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Urinalysis Unit 3 Chapter 6

STUDY
PLAY
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