Aubf Lab_Lesson 3 Microscopic Analysis Of Urine

Front 1

Described as the 3rd part of routine urinalysis and is performed to identify insoluble substances from the blood, kidney, lower urogenital tract, and external contaminants

Back 1

Microscopic Examination of Urine

Front 2

Microscopic correlation of color

Back 2

blood

Front 3

microscopic correlation of clarity

Back 3

hematuria vs hemogloburia/myoglobinuria

confirms pathologic and non-pathologic cause of turbidity

Front 4

microscopic correlation of blood

Back 4

rbc, rbc cast

Front 5

microscopic correlation of protein

Back 5

casts, cells

Front 6

microscopic correlation of nitrite

Back 6

bacteria, wbc

Front 7

microscopic correlation of leukocyte esterase

Back 7

wbc, wbc cast, bacteria

Front 8

microscopic correlation of glucose

Back 8

yeast

Front 9

SPECIAL POPULATIONS TO BE CONSIDERED DURING MACROSCOPIC SCREENING

Back 9

Pregnant women

Pediatric

Geriatric

Diabetic

Immunocompromised

Renal patients

Front 10

specimen preparation

must be _________. Because Formed elements (RBCs, WBCs, hyaline casts) – __________

Back 10

fresh or adequately preserved - disintigrate rapidly

Front 11

specimen preparation

cause precipitation of amorphous urates and phosphates and other normal crystals that can obscure other elements in the urine sediment.

Back 11

refrigeration

Front 12

specimen preparation

WARMING ___ the specimen prior to centrifuging may dissolve some of these crystals

Back 12

37°C

Front 13

function

Identifies WBCs, epithelial cells, and casts

Back 13

sternheimer-malbin

Front 14

action

Enhances nuclear detail

Back 14

toluidine blue

Front 15

function

Differentiates WBCs and renal tubular epithelial (RTE) cells

Back 15

toluidine blue

Front 16

action

Methylene blue and eosin Y stains eosinophilic granules

Back 16

hansel stain

Front 17

function

Identifies urinary eosinophils

Back 17

hansel stain

Front 18

action

Differentiates gram- positive and gram-negative bacteria

Back 18

gram stain

Front 19

function

Identifies bacterial casts

Back 19

gram stain

Front 20

action

Lyses RBCs and enhances nuclei of WBCs

Back 20

2% acetic acid

Front 21

function

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

Back 21

2% acetic acid

Front 22

action

Stain triglycerides and neutral fats orange-red; Do not stain cholesterol

Back 22

lipid stains: oil red o and sudan iii

Front 23

specimen preparation

minimizes external contamination of the sediment and dilute random specimens may cause false-negative readings.

Back 23

midstream clean-catch specimen

Front 24

function

Identify free fat droplets and lipid- containing cells and casts

Back 24

lipid stains: oil red o and sudan iii

Front 25

action

Stains structures containing iron

Back 25

prussian blue

Front 26

function

Identifies yellow-brown granules and hemosiderin in cells and casts

Back 26

prussian blue

Front 27

microscopic technique

Used for routine urinalysis

Back 27

bright-field microscopy

Front 28

microscopic technique

Enhances visualization of elements with low refractive indices

Back 28

phase-contrast microscopy

Front 29

microscopic technique

Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals

Back 29

polarizing microscopy

Front 30

microscopic technique

Aids in identification of T. pallidumm

Back 30

dark-field microscopy

Front 31

microscopic technique

Allows visualization of naturally fluorescent microorganisms

Back 31

fluorescene microscopy

Front 32

microscopic technique

Produces a three-dimensional microscopy image and layer-by-layer image of a specimen

Back 32

interference contrast

Front 33

rbc in normal urine

Back 33

0-2 / hpf

Front 34

spx volume

Back 34

10-15mL (frequently, 12mL)

Front 35

wbc in normal urine

Back 35

0-5 / hpf

Front 36

hyaline cast in normal urine

Back 36

0-2 / lpf

Front 37

epithelial cells in normal urine

Back 37

several / hpf

Front 38

Smooth, non-nucleated, biconcave disks (7mm)

Back 38

rbc

Front 39

crenated rbc

Back 39

hypertonic urine

Front 40

ghost cells

Back 40

hypotonic urine

Front 41

RBCs are frequently confused with _______

Back 41

yeast cells, oil droplets, and air bubbles.

