05.11 - Urinalysis (Huch) - PP + Handout, No reading Flashcards
Renal Tubular Epithelial Cells are most commonly found when there is
Acute Tubular Injury
When do you see Waxy Casts
CHRONIC Kindey Disease
Nephrotic Range of proteinuira
3.5 grams/24 hours
Proteinuria in Renal vs Extra-Renal origin hematuria
Renal Origin Hematuria often associated with proteinuria; absent in extra-renal origin
Cast with bright white line around edges, cracks around sides, broken edges
Waxy
What forms matrix of all casts
Tamm-Horsfall protein
Specific gravity is determined by
Numer and weight of solutes
Cystine crystals are associated with
Always pathologic, associated with very dense nephrolithiasis
RBC Casts is Pathognomonic for
Glomerulonephritis
Diseases affecting only the glomerular basement membrane in a non-inflammatory manner should lead to
Pure Nephrotic Urine
Negative Anion Gap means
GI losses, and kidneys are excreting as much acid as possible into urine
Which Bilirubin is water soluble?
Conjugate (Direct)
Urinary Anion Gap is an assessment of
Hyperchloremic Metabolic Acidosis
RBC Casts in Renal vs Extra-Renal origin hematuria
RBC casts are pathognomonic for renal origin/glomerulonephritis
Mesangial Pattern Urine
Hematuria and probably RBC casts, in absence of major proteinuria
Granular Casts represent
Breakdown of cellular debris as it passes thru tubules
RBC range in normal urine
0-2 rbc/hpf; Negative diptick
Protein in Hyaline Casts is
Tamm-Horsfall
Where is Tamm-Horsfall protein produced
Thick Ascending Limb cells - forms matrix of all casts
Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop should result in
Nephritic Urine
Crenated RBC’s indicate
Concentrated supernatant
Fatty Casts are Pathognomonic for
Nephrotic Syndrome
What should lead to Pure Nephrotic Urine
Diseases affecting only the glomerular basement membrane in a non-inflammatory manner
Nephritic implies
Active inflammation with cellular infiltration (ie proliferative changes)
Which Bilirubin will not be present in urine
Unconjugated (indirect) b/c not water soluble
How will Obstructive Uropathy typically present
Tubular Pattern of Urine
Lipiduria =
Nephrotic Syndrome, Heavy Proteinuria
Tubular Proteinuria
Smaller amounts: Failure to reabsorb low molecular weight proteins in proximal tubule
Flat, six-sided crystals
Cystine Crystals
Renal Tubular Epithelial Cells are hallmark of
Acute Tubular Necrosis (ATN)
Specific gravity of 1.010 corresponds to what Osmolality
300 mOsm/kg
RBC morphology in Renal vs Extra-renal origin hematuria
Dysmorphic in Renal Origin (pass thru glomerulus)
Conditions with Urinary WBC’s
Commonly UTI; Also Pyelonephritis, Allergic Interstitial Nephritis, Intense Glomerulonephritis
When is Leukocyte Esterase positive?
Increased numbers of Neutrophils in urine
Alternative to measuring proteinuria over 24 hour period
Ratio of urine protein over creatinine is reliable estimate of quantitative proteinuria
Waxy casts are also known as
Renal Failure Casts
What leads primarily to Hematuria
Diseases which have active proliferative inflammation that involve the mesangium
Tubular Urine
No heavy proteinuria, maybe Microscopic Hematuria, maybe Renal Tubular Epithelial Cells, GRANULAR CASTS, High specific gravity
Cellular infiltration and Pyuria in Non-Inflammatory Tubular Injury
None or little of either
3+ and 4+ proteinuria suggests
Nephrotic Range Proteinuria
Type of casts seen in chronic kidney disease
Waxy
Origin of Tamm-Horsfall proteins
Secreted by Tubular Cells
What do Squamous Epithelial Cells indicate in urine
Nothing, can be predominant if vaginal contamination of sample
Cellular infiltrate directly injuring tubules, such as Allergic Interstitial Nephritis
Inflammatory Tubulitis
When is specific gravity not a marker of concentration
When there are abnormal numbers of heavy solutes in urine (glycosuria, contrast media)
In metabolic acidosis, urinary pH is below
5.3
What test detects all protein in urine
Sulfosalicylic Acid Test
Renal Tubular Epithelial Cells should make you think
Acute Kidney Injury, ATN
Injury typically caused by Ischemia (ATN)
Non-Inflammatory Tubular
Larger, denser, acellular casts
Waxy
Urine with high specific gravity
Tubular: damage to tubules causing inability to dilute or concentrate
Hallmark of Tubular Urine
Granular Casts
Urine in Nephrotic Syndrome
Proten and Lipid
Clots in Renal vs Extra-Renal origin hematuria
Clots may be present in Extra-Renal origin
What is almost invariably present in Inflammatory Tubulitis
Sterile Pyuria
Urinary Anion Gap helps you distinguish
Whether etiology is GI (diarrhea secretion of HCO3-) or Urinary (inability to excrete H+)
Only normal cast in urine
Hyaline Cast
Which is found in normal urine, Nitrite or Nitrates?
