CLINICAL MICROSCOPY (URINALYSIS) RATIO
1. HPO, mucus threads (rare, few, mod, many/LPF) (C)
2. Glucose positive in urine chemical testing, (A) Yeast cells – can be seen in DM, also with
vaginal moneliasis, immunocompromised patients, common yeast cells – C. albicans
(Yeast cells – have buds, mycelia (stem-like structures)
3. Organized vs Unorganized
a. Organized – biological specimens (epithelial cells, bacteria, parasites, WBC, RBC)
b. Unorganized – crystals
4. Glitter cells in hypotonic urine
a. Cells in hypotonic solution, swells (water goes inside the cell) Pus cells are
granulated (so granules make it sparkly)
5. Fat oval bodies – RTEs, able to absorb fats or lipids, this can indicate glomerular damage.
When doing microscopy with RTEs and oval bodies, it must be differentiated to see
artifacts of oil, Oval fat bodies are RTEs with “laman sa loob”
6. Ghost cells
a. RBCs – burst
7. Major protein constituent – Tamm-Horsfall protein (uromodulin)
8. Benzoic acid – comes from vegetable, fruit, wine diet  these all contain phenolic
compounds, so they metabolize to benzoic acid then they are excreted in the urine as
hippuric acid
9. Parasites in urine sediment:
a. S. haematobium
b. T. vaginalis
c. E. vermicularis – eggs from anus can contaminate urine
10. Most common cast – hyaline cast, 0-2/LPF, normal
a. Pathologic cases of hyaline casts
i. Acute glomerulonephritis
ii. Chronic Renal Failure
iii. congestive Heart failure
iv. pyelonephritis
11-15
Acidic – CaOx
The rest, alkaline
16-20
CaOx – envelope shape (characteristic), dumbbell is Ca2CO3
CaPO3 – rosette
PO33 – coffin lid
Ammonium biurate – thorny apple
21. Cystine – Cystinuria, more of an autosomal recessive disorder, presence of high level of
amino acid in urine, uncommon since protein should be reabsorbed by the body
22. Inflammation, Infection = (-itis), pyelonephritis, interstitial nephritis – WBC (wbcs are our
first line of defense)
23. Heavy metal toxcicity, chemical or drug induced toxicity, viral infections, allograft rejections
– epithelial cell cast
24. ESRD – waxy cast, (cannot be seen by itself, always with other type of casts – after all it’s
end stage na)
25. TUBULAR REABSORPTION – (C) ascending loop of Henle
26. ALWAYS pathologic (glomerular damage) – RBC cast, depends on the number and
circumstances
27. Crystals: colorless, hexagonal plates – Cysteine
28. Yellow to brown sphere with concentric and radial striations – Leucine (looks like Taenia
egg)
29. Urine crystal solubility – precipitation varies with temperature (dumadmai crystals kapag
refrigerated), pH (acidic vs alkaline crystals), solute concentrations (more concentrated, mas
madaming crystals)
30. Clear urine with (+) blood chemical test = Hemoglobin present, the glomerulus cannot filter
hemoglobin
31-33.