Front 42

Larger than RBCs (12mm)

Back 42

wbc

Front 43

predominant WBC found in the urine sediment

contain granules and multilobed nuclei

Back 43

neutrophils

Front 44

Centrifugation for ______ at a relative centrifugal force (RCF) of ____ produces an optimum amount of sediment with the least chance of damaging the elements.

Back 44

5 mins - 400

Front 45

neutrophils which are exposed to hypotonic urine

Back 45

glitter cells

Front 46

WBC

When stained with ________, these large cells stain light blue as opposed to the violet color usually seen with neutrophils

Back 46

Sternheimer-Malbin stain

Front 47

true or false

Glitter cells are of no pathologic significance

Back 47

true

Front 48

an increase in urinary WBCs. Indicates the presence of an infection or inflammation in the genitourinary system.

Back 48

pyuria

Front 49

frequent causes of pyuria

Back 49

pyelonephritis

prostatitis

cystitis

urethritis

Front 50

wbc

primarily associated with drug-induced interstitial nephritis

small numbers may be seen with UTI and renal transplant rejection.

Back 50

eosinophils

Front 51

The preferred eosinophil stain is _____. (_______ stain can also be used.)

Back 51

Hansel stain - Wright's

Front 52

Finding of more than ___ eosinophils is considered significant

Back 52

1%

Front 53

wbc

May be seen in increased numbers in the early stages of renal transplant rejection.

Back 53

mononuclear cells

Front 54

correlation of rbc

Back 54

color

reagent strip blood reaction

Front 55

A uniform amount of urine and sediment should remain in the tube after decantation.

Back 55

0.5 to 1.0 ml

Front 56

correlation of wbc

Back 56

leukocyte esterase; nitrite

specific gravity; pH

Front 57

derived from the linings of the genitourinary system.

Back 57

epithelial cells

Front 58

Three types of epithelial cells are seen in urine

Back 58

squamous

transitional (urothelial)

renal tubular

Front 59

epithelial cells

Contain an abundant, irregular cytoplasm and a prominent nucleus.

Originate from the linings of the vagina and female urethra and the lower portion of the male urethra.

Back 59

squamous epithelial cells

Front 60

Variation of squamous epithelial cells

Indicative of vaginal infection by the bacterium Gardnerella vaginalis

Back 60

clue cells

Front 61

Smaller than squamous cells and have a distinct, centrally located nuclei

Originate from the lining of the renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male urethra

Back 61

transitional epithelial cells

Front 62

three forms of transitional epithelial cells

Back 62

spherical

polyhedral

caudate

Front 63

clumps of TEC. Present following invasiveurologic procedures such as catheterization and are of no clinical significance

Back 63

syncytia

Front 64

most significant epithelial cell in the urine. It has a small eccentric nucleus.

Back 64

RTE CELLS

Front 65

When using the conventional glass-slide method, the recommended volume is ________ covered by a 22 × 22 mm glass cover slip.

Back 65

20 mL (0.02 L)

Front 66

smaller; round or oval

Mistaken for WBCs and spherical transitional epithelial cells

Back 66

DCT - RTE cells

Front 67

Tubular injury is suggested when ____ are present

Back 67

> 5/hpf

Front 68

RTE cells that contain large, non-lipid-filled vacuoles.

These cells can be seen in renal tubular necrosis.

Presence is associated with dilation of endoplasmic reticulum before the death of injured cells.

Back 68

bubble cells

Front 69

renal tubular epithelial cells that have absorbed lipids that are highly retractile and stain with Sudan III or oil red O.

may indicate nephrotic syndrome.

Back 69

oval fat bodies

Front 70

not normally present in urine.

may be present in the form of cocci (spherical) or bacilli (rods).

