Microscopic Examination of Urine

without the microscopy part | kentakiii

High power

RBCs and WBCs as the average number per

concentrated (hypersthenuric) urine

the cells shrink due to loss of water and may appear crenated or irregularly shaped

dilute (hyposthenuria) urine

, the cells absorb water, swell, and lyse rapidly, releasing their hemoglobin and leaving only the cell membrane

Rbc

appear as smooth, nonnucleated, biconcave disks measuring approximately 7 mm in diameter

Ghost cells

large empty cells are called

RBCs

Of all the urine sediment elements, ___ are the most difficult for students to recognize.

Yeast cells

usually exhibit budding

Air bubble and oil droplets

which are highly refractile, when the fine adjustment is focused up and down

Renal bleeding

Studies have focused on the morphology of urinary RBCs as an aid in determining the site of

Dysmorphic

RBCs that vary in size, have cellular protrusions, or are fragmented are termed

Glomerular bleeding

Dysmorphic rbcs are associated with

Acanthocyte

The dysmorphic cell associated most closely with glomerular bleeding appears to be the

Neutrophil

The predominant WBC found in the urine sediment

Glitter cells

Brownian movement of the granules within these larger cells produces a sparkling appearance, and they are referred to as

Neutrophil

Glitter cells are associated with what type of wbc

Eosinophil

is associated primarily with drug-induced interstitial nephritis

Eosinophil

may be seen with urinary tract infection (UTI) and renal transplant rejection.

Hansel

The preferred eosinophil stain is

1%

Eosinophils are not normally seen in the urine; therefore, the finding of more than ___eosinophils is considered significant.

Lymphocytes

are the smallest WBCs and resemble rbc

Lymphocytes

They may be seen in increased numbers in the early stages of renal transplant rejection

Renal tubular epithelial cells

are usually larger than WBCs with an eccentrically located nucleus.

<5

Usually, ___ leukocytes per hpf are found in normal urine;

Female

High number of lymphocytes are found in

Pyuria

An increase in urinary WBCs is called

Yeast, air bubbles, oil droplets

Source of error for rbc

Rte

Source of errror for wbc

Prostitis, pyelonephritis, cystitis, urethritis

Bacterial infections caused by pyuria

glomerulonephritis, lupus erythematous, interstitial nephritis, tumor

Non bacterial disorders caused by pyuria

Squamous

Largest cells in the sediment with abundant, irregular cytoplasm and prominent nuclei

Squamous

the first structures observed when the urine sediment is examined under low-power magnification

Squamous

can be misidentified when they are folded and look like a cast or when they begin to disintegrate in urine that is not fresh.

Femalw

Increased amounts of squamous are seen more frequently in urine from

Clue cell

A variation of the squamous epithelial cell is the

Clue cells

indicative of vaginal infection by the bacterium Gardnerella vaginalis

Squamous

Clue cells are associated with what type of cell

G. vaginalis

Clue cells are indicative of what bacteria

70%

To be considered a clue cell, the bacteria should cover most of the cell surface for about

Transitional

Spherical, polyhedral, or caudate with centrally located nucleus

Transitional

A type of cell capable of absorbing large amounts of water

Male urethra

Transitional epithelial cells originate from the lining of the renal pelvis, calyces, ureters, and bladder and from the upper portion of the

syncytia

Increased numbers of transitional cells seen singly, in pairs, or in clumps (

Rte cells

Rectangular, columnar, round, oval, or cuboidal with an eccentric nucleus possibly bilirubin stained or hemosiderinladen

Dct cells

They can be mistaken for WBCs and spherical transitional epithelial cells.

Cuboidal

RTE cells from the collecting duct are

Columnar

Rct cells from the proximal are

Round

Rct cells from the distal are

Rte cells

The presence of increased amounts is indicative of necrosis of the renal tubules, with the possibility of affecting overall renal function.

