MEDT 208 Microscopic examinations study objectives
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| 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.
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| What is the recommended method for standardizing Specimen Preparation? | Proper patient education, & sample processing.
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| What is the recommended method for standardizing Specimen Volume? | 12 mL (recommended)
10-15 mL ok
6 mL (Infants)
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| What is the recommended method for standardizing Centrifugation? | 400-450g x 5 minutes
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| What is the recommended method for standardizing Sediment Preparation? | Use same supplies, steps, timing intervals, equipment.
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| What is the recommended method for standardizing Volume of Sediment Examined? | Determined by commercial slides used & microscope optical qualities; use standardized slide.
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| What is the recommended method for standardizing Examination of Sediment? | Standard terminology (qualitative or enumerative).
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| 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.
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| 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
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| What are abnormal urine sediment constituents? | Crystals, parasites, oval fat bodies, mucus (male), yeast, bacteria, RTEs
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| 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.
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| What is the clinical significance of RBCs in urinary sediment? | Glomerulonephritis
Trauma
Systemic & renal disease
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| What is the clinical significance of WBCs in urinary sediment? | Pyelonephritis
Cystitis
Urethritis
UTI
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| 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.
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| 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.
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| 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.
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| What is the clinical significance of WBC Casts in urinary sediment? | Pyelonephritis.
Acute interstitial nephritis
Renal inflammation or infection
Chronic renal disease
Acute glomerulonephritis
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| What is the clinical significance of Bacterial Casts in urinary sediment? | Pyelonephritis.
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| 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
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| What is the clinical significance of Granular Casts in urinary sediment? | Normal metabolism.
Exercise, activity.
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| 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
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| 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
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| 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
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| Squamous Epithelial Cells: description, origin & significance. | Description: Huge + irregular edges
Origin: Normal sloughing
Significance: Mostly normal, except clue cells (Gardnerella infection)
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| Transitional Epithelial Cells: description, origin & significance. | Description: Central nucleus
Origin:
Significance: Catheterization, malignancy
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| Renal Tubular Epithelial Cells: description, origin & significance. | Description: Eccentric nucleus
Origin: Renal tubules
Significance: Tubular necrosis, salicylate poisoning
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| How are urinary casts formed? | Tamm Horsfall (TH) protein secreted by RTE of DCT & collecting duct. Protein fibrils form into matrix.
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| Is Tamm Horsfall (TH) protein detected by urine reagent strips? | No.
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| Normal, golden-brown, polarizing, rhombic, football-shaped crystals found in acidic urine. | Uric acid
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| Normal, colorless or yellow-brown crystals found in acidic urine that cause a pink precipitate upon refrigeration. | Amorphous urates
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| Normal, colorless, envelope/two-pyrimid shaped, or oval/dumbell shaped crystals found in acidic urine. | Calcium oxalate
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| Calcium phosphate are normal, colorless crystals found in ____ urine. | Alkaline
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| Normal, amorphous, colorless, crystals found in alkaline urine that form white precipitate upon refrigeration? | Amorphous phosphates
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| Normal, colorless, crystals found in alkaline urine that are shaped like flat rectangle or thin prisms in rosettes. | Calcium phosphate
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| Normal, colorless, coffin-lid shaped crystals found in alkaline urine? | Triple phosphate
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| Normal, dark yellow-brown, "thorny-apple" shaped crystals found in alkaline urine. | Ammonium biurate
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| Which amorphous crystal causes white precipitate upon refrigeration? | Amorphous phosphates
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| Which amorphous crystal causes pink precipitate upon refrigeration? | Amorphous urates
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| Which crystals are indicative of antifreeze poisoning? | Calcium oxalate
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| Which crystal is a major component of renal calculi? | Calcium oxalate
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| Normal, colorless crystals found in alkaline urine shaped like small, dumbbells or spheres. Indicates an old specimen. | Calcium phosphate
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| An abnormal crystal indicative of cystinuria found in acidic urine; generally non-polarizing, hexagon shaped w/thin & thick plates. | Cystine
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| An abnormal crystal indicative of nephrotic syndrome; highly birefringent, rectangular plates w/characteristic notched corners, often confused w/radiographic contrast media. | Cholesterol crystals
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| Which three crystals are seen together in liver disease? | Bilirubin
Tyrosine
Leucine
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| Abnormal crystal seen in liver disease that is yellow, and shaped as clumped needles/granules. Indicates viral hepatitis. Found in acidic urine. | Bilirubin crystals
