[CM] MICROSCOPIC EXAMINATION OF URINE

12 ml (10-15ml)

Recommended volume of transferred urine in sediment preparation

400 RCF

5 mins

Speed and time of urine sediment preparation

0.5-1ml

remained urine volume after decantation

20 ul

Volume of sediment examined

3ml

if less than 12 ml urine is available, centrifuge ___ mL of it

do not centrifuge, examine directly

course of action if only less than 3ml urine is available

addis count

Quantitative measure of formed elements of urine using hemacytometer

12 hour urine

Specimen used for addis count

formalin

preservative for addis count

0 to 500,000 RBCs,

0 to 1,800,000 WBCs and epithelial cells and

0 to 5,000 hyaline casts in a 12-hour urine

Normal values for Addis count

0-2 or 0-3 / HPF

Normal value of RBC

crenated or shrink

change in RBC: Hypertonic urine

swell / hemolyze (ghost cell) / shadow cell

change in RBC: hypotonic urine

Dysmorphic with projections; fragmented (ACANTHOCYTES)

change in RBC: Glomerular membrane damage

Yeasts

Oil droplets

Air bubbles

Monohydrate calcium oxalate crystals

Sources of error in microscopic RBC identification

2% acetic acid

Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals

0-5 or 0-8 /hpf

NV of WBC in urine

neutrophils

most predominant WBC in urine

glitter cells

WBCs in hypotonic urine exhibiting Brownian movt

acute interstitial nephritis

a significant increase in eosinophils (>1%) is seen in what condition

pale blue

under sternheimer-malbin stain, glitter cells stain what color

pale pink

under sternheimer-malbin stain, leukocytes stain what color

squamous epithelial cell

Largest cell with abundant irregular cytoplasm & prominent nucleus

clue cell

SEC covered with gardnerella vaginalis (bacterial vaginosis)

squamous epithelial cell

cell that is used as a point of reference

transitional epithelial cell

Spherical, polyhedral, or caudate with centrally located nucleus

transitional epithelial cell

"bladder cell"

derived from: renal pelvis, calyces, ureter, urinary bladder and upper male urethra

renal tubular epithelial cell (RTE)

most clinically significant epithelial cell

nephron

origin of RTE cell

eccentric

position of RTE nucleus

>2 RTE/hpf

value of RTE that indicates tubular injury

Collecting duct

RTE cell from ________________ is columnar , polygonal or cuboidal with flat edge

oval fat body

Lipid containing RTE

HIGHLY REFRACTILE

Seen in Nephrotic Syndrome

nephrotic syndrome

Oval fat body is seen in

cholesterol

"maltese cross"

bubble cell

RTE cell with nonlipid-filled vacuoles

Seen in acute tubular necrosis

acute tubular necrosis

bubble cells are seen in what condition

bacteria + WBCs

True UTI =

E. coli

most common cause of UTI

motility

what differentiates bacteria from amorphous urates and phosphates

yeast + WBCs

true yeast infection =

Trichomonas vaginalis

most frequently encountered parasite in urine

ping-pong disease

T. vaginalis is the agent of what disease

E. vermicularis egg

most common fecal contaminant

S. haematobium egg

Blood fluke with terminal spine that causes hematuria

- associated with bladder cancer

NMP (nuclear matrix protein)

BTA (bladder tumor antigen)

urinary bladder cancer markers (2)

spermatozoa

Oval, slightly tapered head

long flagella like tail

seen after sexual intercourse

Tamm-Horsfall protein (Uromodulin)

major constituent of mucus threads

Epithelial cells

Mucus threads

Casts

SEC

Abnormal crystals and casts

Constituents that are quantitated per LPF

Moderate

Ten (10) calcium oxalate crystals were seen per HPF. How do you report this finding?

a. Rare

b. Few

c. Moderate

d. Many

Rare

9 bacteria were seen per HPF. How do you report this?

a. Rare

b. Few

c. Moderate

d. Many

10-50

Few bacteria:

a. 0-10

b. 10-50

c. 50-200

d. >200

cylinduria

excretion of casts is termed as

DCT and Collecting duct

Casts are formed in the

Tomm-Horsfall protein (Uromodulin)

major constituent of casts (produced by RTE cell)

True

True or False

Cylindriods have the same significance as casts

coverslip edges with subdued light

Examination of casts is perfomed on which part of the coverslip?

