Body Fluid Analysis

Gives three-dimensional images, but high cost prevents use by most laboratories

Interference contrast

Confirms presence of cholesterol, which forms a Maltese cross pattern with polarized light; also used on crystals

polarizing

Ideal for urine sediments; allows more detailed visualization of translucent or low-refractile components and living cells

phase contrast

Most commonly used microscope

brightfield

red blood cells

white blood cells

white blood cells

Protects fetus while enabling movement and produced by amnion and placenta initially

amniotic fluid

Transabdominally or vaginally with simultaneous ultrasound examination
Transabdominal most common

ambiocentasis

bilrubin is

light sensitive

Cerebrospinal fluid (CSF) has higher levels of what than does plasma

sodium, chloride, and magnesium

CSF has lower concentration of what then plasma

potassium and calcium

Brain and spinal cord surrounded by three membranes called

meninges

Increased numbers of capillary endothelial, mesangial, and epithelial cells in glomerular tuft

Cellular proliferation

Neutrophils and macrophages attracted by a local chemotactic response

leukocytic infiltration

Any process that results in enlargement of basement membrane (immune complexes and diabetes)

Glomerular basement thickening

Accumulation of homogeneous eosinophilic extracellular material

Hyalinization with sclerosis

Most often immune mediated

glomerular

Result from toxic or infectious substances

tubular

Result from toxic or infectious substances

interstitial

Caused by a reduction in renal perfusion that induces morphologic and functional changes in kidney

vascular

Systemic diseases that initially and principally involve other organs but also affect kidneys

secondary glomerular diseases

Specifically affect kidneys, often only organ involved

primary glomerular diseases

•Primary diseases consist of several different types of

glomerulonephritis

hematuria, proteinuria, oliguria, azotemia, edema, and hypertension are all clinical features of

glomerular diseases

blood in urine

hematuria

protein in urine

proteinuria

limited output, less than 400 mL/day

oliguria

Elevated levels of urea and other nitrogen compounds in the blood

azotemia

greater than 3L/day, a lot of pee

polyuria

ADH decreased

Neurogenic diabetes insipidus

Lack of renal response to ADH

Nephrogenic diabetes insipidus

Used to differentiate causes of polyuria due to water diuresis 

Fluid deprivation tests

heavy proteinuria, hypoprotenemia, hyperlipidemia, lipiduria, edema, mild hematuria and fatty, waxy, and renal tubular epithelial casts are all signs of what

nephrotic syndrome

immnoglobulin A (IgA) neuropathy and minimal change disease are all types of what

glomerulonephritis

Autoimmune disorder with immune complex deposits and complement activation

Systemic lupus erythematosus (SLE)

Carbohydrate metabolism disorder leads to glomerular syndrome, hypertension, susceptibility to pyelonephritis

diabetes mellitus

Systemic disease involving many organs; characterized by deposits of amyloid, a pathologic protein substance

amyloidosis

amyloidosis leads to what

proteinuria and nephrotic syndrome

Seen in sepsis, shock, trauma

Ischemic ATN

From exogenous or endogenous nephrotoxins

Toxic ATN

Fanconi’s syndrome, Cystinosis and cystinuria, Renal glucosuria, Renal phosphaturia, and Renal tubular acidosis are all signs of what

tubular dysfunction

Urinary tract infections (UTIs), Acute pyelonephritis, Chronic pyelonephritis, Acute interstitial nephritis, and Yeast infections are examples of what

Tubulointerstitial disease/infections

-Sudden decrease in glomerular filtration rate (GFR), azotemia, and oliguria

-Functional abnormality; but no cellular changes

-Classified as prerenal, renal, and postrenal

Acute renal failure

-Progressive loss of renal function

-Due to hypertrophy of remaining healthy nephrons, not clinically recognizable until 80% to 85% function lost

Chronic renal failure

Azotemia, acid-base imbalance, abnormal calcium (Ca) and phosphate (PO₄) metabolism is indicative of what

Chronic renal failure

Chronic renal failure causes what

abnormal calcium (Ca) and phosphate (PO₄) metabolism

how much of renal calculi contain calcium

75%

what are the factors that influence calculi formati

-Supersaturation of chemical salts in urine

-Optimal urinary pH

-Urinary stasis

-Nucleation or original crystal formation

Renal Calculi is found primarily where

renal calyces, renal pelvis, ureters, or bladder

Cystinosis and cystinuria, Maple syrup urine disease (MSUD), Phenylketonuria (PKU), Alkaptonuria, Tyrosinuria, and Melanuria are examples of what