Back 70

bacteria

Front 71

bacteria

To be considered significant for UTI, bacteria should be accompanied by _____.

Back 71

WBCs

Front 72

bacteria

Can be indicative of either _______.

Back 72

lower or upper UTI

Front 73

Specimens containing increased bacteria and leukocytes are routinely followed up with a specimen for ________.

Back 73

quantitative urine culture

Front 74

appear in the urine as small, refractile oval structures that may or may not contain a bud.

Back 74

yeast

Front 75

manner of reporting casts

Back 75

average number per low-power field (lpf) following examination of 10 fields.

Front 76

yeast

seen in diabetic patients, immunocompromised patients, and women with vaginal moniliasis.

Back 76

Candida albicans

Front 77

A true yeast infection should be accompanied by the presence of .

Back 77

WBCs

Front 78

most frequent parasite encountered in the urine

is a sexually transmitted pathogen associated primarily with vaginal inflammation.

Back 78

Trichomonas vaginalis

Front 79

T. vaginalis

Infection of the male urethra and prostate is _______. Males are often _________ carriers

Back 79

asymptomatic

Front 80

T. vaginalis

trophozoite is a _______ with an undulating membrane.

Back 80

pear-shaped flagellate

Front 81

T. vaginalis

motility

Back 81

rapid darting movement

Front 82

bladder parasite; associated with bladder cancer in other countries.

Back 82

Schistosoma haematobium

Front 83

pinworm ; most common contaminant

Back 83

Enterobius vermicularis

Front 84

easily identified in the urine sediment by their oval, slightly tapered heads and long, flagella-like tails.

Back 84

spermatozoa

Front 85

manner of reporting wbc and rbc

Back 85

average number per 10 high-power fields (hpf)

Front 86

manner of reporting epithelial cells, crystals and other elements

Back 86

rare, few, moderate, and many or 1+, 2+, 3+, and 4+ following laboratory format as to lpf or hpf use.

Front 87

action

Delineates structure and contrasting colors of the nucleus and cytoplasm

Back 87

sternheimer-malbin

Front 88

specimen preparation

WARMING ___ the specimen prior to centrifuging may dissolve some of these crystals

Back 88

37°C

Front 89

function

Identifies WBCs, epithelial cells, and casts

Back 89

sternheimer-malbin

Front 90

action

Enhances nuclear detail

Back 90

toluidine blue

Front 91

function

Differentiates WBCs and renal tubular epithelial (RTE) cells

Back 91

toluidine blue

Front 92

action

Methylene blue and eosin Y stains eosinophilic granules

Back 92

hansel stain

Front 93

function

Identifies urinary eosinophils

Back 93

hansel stain

Front 94

action

Differentiates gram- positive and gram-negative bacteria

Back 94

gram stain

Front 95

function

Identifies bacterial casts

Back 95

gram stain

Front 96

action

Lyses RBCs and enhances nuclei of WBCs

Back 96

2% acetic acid

Front 97

function

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

Back 97

2% acetic acid

Front 98

action

Stain triglycerides and neutral fats orange-red; Do not stain cholesterol

Back 98

lipid stains: oil red o and sudan iii

Front 99

specimen preparation

minimizes external contamination of the sediment and dilute random specimens may cause false-negative readings.

Back 99

midstream clean-catch specimen

Front 100

function

Identify free fat droplets and lipid- containing cells and casts

Back 100

lipid stains: oil red o and sudan iii

Front 101

action

Stains structures containing iron

Back 101

prussian blue

Front 102

function

Identifies yellow-brown granules and hemosiderin in cells and casts

Back 102

prussian blue

Front 103

microscopic technique

Used for routine urinalysis

Back 103

bright-field microscopy

Front 104

microscopic technique

Enhances visualization of elements with low refractive indices

Back 104

phase-contrast microscopy

Front 105

microscopic technique

Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals

Back 105

polarizing microscopy

Front 106

microscopic technique

Aids in identification of T. pallidumm

Back 106

dark-field microscopy

Front 107

microscopic technique

Allows visualization of naturally fluorescent microorganisms

Back 107

fluorescene microscopy

Front 108

microscopic technique

Produces a three-dimensional microscopy image and layer-by-layer image of a specimen

