Busy. Please wait.
or

show password
Forgot Password?

Don't have an account?  Sign up 
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove Ads
Don't know
Know
remaining cards
Save
0:01
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards




share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Urine Microscopics

MEDT 208 Microscopic examinations study objectives

QuestionAnswer
What are the advantages of commercial systems vs. glass-slide method for urine sediment examination? Commercial systems produce same concentration & sediment volume; control microscopic variables, cost competitive, easily adapted to, and required for reproducible (accurate) results.
What is the recommended method for standardizing Specimen Preparation? Proper patient education, & sample processing.
What is the recommended method for standardizing Specimen Volume? 12 mL (recommended) 10-15 mL ok 6 mL (Infants)
What is the recommended method for standardizing Centrifugation? 400-450g x 5 minutes
What is the recommended method for standardizing Sediment Preparation? Use same supplies, steps, timing intervals, equipment.
What is the recommended method for standardizing Volume of Sediment Examined? Determined by commercial slides used & microscope optical qualities; use standardized slide.
What is the recommended method for standardizing Examination of Sediment? Standard terminology (qualitative or enumerative).
For what reasons should urine specimens be referred for cytodiagnositc testing? Quantification or differentiation of WBC & epithelial cells; Early detection of renal allograft rejection; Differential diagnosis of renal disease; ID of RBCs, cell fragments, epis, cellular incisions, cellular casts; Specimens for eosinophil detection.
What are normal urine sediment constituents? RBC, WBC (0-8/hpf or 10/uL), Epis, Hyaline casts (0-2/hpf); Sperm; Mucus (female); Squamous epis; Transitional epis
What are abnormal urine sediment constituents? Crystals, parasites, oval fat bodies, mucus (male), yeast, bacteria, RTEs
What are the characteristics of urine artifacts that differentiate them from significant constituents? Artifacts: inconsistent size, big artifacts visible in all focuses, may be material fibers, meat/veggie fibers, hair; artifacts polarize (casts will not except fatty); fibers polarize.
What is the clinical significance of RBCs in urinary sediment? Glomerulonephritis Trauma Systemic & renal disease
What is the clinical significance of WBCs in urinary sediment? Pyelonephritis Cystitis Urethritis UTI
What is the clinical significance of Oval Fat Bodies in urinary sediment? Tubular epithelial degeneration of nephron. Associated w/large amounts of protein. Nephrotic syndrome.
What is the clinical significance of Hyaline Casts in urinary sediment? 0-2/hpf normal. Mild-severe renal disease (Glomerulonephritis, pyelonephritis, chronic renal disease, congestive heart failure). Strenuous exercise.
What is the clinical significance of RBC Casts in urinary sediment? Glomerular or nephron damage. Strenuous exercise. Intrinsic renal disease. Acute glomerulonephritis. AIN Severe nephritis.
What is the clinical significance of WBC Casts in urinary sediment? Pyelonephritis. Acute interstitial nephritis Renal inflammation or infection Chronic renal disease Acute glomerulonephritis
What is the clinical significance of Bacterial Casts in urinary sediment? Pyelonephritis.
What is the clinical significance of Epithelial Cell Casts in urinary sediment? Heavy damage to renal tubules. Heavy metals Viral infections Drug toxicity Graft rejection Pyelonephritis
What is the clinical significance of Granular Casts in urinary sediment? Normal metabolism. Exercise, activity.
What is the clinical significance of Waxy Casts in urinary sediment? Extremem urinary stasis Renal failure Tubular obstruction w/prolonged stasis Called renal failure casts Severe chronic renal failure Malignant hypertension Acute renal disease Diabetes mellitus
What is the clinical significance of Fatty Casts in urinary sediment? End-stage renal disease Nephrotic syndrome Diabetes mellitus Mercury poisoning Crushing injury w/disruption of body fat