Amino Acid Metabolism Disorders

Problems with glucose metabolism

Diabetes mellitus

what is a long term effect of Diabetes mellitus

glomerular damage and chronic renal failure

Decreased antidiuretic hormone (ADH) or nephrons are resistant to ADH

Diabetes insipidus

Diabetes insipidus results in

polyuria

Hereditary defects of heme synthesis pathway. Increased porphyrins and porphyrin precursors in blood and urine

porphyrias

the analytical detection method used to screen for the substances produced in the many metabolic disorders

Tandem mass spectrometry (MS/MS)

used to screen for inherited metabolic disorders

Heel stick blood samples from neonates

outer layer next to bone

dura mater

middle layer resembling a spiderweb

Arachnoid mater

innermost layer adhering to surface of neural tissues

Pia mater

flows in subarachnoid space between arachnoid mater and pia mater, where it bathes and protects brain and spinal cord

CSF

Interface between blood and CSF called

blood-brain barrier

CSF forms, circulates, and is reabsorbed into ______, dynamically turning over ______ each hour

blood, 20 mL

If reabsorption process is blocked, CSF does what

builds up causing hydrocephalus

Collected by aseptic lumbar puncture in third or fourth lumbar interspace with local anesthesia

CSF collection

for csf testing what are the labeled tubes

chemistry, microbiology, cell counts

Normal what is clear and colorless with viscosity like water

CSF

increased number of cells in CSF

Pleocytosis

Cloudy CSF associated with white blood cells (WBCs)

greater than 200 cells/mL

Cloudy CSF associated with red blood cells (RBCs)

greater than 400 cells/mL

Microorganisms or increased protein can cause

cloudy CSF

abnormal color of CSF, usually yellow, orange, or pink due to various conditions

Xanthochromia

in Traumatic tap what has the greatest amount of blood and the least

tube 1, tube 3

After centrifugation what is the traumatic tap’s supernatant

colorless supernatant

After centrifugation what is the hemorrrhage supernatant

xanthochromic supernatant

ØConsistent amount of blood in all three tubes

hemorrage

Macrophages stain positive for _______ and may include _________

hemosiderin, hematoidin crystals

In adults, normal cell count is ______ white blood cells per microliter (WBCs/μL), specifically ______

0 to 5; lymphocytes and monocytes

Cell counts performed immediately to prevent lysing of WBCs; lysing slowed at

4 C

what is not normally present in microscopic examination

RBCs

If dilution needed, use

normal saline

Increased in diseases of central nervous system (CNS) and variety of other conditions

white blood cell counts

CSF diluted with _______ to lyse RBCs

2% acetic acid

In bacterial meningitis, up to 90% of WBCs can be

neutrophils

Increased in viral, TB, fungal, or syphilitic meningitis particularly in later stages

lymphocytes

Increased in viral, TB, fungal, or syphilitic meningitis particularly in later stages

neutrophils

Are abnormal when seen in multiple sclerosis and acute viral and chronic inflammatory conditions

plasma cells

May be increased in a mixed cell pattern such as TB or fungal meningitis, chronic bacterial meningitis, or rupture of cerebral abscess

monocytes

-10% or greater with parasitic, fungal, or allergic reactions

-Following injection of radiographic contrast media or medications

-Can also result from an allergic reaction to malfunctioning intracranial shunts

eosinophils

Often found after hemorrhage because of phagocytic ability

macrophages

Total Protein in Cerebrospinal Fluid is normall y

15 to 45 mg/dL

Increased in CSF from

-Contamination with blood during traumatic tap

-Change in blood-brain barrier

-Decreased reabsorption into venous blood

-Increased synthesis in CNS

Bacterial, viral, and other forms of meningitis, Cerebral infarction, Hemorrhage, Endocrine disorders, Multiple sclerosis, Obstruction of CSF flow, Trauma all results from

Increased protein seen in numerous disorders

-Increased reabsorption because of increased intracranial pressure

-Loss of fluid because of trauma or invasive procedures

decreased protein

Used to assess permeability of blood-brain barrier

Fluid (CSF)/Serum Albumin Index

Values greater than this range of Immunoglobulin G (IgG) index are associated with

increased intrathecal production of IgG

Values less than this range of Immunoglobulin G (IgG) index are associated with

indicate a compromised blood-brain barrier

indicate a compromised blood-brain barrier

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