May cause stone formation
  • Infection w/ urea-splitting bacteria`
84
Q

Colorless granules; often form in pairs to give appearance of dumbbells; may aggregate to look like amorphous material

A

Calcium carbonate

85
Q

Calcium carbonate

- Clinical significance

A
  • None

- May be seen after ingesting a large amount of vegetables

86
Q

Granular, amorphous, or crystalline prisms w/ one end (looks like a finger pointing)

A

Calcium phosphate

87
Q

Calcium carbonate

- Clinical significance

A
  • Normal
  • Cystitis w/ urinary retention
  • May form stones
88
Q

Yellow-brown spheres w/ radiating spicules (thorny apples)

A

Ammonium biurates

89
Q

Ammonium biurates

- Clinical significance

A
  • None

- May be seen w/ ammonia-producing bacteria

90
Q

Presence of WBCs in urine

91
Q

Presence of RBCs in urine

92
Q

Fat in the urine

93
Q

Cells of ____ Loop of Henle continuously secrete ____

A

Ascending; uromodulin

94
Q

Composition of casts

A

Fibrous protein network of uromodulin (as urine is concentrated)

95
Q

Formation of casts

A

Cells of the ascending loop of hence continuously secrete uromodulin and as the urine becomes increasingly concentrated, in the DCTs and CDs, uromodulin forms fibrils that attach it to the lumen cells.

96
Q

Another name for Tamm-Horsfall glycoprotein

A

Uromodulin

97
Q

Factors that promote formation of casts

A
  • Urinary stasis
  • Acidic pH
  • High SG
  • Increased plasma proteins (such as albumin) in the ultrafiltrate
98
Q

Two locations w/in the nephron are the sites of the most cast formation b/c the SG is the highest and the pH is lowest

A

Distal tubules; collection ducts

99
Q

Two factors that increase the rate of cast degradation

A
  • Alkaline urine

- SG < 1.003

100
Q

Stages of cellular degeneration in a cast

A
  1. Hyaline casts
  2. Cellular cast
  3. Mixed granular cast
  4. Coarsely granular cast
  5. Finely granular casts
  6. Waxy cast
101
Q

Significance of mucus

A
  • No significance

- May be increased in inflammation or irritation

102
Q

Significance of bacteria w/ particular attention paid to clue cells

A

Frequent contaminant of skin or vagina; in combination w/ excess WBCs source is likely bacterial vaginosis

103
Q

Significance of yeast/fungi

A
  • May be a vaginal contaminant (Candida albicans and Candida glabrata are the most common species found)
  • More commonly found in immunocompromised and diabetes mellitus patients
104
Q

Significance of Trichomonas vaginalis

A
  • Protozoan flagellate (only one found in urine)
  • STD
  • Primarily a female infection (males asympatomatic carriers)
105
Q

Significance of helminth Schistosoma hematobium

A
  • Aka blood fluke

- Introduced into urine through the bladder wall

106
Q

Significance of helminth Enterobius vermicularisi

A
  • Aka pin worm

- Fecal contaminant

107
Q

Significance of arthropod Scarcoptes scabei

A
  • Aka mites (cause of scabies)

- Found in the urine as a result of falling into urine from skin of the pubic or perianal area

108
Q

Significance of arthropod Phthirus pubis

A
  • Aka “crabs”
  • Spread sexually
  • Lives on pubic hair and falls into urine
109
Q

Acellular casts

A
  • Hyaline
  • Granular
  • Waxy
  • Fatty
110
Q

Cellular casts

A
  • WBC
  • RBC
  • Bacterial
  • Epithelial cells
  • Mixed
111
Q

Most common urinary cast composed almost entirely of uromodulin; low refractive index makes it difficult to visualize; may have a few inclusions

A

Hyaline cast

112
Q

Hyaline cast

- Significance

A
  • A few are normal (0-2/lpf), esp after exercise and stress (athlete pseudonephritis)
  • Physiologic dehydration
  • Mild renal disease
  • Pathologic causes (acute glomerulonephritis, pyelonephritis, chronic kidney disease)
113
Q

Two types of granular casts

A

Fine and coarse

114
Q

Formed by the lysosomal excretion of metabolism byproducts by the renal tubular epi cells; normal patients may have them after strenuous exercise

