AUBF 311: Microscopic Exam of Urine

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56 Terms

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Microscopic Exam

3rd part of routine urinalysis with the purpose to detect and identify insoluble materials present in urine

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10 - 15 mL

Standard amount of urine specimen volume

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12 mL

Recommended amount of urine specimen volume

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Cintrifugation

400 RCF for 5 minutes

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20 uL or 0.02 mL

Recommended volume of sediment for microscopy

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10

Minimum number of fields observed for microscopic exam of urine

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LPO

Objective lens used to detect casts and to ascertain general composition of the sediment

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Near edges of cover slip

Casts tend to locate in this are when using conventional glass-slide method for urinary microscopy

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Reduced Light

Due to many sediment constituents having a refractive index, it is essential that they’re observed under what condition when using bright-field microscopy?

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  1. Casts

This sediment is reported as average number per LPF

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  1. RBC

  2. WBC

These sediments are reported as average number per HPF

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  1. Epithelial cells

  2. Crystals

These sediments are reported as semi-quantitative terms:

  • Rare (1+)

  • Few (2+)

  • Moderate (3+)

  • Many (4+)

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Addis Count

Quantitative measurement of formed elements of urine (12-hr specimen)

  • Uses hemacytometer

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Sternheimer-Malbin Stain

  • Most commonly used supravital stain

  • Consists of Crystal Violet + Safranin O

    • WBCs

    • Epithelial cells

    • Casts

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Toluidine Blue

  • 0.5%

  • Metachromatic stain that enhances nuclear detail

    • WBCs

    • Renal tubular epithelial (RTE) cells

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Acetic Acid

  • 2%

  • Lyses RBCs and enhances nuclei of WBCs

    • RBCs

    • WBCs

    • Yeast

    • Oil droplets

    • Crystals

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Oil Red O + Sudan III

  • Lipid stains that dyes TAGs and neutral fats into orange-red, but not cholesterol

  • Uses polarizing microscopy

    • Free fat droplets

    • Lipid-containing sediments

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Gram Stain

Stain used for bacterial casts (ewan ko na lang sayo kung ‘di mo pa alam ‘to)

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Hansel Stain

Stain used to identify EOs in urine

  • Composed of:

    • Eosin Y

    • Methylene blue

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Prussian Blue

Stains structures containing iron

  • yellow-brown granules of hemosiderin (cells and casts)

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Bright-Field Microscope

Microscope used for routine urinalysis

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Phase-Contrast Microscope

Microscope that enhances visualization of elements with low refractive index

  • Hyaline cast

  • Mixed cellular cast

  • mucous threads

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Trichomonas vaginalis

Bacteria that has low refractive index, observed using phase-contrast microscope

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Polarizing Microscope

Microscope that detects presence/absence of birefringence and aids in identification of:

  • lipids

  • crystals

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Dark-Field Microscope

Microscope that aids in identification of Treponema pallidum (Syphilis)

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Fluorescence Microscope

Microscope that allows visualization of naturally fluorescent microorganisms or those stained by fluorescent dyes

  • “Immunofluorescence”

    • Bacteria

    • Viruses

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Interference-Contrast Microscope

Microscope that produces a 3-Dimensional, layer-by-layer imaging of a specimen

  1. Modulation-Contrast Microscope (Hoffman)

  2. Differential Interference-Contrast Microscope (Nomarski)

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RBC

  • 0 - 3 HPF

  • Hematuria

  • Crenate or Shrink = hypersthenuric / concentrated urine

  • Swell and Hemolyze = hyposthenuric / diluted urine

  • Sources of Identification Error:

    1. Yeast

    2. Oil droplets

    3. Air bubbles

<ul><li><p><span style="color: red;"><strong>0 - 3 HPF</strong></span></p></li><li><p>Hematuria</p></li><li><p>Crenate or Shrink = hy<span style="color: red;">per</span>sthenuric / concentrated urine</p></li><li><p>Swell and Hemolyze = hy<span style="color: red;">po</span>sthenuric / diluted urine</p></li><li><p>Sources of Identification Error:</p><ol><li><p>Yeast</p></li><li><p>Oil droplets</p></li><li><p>Air bubbles</p></li></ol></li></ul><p></p>
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Ghost Cells

Term used to refer to RBCs that only contains the cell membrane due to leakage of Hgb caused by hemolysis