Back 108

interference contrast

Front 109

rbc in normal urine

Back 109

0-2 / hpf

Front 110

spx volume

Back 110

10-15mL (frequently, 12mL)

Front 111

wbc in normal urine

Back 111

0-5 / hpf

Front 112

hyaline cast in normal urine

Back 112

0-2 / lpf

Front 113

epithelial cells in normal urine

Back 113

several / hpf

Front 114

Smooth, non-nucleated, biconcave disks (7mm)

Back 114

rbc

Front 115

crenated rbc

Back 115

hypertonic urine

Front 116

ghost cells

Back 116

hypotonic urine

Front 117

associated with glomerular bleeding

Back 117

dysmorphic rbc

Front 118

RBCs are frequently confused with _______

Back 118

yeast cells, oil droplets, and air bubbles.

Front 119

Larger than RBCs (12mm)

Back 119

wbc

Front 120

predominant WBC found in the urine sediment

contain granules and multilobed nuclei

Back 120

neutrophils

Front 121

Centrifugation for ______ at a relative centrifugal force (RCF) of ____ produces an optimum amount of sediment with the least chance of damaging the elements.

Back 121

5 mins - 400

Front 122

neutrophils which are exposed to hypotonic urine

Back 122

glitter cells

Front 123

WBC

When stained with ________, these large cells stain light blue as opposed to the violet color usually seen with neutrophils

Back 123

Sternheimer-Malbin stain

Front 124

true or false

Glitter cells are of no pathologic significance

Back 124

true

Front 125

an increase in urinary WBCs. Indicates the presence of an infection or inflammation in the genitourinary system.

Back 125

pyuria

Front 126

frequent causes of pyuria

Back 126

pyelonephritis

prostatitis

cystitis

urethritis

Front 127

wbc

primarily associated with drug-induced interstitial nephritis

small numbers may be seen with UTI and renal transplant rejection.

Back 127

eosinophils

Front 128

The preferred eosinophil stain is _____. (_______ stain can also be used.)

Back 128

Hansel stain - Wright's

Front 129

Finding of more than ___ eosinophils is considered significant

Back 129

1%

Front 130

wbc

May be seen in increased numbers in the early stages of renal transplant rejection.

Back 130

mononuclear cells

Front 131

correlation of rbc

Back 131

color

reagent strip blood reaction

Front 132

A uniform amount of urine and sediment should remain in the tube after decantation.

Back 132

0.5 to 1.0 ml

Front 133

correlation of wbc

Back 133

leukocyte esterase; nitrite

specific gravity; pH

Front 134

derived from the linings of the genitourinary system.

Back 134

epithelial cells

Front 135

Three types of epithelial cells are seen in urine

Back 135

squamous

transitional (urothelial)

renal tubular

Front 136

epithelial cells

Contain an abundant, irregular cytoplasm and a prominent nucleus.

Originate from the linings of the vagina and female urethra and the lower portion of the male urethra.

Back 136

squamous epithelial cells

Front 137

Variation of squamous epithelial cells

Indicative of vaginal infection by the bacterium Gardnerella vaginalis

Back 137

clue cells

Front 138

Smaller than squamous cells and have a distinct, centrally located nuclei

Originate from the lining of the renal pelvis, calyces, ureters, and bladder, and from the upper portion of the male urethra

Back 138

transitional epithelial cells

Front 139

three forms of transitional epithelial cells

Back 139

spherical

polyhedral

caudate

Front 140

clumps of TEC. Present following invasiveurologic procedures such as catheterization and are of no clinical significance

Back 140

syncytia

Front 141

most significant epithelial cell in the urine. It has a small eccentric nucleus.

Back 141

RTE CELLS

Front 142

larger; rectangular shape and are referred to as columnar / convoluted cells

Mistaken for granular or fatty cast

Back 142

PCT - RTE cells

Front 143

When using the conventional glass-slide method, the recommended volume is ________ covered by a 22 × 22 mm glass cover slip.

