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Urine Microscopics
MEDT 208 Microscopic examinations study objectives
| Question | Answer |
|---|---|
| What are the advantages of commercial systems vs. glass-slide method for urine sediment examination? | Commercial systems produce same concentration & sediment volume; control microscopic variables, cost competitive, easily adapted to, and required for reproducible (accurate) results. |
| What is the recommended method for standardizing Specimen Preparation? | Proper patient education, & sample processing. |
| What is the recommended method for standardizing Specimen Volume? | 12 mL (recommended) 10-15 mL ok 6 mL (Infants) |
| What is the recommended method for standardizing Centrifugation? | 400-450g x 5 minutes |
| What is the recommended method for standardizing Sediment Preparation? | Use same supplies, steps, timing intervals, equipment. |
| What is the recommended method for standardizing Volume of Sediment Examined? | Determined by commercial slides used & microscope optical qualities; use standardized slide. |
| What is the recommended method for standardizing Examination of Sediment? | Standard terminology (qualitative or enumerative). |
| For what reasons should urine specimens be referred for cytodiagnositc testing? | Quantification or differentiation of WBC & epithelial cells; Early detection of renal allograft rejection; Differential diagnosis of renal disease; ID of RBCs, cell fragments, epis, cellular incisions, cellular casts; Specimens for eosinophil detection. |
| What are normal urine sediment constituents? | RBC, WBC (0-8/hpf or 10/uL), Epis, Hyaline casts (0-2/hpf); Sperm; Mucus (female); Squamous epis; Transitional epis |
| What are abnormal urine sediment constituents? | Crystals, parasites, oval fat bodies, mucus (male), yeast, bacteria, RTEs |
| What are the characteristics of urine artifacts that differentiate them from significant constituents? | Artifacts: inconsistent size, big artifacts visible in all focuses, may be material fibers, meat/veggie fibers, hair; artifacts polarize (casts will not except fatty); fibers polarize. |
| What is the clinical significance of RBCs in urinary sediment? | Glomerulonephritis Trauma Systemic & renal disease |
| What is the clinical significance of WBCs in urinary sediment? | Pyelonephritis Cystitis Urethritis UTI |
| What is the clinical significance of Oval Fat Bodies in urinary sediment? | Tubular epithelial degeneration of nephron. Associated w/large amounts of protein. Nephrotic syndrome. |
| What is the clinical significance of Hyaline Casts in urinary sediment? | 0-2/hpf normal. Mild-severe renal disease (Glomerulonephritis, pyelonephritis, chronic renal disease, congestive heart failure). Strenuous exercise. |
| What is the clinical significance of RBC Casts in urinary sediment? | Glomerular or nephron damage. Strenuous exercise. Intrinsic renal disease. Acute glomerulonephritis. AIN Severe nephritis. |
| What is the clinical significance of WBC Casts in urinary sediment? | Pyelonephritis. Acute interstitial nephritis Renal inflammation or infection Chronic renal disease Acute glomerulonephritis |
| What is the clinical significance of Bacterial Casts in urinary sediment? | Pyelonephritis. |
| What is the clinical significance of Epithelial Cell Casts in urinary sediment? | Heavy damage to renal tubules. Heavy metals Viral infections Drug toxicity Graft rejection Pyelonephritis |
| What is the clinical significance of Granular Casts in urinary sediment? | Normal metabolism. Exercise, activity. |
| What is the clinical significance of Waxy Casts in urinary sediment? | Extremem urinary stasis Renal failure Tubular obstruction w/prolonged stasis Called renal failure casts Severe chronic renal failure Malignant hypertension Acute renal disease Diabetes mellitus |
| What is the clinical significance of Fatty Casts in urinary sediment? | End-stage renal disease Nephrotic syndrome Diabetes mellitus Mercury poisoning Crushing injury w/disruption of body fat |
| What is the clinical significance of Broad Casts in urinary sediment? | Significant urinary stasis + obstruction or disease Acute tubular necrosis Severe chronic renal disease End-stage kidney disease Urinary tract obstruction Renal failure |