<p>Term used to refer to RBCs that only contains the cell membrane due to leakage of Hgb caused by hemolysis</p>
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Dysmorphic RBCs

RBCs that exhibit varying size (anisocytosis) and shape (poikilocytosis)

  • Primarily associated with glomerular bleeding = acanthocytes

  • Strenous exercise

<p>RBCs that exhibit varying size (<span style="color: red;">anisocytosis</span>) and shape (<span style="color: red;">poikilocytosis</span>)</p><ul><li><p>Primarily associated with glomerular bleeding = acanthocytes</p></li><li><p>Strenous exercise</p></li></ul><p></p>
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WBCs

  • 0 - 8 HPF

  • Pyuria (pus) / Leukocyturia

    1. NEUTs: predominant WBC, swells and lyse in hyposthenuric urine

    2. EOs: primarily associated with drug-induced interstitial nephritis (acute)

    3. Mononuclear cells: LYMPHs, MONOs, macrophages, and histiocytes

<ul><li><p><span style="color: red;"><strong>0 - 8 HPF</strong></span></p></li><li><p>Pyuria (pus) / Leukocyturia</p><ol><li><p><span style="color: red;">NEUTs</span>: predominant WBC, swells and lyse in hyposthenuric urine</p></li><li><p><span style="color: red;">EOs</span>: primarily associated with drug-induced interstitial nephritis (acute)</p></li><li><p><span style="color: red;">Mononuclear cells</span>: LYMPHs, MONOs, macrophages, and histiocytes</p></li></ol></li></ul><p></p>
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Glitter Cells

Other term for Neutrophil; granules undergo brownian movement, producing sparkling appearance

<p>Other term for Neutrophil; granules undergo brownian movement, producing sparkling appearance</p>
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Squamous Epithelial Cells

Largest cells w/ abundant, irregular cytoplasm

  • Represent normal cellular sloughing and have no pathological significance

  • Originate from linings of:

    • Female: vagina + urethra

    • Male: lower urethra

<p>Largest cells w/ abundant, irregular cytoplasm</p><ul><li><p>Represent normal cellular sloughing and have no pathological significance</p></li><li><p>Originate from linings of:</p><ul><li><p>Female: vagina + urethra</p></li><li><p>Male: lower urethra</p></li></ul></li></ul><p></p>
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Clue Cell

Squamous epithelial cell variation that is indicative of bacterial vaginosis by Gardnerella vaginalis

  • must be 70% covered with Gardnerella coccobacillus

<p>Squamous epithelial cell variation that is indicative of bacterial vaginosis by <span style="color: red;">Gardnerella vaginalis</span></p><ul><li><p>must be <span style="color: red;">70%</span> covered with Gardnerella coccobacillus</p></li></ul><p></p>
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Transitional Epithelial Cells

Smaller than squamous cells and have centrally located nucleus; water absorbability

  • Originates from lining of:

    • Both: renal pelvis, calyces, ureters, and bladder

    • Male: upper urethra

<p>Smaller than squamous cells and have centrally located nucleus; water absorbability</p><ul><li><p>Originates from lining of:</p><ul><li><p>Both: renal pelvis, calyces, ureters, and bladder</p></li><li><p>Male: upper urethra</p></li></ul></li></ul><p></p>
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Renal Tubular Epithelial (RTE) Cells

Epithelial cells that vary in size and shape depending on are of origin and is indicative of necrosis of renal tubules

  • PCT: “columnar/convoluted cells”; larger, rectangular, resemble casts

  • DCT: smaller, round, resemble WBCS and spherical transitional cells

<p>Epithelial cells that vary in size and shape depending on are of origin and is indicative of necrosis of renal tubules</p><ul><li><p>PCT: “columnar/convoluted cells”; larger, rectangular, resemble casts</p></li><li><p>DCT: smaller, round, resemble WBCS and spherical transitional cells</p></li></ul><p></p>
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Oval Fat Bodies

  • Lipid-containing RTE cell (may also be mononuclear cells)

  • Highly refractile

  • Seen together with free-floating fat droplets

  • Maltese cross formation in polarizing microscope

  • “Lipiduria”

    • glomerular damage (nephrotic syndrome)

