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