| Squamous Epithelial Cells: description, origin & significance. | Description: Huge + irregular edges Origin: Normal sloughing Significance: Mostly normal, except clue cells (Gardnerella infection) |
| Transitional Epithelial Cells: description, origin & significance. | Description: Central nucleus Origin: Significance: Catheterization, malignancy |
| Renal Tubular Epithelial Cells: description, origin & significance. | Description: Eccentric nucleus Origin: Renal tubules Significance: Tubular necrosis, salicylate poisoning |
| How are urinary casts formed? | Tamm Horsfall (TH) protein secreted by RTE of DCT & collecting duct. Protein fibrils form into matrix. |
| Is Tamm Horsfall (TH) protein detected by urine reagent strips? | No. |
| Normal, golden-brown, polarizing, rhombic, football-shaped crystals found in acidic urine. | Uric acid |
| Normal, colorless or yellow-brown crystals found in acidic urine that cause a pink precipitate upon refrigeration. | Amorphous urates |
| Normal, colorless, envelope/two-pyrimid shaped, or oval/dumbell shaped crystals found in acidic urine. | Calcium oxalate |
| Calcium phosphate are normal, colorless crystals found in ____ urine. | Alkaline |
| Normal, amorphous, colorless, crystals found in alkaline urine that form white precipitate upon refrigeration? | Amorphous phosphates |
| Normal, colorless, crystals found in alkaline urine that are shaped like flat rectangle or thin prisms in rosettes. | Calcium phosphate |
| Normal, colorless, coffin-lid shaped crystals found in alkaline urine? | Triple phosphate |
| Normal, dark yellow-brown, "thorny-apple" shaped crystals found in alkaline urine. | Ammonium biurate |
| Which amorphous crystal causes white precipitate upon refrigeration? | Amorphous phosphates |
| Which amorphous crystal causes pink precipitate upon refrigeration? | Amorphous urates |
| Which crystals are indicative of antifreeze poisoning? | Calcium oxalate |
| Which crystal is a major component of renal calculi? | Calcium oxalate |
| Normal, colorless crystals found in alkaline urine shaped like small, dumbbells or spheres. Indicates an old specimen. | Calcium phosphate |
| An abnormal crystal indicative of cystinuria found in acidic urine; generally non-polarizing, hexagon shaped w/thin & thick plates. | Cystine |
| An abnormal crystal indicative of nephrotic syndrome; highly birefringent, rectangular plates w/characteristic notched corners, often confused w/radiographic contrast media. | Cholesterol crystals |
| Which three crystals are seen together in liver disease? | Bilirubin Tyrosine Leucine |
| Abnormal crystal seen in liver disease that is yellow, and shaped as clumped needles/granules. Indicates viral hepatitis. Found in acidic urine. | Bilirubin crystals |
| Abnormal crystal seen in inherited amino acid disorders & liver disease. Fine yellow needles in clumps or rosettes. Found in acidic urine. | Tyrosine crystals |
| Abnormal crystal seen in liver disease. Yellow-brown spheres w/concentric circles and radial striations. Found in acidic urine. | Leucine crystals |
| Abnormal, iatrogenic crystal found in acidic urine; colorless needle bundles w/refrigeration. Indicates increased drug doses + dehydration. | Ampicillin crystals |
| Abnormal, most common iatrogenic crystal; found in acidic urine; Indicates treatment for UTI. | Sulfa crystals |
| Abnormal, iatrogenic crystal (similar to cholesterol) that polarizes readily. Very high SG w/refractometer + normal reagent strip SG. Must look at patient history to identify. | Radiographic dye |
| What are the three classifications of formed elements? | Cells Crystals Casts |
| Why would you do a microscopic exam on a urine with a positive glucose? | Yeast (they like sugar) |
| True/False: Revolutions per minute (rpm) does not equal RCF. | True |
| A false negative test for blood may be due to? | Ascorbic acid |
| The false negative glucose backup test is? | Clinitest |
| Which constituents are counted as average per low power field (lpf) | Casts, crystals |
| Which constituents are counted as average per high power field (hpf)? | Cells (WBC, RBC, epis) Bacteria |
