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69 Cards in this Set
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Aspects of microscopic examination that should be standardized:
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volume of urine analyzed
length and force of centrifugal re-suspending vol and conc of sediment vol and amount of sediment examined terminology and reporting format |
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Materials for microscopic examination:
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- Conical centrifuge tubes, or regular test tubes up to 15 mL.
- Centrifuge - Pipettes - slides and coverslips - microscope |
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Procedure for microscopic examination:
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1. Mix the urine specimen.
2. Transfer about 10-12 mL of urine into a labeled centrifuge tube. 3. centrifuge the specimen at a medium speed (1500-2000rpm) for 3-5 minutes. 4. Discard the supernatant by quick inversion of the tube. 5. Re-suspend the sediment that is at the bottom of the tube, by tapping the tube with your fingers. 6. Take the sediment by Pasteur/disposable pipette from the tube and transfer a drop into the clean and dry slide. |
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Sources of error in microscopic examination:
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Drying of the specimen on the slide.
If the supernatant fluid after centrifugation is not poured off properly, it may decrease conc of urine sediments and false result may be reported. If the whole sediment with supernatant is discarded during inverting down the tube for a long period, the whole sediments will be discarded and so again false neg result will be reported. Thus another sample should be collected and the test repeated. |
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Delineates structure and contrasting colors of the nucleus and cytoplasm.
ID's WBCs, epithelial cells and casts. |
Sternheimer-Malbin stain
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Enhances nuclear detail.
Diffs WBCs and renal tubular epithelial cells. |
Toiuidine blue stain
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Lyses RBCs and enhances nuclei of WBCs.
Distinguishes RBCs from WBCs, yeast, oil droplets and crystals. |
2% acetic acid
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Stains triglycerides and neutral fats orange-red.
IDs free fat droplets and lipid-containing cells and casts. |
Lipid stains: Oil Red O and Sudan III
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Methylene blue and eosin Y stains eosinophilic granules.
IDs urinary eosinophils |
Hansel stain
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Stains structures containing iron.
IDs yellow-brown granules of hemosiderin in cells and casts. |
Prussian blue stain
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frequently used, low light via rheostat control not lowering condenser
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bright field
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advantageous for low refractive casts, mucous threads and Trichomonas
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Phase contrast
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crystals and lipids: confirm fat droplets, oval fat bodies and fatty casts
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polarizing
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3D image- fine structures
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interfering contrast
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spirochete Treponema pallidum
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Dark-field
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Organized (formed) elements
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RBCs (HPF)
WBCs (HPF) Bacteria (HPF) Epithelial cells (LPF) Casts (LPF) Parasites (LPF) Yeast cells (LPF) Mucus tread (LPF) Spermatozoa Miscellaneous substances |
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Slightly acidic urine
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calcium carbonate
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acidic, neutral, or slightly alkaline urine crystal
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calcium oxalate crystals
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alkaline, neutral or slightly acidic urine
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triple phosphates
alkaline urine crystals amorphous phosphate calcium carbonate calcium phosphate |
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In concentrated urine RBCs may be:
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crenated
small/shrink cells lose water |
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In diluted urine RBCs may be:
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turgid and increased in size
absorb water swell |
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in alkaline urine RBCs may be:
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small or entirely destroyed forming massive of brownish granules
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In diluted and alkaline urine RBCS will:
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rupture and release the hemoglobin, leaving faint colorless membrane (ghost cells)
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High numbers of RBCs indicate:
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renal disease
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Factors that may result in falsely high RBCs
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menstrual bleeding
vaginal bleeding trauma to peranal area in females following traumatic catheterization aspirin antocoag therapy |
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WBCs in alkaline urine
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may increase their size and become irregular
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High WBCs in urine indicate
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infection or inflammation in urinary or genital tract
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0-5 leukocytes is
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normal
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5-10 leukocytes is
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few
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10-20 leukocytes is
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moderate
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20-30 leukocytes is
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many
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above 30 leukocytes is
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full/field
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presence of RBCs
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acute/chronic glomerulonephritis
tumor in urinary tract renal stone cystitis prostates trauma of the kidney traumatic catherterization |
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increased WBCs in urine may indicate:
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UTI (renal tuberculosis)
all renal diseases bladder tumor cystitis prostates fever exercise |
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very large
abundant irregular cytoplasm rectangular with irregular border single nucleus clue cells |
squamous epithelial cells
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granular with sort of tail.