Renal fragments

Cells from the collecting duct that appear in groups of three or more are called

Oval fat bodies

. Then they appear highly refractile, and the nucleus may be more difficult to observe. These lipid-containing RTE cells are called

Sudan III pr oil red o

Identification of oval fat bodies is confirmed by staining the urine sediment with

Orange red

Fat stains stain triglycerides and neutral fats, producing what color

Polarized

Microscope for lipids

Lipiduria

is associated most frequently with damage to the glomerulus caused by nephrotic syndrome

Bubble cells

they appear to represent injured cells in which the endoplasmic reticulum has dilated before cell death.

Oval fat bodies

Buble cells are found in

Squamous

Increased numbers may indicate contamination of the urine specimen due to poor collection technique

Transitional

Increased numbers may be seen with UTI, renal carcinoma, or after catheterization

Rte

Increased in tubular necrosis, possibly arising from exposure to heavy metals, drug-induced toxicity, hemoglobin and myoglobin toxicity,

Oval fat bodies

Increased in glomerular damage by nephrotic syndrome, tubular necrosis, diabetes mellitus, long bone trauma

Wbc

To be considered significant for UTI, bacteria should be accompanied by

Enterobacteriaceae, Staphylococcusand Enterococcus

The bacteria associated with UTI most frequently are the

Bacteria

Small spherical and rod-shaped structure

Yeast

Small, oval, refractile structures with buds and/or mycelia

Candida albicans

are seen in the urine of patients who are either diabetic or immunocompromised, as well as in women with vaginal moniliasis.

Trichomonas vagilis

The parasite encountered most frequently in the urine is

Trichomonas

is a pearshaped flagellate with an undulating membrane

Vaginal inflammation

T. vaginalis is a sexually transmitted pathogen associated primarily with

Male

Asymptomatic carriers of vaginalis

Phase

microscope that is used to differentiate Trichomonas from WBC, transitional, and RTE cells.

Schistosoma haematobium

ova of the bladder parasite

E. vermicularis

The most common contaminant is ova from the pinworm of intestinal parasites

Speematozoa

Tapered oval head with long, thin tail

Mucus

Single or clumped threads with a low refractive index

Mucus

is a protein material produced by the glands and epithelial cells of the lower genitourinary tract and the RTE cells.

Uromodulin

is a major constituent of mucus.

Uromodulin

is a glycoprotein excreted by the RTE cells of the thick ascending limb of the loop of Henle and by the distal convoluted tubules

Female

Mucus is present more frequently in

Casts

are the only elements found in the urinary sediment that are unique to the kidney

Uromodulin

The major constituent of casts is

Amorphous phosphates and urates

Error for bacteria

Rbc

Error for yeast

Wbc rte

Error for trichomonas

Hyaline casts

Error for mucus

Cylindroids

Formation of casts at the junction of the ascending loop of Henle and the DCT may produce structures with a tapered end. These have been referred to as

Cylindrudria

the presence of urinary casts is termed

Hyaline

The cast seen most frequently is the

zero to two

The presence of ___ hyaline casts per lpf is considered normal,

Hyaline cast

increased numbers after strenuous exercise, dehydration, heat exposure, and emotional stress

Hyaline cast

are increased in acute glomerulonephritis, pyelonephritis, chronic renal disease, and congestive heart failur

Hyaline cast

appear colorless in unstained sediments and have a refractive index similar to that of urine; thus, they can be overlooked easily if specimens are not examined under subdued light

pink color

Sternheimer-Malbin stain produces a ____ in hyaline casts.

Rbc cast

are associated primarily with damage to the glomerulus (glomerulonephritis) that allows passage of the cells through the glomerular membrane

Proteinuria and dysmorphic rbc

Usually RBC casts associated with glomerular damage are associated with

Methemoglobin

Granular, dirty, brown casts representing products of hemoglobin degradation

homogenous

As a RBC cast ages, cell lysis begins and the cast develops a more ___ appearance

Wbc cast

signifies infection or inflammation within the nephron.

Wbc cast

They are associated most frequently with pyelonephritis and are a primary marker for distinguishing pyelonephritis (upper UTI) from cystitis (lower UTI).

pyelonephritis

Bacterial casts containing bacilli both within and bound to the protein matrix are seen in

Granular cast

Identification of bacterial casts can be difficult because casts packed with bacteria can resemble