Urinalysis Unit 3 Chapter 6

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State when to perform a urine microscopic exam

Blood for RBCs and RBC casts
Protein for Casts/cells
Nitrite for bacteria
Leukocyte Esterase forWBCs and WBC casts
Glucose for Yeast
Turbidity to confirm cause

Describe the recommended methods for standardizing specimens?

KOVA (our system)
Count -10
Quick-Read 10
R/S 2000

What is the recommended volume of urine needed?

10-15 mL, 12 mL preferred

Fresh urine is the best. What temperature is the desired?

37 C

How long should you centrifuge a urine specimen?

5 mins at 400 RCF
RCF = 1,118 x 10^-5 x radius in cm x RPM^2
produces optimum amt of sediment w/o damaging formed elements
DO NOT USE BRAKE ON CENTRIFUGE (disturbs sediment)
use capped tubes to prevent aerosols

What is the microscope procedure for viewing urine?

observe 10 HPF under 10x and 40x
light reduced b/c of refractive index of elements similar to urine
low power (10x) detects casts
high power (40x) identify count or grade of formed elements

How do you report out test results for urine?

casts reported as avg #/10 LPF
RBCs, WBCs, epithelial, renal cells reported as avg #/10 HPF
bacteria, mucous, and crystals reported as tr, 1+ to 4+

How is the sediment preparation done?

leave .5 ml to 1.0 ml of urine
Kova pipette holds back 1.0 ml of urine
mix sediment with Kova pipette

List the elements found in the urine

RBC, WBC, Glitter cells, renal tubular epithelial cells, tranisitional epiithelial cells, squamous epithelial cells, hylaine, course granular, finely granular, waxy, fat, red cell and white cell casts

What is the basic principle of the brightfield microscope?

Objects appear darker against light background
Most commonly used type of microscope
Sediment must be observed using decreased light by adjusting the rheostat not condenser
Staining of sediment increases visualization of elements

What power do you want to use to view casts?

Low

Briefly describe how to care for a microscope?

Carry microscope with two hands, supporting the base with one hand. Always hold the micropscope in a vertical poisiton. Only clean with lens tissue and commerical lens cleaner. Do not use 10 X and 40 X objectives with oil. Always remove slides with the lower power objective raised. Store with low power objective in position and the stage centered

What is the principle for the Phase Contrast micropscope?

enhances visualization of elements with low refractive indices, such as hyaline cast, mixed cellular cast, mucous threads, and Trichomonas

What is the principle for the polarizing micropscope?

procedure in which the maginified birefringent images appear bright colored against black background.

Define birefringent?

The resolution or splitting of a light wave into two unequally reflected or transmitted waves by an optically anisotropic medium such as calcite or quartz. Also called double refraction.

What are the steps for adjusting a phase contrast micropscope?

Focus the microscope in the bright field with a specimen slide.
Select the low power condenser ring
Select the corresponding ring objectives
Remove ocular, insert adjustment telescope.
Observe the dark and light rings called annuli
With the adjusting screw on the telescope, center the light annulus or condenser over the dark annulus/objective. Replace ocular

Define hypotonic

dilute urine, absorbe water and swells. Can make a sparkling appearance called glitter cells for WBC

Define isotonic

normal urine, same concentration in and out of cell

Define hypertonic

concentrated urine, cells shrink due to loss of water and appear crenated.

Name some normal sediments in urine

RBC, WBC, small cast such as hyaline or granular, muscus, sperm, artifacts, microorganisms

Name some normal crystals?

acid pH, amorphous urates, uric acid, alkaline pH, ammonium biurate, acid neutral pH calcium oxalate, phosphates

Name abnormal crystals seen in urine?

cytesine, cholestrol, leucine, tyrosine, bilirubin, sulfonamides, radiographic dye, and ampicillin

What are the three abormal crystals seen in liver disorders?

tyrosine, leucine, and billirubin

Give examples of artifcates

starch, pollen, oil, air bubbles, fibers, fecal, hair.
http://ahdc.vet.cornell.edu/clinpath/modules/ua-sed/contam.htm

Urine sediment pictures

http://www.enjoypath.com/cp/Chem/Urine-Morphology/Urine-morphology.htm

Compound microscope

http://water.me.vccs.edu/courses/ENV295Micro/lab1.html

Urine sediment chart in the classroom

http://www.marketlabinc.com/product.asp?P_ID=6171

How do Cast form?

http://ahdc.vet.cornell.edu/clinpath/modules/ua-sed/casts.htm

Give examples of contamination

fecal, bacteria, blood

What are the normal values for RBC

0-2 Hpf

What are the normal values for WBC?

0-5 Hpf

What is the normal values for hyaline cast?

0-2 Lpf

Bacteria are reported as:

few, moderate, many

When observing squamous cells, what power do you view on first, and what power do you use to confirm

1) low power
2) confirm high power

What microscope would you want to use to view bacteria?

phase microscope

What turns hyaline cast pink?

SternheimerMablin stain

What can cause hyaline cast to be in the urine?

strenuous exercise, dehydration, heat exposure, emotional stress.

An increase in hyaline cast are seen in the following disorders?

acute glomerulonephritis, pyelonephritis, chronic liver failure, and congestive heart failure

Eosinophils are seen is what health conditions?

UTI, and renal transplant rejections

What are the shapes of bacteria?

cocci/spherical and bacilli/rod

For a UTI to be considered for bacteria what else must be present?