What is the clinical significance of Broad Casts in urinary sediment? Significant urinary stasis + obstruction or disease Acute tubular necrosis Severe chronic renal disease End-stage kidney disease Urinary tract obstruction Renal failure
Squamous Epithelial Cells: description, origin & significance. Description: Huge + irregular edges Origin: Normal sloughing Significance: Mostly normal, except clue cells (Gardnerella infection)
Transitional Epithelial Cells: description, origin & significance. Description: Central nucleus Origin: Significance: Catheterization, malignancy
Renal Tubular Epithelial Cells: description, origin & significance. Description: Eccentric nucleus Origin: Renal tubules Significance: Tubular necrosis, salicylate poisoning
How are urinary casts formed? Tamm Horsfall (TH) protein secreted by RTE of DCT & collecting duct. Protein fibrils form into matrix.
Is Tamm Horsfall (TH) protein detected by urine reagent strips? No.
Normal, golden-brown, polarizing, rhombic, football-shaped crystals found in acidic urine. Uric acid
Normal, colorless or yellow-brown crystals found in acidic urine that cause a pink precipitate upon refrigeration. Amorphous urates
Normal, colorless, envelope/two-pyrimid shaped, or oval/dumbell shaped crystals found in acidic urine. Calcium oxalate
Calcium phosphate are normal, colorless crystals found in ____ urine. Alkaline
Normal, amorphous, colorless, crystals found in alkaline urine that form white precipitate upon refrigeration? Amorphous phosphates
Normal, colorless, crystals found in alkaline urine that are shaped like flat rectangle or thin prisms in rosettes. Calcium phosphate
Normal, colorless, coffin-lid shaped crystals found in alkaline urine? Triple phosphate
Normal, dark yellow-brown, "thorny-apple" shaped crystals found in alkaline urine. Ammonium biurate
Which amorphous crystal causes white precipitate upon refrigeration? Amorphous phosphates
Which amorphous crystal causes pink precipitate upon refrigeration? Amorphous urates
Which crystals are indicative of antifreeze poisoning? Calcium oxalate
Which crystal is a major component of renal calculi? Calcium oxalate
Normal, colorless crystals found in alkaline urine shaped like small, dumbbells or spheres. Indicates an old specimen. Calcium phosphate
An abnormal crystal indicative of cystinuria found in acidic urine; generally non-polarizing, hexagon shaped w/thin & thick plates. Cystine
An abnormal crystal indicative of nephrotic syndrome; highly birefringent, rectangular plates w/characteristic notched corners, often confused w/radiographic contrast media. Cholesterol crystals
Which three crystals are seen together in liver disease? Bilirubin Tyrosine Leucine
Abnormal crystal seen in liver disease that is yellow, and shaped as clumped needles/granules. Indicates viral hepatitis. Found in acidic urine. Bilirubin crystals
Abnormal crystal seen in inherited amino acid disorders & liver disease. Fine yellow needles in clumps or rosettes. Found in acidic urine. Tyrosine crystals
Abnormal crystal seen in liver disease. Yellow-brown spheres w/concentric circles and radial striations. Found in acidic urine. Leucine crystals
Abnormal, iatrogenic crystal found in acidic urine; colorless needle bundles w/refrigeration. Indicates increased drug doses + dehydration. Ampicillin crystals
Abnormal, most common iatrogenic crystal; found in acidic urine; Indicates treatment for UTI. Sulfa crystals
Abnormal, iatrogenic crystal (similar to cholesterol) that polarizes readily. Very high SG w/refractometer + normal reagent strip SG. Must look at patient history to identify. Radiographic dye
What are the three classifications of formed elements? Cells Crystals Casts
Why would you do a microscopic exam on a urine with a positive glucose? Yeast (they like sugar)
True/False: Revolutions per minute (rpm) does not equal RCF. True
A false negative test for blood may be due to? Ascorbic acid
The false negative glucose backup test is? Clinitest
Which constituents are counted as average per low power field (lpf) Casts, crystals