Nitrate
Are ketones found in normal urine?
No
Positive Nitrite suggests
UTI with Nitrate-Reduing Bacteria (gram negative)
Intense Glomerulonephritis is usually a feature of
Lupus
Glycosuria in presence of normal blood glucose implies
Proximal Tubular Dysfunction
Urine pH > 7.5-8.0 suggests
UTI with Urea-Splitting Bacteria (proteus)
When Free Hemoglobin and Myoglobin in urine
Dipstick positive, but urinary sediment will be negative for RBC’s
What is Pyelonephritis
Infected Tubules
Heaviest proteinuria is found when
source is glomerulus
Triple Phosphate Crystals are associated with
Infection
Injury typically caused by Direct Tubular Toxins
Non-Inflammatory Tubular
Normal range of Urinary pH
5-6.5
Most common Uropathogens
Gram Negative Bac
Urinar Casts represent
Precipitates of protein forming in lumen of tubules
What is present in urine of Pyelonephritis
Pyuria and Bacteruria
Normal range for urinary WBC’s
0-4/hpf
Large, plate-like cell with abundant cytoplasm and very small nucleus
Squamous Epithelial Cell
Non-inflammatory Tubular Injury would be typical of
Ischemia (ATN) or Direct Tubular Toxins
Urine: Varying levels of protein, almost invariable hematuria, frequently RBC casts
Nephritic Urine
What should result in Nephritic Urine
Diseases which involve active inflammation/proliferation involving both the mesangium and capillary loop
When do you seen Uric Acid Crystals in urine
Normal urine that’s been sitting or refrigerated
When are Ketones present in urine
Fasting, DKA, AKA
Negative dipstick for albumin, but positive sulfosalicylic acid test indicates
Light Chain proteinuria (MM)
Any pathologic process that leads to renal injury should also lead to
Abnormal urinalysis with potential changes in GFR
What does Tubular Proteinuria reflect
Promxial Tubular Dysfunction
RBC Casts are Pathognomonic for
Glomerulonephritis
Large cell with nucleus about same size as WBC
Renal Tubular Epithelial Cell
“Coffin Lid” crystals
Triple Phosphate Crystals
Specific gravity of 1.030 corresponds to what Osmolality
1200 mOsm/kg
Osmolality is determined by (as opposed to specific gravity)
Only the number of solutes
Hyaline Casts are found in healthy persons in states of
Volume Depletion
Diseases only involving the tubules should lead to
Tubular Pattern of Urine
Diseases involving the microcirculation will lead to
Altered GFR, frequently signs of glomerular injury with proteinuria and hematuria
Urine: Heavy proteinuria, Lipiduria, and signs of proliferation/inflammation with hematuria
Mixed Nephritic and Nephrotic
Morphology of Urinary WBC’s
Granular cytoplasm, irregular nucleus, “glitter cells”
Diseases which have active proliferative inflammation that involve the mesangium only lead to
Primarily to hematuria
Most common type of Renal Stone
Calcium Oxalate Crystals
Nephritic changes will be manifest in urine by
Varying levels of protein and hematuria, frequently with RBC casts
Elevated levels of plasma conjugated bilirubin lead to
Urinary excretion
Most common cause of positive dipstick for blood is
presence of RBC’s in urinary sediment
Normal limit of protein excretion
Less than 150mg/day
