Urinalysis

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Questions and Answers

Which of the following conditions will cause hyaline casts to be missed if a technician is not careful?

  • Specimen is examined under high-intensity light (correct)
  • Specimen is stained with Sternheimer-Malbin stain.
  • Specimen is examined under reduced light
  • Specimen is examined using phase-contrast microscopy

Which of the following describes dysmorphic red blood cells (RBCs)?

  • RBCs that vary in size, have protrusions, or are fragmented (correct)
  • RBCs that are crenated due to hypersthenuria
  • RBCs that are swollen and hemolyzed
  • RBCs of uniform size and shape

The laboratory is having trouble differentiating between red blood cells (RBCs), yeast, oil droplets and crystals. Which of the following stains can be used to enhance the nuclear detail?

  • Acetic acid (correct)
  • Hansel stain
  • Gram stain
  • Sternheimer-Malbin stain

Which microscopic element is characteristically associated with drug-induced interstitial nephritis?

<p>Eosinophils (C)</p> Signup and view all the answers

What does the presence of glitter cells signify?

<p>Hypotonic urine (D)</p> Signup and view all the answers

Which formed element found in urine is unique to the kidney?

<p>Cast (A)</p> Signup and view all the answers

A broad waxy cast signifies

<p>extreme urine stasis. (A)</p> Signup and view all the answers

What urinary crystal is commonly associated with ethylene glycol (antifreeze) poisoning?

<p>Calcium oxalate monohydrate (D)</p> Signup and view all the answers

In bright-field microscopy, what does adjusting the aperture diaphragm to 75% of the numerical aperture of the objective achieve?

<p>Maximum resolution (C)</p> Signup and view all the answers

When cholesterol crystals are observed in a urine sample, which other components would be expected?

<p>Fatty casts and oval fat bodies (C)</p> Signup and view all the answers

What is the primary function of uromodulin (Tamm-Horsfall protein) in the formation of casts?

<p>Provides a matrix for cast formation (C)</p> Signup and view all the answers

If formed elements are not well visualized under brightfield microscopy, which type of microscopy should be used?

<p>Phase-contrast (B)</p> Signup and view all the answers

What urine sediment component is typically found in increased numbers after invasive urologic procedures (catheterization)?

<p>Transitional epithelial cells (C)</p> Signup and view all the answers

What microscopic finding is critical to the early diagnosis of glomerular disorders and malignancy of the urinary tract?

<p>Hematuria (A)</p> Signup and view all the answers

What test result is most commonly associated with the presence a 3+ Leukocyte Esterase result in a urine sample?

<p>Bacteria (C)</p> Signup and view all the answers

What urine characteristic(s) is/are MOST affected if a lab forgets to refrigerate a urine sample from a patient suspected of having a UTI?

<p>pH and nitrite (B)</p> Signup and view all the answers

What cellular structure does the Hansel stain specifically target in microscopic analysis?

<p>Eosinophils (D)</p> Signup and view all the answers

How does polarized microscopy aid in the identification of crystals and lipids in urine?

<p>Producing characteristic colors or Maltese cross formations (A)</p> Signup and view all the answers

What is the origin of the granules observed in non-pathologic granular casts?

<p>Lysosomes excreted by RTE cells during normal metabolism (A)</p> Signup and view all the answers

Which condition primarily signifies infection or inflammation exclusively within the nephron?

<p>WBC casts (C)</p> Signup and view all the answers

Which urine microscopy technique provides a three-dimensional image that is especially useful for viewing fine structural detail?

<p>Interference-contrast microscopy (A)</p> Signup and view all the answers

Identify the most critical step for accurate microscopic urine sediment examination

<p>Resuspension of the sediment. (B)</p> Signup and view all the answers

What part of a microscope is the most important for proper light settings?

<p>Rheostat (D)</p> Signup and view all the answers

Before reporting the findings from a urine microscopic examination, a technician should correlate the results with:

<p>The physical and chemical findings (C)</p> Signup and view all the answers

What is the purpose of performing a microscopic examination of urine?

<p>Detect and identify insoluble materials (C)</p> Signup and view all the answers

Which type of urine specimen is recommended for cytodiagnostic urine testing?

<p>Voided first morning (B)</p> Signup and view all the answers

What part of the microscope serves as the primary adjustment to regulate the amount of light passing through the specimen?

<p>Condenser (C)</p> Signup and view all the answers

What does the height of the small, unstained specimen observed in bright-field microscopy most depend upon?

<p>Refractive index (D)</p> Signup and view all the answers

What are the two types of adjustments to the condenser that provide optimal viewing?

<p>Centering and Kohler Illumination (D)</p> Signup and view all the answers

Prior to the utilization of a stain, what type of microscope is BEST to observe a wet preparation?

