Urinalysis CHAPTER 5-5
Myoglobin
A pigmented oxygen carrying protein found in muscle tissue (cam cause urine to be red)
A drop of urine is added to a tablet that has been placed on a filter paper
Acetest
Confirmatory test for ketone which can be use for both serum and urine
Acetest
What can dissolve red cells?
Acetic acid.
How cast count and clasified
- Counted using low light and low lower objective( x10) -classified using higher power objective (x40)
What do red blood cells tend to get confused with?
Yeast cells.
Ammonum biurate crystals ( thorn apples )
Yellow brow with thorny projection
How should the RBC reported n this example
-10HPF are counted -2,4,0,1,3,2,0,1,2=19 -19is divided by 10 fields that we count = 1.9=0-2 RBCs/HPF
How is urine sediment prepared for a microscopic examination?
-10to12or 15 ml of well mixed urine o be poured into a conical centrifuge tube and centrifuge in 400 g for 5 minute -then 0.5 to 1.0 ml of supernatant is removed by pouring the pipeting . -the sediment is resuspended in the urine remaining in the tube by gently tapping the tip of the tube . -one drop of the suspension is pipettes onto a microscopic slide and covered with a cover glass
Normal amounts of commonly encountered sediments
0-2 RBCs/hpf 0-5 wbcs/hpf 0-2 hyaline casts/lpf
Size of wbcs
12 microns
In the clintest
5to10 drops of water are added to a heat resistant test tube seated in a test tube rack
To differentiate between RBC and yeasts
Add 1 drop do dillute(2%) acetic acid to drop of urine sediment :the acid will lyse (destroy ) RBC if they were present
Yellow brown or green brown urine
Bilirubin,biliverdin, or bile pigments
What microscope is used for most sediment examination?
Bright field microscopy.
Small renal cells can be differentiate from neutrophil if WBC
By adding one drop of dilute acetic acid to sediment :the nucleus of renal cells is round and neutrophil will be segmented or lobed
Melanin
Causes Dark or black urine
What can happen to RBCs in dilute urine?
Cells may swell and rupture releasing the hemoglobin.
A copper reduction test that can detects reducing sugar like galactose ,fructose and glucose
Clinitest
Appearance of RBCs and size
Colorless and 6-8 microns in diameter. Cells may appear cremated in concentrated urine. Hypertonic solution.
Calcuim oxlate
Colorless refractile ,octahedral crystals ,like envelope
Cellular casts
Contain epithelial cells , red or white blood cells embedded in the protein matrix of the cast.
What happens to cells in dillute urine samples
Destroyed which falsely decrease their number during the microscopic examination
Granular cast
Disintegrated cells, fine or coarse granules
Dark Amber urine
Due to high specific gravity,bilirubin,certain drugs,and large doses of vitamin c
Ghost cells
Empty cellular RBC membranes.
Leukocyte estrase still be positive
Even some bacteria don't have the ability to convert nitrates to nitrites
Reagent strip by instrumentation
Even that the strip reader reduce error caused by incorrect timing off reaction or incorrect interpretation of colors
Waxy cast
Flattened and irregular serrated margins. Opaque or dense formed as a result of prolonged tubular stasis
Uris acid
Form yellow brown crystals that have a variety of shape irregular ,needle like,rhombic ,clusters or rosettes
Name 10 chemical tests routinely performed on urine strip method
Glucose,bilirubin,ketones,blood,PH ,protein,urobilinogen,nitrite,leukocyte ester are,specific gravity
WBC
Granular appearance and have a visible nucleus
What part of WBC can be seen under microscope?
Granules and nuclear loves.
Red urine
Hematuria, hemoglobinuria, myoglobin ,porphyrins
Brown or black urine
Hemoglobin that oxidize to form methemoglobin in acidic urine that has been undisturbed . Hemogentisic acid can also cause brown/black color.
Confirmatory test for bilirubin
Ictotest
Cast
In conditions like slow urine flow ,acid ph,increased in solute .the mucoprotein also called Tamm horsfall protein accumulate and begins to gel forming
Clinitest
It important to observe the pass through reaction ( color change from blue to green and then to orange )
If crystals found in urine sediment
It should identified to know if it is normal or it is significant of certain metabolic disease of low solubility drugs such as sulfa drugs .
3 confirmatory test
Ketone ,bilirubin .protein
Explain how cast form
Kidney tubules normally secrete small amount of mucoprotein (Tamm horse all protein )this protein accumulate and begins to gel ,forming casts in some condition :slow urine flow,acid PH,and increased solutes.
Calcuim phosphate crystals
Large ,flats thin plates appear granular mistakenly can look like squamous epithelial cells
Epithelial cells
Larger than wbc's, appear flattend, distinctive round to oval nucleus
The indicator of early renal disease
Microalbumin
Test strip used to detect amount of album to low to be detected with routin chemistry reagent strip
Microalbumin test stirps
Bacteria and mucus Are reported as
Negative,1+,2+,3+,4+.
Is clinitest used to diabet milletus
No
Amorphous
No definite shape
Amorphous urate cristals
No definite shape can appear pink to the eye
Spermatozoa
Oval head and single long flagellum
Yeast
Ovoid fungi ,budding or in chains
RBC
Pale ,light reflective disc under high power
Normal urine
Pale yellow to Amber
What type of sediment would be used for high refractive index?
Phase contrast microscopy.
A Portion of supernatant from a centrifuge urine is treated of sulfosalicylic acid
Protein percepitation test
Presence of white cells in the urine. May or may not be pathological.
Pyuria
Protozoa
Single felled eukaryotic (recognized by flagella
Ammonium magnesium phosphate crystals (triple phosphate crystals )
Six sided ,colorless .highly refractive prisms described as COFFIN -LIDS
Calcuim carbonate
Small colorless ,dumbbell shaped
How does casts reported
They are reported as the number of casts per low power field (LPF)
How do RBC ,WBC and epithelial cells are reported
They are reported as the number of cells per high power field (HPF)
Bacteria
Tiny round or rod-shaped
What is he advantages of using a standardized system such as the KOVA system,CenSlIDe,UriSystem
To eliminate the variation in technique among technicians
Hyaline cast
Transparent, colorless cylinders
the crystals commonly seen in normal acid urine are
Uris acid ,amorphous urate and phosphates ♠️,C oxlate ,carbonate,and C phosphate).♥️Ammonium biurate,ammonium biurate phosphate
Amorphous phosphate
White precipitate ,Colorless amorphous granular
the significant crystals commonly seen in urine sediment
cystine,leucine,tyrosine,cholesterol,sulfa,hippuric acid ,radiographic media
A few drops of urine are placed on the mat The tablet is placed on the moist area and water is dropped on the table
ictotest