HARR7.2 Urine Microscopy and Clinical Correlations

Which of the following dyes are used to make Sternheimer-Malbin stain?

A. hematoxylin and eosin

B. crystal violet and safranin

C. methylene blue and eosin

D. methylene blue and safranin

B

Which of the following statements regarding WBCs in urinary sediment is true?

A. "glitter cells" seen in urinary sediment are a sign of renal disease

B. bacteriuria in the absence of WBCs indicates lower urinary tract infection (UTI)

C. WBCs other than PMNs are not found in urinary sediment

D. WBC casts indicate that pyuria is of renal, rather than lower urinary, origin

D

Which description of urinary sediment with the Sternheimer-Malbin stain is correct?

A. transitional epithelium: cytoplasm pale blue, nucleus dark blue

B. renal epithelium: cytoplasm light blue, nucleus dark purple

C. glitter cells: cytoplasm dark blue, nucleus dark purple

D. squamous epithelium: cytoplasm pink, nucleus pale blue

A

SITUATION: A 5mL urine specimen is submitted for routine urinalysis and is analyzed immediately. The SG of the sample is 1.012, and the pH is 6.5. The dry reagent strip blood test result is a large positive (3+), and the microscopic examination shows 11 to 20 RBCs/HPF. The leukocyte esterase reaction is a small positive (1+), and the microscopic examination shows 0 to 2 WBCs/HPF. What is the most likely cause of these results?

A. myoglobin is present in the sample

B. free hemoglobin is present

C. insufficient volume is causing microscopic results to be underestimated

D. some WBCs have been misidentified as RBCs

C

Which of the following statements regarding epithelial cells in the urinary system is correct?

A. caudate epithelial cells originate from the upper urethra

B. transitional cells originate from the upper urethra, ureters, bladder, or renal pelvis

C. cells from the proximal renal tubule are usually round

D. squamous epithelium line the vagina, urethra, and wall of the urinary bladder

B

Which of the statements regarding examination of unstained urinary sediment is true?

A. renal cells can be differentiated reliably from WBCs

B. large numbers of transitional cells are often seen after catheterization

C. neoplastic cells from the bladder are not found in urinary dediment

D. RBCs are easily differentiated from nonbudding yeast

B

Which of the following statements regarding cells found in urinary sediment is true?

A. transitional cells resist swelling in hypotonic urine

B. renal tubular cells are often polyhedral and have an eccentric round nucleus

C. trichomonads have an oval shape with a prominent nucleus and a single anterior flagellum

D. clumps of bacteria are frequently mistaken for blood casts

B

Which of the following statements regarding RBCs in the urinary sediment is true?

A. yeast cells will lyse in dilute acetic acid but RBCs will not

B. RBCs are often swollen in hypertonic urine

C. RBCs of glomerular origin often appear dysmorphic

D. yeast cells will tumble when the cover glass is touched, but RBCs will not

C

Renal tubular epithelial cells are shed into urine in largest numbers in which condition?

A. malignant renal disease

B. acute glomerulonephritis

C. nephrotic syndrome

D. cytomegalovirus (CMV) infection of the kidney

D

The ova of which parasite is likely be found in the urinary sediment?

A. trichomonas vaginalis

B. entamoeba histolytica

C. schistosoma hematobium

D. trichuris trichiura

C

Oval fat bodies are often seen in:

A. chronic glomerulonephritis

B. nephrotic syndrome

C. acute tubular nephrosis

D. renal failure of any cause

B

Which statement regarding urinary casts is true?

A. many hyaline casts may appear in urinary sediment after jogging or exercise

B. the finding of even a single cast indicates renal disease

C. casts can be seen in significant numbers even when protein tests are negative

D. hyaline casts will dissolve readily in acid urine

A

Which condition promotes the formation of casts in urine?

A. chronic production of alkaline urine

B. polyuria

C. reduced filtrate formation

D. low urine SG

C

The mucoprotein that forms the matrix of a hyaline cast is called:

A. bence-jones protein

B. β-miroglobulin

C. tamm-horsfall protein

D. arginine-rich glycoprotein

C

"Pseudocasts" are often caused by:

A. a dirty cover glass or slide

B. bacterial contamination

C. amorphous urates

D. mucus in urine

C

Which of the following statements regarding urinary casts is correct?

A. fine granular casts are most significant than coarse granular casts

B. cylindruria is always clinically significant

C. the appearance of cylindroids signals the onset of end-stage renal disease

D. broad casts are associated with severe renal tubular obstruction

D

A sediment with moderate hematuria and RBC casts most likely results from:

A. chronic pyelonephritis

B. nephrotic syndrome

C. acute glomerulonephritis

D. lower urinary tract obstruction

C

Urine sediment characterized by pyuria with bacterial and WBC casts indicates:

A. nephrotic syndrome

B. pyelonephritis

C. polycystic kidney disease

D. cysitis

B

Which type of casts signals the presence of chronic renal failure?

A. blood casts

B. fine granular casts

C. waxy casts

D. fatty casts

C

SITUATION: Urinalysis of a sample from a patient suspected of having a transfusion reaction reveals small, yellow-brown crystals in the microscopic examination. Dry reagent strip tests are normal with the exception of a positive blood reaction (moderate). and trace positive protein. The pH of urine is 6.5. What test should be performed to positively identify the crystals?

