AUBF WEEK 7: MICROSCOPIC EXAMINATION OF URINE SEDIMENT PART II

7 um (6-8 um)

Size of RBC

Crenated RBC

A hypertonic urine would affect RBC in what way?

Ghost Cell or Shadow Cell RBC

A hypotonic urine would affect RBC in what way?

Yeast Cells, Air Bubbles, Oil Droplets, WBC

Sources of error for RBCs (4)

Average number of RBC / hpf

Reporting RBC

0-2 / hpf

Normal value for RBC

Acetic Acid

What solution may remove RBC?

Microscopic Hematuria

Supposed a MT finds RBCs in a yellow-colored urine. What phenomenon is this?

RBC

Identify the microscopic particle

Yeast Cell

Identify the microscopic particle

Air Bubble

Identify the microscopic particle

RBC

Identify the microscopic particle

Crenated RBC

Identify the microscopic particle

Air Bubble

Identify the microscopic particle

RBC

Identify the microscopic particle

Crenated RBC

Identify the microscopic particle

Dysmorphic RBC

RBC with a protrusion or fragmentation

Renal or Glomerular Bleeding

Suppose an MT finds a number of dysmorphic RBCs in a px’s urine. What may be the cause of this?

Dysmorphic RBC

Acanthocyte with multiple protrusions

Wright’s Stain

Stain used in checking for dysmorphic RBCs characteristic traits.

Dysmorphic RBC

Identify the microscopic particle

Glomerulonephritis, Vascular Injury, Renal Calculi, Malignancy

Clinical significance of RBC (4)

Bleeding distal to the kidneys

Suppose an MT finds incomplete RBCs with casts in a px’s urine. What does this implicate?

Renal Bleeding

Suppose an MT finds incomplete RBCs with no casts in a px’s urine. What does this implicate?

Glomerular Damage or Vascular Injury

Suppose a px produced a red cloudy urine and an MT performed microanalysis and discovered an RBC amount of 125/hpf. What does this implicate?

Renal Calculi, Malignancy, or Early-stage Glomerular Disorders

Suppose a px produced a clear yellow urine and an MT performed microanalysis and discovered RBCs. What does this implicate?

Strenuous Exercise

Suppose an MT discovers RBC in a px’s urine along with hyaline and granular casts. What may be the cause of this?

Pyuria

Described as an increase numbed of WBCs in the urine.

Glitter Cells

What happens to WBC when urine is diluted and hypotonic?

Glitter Cells

Suppose an MT discovers WBCs with swelled nuclei and cytoplasmic granules exhibiting Brownian movement. What did they find out?

High pH and Hypotonic Urine

What may be the cause of WBC lysis?

WBC

Identify the microscopic structure

WBC

Identify the microscopic structure

Glitter Cell

Identify the microscopic structure

Glitter Cell

Identify the microscopic structure

WBC

Identify the microscopic structure

RBC

Identify the microscopic structure

WBC

Identify the microscopic structure

WBC

Identify the microscopic structure

WBC

Identify the microscopic structure

Renal Tubular Epithelial Cells, RBCs

Sources of Error for WBC

Average/10 hpf

Reporting of WBC values

0-5

Normal values of WBC per hpf

Leukocyte Esterase, Nitrite, pH

An increase in the WBC values in urine would affect what parameters? (3)

Inflammation or Infection of Renal Origin

Suppose an MT counted a significant amount of WBC in urine along with WBC casts. What is the clinical significance?

Pyelonephritis, Cystitis, Prostatitis, Urethritis

Bacterial infections that produce WBC in urine (4)

Glomerulonephritis, Lupus Erythematosus, Interstitial Nephritis, Tumors

Non-bacterial infection that produce WBC in urine (4)

WBC

Identify the microscopic Structure

Eosinophil

WBC that is not normally seen in urine

Hansel and Wright

What stains can be used to visualize eosinophil in a urine specimen?

Uses Methylene Blue in Eosin Y

What is the mechanism of Hansel stain?