| What stain(s) are used for lipids? | Oil Red O & Sudan III |
| What stain is used for urinary eosinophils? | Hansel's stain |
| What stain is used for visualization of hemosiderin granules? | Prussian blue stain |
| What is most essential for microscopic examination of urine sediments? | Reduced light |
| Are glitter cells (crenated WBC) in urine pathogenic or non-pathogenic? | Non-pathogenic |
| What clinical condition do eosinophils in urine indicate? | Drug-induced interstitial nephritis |
| What are the three types of epithelial cells found in urine? | Squamous Transitiaonal Renal tubular |
| Which of the three types of epithelial cells found in urine is pathological, and what condition do they indicate? | RTEs Tubular necrosis |
| What are Oval Fat Bodies? | RTE cells that have absorbed lipids. |
| Seeing a Maltese Cross under polarized light is characteristic of? | Oval fat bodies |
| Urinary casts come from the? | Kidney |
| This most frequently seen cast has normal parallel sides or convoluted, wrinkled, cylindroid, occasional adhering cell or granule, and may be caused by stress, exercise, fever or dehydration. | Hyaline cast |
| A cast containing mostly tightly packed neutrophils w/in a matrix; seen in infection & inflammation of tubules (pyelonephritis & acute interstitial nephritis). | WBC Cast |
| A cast orange-red in color w/embedded cells in a matrix. Indicative of glomerular damage or nephron capillary damage, or strenuous exercise. Often seen w/RTEs. | RBC cast. |
| A cast seen in pyelonephritis, that can be confirmed w/gram stain. | Bacterial Cast |
| Casts usually containing small round cells w/single nuclei in a matrix. Indicates heavy damage to renal tubules or heavy metals. May be bilirubin-stained. | RTE cast |
| Casts seen with oval fat bodies and fat droplets. Highly refractile. Indicates nephrotic syndrome, diabetes, crushing trauma, tubular necrosis. Ominous sign of end-stage renal disease. | Fatty casts |
| Coarse and finely granular casts. Indicates normal metabolism, exercise and activity. | Granular casts |
| Highly refractile casts indicating extreme urinary stasis & renal failure. Fragmented w/jagged ends and notches. | Waxy casts |
| AKA "renal failure casts". Most common are granular and waxy. | Broad casts |
| Why are yeast infections common in patients with diabetes mellitus? | Yeast grows well in an acid, glucose environment. |
| With a blood glucose level of 250 mg/dL, should glucose be present in the urine? | YES (exceeds renal threshold) |
| Will yeast cause a positive nitrite reaction? | No, yeast does not cause a positive nitrite reaction. |
| If you are having difficulty keep all constituents in focus at the same time on the microscope, it means? | The large constituents are in a different plane. |
| What is a possible cause of unusual microscopic constituents? | Airborne construction artifacts |
| What microscopy techniques can be used to aid in differentiating a cast and an artifact? | Sternheimer-Malbin stain & polarizing microscopy |
| Increased RTEs indicate damage to the? | tubules |
| What is causes RTE cells to be bile-stained? | Reabsorption of bilirubin |
| State a disorder in which the urobilinogen level is elevated and the bilirubin result is negative. | Intravascular hemolysis |
| What test checks for the presence of bilirubin? | Icotest |
| Are you concerned about the presence of waxy casts and a negative protein in urine from a 6-month-old girl? | Concerned |
| Are you concerned about increased transitional epithelial cells in a specimen obtained following cystoscopy? | Not concerned |
| Are you concerned about tyrosine crystals in a specimen with a negative bilirubin test result? | Concerned |
| Are you concerned about cystine crystals in a specimen from a patient diagnosed with gout? | Concerned |
| Are you concerned about crystals that appear to be cholesterol crystals in urine with a specific gravity greater than 1.040? | Not concerned |
| Are you concerned about Trichomonas vaginalis in a male urine specimen? | Concerned |
| Are you concerned about amorphous urates and calcium carbonate crystals in a specimen with a pH of 6.0? | Concerned |
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