volume of urine recommended for urinalysis

volume range of urine recommended for urinalysis

amount of sediment obtained

components that should be counted and classified

components that should be assessed qualitatively

minimum fields assessed for urine components depending on specific components

used to enhance visualization

most common supra vital stain for urine

distinguishes various cell components differently to help in identification

brings out nuclear detail of WBCs and lyses RBCs

fat stains that identify fat inside cells or free floating; within renal cells or macrophages (oval fat bodies)

does not stain and must be confirmed with polarizing microscopy

used to identify bacteria and yeast; rarely used in UA

stains iron in hemosiderin granules blue; can be free floating or inside cells

methylene blue and eosin-Y; for identification of eosinophils

most commonly used microscope technique in urinalysis

ideal for urine sediments; allows more detailed visualization of RBC morphology and translucent or low-refractive components and living cells

confirms presence of cholesterol; also used on crystals

forms a maltese cross pattern with polarized light

gives 3-D images; high cost

a technique used to produce permanent microscope slides of urine sediment and body fluids; produces a monolayer of sediment components

pg 132-3. 192-210, Table 7.5 pg. 137, ph 140, 144-5

red blood cell reference interval

white blood cell reference interval

hyaline cast reference interval

squamous epithelial cell reference interval

transitional epithelial cell reference interval

renal epithelial cell reference interval

bacteria and yeast reference interval

abnormal crystal reference interval

LPF

HPF

small, biconcave disks, approximately 8um in diameter and 3um deep with no nucleus

RBC hypertonic (concentrated) urine

RBC hypotonic (dilute) urine

concentrated urine

dilute urine

increased RBC casts and significant protein

increased RBCs no casts or protein

positive strip test no RBCs seen; false positive

false negative RBC strip test

most common WBC in blood and urine

WBCs in hypotonic urine

WBCs in hypertonic urine

WBCs, WBC casts along with positive protein

increased WBCs, no casts and no protein (or lower level)

increased WBCs in urine

predictor of acute interstitial nephritis due to drug sensitivity

used to detect eosinophils

seen in viral infections kidney transplant rejection

monocytes and macrophages

the most common and largest of the epithelial cells; use low power; rarely significant, usually caused by contamination

line calyces, renal pelvis, ureters, and bladder; various size and shape; seen in UTI, urinary procedures, and carcinoma (in sheets)

convoluted tubular and collecting duct cells enumerated; seen in acute ischemic or toxic renal tubular disease from heavy metals or drug (ahminoglycosides) toxicity

formed in distal and convoluted tubules with a core matrix of uromodulin (Tamm-Horsfall protein) secreted by renal tubular cells; seen in acidic urine

types of casts that are normal in small amounts

most commonly observed casts in the urine sediment; two or few/lpf are normal; seen in excess in strenuous exercise, dehydration, fever, emotional stress, CHF, and renal disease

indicates prolonged stasis (take as long as 48 hours or more to form) and tubular obstruction; believed to be advanced stages of other casts; found in chronic renal failure, acute renal disease, hypertension, and renal allograft rejection

casts diagnostic of intrinsic renal disease; most often of glomerular origin, but may result from tubular damage; accompanied by proteinuria

must accompany increased numbers or abnormal casts

casts that indicates renal inflammation or infection

casts composed primarily of uromodulin protein; not usually clinically significant casts unless they are very broad which may indicate poor prognosis; may be formed by degradation of other cellular casts

casts with oval fat bodies indicating renal tubular death; signify a severe renal pathological condition, accompanied by significant proteinuria

must be correlated with chemical tests

three cast look-alikes

result of precipitation of urine solutes, not usually present in freshly voided urine; significant in fresh voided indicates tubular damage

factors influencing crystal formation

crystals present in acidic urine

crystals present in alkaline urine

crystals present in metabolic conditions

crystals present in iatrogenic origin

2

present in urine 5.7-7.0; have no clinical significance; may appear as brick dust due to uroerythrin

sodium, potassium, and ammonium salts of urine acid that appear as small yellow-brown balls or spheres; no clinical significance

occur in many forms, most common is rhombic or diamond shape, also cubes, barrels, or bands and can form rosettes; appear only when urine pH is less than 5.7; commonly seen in gout or after cytotoxic drug administration

appear as colorless to light-yellow slender, pencil-like prisms; no clinical significance

most frequently observed crystals in human urine; form at any pH, commonly formed in high ascorbic acid diets or during refrigeration; seen in ethylene glycol (antifreeze ingestion) and during severe chronic renal disease; envelope crystals

found in alkaline and neutral urine; indistinguishable from amorphous urates; precipitate appears white or gray; no clinical significance

colorless and appear in different forms; most common is coffin lid; found in alkaline or neutral urine; little clinical significance, but found in conjunction with UTIs

common and have no clinical significance; found in neutral and slightly alkaline (sometimes slightly acidic) urine

thorny apple appearance (yellow brown spheres with striations on surface); normal urine solute seen after storage; significant in fresh urine indicating renal tubular damage

appear as tiny, colorless granular crystals usually found in pairs or tetrads; no frequently found and no clinical significance

indicate large amounts of bilirubin in the urine; only form in acidic urine; appear as small clusters of fine needles

colorless, hexagonal plates with uneven sides; present primarily in acidic urine; clinically significant indicating disease (hereditary cystinosis or cystinuria);

form in acidic urine and dissolve in alkaline urine; rarely seen but indicate abnormal process such as severe liver disease or a rare inherited metabolic disorder

clear, thin parallelogram plates with notched corners; indicate large amounts of cholesterol and ideal conditions that allowed them to precipitate out into the urine; usually accompany oval fat bodies, fatty casts, and large amounts of protein; signify nephrotic syndrome, kidney disease

form due to treatment administered such as drugs, dyes, contrast media

most common bacteria in urine

presence indicates UTI (accompanied by leukocytes) or contamination; reported as few, moderate, or many per HPF

colorless ovoid cells resembling RBCs; seen often as vaginal contaminant

prepared to view yeast

most common cause of parasitic gynecologic infection in females as an STD; turnip-shaped flagellates and have jerky motility in wet preps; reported as present

an anaerobic bacterium; clue cells present; characteristic of bacterial vaginosis

squamous epithelial cells from the vaginal mucosa with large numbers of bacteria adhering to them

common are Enterobius vermicularis (pinworm), Giardia lamblia and Schistosoma haematobium (schistosomiasis)

a protein produced by the renal tubular epithelium; no clinical significance

found in urine in three forms; free-floating droplets, oval fat bodies, or within fatty casts; triglycerides and/or cholesterol

will stain with Sudan III or an oil red O stain

will not stain, but will demonstrate birefringence with polarizing microscopy

produce a distinctive maltese cross pattern

always clinically significant; present in a variety of renal diseases and may occur after severe crush injuries; always accompanied by proteinuria

form of iron that results in ferritin denaturation; may be seen in urine after a severe hemolytic episode (transfusion reaction); Prussian blue used to identify

indicates ejaculation or recent sexual intercourse

hair, cotton, fabric threads, diapers and hygiene products often appear in urine sediment

originate from body powders or gloves; not perfectly round with a centrally located dimple; exhibits pseudo-maltese pattern with polarized microscopy

come from improper collection or through abnormal connection between urinary tract and the bowel

process of using entire analysis: physical, chemical, and microscopic

purposes of findings in urine sediment