seen with no leukocyte and mucus trade few in number catheterization |
cells from renal pelvis
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oval in shape
seen with leukocytes and filaments catheterization |
cells from urethra
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smaller than epis
larger than leukocytes very granular refractive and clear nucleus with proteins or casts increase=necrosis of renal tubules |
renal epithelial cells
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RTE absorbe lipids present in filtrate
make RTE highly refractile with free floating fat droplets ID with Sudan III or Oil Red O Polarizing light: maltese cross |
oval fat bodies
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Presence of epithelial cells in large number indicates:
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actue tubular damage
acute glomerulonephritis silicate overdose UTI (with large number of leukocytes) |
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Immunologic disorder affecting other major organs
Kidneys filter immune components- deposit on glomerular membranes Results in damage to basement membranes and capillaries |
Glomerular disorder
(immunologic origin) |
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exposure to chemicals
electrical membrane changes, chronic inflammation, basement membrane damage |
glomerular disorder
(non immunologic origin) |
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Affecting glomerulus:
sterile inflammatory RBCs, protein and casts |
glomerulonephritis
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sudden onset
following strep A infection affect glomerular function Fever, edema, oliguria, and hematuria RBC casts and dysmorphic RBCS |
acute post-steptococcal glomerulonephritis (AGN)
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Immune systemic disorder
system lupus erythematosus (SLE) Permanent damage to capillaries proliferation in bowman's capsule marked proteinuria |
Rapidly progressive glomerulonephritis (Crescentic)
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cytotoxic autoantibody against glomerular and alveolar basement membranes
hematuria, proteinuria, and RBC casts |
Goodpasture syndrome
(glomerulonephritis) |
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immune response to antineutrophilic cytoplasmic antibody (ANCA) that binds to neutrophils
granulomas-infection pulmonary- then renal elevated BUN/creatinine |
wegener's granulomatosis
(glomerulonephritis) |
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children- caused by immune response following viral infection
RBC casts renal complications vascularture red rash |
henoch-sshonelein purpura
(glomerulonephritis) |
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AKA Berger disease
IgA complexes don't deposit on the glomerular membrane most common increased levels of IgA microhematuria >20 years with lack of symptom |
IgA nephropathy
(chronic glomerulonephritis) |
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massive proteinuria
high levels of serum lipids hypoproteinemia edema increased passage of proteins increased prod of lipids sodium retention 4+ protein oval fat bodies |
nephrotic syndrome
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podocytes of glomerular dysfunction
allow protein to filter children- edema, hematuria corrected with corticosteroids |
minimal change disease (lipid nephrosis)
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only affects a PORTION of glomeruli
associated with heroine, analgesic use, and AIDS |
focal segmented glomerulosclerosis
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inherited disorders
males during respiratory infections hematuria abnormality in hearing and vision thinning areas of glomeruli URI |
alport syndrome
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AKA kemmelstiel-wilson disease
most common cause of end stage renal disease membrane thickening proliferation of mesangial cells deposit of cells in glycosylated proteins diet and exercise management waxy broad casts and glucosuria |
diabetic nephropathy
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do casts increase or decrease flow?
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increase
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primary disorder dealing with damage to renal tubules
ischemia toxic damage due to tubules via ultrafiltrate (antibiotics) lack of blood flow (necrosis of tubules) presence of RTE |
acute tubular necrosis (ATN)
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failure to inherit gene for tubular reabsorption
systemic condition affecting tubular reabsorption |
hereditary and metabolic tubular disorders
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PCT reabsorption failure
changes in cellular energy required for transport associated with cystinosis, toxic build up, or autoimmune (multiple myeloma) |
faconi syndrome
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sex linked recessive gene or acquired thru medication (lithium and amphotericin B)
sickle cell anemia and polycystic disease ADH disruption low SpG, pale yellow color, polyuria |
nephogenic diabetes insipidus
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autosomal recessive
reabsorption of glucose is decreased increased urine glucose conc. normal glucose in serum |
renal glycosuria or glucosuria
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affects renal intersitial tissues and renal tubules
infections and inflammation UTI's WBCs and bacteria |
tubulointersitial disease
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Upper UTI has ___ casts and lower UTI has ____ casts.
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WBC
no WBC |
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untreated lower UTI leads to upper tract infection
antibiotic treatment and management of underlying conditions can resolve |
acute pyelonephritis
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leads to permanent damage
caused by congenital defects that result in urinary structural defects children WBC casts granular, waxy and broad casts |
chronic pyelonephritis
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pyelonephritis has what kinds of casts?
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WBC
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inflammation of renal tubules and renal intersitium
rapid onset- fever, skin rash allergic reaction- penicillin, methicillin, ampicillin, cephalosporin, sulfonamides increased eosinophils |
actue intersitial nephritis (nephrons)
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sudden loss of renal function
usually reversible decreased GFR, azotemia (BUN/creatinine) presence of RTE, casts, ATN, WBCs |
acute renal failure
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gradual progression
marked decrease GFR azotemia electrolyte imbalance isothenuric urine (kidney cannot dilute or conc urine) abundance of granular, waxy and broad casts |
chronic renal failure
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kidney stones
form in pelvis of the kidney, ureters and bladder vary in size/PAINFUL some may be passed others need lithotripsy pH, stasis, clumps of crystal |
renal lithiasis
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