Body Fluids Exam 2

How will a concentrated (hypertonic) urine affect the appearance of red cells?

They appear crenated

Crenated RBC in urine

What are ghost cells?

Lysed red cells

Under what conditions might ghost cells be seen?

Dilute or hypotonic environment causes the cells to swell and burst

Ghost cells

What is normal range of RBCs in urine per HPF?

0-2

What are 3 significant causes of blood in urine?

Glomerular damage, trauma, stones, infection or tumors

What is normal range of WBCs in urine per HPF?

0-5

What causes the appearance of glitter cells?

Dilute or hypotonic urine will cause water to move into a white cells

Glitter cells

What is actually glittering in glitter cells?

Granules moving around as the cell swells

What type of cells in urine may indicate a possible kidney transplant rejection?

Lymphocytes

A positive leukocyte esterase plus a positive nitrite is consistent with what condition?

UTI

A positive nitrite in conjunction with a negative leukocyte esterase is most consistent with what situation?

An old or unpreserved urine

What term is given to squamous epithelial cells covered with bacteria?

Clue cells

Clue cells

What are 3 types of epithelial cells that may be seen in urine?

Squamous, transitional, and renal tubular

Squamous epithelial cell

Transitional epithelial cell

Renal tubular epithelial cell

What type of epi is most consistent with bladder infections or catheterization?

Transitional

What type of epi is most clinically significant?

Renal tubular

When might renal tubular epis be seen?

Tubule damage or necrosis from toxins, drugs or kidney transplant rejection

What term is used to describe a renal tubular epi filled with fat globules?

Oval fat body

The appearance of maltese cross forms in a cell or cast denotes the presence of what?

Fat, notably cholesterol

What urine sediment findings are most consistent with nephrotic syndrome?

Oval fat bodies, fatty casts, cholesterol crystals, free fat droplets

What condition can cause the appearance of hemosiderin in urine?

Intravascular hemolysis

What are thread-like structures seen in urine that are increased with inflammatory conditions?

Mucus

Mucus

What cells are rarely seen in urine and indicate bladder or kidney cancer?

Malignant cells

Describe the appearance of yeast in urine

Slightly oval, sizes may vary, often budding, hyphae

What type of organism in urine is pear-shaped, about the size of a white cell, and displays jerky motility?

Trichomonas vaginalis

What protein makes up the basic matrix of casts?

Tamm-Horsfall protein

Other than urine, into what other body fluid can Tamm-Horsfall be secreted?

No other body fluids

What pH environment is needed to enhance cast formation?

Acidic

Hyaline cast

RBC cast

WBC cast

Granular cast

Waxy cast

Broad cast

Fatty cast

Which type of cast is considered to be insignificant?

Hyaline

Describe the appearance of hyaline casts

Colorless, parallel sides & rounded ends

In what conditions will hyaline casts be seen?

Dehydration, stress, or fever

Acute glomerulonephritis is often associated with what type of cast?

RBC cast

White cell casts are often associated with what condition?

Pyelonephritis

A urine is positive for white cells but no white cell casts are seen. What is the most likely condition?

Cystitis (lower UTI)

What type of cast is consistent with indistinguishable cellular debris?

Granular

In what portion of the kidney are broad casts formed?

Collecting ducts

Which 2 types of casts form when urine stasis is at its most extreme?

Broad & waxy

Describe the appearance of waxy casts in urine

Clear, containing minimal debris, ends are blunt & often cracks can be seen along the sides

What are 5 normal types of crystals seen in alkaline urine?

Amorphous phosphates, triple phosphate, calcium phosphate, ammonium biurate, & calcium carbonate

What are 3 normal types of crystals seen in acidic urine?

Amorphous urates, uric acid, & calcium oxalate

Whate are 7 abnormal types of crystals seen in acidic urine?

Cysitne, tyrosine, leucine, bilirubin, cholesterol, radiographic dyes, & drug crystals

Amorphous urates/phosphates

Calcium oxalate

Uric acid

Triple phosphate

Calcium phosphate

Ammonium biurate

Calcium carbonate

Cystine

Tyrosine

Leucine

Bilirubin crystal

Cholesterol crystal

Radiographic dye crystals

Drug crystals

What acid crystal may be seen when there is increased metabolism of purines?

Uric acid

In what condition are increased numbers of oval calcium oxalate crystals seen?

Ethylene glycol poisoning

What are 2 significant causes of uric acid crystals in urine?

Gout, chemotherapy, tumor irradiation

What is the easiest way to differentiate amorphous urates from amorphous phosphates?

Check pH
Acidic = urates
Alkaline = phosphates

What are 2 crystals that may be found in old urine samples?

Triple phosphate & ammonium biurate

What descriptive word to we use for triple phosphate?

Coffin lid

What descriptive word to we use for ammonium biurate?

Thorny apple

What descriptive word to we use for calcium carbonate?

Dumbbells

What descriptive word to we use for calcium oxalate?

Square envelopes

In what pH environment are clinically significant urine crystals typically seen?

Acidic

What crystal is described as being hexagonal?

Cystine

In what disorders are cystine crystals seen in urine?

Defect in reabsorption of cystine, may cause kidney stones

What are 3 crystals that are seen in liver disease in urine?

Bilirubin, tyrosine, & leucine

What specific disease is linked to the appearance of leucine crystals?

Maple Syrup Urine Disease

Describe the appearance of leucine crystals in urine

Round with radial striations

If a patient has hepatitis, what crystal would most likely be seen?

Bilirubin

Why is the appearance of drug crystals in urine considered clinically significant?

Indicates the patient needs hydration, crystals can damage tubules.

Describe the appearance of cholesterol crystal in urine

Flat plate with notched corners

What contaminant can mimic the appearance of red cells, and will show a maltese cross form when polarized?

Starch/talc

What condition is linked to the appearance of cholesterol crystals?

Nephrotic syndrome

What type of urine collection is preferable for home pregnancy testing and why?

1st morning sample because it's more concentrated

What is the advantage to testing a clean catch urine?

It won't be contaminated by squamous epi cells or skin bacteria

What disease is a 2 hour post-prandial urine designed to help diagnose?

Diabetes

Why are 24 hour or timed urines preferable when testing for the quantity of chemicals?

Because the secretion of chemicals especially hormones varies over the course of a day

What type of urine collection may arrive in the lab in a syringe?

Supra-pubic aspirate

What is a disadvantage to testing a first morning urine?

May contain more amorphous crystals because it's more concentrated

What is the best way to preserve a urine sample?

Refrigerate

When are chemical preservatives most commonly used?

When a sample is being transported & won't be refrigerated

How may ketones be affected if a urine is not properly preserved?

Decrease due to evaporation

How may glucose be affected if a urine is not properly preserved?

Decrease due to glycolysis

How may nitrite be affected if a urine is not properly preserved?

Increase due to bacterial reduction of nitrates