Term
| What is the clinical significance of the color of urine? |
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Definition
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Term
| What are the physical and chemical parameters included in macroscopic urine? |
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Definition
color Blood
clarity Protein
Nitrite Leukocyte Esterase
Glucose |
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Term
| What is the clinical significance of the clarity of urine? |
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Definition
Hematuria vs. Hemoglobinuria/myglobinuria
**Must confirm pathological and nonpathologiical cause of turbididty |
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Term
| What is the clinical significance of the blood in urine? |
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Definition
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Term
| What is the clinical significance of the protein in urine? |
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Definition
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Term
| What is the clinical significance of the nitrie in urine? |
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Definition
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Term
| What is the clinical significance of the Leukocyte esterase in urine? |
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Definition
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Term
| What is the clinical significance of the glucose in urine? |
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Definition
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Term
| What is the advantage of using the commercial systems ofer the glass-slide method for sediment examination |
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Definition
capped and calibrated centrifuge tubes
decanting pipettes to control sediment volume
slides that control the amoun tof sediment to be examined as well as provide a monolayer of sediment
calibrated grids for more consistent quantification |
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Term
| What is the recommended method for standardization of specimen preperation |
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Definition
**mix the specimen
**midstream catch
**warming refrigerated specimens to 37c
**examine while fresh or adequately preservered |
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Term
| What is the recommended method for standardization of specimen volume |
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Definition
** specimen btw 10 and 15ml centrifuged in conical tube
**12-ml frequently used because reagent strips are easier to immerse
***if 12ml cannot be obtained--report so Dr. can adjust |
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Term
| What is the recommended method for standardization of specimen sediment preperation |
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Definition
**volumes of .5ml and 1.0 ml should be used
**volume of urine centrifuged/sediment volume should = concentration factor
**to maintain a uniform concentration..aspirate urine instead of pour of urine
**sediment should be resuspended
by gentle agitation |
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Term
| What is the recommended method for standardization of specimen centrifugation |
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Definition
** speed and time should be consistent
** 5minutes and an RCF of 400 produces optimum amount of sediment with least chance of damaging elements
** to correct for diameter cahanges in centrifuge heads RCF should be used:
RCF= 1.118x 10^-5 x radius(CM) x RPM^2
**calibration should be done routinely
** To protect against hazardous aerosols all specimens must be in capped tubes |
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Term
| What is the recommended method for standardization of specimen volume for sediment examination |
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Definition
** volume should be consistent on slide
** on glass-slide 20ul should be used |
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Term
| What is the recommended method for standardization of specimen examination |
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Definition
**a minimum of 10 fields under both low 10x and high power 40x
**examine the slide under low power first to detect casts and for general composition of sediment
**then go to higher power
**in glass-slide methods heavier substances tend to move to the outter edges
**ise reduced light when using bright-field microscopy- especially in unstained specimens |
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Term
| What is the recommended method for standardization of specimen reporting |
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Definition
**casts are reported as average of 10 fields on low power
**RBC and WBC is the average of 10 fields on high power
**crystals and epi cells and other elements are reported as 1+, 2+ etc
**microscopic results should match chemical and physical findings!!!! |
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Term
| What is the purpose for the Sternheimer-Malbin stain for examination of urinary sediment |
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Definition
Delineates structur and contrasting colors of the nucleus and cytoplasm
Function: Identification of WBC and epi cells and casts |
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Term
| What is the purpose for the toluidine blue stain for examination of urinary sediment |
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Definition
Enhances nuclear detail
Function: Differentiates WBC and renal tubular epithelial (RTE) cells |
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Term
| What is the purpose for the Sudan III stain for examination of urinary sediment |
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Definition
Stain triglycerides and neutral fats orange-red
Function: Identifies free fat droplets and lipid-containing cells and casts |
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Term
| What is the purpose for the 2% acetic stain stain for examination of urinary sediment |
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Definition
Lyses RBCs and enhances nuclei of WBCs
Function: Distinguishes RBCs from WBCS, yeast, oil droplets, amd crystal |
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Term
| What is the purpose for the Gram stain for examination of urinary sediment |
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Definition
Differentiates gram+ and grami bacteria
Function: Id bacterial casts |
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Term
| What is the purpose for the Hansel stain for examination of urinary sediment |
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Definition
Methylene blue and eosin Y stains eosiophilic granules
Function: Id urinary eosinophils |
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Term
| What is the purpose for the Prussian blue stain for examination of urinary sediment |
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Definition
Stains structures vontaining iron
Function: Id yellow-brown granules of hemosiderin in cells and casts |
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Term
| Identify specimens that should be referred for cytdiagnostic testing |
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Definition
| When unusual cellular findings are seen |
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Term
| Describe basic principle of Bright-field microscopy |
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Definition
**objects appear dark agains light background
**light emits light in visible wavelength range
**elements of urine should be viewed under decreased light as to not miss items with low refractive index |
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Term
| Describe basic principle of Phase-contrast microscopy |
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Definition
Best contrast is achieved when light is shifted 1/4 wavelength and compared with the phase differnece of the specimen.