Which constituents are counted as average per high power field (hpf)? Cells (WBC, RBC, epis) Bacteria
What stain(s) are used for lipids? Oil Red O & Sudan III
What stain is used for urinary eosinophils? Hansel's stain
What stain is used for visualization of hemosiderin granules? Prussian blue stain
What is most essential for microscopic examination of urine sediments? Reduced light
Are glitter cells (crenated WBC) in urine pathogenic or non-pathogenic? Non-pathogenic
What clinical condition do eosinophils in urine indicate? Drug-induced interstitial nephritis
What are the three types of epithelial cells found in urine? Squamous Transitiaonal Renal tubular
Which of the three types of epithelial cells found in urine is pathological, and what condition do they indicate? RTEs Tubular necrosis
What are Oval Fat Bodies? RTE cells that have absorbed lipids.
Seeing a Maltese Cross under polarized light is characteristic of? Oval fat bodies
Urinary casts come from the? Kidney
This most frequently seen cast has normal parallel sides or convoluted, wrinkled, cylindroid, occasional adhering cell or granule, and may be caused by stress, exercise, fever or dehydration. Hyaline cast
A cast containing mostly tightly packed neutrophils w/in a matrix; seen in infection & inflammation of tubules (pyelonephritis & acute interstitial nephritis). WBC Cast
A cast orange-red in color w/embedded cells in a matrix. Indicative of glomerular damage or nephron capillary damage, or strenuous exercise. Often seen w/RTEs. RBC cast.
A cast seen in pyelonephritis, that can be confirmed w/gram stain. Bacterial Cast
Casts usually containing small round cells w/single nuclei in a matrix. Indicates heavy damage to renal tubules or heavy metals. May be bilirubin-stained. RTE cast
Casts seen with oval fat bodies and fat droplets. Highly refractile. Indicates nephrotic syndrome, diabetes, crushing trauma, tubular necrosis. Ominous sign of end-stage renal disease. Fatty casts
Coarse and finely granular casts. Indicates normal metabolism, exercise and activity. Granular casts
Highly refractile casts indicating extreme urinary stasis & renal failure. Fragmented w/jagged ends and notches. Waxy casts
AKA "renal failure casts". Most common are granular and waxy. Broad casts
Why are yeast infections common in patients with diabetes mellitus?   Yeast grows well in an acid, glucose environment.
With a blood glucose level of 250 mg/dL, should glucose be present in the urine?  YES (exceeds renal threshold)
Will yeast cause a positive nitrite reaction? No, yeast does not cause a positive nitrite reaction.
If you are having difficulty keep all constituents in focus at the same time on the microscope, it means? The large constituents are in a different plane.
What is a possible cause of unusual microscopic constituents?   Airborne construction artifacts
What microscopy techniques can be used to aid in differentiating a cast and an artifact? Sternheimer-Malbin stain & polarizing microscopy
Increased RTEs indicate damage to the? tubules
What is causes RTE cells to be bile-stained?   Reabsorption of bilirubin
State a disorder in which the urobilinogen level is elevated and the bilirubin result is negative. Intravascular hemolysis
What test checks for the presence of bilirubin? Icotest
Are you concerned about the presence of waxy casts and a negative protein in urine from a 6-month-old girl? Concerned
Are you concerned about increased transitional epithelial cells in a specimen obtained following cystoscopy? Not concerned
Are you concerned about tyrosine crystals in a specimen with a negative bilirubin test result? Concerned
Are you concerned about cystine crystals in a specimen from a patient diagnosed with gout? Concerned
Are you concerned about crystals that appear to be cholesterol crystals in urine with a specific gravity greater than 1.040? Not concerned
Are you concerned about Trichomonas vaginalis in a male urine specimen? Concerned
Are you concerned about amorphous urates and calcium carbonate crystals in a specimen with a pH of 6.0? Concerned
Created by: 100002485764648