<p>Bright-field Microscopy (C)</p> Signup and view all the answers

Which abnormal constituent would make a urine sample sent to cytology?

<p>Mononuclear cells (C)</p> Signup and view all the answers

What cells absorb lipids?

<p>Oval fat bodies (D)</p> Signup and view all the answers

What action indicates the presence of bilirubin in the urine?

<p>Color (A)</p> Signup and view all the answers

Ammonium biurate crystals under microscope exhibit

<p>Thorny apples (A)</p> Signup and view all the answers

What would be an indicative of tubular injury in the urnine analysis?

<p>RTE Cells (B)</p> Signup and view all the answers

What does an elevated amount of Mucus in a Urine sample indicate?

<p>It has no clinical significance when present in either female or male urine. (C)</p> Signup and view all the answers

A patient shows a red color in their urine. What is a more likely reason?

<p>RBCs (D)</p> Signup and view all the answers

If your are performing a urine analysis and there is a large amount of squamous epithelial cells under the microscope, what does that indicate?

<p>Normal shedding (D)</p> Signup and view all the answers

Flashcards

Microscopic Urine Exam Purpose

Detect and identify insoluble materials in urine.

Formed urine elements

RBCs, WBCs, epithelial cells, casts, bacteria, yeast, parasites, mucus, spermatozoa, crystals, and artifacts.

Urinary Sediment Examination

Examination includes identification and quantitation.

Macroscopic Screening

Specimens meeting specified criteria based on physical and chemical urinalysis results

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Specimen Examination

Fresh or adequately preserved to avoid disintegration of elements.

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Midstream Clean-Catch Specimen

To minimize external contamination.

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Standard Urine Amount

10-15 mL in conical tube.

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Optimum Centrifugation

5 minutes at 400 RCF.

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Sediment Concentration Factor

It calculates the probability of detecting elements.

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Commercial Slide Systems

KOVA, Urisystem, Count-10, Quick-Prep,CenSlide 2000, and R/S Workstations.

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Microscopic Examination

Minimum of 10 fields under low (10x) and high (40x) power

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Low Power (10x) Examination

To detect casts and ascertain general sediment composition.

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Routine Sediment Report

Average number per low-power field (lpf) for casts; average number per high-power field (hpf) for RBCs and WBCs; semiquantitative terms for epithelial cells, crystals, etc.

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Addis Count

First procedure to standardize microscopic urine analysis.

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Correlating urine results

To ensure accuracy, and recheck if discrepancies exist.

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Common Urine Sediment stains

Gram, Sternheimer-Malbin, Toluidine blue and 2% acetic acid

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Sternheimer-Malbin Stain

Crystal violet and safranin O, identifies WBCs, RBCs, epithelial cells and casts.

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Toluidine blue

Enhances visibility of nuclear detail & differentiates cells

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2% Acetic Acid Stain

Lysing RBC's enhances WBC and cellular detail.

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Lipid (Oil Red O and Suden III) stain function

stains triglycerides but will not stain cholesterol

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Gram Stain

Differentiates gram-positive and gram-negative bacteria

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Hansel stain function

identifies urinary eosinophils

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Types of Urinalysis Microscopy

Brightfield, phase-contrast, polarizing, dark-field, fluorescence, and interference-contrast

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Bright-field Microscopy

Objects appear dark against a light background.

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Decreasing Light Intensity

By adjusting the rheostat, not lowering the condenser

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Phase-Contrast Microscopy Adaptation

Objective lens & matching condenser w/ phase rings.

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Phase Microscopy Use

detect casts that are hard to see and increase cell detail.

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Polarizing Microscopy

Rotating light to see crystals and lipids.

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Birefringent

Ability to refract light in two dimensions at 90 degrees to each other

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Crossed Configuration

Polarizing filters set at 90-degree angles to each other.

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Interference-Contrast Microscopy

Produces a 3D image by differing light.

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Dark-Field microscopy

Used for Treponema pallidum(Spirochete) requires dark field condenser.

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Fluorescence Microscopy

Wavelength specific light identifies stained organisms

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Urine Element Visibility

Refractive index and sediment concentration.

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Normal Red Blood Cell (RBC) Appearance

Smooth, non-nucleated biconcave disks.

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RBC measurable characteristic

7um in diameter

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RBCs in Hypersthenuric Urine

Shrink and are irregular.

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RBCs in Hyposthenuric Urine

Swell and lyse, leaving ghost cells

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Entities Confused with RBCs

Yeast cells, oil droplets, and air bubbles.

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Dysmorphic Red Blood Cells (RBCs)

Are associated primarily with glomerular bleeding.

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