Tubulointerstitial Disease and Hypersensitivity to Dugs

Clinical significance of eosinophil in urine (2)

Squamous Epithelial Cell

Among the three epithelial cells, which is the least significant but most numerous?

Vagina, Urethra, Vulva

Sources of SEC in a female px

Distal 1/3 Urethra

Sources of SEC in a male px

Folded cells may resemble casts

Sources of error for SEC

Average per LPF

Reporting for SEC

Increased SEC

Suppose an MT is about to examine a turbid urine. What may be the findings in terms of SEC?

Gardnerella Vaginalis

Microbe associated with clue cells

Bacterial Vaginosis

Suppose an MT discovers clue cells in a px’s urine. What may this indicate?

Squamous Epithelial Cell (SEC)

Identify the microscopic particle

Squamous Epithelial Cell (SEC)

Identify the microscopic particle

Squamous Epithelial Cell (SEC)

Identify the microscopic particle

Squamous Epithelial Cell (SEC)

Identify the microscopic particle

Clue Cell

Identify the microscopic particle

Squamous Epithelial Cell (SEC)

Identify the microscopic particle

Sternheimer Malbin Stain

What stain can be used to distinguish SEC?

Upper Urethra, Ureters, Bladder, Renal Pelvis

Sources of TEC? (4)

Catheterization, Malignancy and Viral Infections

Clinical significance of TEC (2)

Transitional Cell Carcinoma

Suppose an MT discovered large clumps of TEC in a px’s urine. What can be indicated from this?

Transitional Cell Epithelium

Identify the microscopic structure

Transitional Cell Epithelium

Identify the microscopic structure

Round, Oval, Pear, Caudate, Kite

TEC may come in 5 different shapes. What are the shapes?

Renal Tubular Epithelial Cells

The most significant epithelial cell found in urine.

PCT, DCT, Collecting Tubules

Sources of RTEs (3)

PCT-RTE

RTE: rectangular, columnar, convoluted, coarsely granular, and may resemble cast

DCT-RTE

RTE: egg-shaped (round or oval), coarsely granulated, and eccentric nucleus

Collecting Tubule RTE

RTE: w/ one straight edge, cuboidal, polygonal, eccentric nucleus, high NC ratio

0-2/hpf

Normal values of RTEs

Drug and Heavy Metal Poisoning, Pyelonephritis, CMV Infection, Allergic Reaction, Acute Allogenic Transplant Rejection

Possible causes of tubular necrosis (5)

Severe Tubular Injury

Suppose an MT discovers renal fragments in a px’s urine. What does this indicate?

Salicylate Poisoning

Suppose an MT discovers single, cuboidal cells in a px’s urine. What does this indicate?

PCT-RTE

Identify the microscopic particle

DCT-RTE

Identify the microscopic particle

Collecting Tubules RTE

Identify the microscopic particle

DCT-RTE

Identify the microscopic particle

Transitional Epithelial Cells

Identify the microscopic particle

Oval Fat Bodies

Lipid-containing RTEs, are highly vacuolated, and seen with free-floating fat droplets.

Nephrotic Syndrome

Suppose an MT discovers oval fat bodies within a px’s urine. What may this indicate?

Sudan III or Oil Red O

Stains used in distinguishing oval fat bodies

Maltese Cross Fornation

Specific trait of oval bodies under polarized microscopy

Oval Fat Bodies

Identify the microscopic particle

Oval Fat Bodies

Identify the microscopic particle

Oval Fat Bodies

Identify the microscopic particle

Bubble Cells

Vacuolated, non-lipid containing RTEs

Acute Tubular Necrosis

Suppose an MT discovers bubble cells within a px’s urine. What may this indicate?

Vaginal, Urethral, External Genitalia Contamination

Suppose an MT discovers a few bacteria in a px’s urine. What may this indicate?

Gram (-) Enterobacteriaceae E. coli, Staphylococcus, Enterococcus

Bacteria associated with UTI

UTI

Suppose an MT discovers bacteria and WBC in a px’s urine. What may this indicate?

Bacteria

Identify the microscopic particle