Back 143

20 mL (0.02 L)

Front 144

smaller; round or oval

Mistaken for WBCs and spherical transitional epithelial cells

Back 144

DCT - RTE cells

Front 145

cuboidal and are never round; called renal fragments if seen in groups of three or more

Back 145

collecting duct - rte cells

Front 146

Tubular injury is suggested when ____ are present

Back 146

> 5/hpf

Front 147

RTE cells that contain large, non-lipid-filled vacuoles.

These cells can be seen in renal tubular necrosis.

Presence is associated with dilation of endoplasmic reticulum before the death of injured cells.

Back 147

bubble cells

Front 148

renal tubular epithelial cells that have absorbed lipids that are highly retractile and stain with Sudan III or oil red O.

may indicate nephrotic syndrome.

Back 148

oval fat bodies

Front 149

not normally present in urine.

may be present in the form of cocci (spherical) or bacilli (rods).

Back 149

bacteria

Front 150

bacteria

To be considered significant for UTI, bacteria should be accompanied by _____.

Back 150

WBCs

Front 151

bacteria

Can be indicative of either _______.

Back 151

lower or upper UTI

Front 152

Specimens containing increased bacteria and leukocytes are routinely followed up with a specimen for ________.

Back 152

quantitative urine culture

Front 153

appear in the urine as small, refractile oval structures that may or may not contain a bud.

Back 153

yeast

Front 154

manner of reporting casts

Back 154

average number per low-power field (lpf) following examination of 10 fields.

Front 155

yeast

seen in diabetic patients, immunocompromised patients, and women with vaginal moniliasis.

Back 155

Candida albicans

Front 156

A true yeast infection should be accompanied by the presence of .

Back 156

WBCs

Front 157

most frequent parasite encountered in the urine

is a sexually transmitted pathogen associated primarily with vaginal inflammation.

Back 157

Trichomonas vaginalis

Front 158

T. vaginalis

Infection of the male urethra and prostate is _______. Males are often _________ carriers

Back 158

asymptomatic

Front 159

T. vaginalis

trophozoite is a _______ with an undulating membrane.

Back 159

pear-shaped flagellate

Front 160

T. vaginalis

motility

Back 160

rapid darting movement

Front 161

bladder parasite; associated with bladder cancer in other countries.

Back 161

Schistosoma haematobium

Front 162

pinworm ; most common contaminant

Back 162

Enterobius vermicularis

Front 163

easily identified in the urine sediment by their oval, slightly tapered heads and long, flagella-like tails.

occasionally found in the urine of both men and women following sexual intercourse, masturbation, or nocturnal emission.

Back 163

spermatozoa

Front 164

Urine is toxic to _________; therefore, they rarely exhibit the motility observed when examining a semen specimen.

Back 164

spermatozoa

Front 165

manner of reporting wbc and rbc

Back 165

average number per 10 high-power fields (hpf)

Front 166

Protein substance produced by the RTE cells and the urogenital glands; not considered clinically significant

Back 166

mucus

Front 167

major constituent of mucus. Glycoprotein excreted by the RTE cells of the distal convoluted tubules and upper collecting ducts.

Back 167

uromodulin

Front 168

Of all the formed elements in the urine, only _____ are unique to the kidney.

Back 168

casts

Front 169

term for casts in the urine.

Back 169

cylinduria

Front 170

Casts are formed within the _______, taking on a shape similar to the tubular lumen.

Back 170

lumen of the distal convoluted tubule and collecting duct

Front 171

Uromodulin is made by the _______ that line the DCT and upper CD

Back 171

renal tubular epithelial cells

Front 172

formed by the precipitation of urine salts, organic compounds, and medications.

Back 172

crystals

Front 173

important in determining the type of crystal formation.

Back 173

urine pH

Front 174

manner of reporting epithelial cells, crystals and other elements

Back 174

rare, few, moderate, and many or 1+, 2+, 3+, and 4+ following laboratory format as to lpf or hpf use.

Front 175

action

Delineates structure and contrasting colors of the nucleus and cytoplasm

Back 175

sternheimer-malbin