A

Fine granular casts

115
Q

Formed by the death and degeneration of renal tubular cells or cellular casts; pathologic (renal disease)

A

Coarse granular casts

116
Q

Parallel sides w/ notches or serrations; often broad; fragile, may be stubby casts, blunt or broken ends are highly likely; believed to be an advanced stage of degeneration for other casts such as hyaline, granular, or cellular; takes up to 48 hours to form (prolonged urinary stasis); more refractile than hyalline; often other types of casts are also present

A

Waxy casts

117
Q

Waxy casts

- Significance

A
  • Severe renal disease
  • ESRD (esp. broad and waxy)
  • Chronic glomerulonephritis
  • Diabetic nephrosclerosis
  • Malignant hypertension
  • Renal transplant rejection
118
Q

Contains free fat or oval fat bodies

A

Fatty casts

119
Q

Fatty casts

- Significance

A
  • Nephrotic syndrome
  • Fatty degeneration of tubules (tubular necrosis)
  • Diabetic glomerulsclerosis
  • Chronic glomerulonephritis
120
Q

Contains WBCs; 1/3 of the cast surface must be covered in order to be identified

121
Q

Two different origins for WBC casts

A
  • Glomerular

- Tubular

122
Q

WBC casts (glomerular origin)

A

RBC casts will also be seen (greater number than WBC)

123
Q

WBC casts (tubular origin)

A
  • Leukocytes migrate into tubular lumen
  • Look for bacteria (often accompanied by protein and blood)
  • If no bacteria, suspect viral (CMV)
124
Q

WBC casts

- Significance

A
  • Renal infection (pyelonephritis) → look for bacteria and neutrophils
  • Glomerular disease → Red, white, and/or mixed cell casts
  • Acute interstitial nephritis → no bacteria, look for eosinophils, renal inflammation
125
Q

Contains intact RBCs; enters through damaged glomerular basement (most common) or tubular damage; correlate b/w blood reagent strip

126
Q

RBCs are not intact; usually red/brown; may have granular inclusions; correlate w/ blood reagent group

A

Hemoglobin casts (aka blood cast)

127
Q

RBC casts

- Significance

A
  • Glomerulonephritis (Acute, rapidly progressive, Goodpasture’s syndrome)
  • Subacute bacterial endocarditis (SBE)
  • Renal trauma (boxing, football, etc)
128
Q

Often mixed w/ WBCs in the cast; easily confused w/ granular casts (correlate w/ free bacteria and WBCs)

A

Bacterial casts

129
Q

Bacterial cast

- Significance

A

Diagnostic of pyelonephritis

130
Q

Aka epithelial cast; cells are sloughing from the renal tubular epithelium; arranged randomly or in parallel rows; often accompanied by proteinuria and granular casts

A

Renal tubular cell casts

131
Q

Epi vs. WBC cast

A

Epithelial casts are larger and nucleus w/o lobes; sparse cytoplasm w/o granules

132
Q

Renal tubular cell casts

- Significance

A
  • Tubular necrosis
  • Nephrotoxins (mercury, diethylene glycol, chemotherapeutic agents)
  • Viral disease (hepatitis → correlate w/ bilirubin; CMV)
133
Q

RBC/WBC casts

A

Glomerulonephritis

134
Q

WBC/RTE casts; WBC/bacterial cast

A

Pyelonephritis

135
Q

2-6x larger than other casts; formed in pathologically dilated renal tubules or collecting ducts (destruction and widening of tubular walls); accompanied w/ urinary stasis; all types of casts occur in this form, waxy and granular are more common

A

Broad casts

136
Q

Broad casts

- Significance

A
  • Severe renal disease

- ESRD

137
Q

Describe hemoglobin/myoglobin casts

A
  • Yellow-brown

- Hematuria

138
Q

Describe bilirubin casts

A
  • Yellow-brown
  • Bilirubinuria
  • All elements in entire sediment will be pigmented
139
Q

Long thread or ribbon-like structures; produced by glands or lower urinary tract and by vaginal epi cells as well as RTE which secrete uromodulin

140
Q

Spherical/ovoid, budding, hyphal forms

A

Fungi/yeast

Liz's Urinalysis (6 decks)

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