Patient M
UU 1.0 EU(mg/dL), Normal UB3+ (indicates bile obstruction)
-cholelithiasis – presence of stones (gall stones in the bile duct, ergo, bile obstruction)
Patient K
UU 3+ (hemolytic disorders, liver damage) UB (-)
-hemolytic transfusion reaction
Patient L
UU2+
UB (V)
-ex hepatocarcinoma, hemolytic anemia, heap A, serum hepatitis (NOT UREMIA)
34. (-) glucose oxidase (+) clinitest
Glucose oxidase – copper reductase test, very specific for glucose
Clinitest – glucose plus other reducing sugars, monosaccharides
-Urine is (+) sugar except glucose
-Urine may have high ascorbic acid content
-Urine has antibiotics (Cephalosporins)
35. -sucrose is a disaccharide
36. -NOTA (see notes above)
37. Fatty casts, RTE with fat oval bodies – not seen in pyelonephritis (WBC cast)
38. Nephrotic syndrome (not an inflammation nor infection)
39. Acellular casts = Hyaline cast, crystal casts (NOT FATTY CASTS)
40. Epithelial cell casts – (Acute glomerulonephritis – Hyaline casts)
41. A
42. B
43. A
44. B
45. B
46-49. A
50. BONUS
51. Tea colored urine – bilirubin (Rifampin = yellow-orange -> red-orange)
52. Refractometer > Urinometer
-small urine volume and compensates for temperature
-for protein, -0.003
-for glucose, -0.004
53. Least affected by standing or unpreserved urine
Glucose – bababa, glycolysis
pH – tataas, urea is converted to ammonia
Bilirubin – bababa, exposure to light (photooxidation)
A: PROTEIN
54. First morning – preg test due to high levels of hcg
55. Spg of Triple distilled water (ionless, mineral-less), 1.000
56. Black = Melanin (pH=8.0)
57. pH = 9.0 (alkanalized, masyado ng matagal ng nakastand sa Room T), ask for new spx
58. Orthostatic proteinuria – common in teenagers
59. Cloudiness = WBC, Hazy = Protein
60. Isosthenuria = approx.. 1.010 Hyper > 1.010 > Hypo
61. 3-glass infection: prostitis (prostatic infection)
Collect 1st glass -> 2nd glass – midstream clean catch (cleansing of the genitalia) ->
prostatic massage -> 3rd glass
PROSTITIS (+) WBC (+) Bacteria, 1/ 3, highest ang 3, 2 is control (if positive sa ALL: UTI or
contamination) ANSWER: B
62. Phenylketonuria – mousy
63. Ketones (could be in DM)– fruity odor, ammonia odor – bacteria
64. urea – 10 organic component
65. Boric acid – urine preservative for transport
Formalin – sediments
Na fluoride – drug analysis
Tablet preservatives – too many interferences
66. 24 HR URINE – discard first, collect last (if collected first, false increase; if discard last, false
decrease)
67. Suprapubic aspiration – cytologic exams and bacteria
68. D – reagent strip testing is not done in drug testing
69. Urine spg = dissolved solids
70. ADH deficiency = Low spg (ihi ka ng ihi, so di na concentrated urine)
71. Method of choice for XRAY CONTRAST DYE: Reagent strip (release of hydrogen ions are not
affected by the mass of the dye)
72. Assess renal tubular function: osmolality and specific gravity
73. Brown-black urine: melanin
74. Yellow color of urine: urochrome
75. Portwine color : porphyrins
76. Non-pathogenic red colored urine: Rifampin, black berries, fresh beets
Vitamin B complex (dark yellow)
77. Ammonia like odor = bacteria
78. Clarity of urine should be determined using glass tubes since glass has a higher refractive
index
79. Uncontrolled DM: pale urine with high spg (high spg because of excretion of glucose, which
has high molecular weight)
80. Diabetes insipidus – low spg, pale yellow
81. Nitrofurantoin – dark yellow
METHYLDOPA, Metronidazole – black (coke)
NO COLOR FOR VIT C
82. Urine kept for 4 hrs at 4-7 degrees Celsius = acceptable
83. pH – would increase
84. rejected due to time delay CULTURE FIRST BEFORE ROUTINE
85. bacterial contam (A)
86. THREE GLASS COLLECTION METHOD, pre post massage clean catch = prostitis
87. Blue green urine color = anti-depressants (mentos ingestion as well)
88. Nonpathologic urine turbidity: 1,2,3 (yeast is pathologic)
89. NaF – drug analysis, boric acid – urine culture
90. Urine volume factors: fluid intake, variations in the secretion of ADH, fluid lost from non
renal sources (LBM, excretion), sugar or glucose intake from foods (sugar can lessen urine
volume)
91. ALL
92. Physical examination: ALL (Color, Clarity, Specific gravity)
93. yellow foam when shaken = bilirubin
94. spx container = wide mouth, flat bottom, screw cap lids, nonreusable
95. reasons for spx rejection: unlabeled containers, insufficient quantity
96. general screening: random spx
97. 24 hr urine (include first urine): increased results
98. Glucose – decrease
99. Blood cells, glucose – decrease
100. NOT URINE – 1.002 (urine lowest)