urinalysis 2

hw, etc.

time and speed for a centrifuge when preparing a urine specimen for microscopic examination?

5 min

2000 RPM

The minimum number of microscopic fields that should be evaluated under low power (10x) are_____________.

10

What type of epithelial cell is most frequently seen in urine sediment? Are they clinically significant?

squamous

no

squamous epithelial cell appearance

large flattened cells

formed elements which are looked for and quantified under low power (10x)

abnormal casts, hyaline cast, normal crystals, squamous epithelial cells, mucus

formed elements which are looked for and semi quantitated under high power (40x)

types of casts (oval fat bodies, hyaline casts, renal tubular epithelial cells), WBCs, RBCs, renal epithelial cells, epithelial cells by type, bacteria/yeast/other parasites, other miscellaneous items

If the specimen color appears red and pink and the clarity of the specimen is hazy or cloudy, look for

RBCs

If the specimen color is white and the clarity is hazy or cloudy, look for

WBCs

If the biochemical test shows a positive nitrate, look for

WBCs and bacteria

If the biochemical test shows positive leukocyte esterase, look for

WBCs, WBC casts, bacteria

If the biochemical test reveals a positive glucose,

look for yeast

If the biochemical test shows a positive protein,

look for casts

A freshly collected urine specimen appears to have pink dust, which settles upon standing, and is cloudy. What is it?

amorphous urate

What pH would support the observation of a freshly collected urine specimen appears to have pink dust, which settles upon standing, and is cloudy. (acidic or basic)?

acidic

microscopic findings would you expect to see in a freshly collected specimen that has:

Cloudy, positive leukocyte estersase, positive nitrite, positive hemoglobin

WBCs, bacteria, WBC casts, RBCs

Cloudy, positive leukocyte estersase, positive nitrite, positive hemoglobin

explain why it’s caused by WBCs, bacteria, WBC casts, RBCs

nitrite result can be due to WBCs and bacteria

hemoglobin result may be due to the presence of RBCs

leukocyte esterase may be due to the WBC, WBC casts, and bacteria.

RBCs may or may not be seen because they could be lysed and not visible for viewing under the microscope.

structures frequently confused with RBCs

yeast, oil, air bubbles, or calcium oxalate crystals.

why a MLS might see bacteria in the microscopic and not have a positive nitrite?

1. bacteria may be misidentified as an amorphous substance

2. bacteria may be gram-positive or a bacterium that doesn't convert nitrate to nitrite

3. patient doesn't eat enough nitrate, then the converted nitrite would not be detectable in the specimen

4. urine does not spend enough time in the bladder for the bacteria to properly convert nitrate to nitrite.

CSF specimen tube numbers

1- chem

2- micro

3-hematology

4-cytology

xanthochromia caused by

release of hemoglobin from hemolyzed RBCs two hours after a brain hemorrhage (subarachnoid hemorrhage).

xanthochromia looks like

pink with oxyhemoglobin, orange with a combination of colors, and yellow for bilirubin. This color remains even after centrifugation.

how to properly view xanthochromia

the color of the sample should be compared to distilled water with white paper in the background. This specimen should be examined within 1 hour or less to prevent false positives.

conditions where true xanthochromia is present

and why?

The subarachnoid hemorrhage releases hemoglobin from hemolyzed RBC, altering the color of CSF. This process is called erythrophagia.

Jaundice can cause yellow xanthochromia because of the presence of bilirubin in the CSF.

pigment carotene from elevated serum levels,

increased protein concentrations from blood-brain disorders,

melanoma pigment from meningeal melanosarcoma.

three ways to differentiate if blood in a CSF specimen is from a subarachnoid hemorrhage vs. a bloody spinal tap.

centrifuging the specimen,

detecting blood clots in the sample,

detecting how much blood is in the first sample tube compared to the others.

how come centrifuging a specimen helps differentiate subarachnoid hemorrhage vs. a bloody spinal tap?

the supernatant from a traumatic tap appears clear, but the supernatant from a remote hemorrhage/protein is "xanthochromic."

how come detecting blood clots in the sample helps differentiate subarachnoid hemorrhage vs. a bloody spinal tap?

this indicates that the sample is a bloody tap because a CNS hemorrhage does not have clots.

how come detecting how much blood is in the first sample tube compared to the others helps differentiate subarachnoid hemorrhage vs. a bloody spinal tap?

With the traumatic tap, the maximum amount of blood in the first sample tube progressively decreases as the sample tubes fill up.
With a CNS hemorrhage, the blood is consistently mixed in all the collection tubes.

expected glucose value for bacterial meningitis

decreased

viral meningitis glucose level

N

MS glucose level

N

subarachnoid hemorrhage glucose

D

neoplasm/tumor glucose

D

bacterial meningitis protein

I

viral meningitis protein

I

MS protein

N/sl I

neoplasm/tumor protein

I

subarachnoid hemorrhage protein

I

severe head trauma protein

D

How can synovial fluid be differentiated from other fluid types?

The high molecular weight mucopolysaccharide hyaluronic acid or hyaluronate

functions with a specific viscosity to lubricate the joints.

inflammatory vs infectious (fill out on mon)

A pericardial fluid that is clear and pale yellow which has a protein value of 2.5 g/dl and a specific gravity of 1.010 is probably due to which of the following conditions?