** uses a bright-field microscope and a phase-contrast objective lens
**two rings are used--one allows for light to pass through the central clear circular area..the second is to shift the wavelength.
** background must be dark for best contrast |
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Term
| Describe basic principle of polarizing microscopy |
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Definition
Aids in the identification of crystal and lipids
** refract light in 2d at 90c to each other
** halogen quartz lamp
** uses two polarizing filters |
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Term
| Describe basic principle of interference contrast microscopy |
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Definition
**provides 3D image of very fine structural details
**works by spliting the light ray so that the beams pass through different areas of the specimen
** object appears bright against a dark background
**halo appears around object |
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Term
| What is the difference btw normal and normal sediment constituents |
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Definition
| This is really hard to determine..normal constituents can include RBC/WBC and casts. It is when they are in excess that it be a sign of pathology |
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Term
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Definition
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Term
| What is the difference btw normal and normal sediment constituents |
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Definition
| This is really hard to determine..normal constituents can include RBC/WBC and casts. It is when they are in excess that it be a sign of pathology |
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Term
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Definition
*In concentrated urine RBCs become smaller and crenated
*in dilute urine the become larger and may lyse and become ghost cells
*Frequently confused w/yeast, oil droplets, and air bubbles
*oil/air bubbles highly refractile
*can be confused w/WBC when they shrink
*acetic acid will lyse RBCs, but not yease, oil or WBC |
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Term
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Definition
*RBCs that vary in size, hav ecellular protuseions, or are fragmented
*associated w/ glomerular bleeding, but is not the only reason |
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Term
| What is the most common reason for RBCs in the Urine |
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Definition
| Glomerular membrane damage, vascular injury in Genitourinary tract, malignancy and renal calculi. |
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Term
| What does urin look like in the prescence of RBCs |
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Definition
*cloudy and a red to brown color
*prescence may not be detected on chemical strip |
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Term
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Definition
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Term
| What is the typical WBC seen in sediment |
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Definition
*neutrophils
contain granules and multilobed
*hypotonic urine will cause swelling |
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Term
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Definition
| WBCs that have absorbed water, become larger, and the granules undergo bownian movement..pathologically insignificant. |
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Term
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Definition
increased levels of WBC
denotes an ifection in the genitourinary tract |
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Term
| Thre kinds of epithelial cells found in sediment |
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Definition
Transitional epithelial cells
Renal tuular cells
squamous epithelial cells |
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Term
| Squalmous Epithelial cells |
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Definition
*largest found
*nucleus is size or RBC
*may fold making ID hard but resembles casts
*degenerate very quickly
*normal sloughing
*clue cells are pathological in large numbers..they are sq cells covered in bacteria |
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Term
| Transitional Epithelial Cells |
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Definition
*AKA urothelial cells
*smaller than sq cells, come in numerous sizes
*difficult to distinguish from RTE cells
*Originate from lining of renal pelvis,calyces, ureters,bladder and upper portion of male urethra
*abnormal morphology may represent a viral infection or malignant |
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Term
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Definition
*vary in size and shape based on origin
special stains are used to determine
*large and rectangular- PCT
*cuboidal and columnar-collecting duct
*increase amounts may indicate necrosis of the renal tubules
*RTE reabsorb the glomerular filtrate |
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Term
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Definition
*RTE celess that have absorbed lipis from the glomerulus filtrate
*Id by addition of oil R O or Sudan III stain-orang-red and polarized light
*Fat in the urin is associated with glomerulat damage from nephrotic syndrome, but also diabetes mellitus and trauma
*May also form histiocytes also seen in lipid storage disease |
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Term
| Describe the process of cast formation |
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Definition
1. aggregation of Tamm-Horshass protein into individual protein fibrils
2. interweaving of the fibrils forms loose fibril network-this is when other constituents can get trapped
3. more protein network interweaving forming a solid structure
4. attachment of urinary stuff to solid matrix
5. detachment of fibrils from the RTE
6. Excretion |
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Term
| Discuss Significance of Hyaline casts |
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Definition