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| Abnormal crystal seen in inherited amino acid disorders & liver disease. Fine yellow needles in clumps or rosettes. Found in acidic urine. | Tyrosine crystals
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| Abnormal crystal seen in liver disease. Yellow-brown spheres w/concentric circles and radial striations. Found in acidic urine. | Leucine crystals
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| Abnormal, iatrogenic crystal found in acidic urine; colorless needle bundles w/refrigeration. Indicates increased drug doses + dehydration. | Ampicillin crystals
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| Abnormal, most common iatrogenic crystal; found in acidic urine; Indicates treatment for UTI. | Sulfa crystals
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| 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
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| What are the three classifications of formed elements? | Cells
Crystals
Casts
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| Why would you do a microscopic exam on a urine with a positive glucose? | Yeast
(they like sugar)
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| True/False: Revolutions per minute (rpm) does not equal RCF. | True
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| A false negative test for blood may be due to? | Ascorbic acid
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| The false negative glucose backup test is? | Clinitest
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| Which constituents are counted as average per low power field (lpf) | Casts, crystals
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| Which constituents are counted as average per high power field (hpf)? | Cells (WBC, RBC, epis)
Bacteria
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| What stain(s) are used for lipids? | Oil Red O & Sudan III
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| What stain is used for urinary eosinophils? | Hansel's stain
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| What stain is used for visualization of hemosiderin granules? | Prussian blue stain
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| What is most essential for microscopic examination of urine sediments? | Reduced light
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| Are glitter cells (crenated WBC) in urine pathogenic or non-pathogenic? | Non-pathogenic
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| What clinical condition do eosinophils in urine indicate? | Drug-induced interstitial nephritis
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| What are the three types of epithelial cells found in urine? | Squamous
Transitiaonal
Renal tubular
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| Which of the three types of epithelial cells found in urine is pathological, and what condition do they indicate? | RTEs
Tubular necrosis
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| What are Oval Fat Bodies? | RTE cells that have absorbed lipids.
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| Seeing a Maltese Cross under polarized light is characteristic of? | Oval fat bodies
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| Urinary casts come from the? | Kidney
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| 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
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| A cast containing mostly tightly packed neutrophils w/in a matrix; seen in infection & inflammation of tubules (pyelonephritis & acute interstitial nephritis). | WBC Cast
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| 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.
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| A cast seen in pyelonephritis, that can be confirmed w/gram stain. | Bacterial Cast
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| 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
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| 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
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| Coarse and finely granular casts. Indicates normal metabolism, exercise and activity. | Granular casts
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| Highly refractile casts indicating extreme urinary stasis & renal failure. Fragmented w/jagged ends and notches. | Waxy casts
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| AKA "renal failure casts". Most common are granular and waxy. | Broad casts
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| Why are yeast infections common in patients with diabetes mellitus? | Yeast grows well in an acid, glucose environment.
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| With a blood glucose level of 250 mg/dL, should glucose be present in the urine? | YES (exceeds renal threshold)
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| Will yeast cause a positive nitrite reaction? | No, yeast does not cause a positive nitrite reaction.
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| 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.
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| What is a possible cause of unusual microscopic constituents? | Airborne construction artifacts
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| What microscopy techniques can be used to aid in differentiating a cast and an artifact? | Sternheimer-Malbin stain & polarizing microscopy
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| Increased RTEs indicate damage to the? | tubules
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| What is causes RTE cells to be bile-stained? | Reabsorption of bilirubin
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| State a disorder in which the urobilinogen level is elevated and the bilirubin result is negative. | Intravascular hemolysis
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| What test checks for the presence of bilirubin? | Icotest
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| Are you concerned about the presence of waxy casts and a negative protein in urine from a 6-month-old girl? | Concerned
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| Are you concerned about increased transitional epithelial cells in a specimen obtained following cystoscopy? | Not concerned
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| Are you concerned about tyrosine crystals in a specimen with a negative bilirubin test result? | Concerned
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| Are you concerned about cystine crystals in a specimen from a patient diagnosed with gout? | Concerned
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| Are you concerned about crystals that appear to be cholesterol crystals in urine with a specific gravity greater than 1.040? | Not concerned
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| Are you concerned about Trichomonas vaginalis in a male urine specimen? | Concerned
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| Are you concerned about amorphous urates and calcium carbonate crystals in a specimen with a pH of 6.0? | Concerned
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