Urinalysis Module 3

Test 3 Microexamination

What materials are usually present in urine?

WBC, RBC, Epithelial cells, casts, crystals, Bacteria, yeast, parasites, spermatozoa, mucus, artifacts

What specific patient would most likely be tested?

what is most effective method to collect specimen?

pregnant women, diabetic, renal disease pt, geriatric, pediatric.

midstream clean-catch specimen

What can be suspected in an abnormal result?

color/clarity, blood, leukocytes, nitrite, glucose, protein

Microscopic analysis of urine include

specimen preparation, volume of specimen, centrifugation, Identification of formed elements

Macroscopic screening of urine specimen is used to:

Increase cost-effectiveness of urinalysis

What is the normal volume of urine in specimen?

10-15 ml

what can determine a false negative microscopic result?

Braking centrifuge, failing to mix specimen, diluting alkaline urine.

How do we adjust the microscope to examine urine sediment?

scan in reduced light

10 fields on low power (10x)

10 fields on high power (40x)

how can we identify casts on a cover slip? what provides a point of reference on a microscope?

casts are located on the perimeter/edges on a cover slip.

epithelial cells should be focused on first.

what organisms are detected on a low power field?

casts and squamous epithelial cells

what organisms can be detected on a high power field?

WBC, RBC, crystals, bacteria, yeast, parasites, RTE, Transitional epithelial cells, oval fat bodies

The sternheimer-Malbin stain is added to urine to:

increase visibility, change refractive index, delineate constituent structures

Which lipids are stained by Sudan III?

Neutral fats and Triglycerides

Which lipid is capable of polarizing?

Cholesterol

Red blood cells examination

normal range 0-3 hpf

can be seen using high power

average number are seen in 10 hpfs

Hypersthenuric urine shows what type of RBC's?

crenated RBC's due to loss of water

Hyposthenuric urine shows what kind of RBC's?

RBC's swell and lyse, leaving ghost cells

what cause Dysmorphic RBC's (acanthocyte) to show in urine

glomerular bleeding and strenuous excercise

RBCs in urine indicates

glomerular membrane damage and vascular injury to genitourinary tract

What can we indicate when a patient has severe back pain and increased RBC’s?

Renal Calculi

White blood cells examination

Normal value is 0-8 hpfs

larger than RBC's

contains granules and multi lobed nuclei

what is Pyuria?

what can be detected ?

increase in WBC's in urine

Bacteria is detected

Leukocytes that stain pale blue with Sternheimer-Malbin stain and have brownian movement are called:

glitter cells

due to absorption of water and swelling

Eosinophils are WBC's that require what kind of stain?

Hansel stain

mononuclear leukocytes are mistaken for:

Renal Tubular cells

WBC's in urine indicates what?

infections

usually found in females

report if pyuria is found

squamous epithelial cells

largest cells in urine

good reference in microscope

identify in low power field

non-pathological

what is a clinically significant Squamous epithelial cell?

Clue cell

Transitional epithelial cells

smaller than squamous cells

seen in high power field

originate from the bladder

increased Transitional cells are indicative of:

catheterization

Renal Tubular epithelial cells

smaller than transitional cells

proximal tubule- rectangular

distal tubule- small, round, oval

collecting duct- cuboid shape

What are renal fragments? and what does it mean if RTE are present?

RTE cells from collecting duct that appear in groups of 3.

indicates tubular injury and it is most clinically significant

affects the renal function.

what kind of pathologic substances can RTE cause?

bilirubin- cells appear deep yellow

Viral HEP

Liver disease

What are Oval Fat Bodies? and how can we confirm? Under what type of microscope?

lipid containing RTE cells

Staining with fat stain under Polarized microscopy

What can oval fat bodies indicate? what do bubble cells indicate?

glomerular damage

bubble cells= acute tubular necrosis

Bacteria in urine

Not normally present in urine

cocci/bacilli may be seen

associated with WBC's in UTI

specimens positive for increased bacteria should?

followed up with a culture

finding Yeast in urine is commonly associated with:

Diabetes mellitus

what is the most common parasite found in urine? where is it found?

Trichomonas vaginalis

STI that comes from vaginal/urethral contamination

what is the major constituent of Mucus?

uromodulin (glycoprotein from RTE)

has clinical significance

a person submitting urine after strenuous exercise should have___ in their urine:

hyaline casts, granular casts, RBC casts

What is the only formed element found in urine?

How can it be detected and identified in the microscope?

Casts

Detected in low power

Identified in high power

The majority of casts are formed in:

Distal Convoluted tubule

Cylindruria

presence of casts in urine

Hyaline casts examination

Most frequently seen

Normal range: 0-2 per lpf

an increase in hyaline casts indicate what kind of diseases?

Acute glomerulonephritis, pyelonephritis, chronic renal disease, congestive heart failure

What do RBC casts contain and look like?

what does it indicate?

containing intact or deteriorated RBC’s.

Red-orange color; granular dirty-brown casts

indicates bleeding in nephron and glomerular damage. & proteinuria

What do WBC casts indicate?

indicates pyelonephritis

What do bacteria casts contain?

what does it indicate?

contain bacilli, bound to protein matrix, may be mixed with WBC’s

indicates pyelonephritis

what do epithelial cells contain?

what does it indicate? what are they seen with?

contains RTE cells

indicated tubular destruction and seen with WBC casts in pyelonephritis

what are fatty casts seen with?

what does it indicate?

how can we confirm?

seen with oval fat bodies and free fat droplets

indicates Nephrotic syndrome

confirm with fat stain or polarized/phase microscope

what are mixed cell casts

contain RBC& WBC=glomerulonephritis

WBC and RTE/WBC and bacteria= pyelonephritis

what are granular casts?

What do non pathogenic granular casts contain?

coarsely/fined granular

Cellular lysosomes

what do waxy casts represent?

how are they identified

represents extreme urine stasis, brittle consistency, and require staining to be visualized.

appear as fragmented with jagged ends and notched sides. Pink

Broad casts are also known as what?

what does it indicate?

are known as renal failure casts

indicates destruction of tubular walls

casts and fibers can be differentiated by using what kind of light?

polarized light

What 3 things enhance cast formation?

Urine stasis, pH, increased Sodium and Calcium

What affects solubility of crystal formation?

what is key to crystal identification?

where are all abnormal crystals found?

temperature, pH, solute concentration

pH is key to identification

abnormal crystals are found in acidic urine

Amorphous Urates

pink sediment

acidic

Uric acid

yellow-brown to colorless

acidic

Calcium oxalate Dihydrate

envelope form

acidic

Calcium Oxalate monohydrate

ovoid shape

acidic

Triple phosphate

coffin lid shaped

alkaline

Calcium phosphate

rectangular thin prisms

alkaline

Calcium carbonate

spherical/ dumb-bell shaped

alkaline

Ammonium biurate

thorny apple shaped in old specimens

alkaline

Amorphous phosphate

white precipitate

alkaline

Abnormal crystals are found in what type of urine?

found in acidic urine; rarely in neutral pH

what crystals are able to routinely polarize?

Uric acid, Cholesterol, Radiographic dye

Abnormal crystals: Cystine

hexagonal plates that are thin or thick

Abnormal crystals: Cholesterol

rectangular plates with notch in one or more corners

Abnormal crystals: Tyrosine

needles arranged in clumps

severe liver disorders

Abnormal crystals: Leucine

concentric circles, radial striations

Abnormal crystals: Bilirubin

bright yellow clumps