WBC

If seen in large amount this is because there was sloughing of old cells. What kind of cell is this?

epithelial cells

This is the largest cell found in urine sediment

squamous

Will squamous cells disappear in fresh urine

no, only in old urine

How do you report squamous cells?

rare, few, moderate, many Lpf

Would a clean catch or midstream contain less squamous cells

yes

What are Clue cells?

variation in squamous cells, seen in vaginal infections. Which can be an indication of Gardnerella vaginialis.

What are the shapes of Tranistional epithelial cells?

spherical, polyhedral, and caudate

How are transitional epithelial cells reported?

rare, few, moderate, many Lpf

Where do transitional epithelial cells originate from?

lining of the renal pelvis, calyces, urethers, bladder, and portions of the upper urethra

Where are RTE from?

proximal convoluted tubules

Cells of the DCT that appear in groups of three or more indicate?

renal fragments, tubular injuryq

How do you report RTE?

rare, few, moderate, many

How can you tell the difference between a RBC and yeast

yeast have a budding appearance.

What type of disorders would you most likely see yeast in urine

Diabetes, immunocomprimised, and vaginal moniliasis

What do oil droplets look like

air bubbles

Why would you see RBC in the urine?

damage to the glomerular membrane, vascular injury with the GI tract

Why would you see WBC?

infection, renal transplant rejection, bacterial infections, pyelonephritis, cystitis, prostatitis, and non bacterial disorders such as glomerulonephritis, lupus, interstitial nephritis, and tumors

What are oval fat bodies?

RTE absorb lipids that are present in glomerular filtrate. Highly refractile. Seen in conjunction with free floating fat droplets.

What type of microscope would you use for oval fat bodies

polarized

What stains do you use to confirm oval fat bodies

Sudan III and Oil Red O fat stains

What are the droplets of oval fat bodies composed of?

triglycerides, neutral fats, cholestrol

Maltese cross formation contains?

cholestrol

How do you report oval fat bodies?

the average number per Hpf

Describe the process of cast formation

A cast forms, urinary flow within the tubule decreases as the lumen becomes blocked

What is the main protein for cast?

Tamm-Horsfall protein

What are the other proteins of cast?

albumin, immunoglobulins

Red Blood cell cast can show there is bleeding in the ______, and damage to the ________

Nephron
Glomerulus

Red blood cell cast are associated with?

proteinuria, and dysmorphic erythrocytes, strenuous exercise

This is the primary maker to distinguish between upper and lower UTI

pyleonephritis

This cast is seen in advanced tubular destruction

Epithelial cell cast, due to urinary stasis

What can cause Epithelial cast?

heavy metals, drug inducedm chemical toxicity, viral infections, and allografts.

Billirubin stain RTE are seen in ______

hepatitis

The origin of this cast is lysosomes by the RTE cells during normal metabolism

Granular cast

This cast is indicated for chronic renal failure

waxy cast

This cast indicated destruction or widening of the tubules, urinary stasis the most commonly seen

broad cast

What are some acid urines?

urates consistiing of amorphous urates, acid urine, acid urates, and sodium urates, calcium oxaltes

What are the shapes of acid urine sediments?

rhombic, four sided flat plates, wedges and rosettes

High levels of acid urine are seen in patient with

leukemia who are recieving chemotherapy, Lesch-Nyhan Syndrome and gout

Finding clumps of calcium oxalate is an indication of

renal calculi

What are foods that increase the acid in the urine?

tomatoes, asparagus and asorbic acid

Alkaline urates are majority _____

phosphates

What are the phosphates that are seen in alkaine urine?

amorphous phospates, triple phosphates, and calcium phosphate. Then calcium carbonate, ammonium biurate.

This is a coffin shape

triple phosphate

This is shaped like a diamond.

oxalate

List the protozoan that are commonly found in urine

Trichamomas, Enterobius vermicularis, schistosoma, hamatobium

What are the most frequently seen artifact?

starch, pollen, oil droplets, air bubbles, fibers, fecal

Cystine

inherited disorder forming renal calculi, renal tubules

What is the post test done for cystine?

cyanidenitroprusside

This is a rectangle with a notch

Cholestrol crystals

Cholestrol crystals is associated with this disorder?

lipiduria

How can you test to make sure that what you are seeing is radiographic dye?

Specific gravity

This is associated with liver disorders, fine colorless to yellow needles that frequently clump and form rosettes. Usually inherited disorders of amino acid metabolism

Tyrosine

This is yellow brown spheres that demonstrates concentric circles and radial striations

lecuine, liver

Hepatic disorder producing large amounts of bilirubin in the urine

bilirubin crystals

What disorders happen with bilirubin crystals?

tubular damage, viral hepatitis

This type of crystal is seen with massive doseage of antibotics

ampicillian crystals

This type of crystal is seen antibotics that are used to treat UTI's

Sulfonamide crystals

Discuss amorphous crystals

Warm specimen to 37 C, add acedic acid if alkaline pH

You return from your lunch break to find that several urine specimens are waiting in the refrigerator to be tested. One of the specimens have a thick layer of pinkish-colored fluffy sediment in the bottom. What might this sediment be?

precipitated amorphous urate crystals

Cystine Disorders

cystinuria
- cystinosis
- homocystinuria

What may cause protein to appear in the urine?

changes in glomerular blood flow or enhanced glomerular permeability

An ill patient give a urine specimen that is pale and greenish, contains a large amount of sugar, has a high specific gravity, low pH, and has ketone bodies. What is the diagnosis?

uncontrolled diabetes; excess glucose, abnormal color, and increased density indicate increased permeability of the glomerulus (nephropathy

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