CHF

Analysis of a seminal fluid specimen - a tech diluted 20 uL of semen with 180 uL of diluent. She observed 100 sperm on each side, using the 5 RBC squares in the center square on an Improved Neubauer hemacytometer.

dilution?

sperm count / uL

sperm count /mL

1/10

50,000

50,000,000

At what value(s) are the baby’s lungs considered mature for L/S

>3.0

At what value(s) are the baby’s lungs considered mature for L/S - safe to deliver

>2.0

At what value(s) are the baby’s lungs considered mature for phosphatidyl glycerol

>0.3

At what value(s) are the baby’s lungs considered mature for foam stability

>0.48

At what value(s) are the baby’s lungs considered mature for lamellar body count

50,000/uL

purpose of delta A450 test

assesses hemolytic disease of the newborn by measuring bilirubin concentration (the breakdown product of hemolyzed RBCs) in amniotic fluid.

During normal RBC destruction in the fetus, unconjugated bilirubin is made and rapidly removed into maternal circulation by the placenta, but with HDN, the destroyed RBCs enter the amniotic fluid. The level of bilirubin present in amniotic fluid directly correlates to the severity of hemolysis.

substances that interfere with delta A450 test

blood contamination, meconium contamination, and any exposure to light

transudates vs exudates

infectious vs inflammatory fluid pathological

infectious: bacterial infection S. aureus and N. gonorrhoeae, Haemophilus, mycobacterium, fungi, anaerobic bacteria

inflammatory: immunological diseases RA, lupus

infectious vs inflammatory fluid appearance

infectious: cloudy, low viscosity, yellow, green, milky

inflammatory: cloudy, yellow, low viscosity

infectious vs inflammatory fluid WBC count

infectious: >50 × 10^9/L

inflammatory: 3-50 × 10^9/L

infectious gluose and neutrophil

low glucose content

>90% neutrophils

acute glomerulonephritis caused by

renal glomeruli damage, triggering inflammation and proliferation of glomerular tissue-damage to the basement membrane

(but tubular function is normal)

acute glomerulonephritis symptoms

RBC casts, Na and H2O retention, elevated BUN/creatinine, losing blood in urine anemia, decreased GFR, hematuria and proteinuria, glomerular lesions

acute glomerulonephritis related to what infection

recent strep infection

chronic glomerulonephritis

>6 months, lengthy inflammation with scarring and loss of functioning nephrons

chronic glomerulonephritis symptoms

slight decrease in renal function and proteinuria and hematuria at first, gradual development of uremia, azotemia (nitrogenous waste)

nephrotic syndrome cause

glomerular basement membrane injury and increased permeability

nephrotic syndrome symptoms

1. massive proteinuria

2. hypoalbuminemia

3. hyperlipidemia

4. lipiduria (losing proteins transporting lipids) OVAL FAT BODIES

cystinosis can lead to what?

fanconi syndrome

fanconi syndrome causes

heavy metal poisoning, cystinosis (hereditary)

fanconi syndrome results

aminoaciduria, proteinuria, glycosuria, phosphaturia

tubular diseases or defects include what?

renal tubular acidosis type I (distal tubules), II (proximal tubules), acute tubular inflammation

where do tubular diseases/defects happen?

in most renal diseases after the glomerular filtration rate declines. the ability to excrete/reabsorb substances decreases

what causes renal tubular acidosis?

kidneys can’t excrete enough acid

T/F renal tubular acidosis is the most clinically significant tubular disease

true

what happens during renal tubular acidosis type I: distal tubules?

decreased H+ secretion into distal tubules

H+ are retained and K is excreted instead

how to diagnose renal tubular acidosis type I: distal tubules

urine pH >5.3

usually the pH is lower to eliminate acid

what happens during renal tubular acidosis type II: proximal tubules?

proximal tubules can’t reabsorb bicarbonate (the base for the body), bicarb gets excreted in the urine

the patient excretes excessive bicarb ion and gets hyperchloremic acidosis, chloride is retained and elevated levels are in the plasma

SYMPTOMS of renal tubular acidosis type I: distal tubules

low serum phosphate and uric acid

glucose and amino acids in the urine

<2g protein/day in urine

urine pH isn’t low enough

acute tubular inflammation caused by

bacterial-viral-fungal infection, pain-relief drug toxicity, radiation toxicity, methicillin hypersensitivity, and renal transplant rejection

acute tubular inflammation symptoms

decreased GFR, decreased ability to concentrate urine (low SG), excreted acid in urine, WBC casts, problems with sodium balance

mechanism of acute renal failure

direct damage to renal tubules causes sudden, sharp decline in renal function over hours/days

toxic/hypotoxic occurrence in the kidney

acute renal failure symptoms

oliguria, anuria (<200mL), increased BUN and creatinine, metabolic acidosis, decreased ability to excrete electrolytes and water (edema), GFR <10mL/min

pre-renal failure problem

blood flow/supply problem

CHF, cardiovascular system failure, hypovolemia

renal failure problem

acute tubular necrosis, vascular obstruction, inflammation, glomerulonephritis

post-renal problem

urinary tract post-kidney

lower urinary tract obstruction

blasser rupture

what causes chronic renal failure?

chronic kidney disease,

increased with: diabetes, obesity, aging, metabolic syndrome, diabetic nephropathy

what causes diabetic nephropathy

glomerular problems: diabetic urine is hyperosmolar (glucosuria, ketosuria, polyuria, nocturia)

increased basement membrane permeability exacerbating renal damage

chronic insufficiency/nephrotic syndrome

end-stage renal disease caused by

kidney failure to function usually after chronic kidney disease (up to 20 yrs before)

<10% kidney function, needing dialysis/kidney transplant

ESRD symptoms

low urine volume, increased BUN to 70-80 mg/dL

creatinine increased to 7 mg/dL

eGFR <15

what does this cause?

renal hypertension

2 UTI infections

pyelonephritis and acute cystitis

pyelonephritis caused by

infections in the kidney

WBCs are diagnostic for it!

acute cystitis caused by

infection in the urinary bladder