A. confirmatory test for bilirubin

B. cyanide-nitroprusside test

C. polarizing microscopy

D. prussian blue stain

D

When examining urinary sediment, which of the following is considered an abnormal finding?

A. 2 RBCs/HPF

B. 1 hyaline cast per low power field (LPF)

C. 1 renal cell cast per LPF

D. 5 WBCs/HPF

C

SITUATION: A urine sample with a pH of 6.0 produces an abundance of pink sediment after centrifugation that appears as densely packed yellow to reddish brown granules under the microscope. The crystals are so dense that no other formed elements can be evaluated. What is the best course of action?

A. request a new urine specimen

B. suspend the sediment in prewarmed saline, and then repeat centrifugation

C. acidify a 12 mL aliquot with three drops of glacial acetic acid, and heat to 56 C to 5 minutes before centrifuging

D. add five drops of 1N HCl to the sediment and examine

B

How can hexagonal uric acid crystals be distinguished from cystine crystals?

A. cystine is insoluble in hydrochloric acid, but uric acid is soluble

B. cystine gives a positive nitroprusside test after reduction with sodium cyanide

C. cystine crystals are more highly pigmented

D. cystine crystals form at neutral or alkaline pH, uric acids forms at neutral to acidic pH

B

The presence of tyrosine and leucine crystals together in urinary sediment usually indicates:

A. renal failure

B. chronic liver disease

C. hemolytic anemia

D. hartnup disease

B

Which of the following crystals is considered nonpathological?

A. hemosiderin

B. bilirubin

C. ammonium biurate

D. cholesterol

C

At which pH are ammonium biurate crystals usually found in urine?

A. acid urine only

B. acid or neutral urine

C. neutral or alkaline urine

D. alkaline urine only

D

Which of the following crystals is seen commonly in alkaline and neutral urine?

A. calcium oxalate

B. uric acid

C. magnesium ammonium phosphate

D. cholesterol

C

Which crystal appears in urine as long, thin hexagonal plate and is linked to ingestion of large amounts of benzoic acid?

A. cystine

B. hippuric acid

C. oxalic acid

D. uric acid

B

Small, yellow needles are seen in the sediment of a urine sample with a pH of 6.0. Which of the following crystals can be ruled out?

A. sulfa crystals

B. bilirubin crystals

C. uric acid crystals

D. cholesterol crystals

D

Oval fat bodies are derived from:

A. renal tubular epithelium

B. transitional epithelium

C. degenerated WBCs

D. mucoprotein matrix

A

Oval fat bodies are often associated with

A. lipoid nephrosis

B. acute glomerulonephritis

C. aminoaciduria

D. pyelonephritis

A

Urine of constant SG ranging form 1.008 to 1.010 most likely indicates:

A. addison disease

B. renal tubular failure

C. prerenal failure

D. diabetes insipidus

B

Which of the following characterizes prerenal failure, and helps to differentiate it from acute renal failure caused by renal disease?

A. BUN: creatinine ratio of 20:1 or higher

B. urine: plasma osmolal ratio of less than 2:1

C. excess loss of sodium in urine

D. dehydration

A

Which of the following conditions characterizes chronic glomerulonephritis and helps differentiate it from acute glomerulonephritis?

A. hematuria

B. polyuria

C. hypertension

D. azotemia

B

Which of the following conditions is seen in acute renal failure and helps differentiate it from prerenal failure?

A. hyperkalemia and uremia

B. oliguria and edema

C. low creatinine clearance

D. abnormal urinary sediment

D

Which of the following conditions characterizes acute renal failure and helps differentiate it from chronic renal failure?

A. hyperkalemia

B. hematura

C. cylindruria

D. proteinuria

A

The serum concentration of which analyte is likely to be decreased in untreated cases of acute renal failure?

A. hydrogen ions

B. inorganic phosphorous

C. calcium

D. uric acid

C

Which of the following conditions is associated with the greatest proteinuria?

A. acute glomerulonephritis

B. chronic glomerulonephritis

C. nephrotic syndrome

D. acute pyelonephritis

C

Which of the following conditions is often a cause of glomerulonephritis?

A. hypertension

B. CMV infection

C. systemic lupus erythematosus (SLE)

D. heavy metal poioning

C

Acute pyelonephritis is commonly caused by:

A. bacterial infection of medullary interstitium

B. circulatory failure

C. renal calculi

D. antigen-antibody reactions within the glomeruli

A

Which of the following is associated with nephrotic syndrome?

A. hyperlipidemia

B. uremia

C. hematuria and pyuria

D. dehydration

A

Which of the following conditions is a characteristic finding in patients with obstructive renal disease?

A. polyuria

B. azotemia

C. dehydration

D. alkalosis

B (azotemia = increased BUN)

Whewllite and weddellite kidney stones are composed of:

A. magnesium ammonium phosphate

B. calcium oxalate

C. calcium phosphate

D. calcium carbonate

B

Which of the following abnormal crystals is often associated with formation of renal calculi?

A. cystine

B. amipicillin

C. tryosine

D. leucine

A

Which statement about renal calculi is true?

A. calcium oxalate and calcium phosphate account for about three-fourths of all stones

B. uric acid stones can be seen on radiography

C. triple phosphate stones are found principally in the ureters

D. stones are usually composed of single salts

A