Module 4 Urinalysis

Ch. 8-15

3 forms of renal disease

Glomerular, Tubular, Interstitial

what are Glomerular diseases?

Acute glomerulonephritis and nephrotic syndrome

Most glomerular disorders are caused by:

Immunologic disorders

Damage in the glomerulus can result in:

deposition of immune complexes, amyloid materials, and cellular infiltration.

Acute Glomerulonephritis symptoms:

Lab findings:

fever, edema, fatigue, hypertension, oliguria, hematuria, strep. infection in children

red, cloudy urine

Increased protein

RBC casts

Nephrotic syndrome

Lab findings:

can result to glomerulonephritis and renal failure

Heavy proteinuria

RTE cells

Oval fat bodies

Tubular disorders

cause tubular damage

Acute tubular necrosis

Hereditary/ Metabolic

Acute tubular necrosis symptoms

Lab findings:

damage to RTE cells, shock, trauma

Mild proteinuria

Hematuria

RTE cells w/ other casts

Ischemia frequently produces what disease:

Acute renal tubular necrosis

Hereditary/ Metabolic diseases

affects tubular function

causes uromodulin associated kidney disease, diabetic nephropathy, nephrogenic diabetes insipidus, renal glycosuria.

Interstitial disorders

UTI is most common (cystitis)

Acute pyelonephritis, Chronic pyelonephritis, Acute Interstitial nephritis

What does it mean when there is an increase of WBC’s and WBC casts?

tubular inflammation

Acute pyelonephritis symptoms

Lab findings:

upper respiratory tract infection, urinary frequency, burning upon urination, back pain.

WBC casts

Acute Interstitial Nephritis symptoms

Lab findings:

oliguria, edema, decreased urination, fever, skin rash, allergic reaction to medication.

WBC casts w/o bacteria

Renal failure symptoms

Lab findings:

Renal diseases:

Increased BUN and creatinine serum levels

granular, waxy, broad casts

Acute renal failure and Chronic renal failure

Which renal failure disorder are waxy and broad casts often seen?

Chronic renal failure

Renal Lithiasis

Lab findings:

formation of renal calculi, large- stag horn stones

Hematuria; calcium oxalate/ phosphate

The most common component of renal calculi is:

Calcium oxalate

The only protein produced by kidney is:

Uromodulin

A patient with severe back pain is being evaluated for renal calculi will most likely show what in urine?

Hematuria in urine

what do Overflow disorders cause?

What do renal disorders cause?

disrupt normal metabolic pathway, inborn error of metabolism

malfunction in tubular reabsorption mechanism

what do Amino acid disorders cause?

what specific food do they have to avoid?

Phenylketonuria (PKU)

can damage child’s mental capacity

avoid phenylalanine (milk) from diet

what does Melanuria cause?

what does it produce?

dark urine, albinism

Malignant melanoma

Alkaptonuria

what kind of test do they use?

What does it fail to produce?

Black alkaline urine, black- stained diapers, brown pigment tissues

Clinitest (false positive)

Homogenistic acid

Branched chain amino acid disorders

what amino acids are involved?

Maple syrup urine disease (MSUD)

leucine, isoleucine, and valine

Tryptophan disorders

increased excretion of indican and 5-HIAA

Indicianuria

what is harnup disease?

increased indole is reabsorbed, excreted by kidney

blue diaper syndrome

what does 5-HIAA mean in urine?

what kind of foods do they avoid?

5-HIAA in urine due to excess serotonin production

banana, pineapple, tomatoes

What are the two different cystine disorders?

Cystinuria & cystinosis

Cystinuria

affects renal tubular reabsorption of cystine

increased calculi formation

what causes Porphyrin disorders?

urine macroscopic:

Inherited from genes, lead poisoning, alcoholism, low iron, liver/renal disease

port wine color in urine

Mucopolysaccharide disorders

what do they cause?

Hurler syndrome, Hunter syndrome, Sanfilippo syndrome.

all cause abnormal skeletal structure & mental retardation

Purine disorders

Lesch-Nyhan disease

inherited, uric acid crystal excretion, orange sand in diaper

Three layers of meninges

Dura mater (outer), Arachnoid (middle), and Pia mater (surfaces of brain and spinal cord)

What is the space between arachnoid and pia mater called?

what is it formed by?

Subarachnoid- CSF flows through

selective filtration

Blood brain barrier

tight-fitting endothelial cells; prevent filtration of large molecules

CSF function:

Protects/ supports brain and spinal cord

supplies nutrients

removes metabolic waste

CSF specimen collection:

what are the specimen tubes?

collected between third to fifth lumbar vertebrae in spinal cord

1. Chemistry/ serology

2. Hemotology

3. Microbiology

(must be process STAT)

What does cloudy and milky appearance mean in CSF?

what is xanthochromic mean in appearance?

Cloudy= infection; Milky= lipid/ protein

Xanthochromic= pink, yellow, orange CSF

What causes a traumatic tap?

blood vessel is punctured during tap

What happeneds to the tube distribution in a traumatic tap?

what would it look like?

decreasing tubes 1-3

more blood in 1st tube, fibrinogen- clotted blood, bright red blood.

Cerebral hemorrhage tube distribution:

How would it look like?

even distribution in all tubes

no clots, no fibrinogen (too large to cross BBB)

What do we count in a CSF?

WBC and total cell count

Formula for CSF cell count:

number of cells counted x dilution/ number of cells counted x 0.1= cells/ uL

What type of method do we use to differentiate cell count?

Stained smear only

What are normal WBC’s found in Adults and Children?

what is the ratio in adults?

Adults= monocytes:lymphocytes, 70:30

Children= 30:70

what is pleocytosis?

increased amounts of all cells

What do neutrophils mean in CSF?

what to lymphocytes mean in CSF?

neutrophils= bacterial

lymphocytes= viral, tubercular, fungal, parasitic (multiple sclerosis), seen in HIV/ AIDS

What is the biggest WBC called?

monocytes

what infections do Eosinophils cause?

fungal and parasitic infections

What are macrophages?

what do they phagocytize?

remove other debris and cellular

phagocytize RBC’s

What is shown in an abnormal result in a chemistry test?

permeability of blood-brain barrier

Protein levels in CSF:

Normal: 15 to 45 mg/ dL

increased levels: damage to Blood-brain barrier, IG production

decreased levels: fluid leakage

what is the most common cause of increased damage to Blood-brain barrier?

Meningitis and hemorrhage

The detection of oligoclonal bands represents:

Multiple sclerosis in CSF:

represents inflammation

MS= no bands in serum and bands in CSF

Glucose in CSF have decreased values relative to what?

what is the percentage of plasma glucose in CSF?

values that are decreased relative to plasma values

60% to 70% plasma glucose

CSF glucose clinical significance:

decreased glucose with increased neutrophils in bacterial meningitis

CSF lactate levels:

levels remain elevated until treatment becomes effective

CSF glutamine is produced by:

produced by brain cells from ammonia

What microbiology test do we use to detect?

what kind of centrifuge do we do for gram stain?

what other cultures should drawn?

what smear is important for growth time delay?

Gram stain is best for detection

cytocentrifuged CSF helps gram stain

Blood cultures must also be drawn

TB smears

Common parasite found in CSF:

where is it found?

where does it enter in the body?

Naegleria fowleri- mobile amoeba

pools, lakes, ponds (freshwater)

Through nasal passage and migrates to brain

Serologic testing is used for:

Who produced this test?

neurosyphilis, third stage

VDRL (The Venereal Disease Research Laboratories)