    • severe tubular necrosis

    • diabetes mellitus

<ul><li><p>Lipid-containing RTE cell (may also be mononuclear cells)</p></li><li><p>Highly refractile</p></li><li><p>Seen together with free-floating fat droplets</p></li><li><p>Maltese cross formation in polarizing microscope</p></li><li><p>“Lipiduria”</p><ul><li><p>glomerular damage (nephrotic syndrome)</p></li><li><p>severe tubular necrosis</p></li><li><p>diabetes mellitus</p></li></ul></li></ul><p></p>
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Bubble Cells

RTE cell containing large, nonlipid-filled vacuole

  • Acute Tubular Necrosis

<p>RTE cell containing large, nonlipid-filled vacuole</p><ul><li><p>Acute Tubular Necrosis</p></li></ul><p></p>
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False

True or False: Urine specimen found with bacteria indicates UTI

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True

True or False: Urine specimen found with bacteria and WBCs indicates UTI

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Enterobacteriaceae

Bacterial family that commonly cause UTIs

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Yeast

  • Small, refractile oval structures

  • Severe infection = branched / mycelial form

    • Candida albicans

<ul><li><p>Small, refractile oval structures</p></li><li><p>Severe infection = branched / mycelial form</p><ul><li><p><span style="color: red;">Candida albicans</span></p></li></ul></li></ul><p></p>
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Trichomonas vaginalis

Most encountered parasite in urine

  • Pear-shaped flagellate

  • Rapid darting motility

<p>Most encountered parasite in urine</p><ul><li><p>Pear-shaped flagellate</p></li><li><p>Rapid darting motility</p></li></ul><p></p>
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Hyaline Cast

Cast most frequently seen

  • “Prototype cast”

<p>Cast most frequently seen</p><ul><li><p>“Prototype cast”</p></li></ul><p></p>
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Cylindruria

Presence of urinary casts

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RBC Cast

Most fragile cast that indicates bleeding w/n the nephron

<p>Most fragile cast that indicates bleeding w/n the nephron</p>
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WBC Cast

Indicates infection or inflammation w/n nephron

  • “Pyelonephritis”

<p>Indicates infection or inflammation w/n nephron</p><ul><li><p>“Pyelonephritis”</p></li></ul><p></p>
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Pseudoleukocyte Cast

Clump of WBC typically seen in lower UTI

  • Not a true cast

  • Absence of cast matrix

<p>Clump of WBC typically seen in lower UTI</p><ul><li><p>Not a true cast</p></li><li><p>Absence of cast matrix</p></li></ul><p></p>
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Bacterial Cast

Their presence should be considered when WBC CAST and many free WBCs and bacteria are seen in the sediment

  • “Pyelonephritis”

  • Similar to granular cast

<p>Their presence should be considered when WBC CAST and many free WBCs and bacteria are seen in the sediment</p><ul><li><p>“Pyelonephritis”</p></li><li><p>Similar to granular cast</p></li></ul><p></p>
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Uromodulin

Major constituent of casts

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Epithelial Cell Cast

Casts containing RTE due to advanced tubular destruction

<p>Casts containing RTE due to advanced tubular destruction</p>
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Fatty Cast

Highly refractile cast matrix that contains fat droplets and oval fat bodies

<p>Highly refractile cast matrix that contains fat droplets and oval fat bodies</p>
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Granular Cast

Casts that are coarsely and finely granular

  • Granules originate from RTE cell lysosomes

<p>Casts that are coarsely and finely granular</p><ul><li><p>Granules originate from RTE cell <span style="color: red;">lysosomes</span></p></li></ul><p></p>
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Waxy Cast

Final degenerative form of all types of cast

  • Brittle and w/ jagged ends

  • “Chronic Renal Failure”

<p>Final degenerative form of all types of cast</p><ul><li><p>Brittle and w/ jagged ends</p></li><li><p>“Chronic Renal Failure”</p></li></ul><p></p>
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Broad Cast

Cast that indicates destruction (widening) of tubular walls

  • “Renal Failure Cast”

  • Any cast can be broad

<p>Cast that indicates destruction (widening) of tubular walls</p><ul><li><p>“Renal Failure Cast”</p></li><li><p>Any cast can be broad</p></li></ul><p></p>
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Crystal Formation

Precipitation of urine solutes and medications with iatrogenic compounds in

  • Low temperature

  • High SG