Hyaline cast

Prototype cast (beginning of all types of cast)

Hyaline cast

most frequently encountered and most difficult cast to discover

hyaline >> cellular >> coarsely granular >> finely granular >> waxy

Order of cast degeneration

0-2/lpf

Normal value of Hyaline cast

strenuous exercise

physiologic cause of hyaline cast formation

RBC cast

Most fragile cast that indicates bleeding within the nephron (orange red color)

Blood cast or Hemoglobin Cast

"muddy brown cast"

Indicates bleeding, contains hemoglobin from lysed rbcs

WBC cast

indicates inflammation or infection within the nephron

Sig: Pyelonephritis, Acute interstitial nephritis

phase microscopy

supravital stain

used to distinguish WBC cast from RTE cast

pseudoleukocyte cast

(not a true cast)

Clump of leukocytes that are seen in lower UTI

RTE cast

Casts signifying advance tubular destruction, tubular damage

bacterial cast

casts signifying pyelonephritis

confirmation is done by performing GRAM STAIN

finely granular cast

Sandpaper appearance

granular cast

casts that are composed of granules derived from the lysosomes of RTE cells during normal metabolism

Sig: Glomerulonephritis, pyelonephritis, stress, strenuous exercise

False

True or False

Fat globules are stained by Sternheimer-Malbin stain

lipid stains

identification of TAG and neutral fats

polarizing microscope

identification of cholesterol

Nephrotic syndrome

primary significance of fatty cast

waxy cast

final degenerative form of all types of casts

brittle, highly refractile, with jagged ends

Chronic renal failure

primary significance of waxy cast

broad cast

often referred to as renal failure cast

-- they are a mold of the DCT and indicate destruction of the tubular walls.

granular and waxy

Most commonly seen broad casts are

extreme urine stasis

renal failure

Broad Cast -Clinical Significance

crystalluria

the excretion of crystals in the urine

crystals

the most recognized but the most insignificant part of urine sediments

crystals

formed by the precipitation of urine solutes

pH

Solute concentration

Temperature

factors that contribute to crystal formation

amorphous urates

Fluffy orange or pink sediment (brick dust) due to uroerythrin

amorphous urates

yellow brown pigments (microscopic)

uric acid

amorphous urates turns into __________ after adding acetic acid

ammonium biurate

amorphous urates turns into _____________ ____________ after adding ammonium hydroxide

heat 60C

alkali

amorphous urate is soluble in (2)

uric acid

most pleomorphic crystal

rhombic (diamond)

Whetstone (4-sided flat plate)

Lemon shaped

forms of uric acid

cystine crystals

hexagonal forms of uric acid may be mistaken as

Lesch-Nyhan syndrome

chemotherapy

gout

uric acid crystals are increased in what conditions

Calcium oxalate

most frequently observed urinary crystal

dihydrate calcium oxalate crystals (WEDDELLITE)

envelope bipyramidal octahedron / emerald cut diamont

Monohydrate calcium oxalate (WHEWELITE)

oval / dumbbel shape

calcium oxalate

A crystal that is increased in:

- foods rich in oxalic acid (tomato) and ascorbic acid

- ethylene glycol or methoxyflurane poisoning

dilute HCl

Calcium oxalate is soluble in?

calcium sulfate

cigarette butt appearance and soluble in acetic acid

hippuric acid

yellow brown colorless elongated prism

soluble in water and ETHER