*normal value 0-2 lpf
*increases levels are due to stenuous exercise, dehydration,stress
*Pathological reals would be acute glomerlularnephritis, pyelonephritits, CGheart faliure and chronic renal disease
*They are hard to see because the refractive index is similar to urine
*Use of Sternheimer-malbin stain or phase microscopy
*have parallel sides and rounded edges
and can appear as cylindrical forms, wrinkled forms or convoluted forms
*may have components inside |
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Term
| Discuss significance of RBC casts |
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Definition
*indicate nephron bleeding and damages done to glomerlus this is due to passage of RBCs through the membrane
*associated with proteinuria and dysmorphic RBC
*ornage-red in color
*differentiate between cast and clumo of RBC
*orange-red,red-brown color may indicate hemoglobinuria
*Hg broken dwn to Mg-brownish color and is associated w/acute tubular necrosis
*increase hg is toxic to kidneys |
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Term
| Discuss the signicifance of bacterial casts |
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Definition
pyelonephritis can be indicated in bacterial casts that have bacilli both within and bound to the matrix
*can be difficult to id because they can resemble granular casts
*should be considered when WBC casts and WBCs and bacteria are seen in sediment
*confirmation is made by performing a grm stain |
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Term
| Discuss the significance of epithelial casts |
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Definition
| *represents the presence of advance tubular destruction, producing stasis along w/distruption of tubular lining |
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Term
| Discuss the significance of granular casts |
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Definition
*origin of granules may be from lysosomes excreted by RTE
*In disease states the granules may represent the disintegration of cellular casts and tubule cells or protein aggregates of glomerular filtrate
*may be mistaken for columnar RTE cells |
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Term
| Describe and discuss clinical significance for Waxy Casts |
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Definition
They are present during EXTREME urinary stasis indicating chronic renal failure
*highly brittle and refractivedue to the breakdown of hyaline cast matrix along with any other cell debri and granules in the matrix
*often appear fragmented w/jagged ends and have notches in their side |
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Term
| Discribe and discuus the significance of fatty casts |
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Definition
seen in conjunction w/oval fat bodies and free fat droplets
*Most associated w/nephrotice syndrome and toxic tubular necrosis, diabetes mellitus and crush injuries
*highly refractile
*Use Sedan III or Oil Red O fat stains |
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Term
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Definition
AKA; Renal Faliure casts
represent extreme urine stasis
*shaped like DCT and their presence indicates widening of the tubular walls
*bile stainel broad waxy casts are seen in tubular necrosis caused by viral Hep C |
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Term
| Name and Identify normal crystal found in acidic urine |
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Definition
Uric acid crystals
Amorphous urates
Calcium oxalate-both alkaline/acidic |
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Term
| Name and Identify normal crystal found in alkaline urine |
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Definition
Amporphus phosphates
Calcium Phosphate
Triple Phosphate
Ammonium biruate
Calcium carbonate |
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Term
| Clinical significance of cystine crystals |
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Definition
**found in urine of persons with an inherited metabolic disoreder
**tendency to form calculi
*appear as colorless, hexagonal plates
**confirmation done by using cyanide-nitroprusside test |
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Term
| Clinical significance of cholesterol crystal |
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Definition
*rarely seen unless specimens have been refrigerated-lipids remail in droplet form
**Appear as rectangular shaped plate with notches in one or more corners
**seen in disorders of lipiduria such as nephrotic syndrome and in conjunction with fatty casts and oval fat bodies |
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Term
| Clinical significance of leucine, tyrosine and bilirubin crystals |
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Definition
rarely seen unless liver disease is present
* Tyrosine- appear as colorless-yellow clumps of rosettes and can be seen w/leucine crystas. They are also associated with aa metabolism
*Leucine-spheres-yellow-to brown w/ radial striations
Bilirubin-clumped needle appearence with characteristic yellow. May be incorporated into casts when renal tubular damage or viral hep is present |
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Term
| Clinical significance for sulfonamide crystals |
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Definition
*dehydration and UTIs
**when found in fresh urine can be a sign of tubular damage
*come in a variety of shapes and colors-needles, rosettes sheaves of wheat and colors from none to yellow-brown
**can preform a diazo reaction to confirm |
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Term
| Clinical significance of Ampicillin Crystals |
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Definition
appears after massive dose of the antibiotic is given with inadequate hydration
**Appear as bundles of needles |
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Term
| differentiate between actual sediment and artifacts |
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Definition
| most common artifacts: starch granules, oil and air droplets, pollen and fibers as well as feces |
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