CEREBROSPINAL FLUID & AMNIOTIC FLUID Flashcards
viscous CSF
- Metastatic mucin-producing adenocarcinoma
- Cryptococcal meningitis
- Liquid Nucleus Pulposus
(MCL)
Routinely performed on CSF
wbc count
to correct for wbc count and total protein concentration, subtract ______ for every 700 RBCs seen
1 wbc
to correct for wbc count and total protein concentration, subtract ______ in total protein concentration for every 10,000 RBCs/uL
8mg/dL
in CSF differential count, specimen should be ______ first before preparing a smear
concentrated
4 types of csf differential count
- routine centrifugation
- cytocentrifugation
- sedimentation
- filtration
in cytocentrifugation, addition of _________ will increase cell yield or recovery and decreases cellular distortion
30% albumin
Viral, Tubercular, & Fungal Meningitis
Multiple Sclerosis
a. neutro
b. lympho, mono
c. macro
b
Bacterial meningitis
Early case of viral, tubercular & fungal meningitis
Cerebral hemorrhage
a. neutro
b. lympho, mono
c. macro
a
Intracranial hemorrhage
a. neutro
b. lympho, mono
c. macro
c
BLAST FORMS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
a
Lymphoma cells
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
b
plasma cells
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
c
EPENDYMAL, CHOROIDAL,
& SPINDLE-SHAPED CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
d
MALIGNANT CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
e
MALIGNANT CELLS
a. acute leukemia
b. disseminated lymphoma
c. multiple sclerosis, lymphocyte reactions
d. diagnostic procedures, neurosurgery, pneumoencephalography
e. Metastatic carcinoma, primary CNS carcinoma
e
normal value of CSF protein in adults
15-45 mg/dL
normal value of CSF protein in infants
150 mg/dL
normal value of CSF protein in immature
500 mg/dL
MAJOR CSF PROTEIN
albumin
2ND MOST PREVALENT
pre-albumin
ALPHA GLOBULINS
haptoglobin, ceruloplasmin
BETA GLOBULINS
b2- transferrin,
“tau”
GAMMA-GLOBULINS
IgG and IgA
clinical significance of pellicle
tubercular meningitis
NOT FOUND in CSF
- IgM
- fibrinogen
- lipoprotein
CSF protein decreased results
- CSF leakage/trauma
- recent puncture
- rapid CSF production
- water intoxication
2 methods in CSF protein determination (TOTAL PROTEIN)
turbidimetric
dye-binding
2 methods in turbidimetric
trichloroacetic acid
sulfosalicylic acid
which of the following is the preferred method
a. Sulfosalicylic acid
b. Trichloroacetic acid
b
which of the following precipitates both albumin and globulin
a. Sulfosalicylic acid
b. Trichloroacetic acid
b
which of the following precipitates albumin only
a. Sulfosalicylic acid
b. Trichloroacetic acid
a
in sulfosalicylic acid, adding _______ will precipitate globulins
Na2SO4
in total protein - dye binding, we use
coomasie brilliant blue
2 methods in CSF protein determination
total protein and protein fractions
2 methods in protein fractions
CSF/serum albumin index
IgG index
normal value in CSF/serum albumin index
<9
normal value in CSF/serum albumin index
<9
abnormal value in CSF/serum albumin index
> 9
CSF/SERUM ALBUMIN
INDEX
9-14
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
a
CSF/SERUM ALBUMIN
INDEX
9-14
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
a
CSF/SERUM ALBUMIN
INDEX
15-30
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
b
CSF/SERUM ALBUMIN
INDEX
>30
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
c
CSF/SERUM ALBUMIN
INDEX
100
a. Slight impairment
b. Moderate impairment
c. Severe impairment
d. Complete damage to BBB
d
IgG index normal value
<0.70
IgG index abnormal value
> 0.70
detection of oligoclonal bands in gamma region, indicates immunoglobulin production
CSF electrophoresis
Presence of 2 oligoclonal bands in CSF but not in serum can be seen in
MS. NENG
- multiple sclerosis
- neurosyphilis
- encephalitis
- neoplastic disorder
- guillain-barre syndrome
demyelinating disorder, Abs against myelin sheath
MS
- (+) Anti-myelin sheath autoantibody
- (+) oligoclonal band in CSF but not in serum
- (+) Myelin Basic Protein (MBP)
- Inc. IgG Index
MS
CSF GLUCOSE is collected ___ hrs before ____________
2
spinal tap
CSF glucose normal values
60-70% (2/3)
or
50-80 mg/dL of blood glucose
CSF glucose is normal in
viral meningitis
waste product of glucose metabolism
CSF LACTATE
glucose is _______________ to lactate
inversely proportional
CSF lactate normal values
10-24 mg/dL
product of ammonia and alpha-ketoglutarate in brain cells
CSF GLUTAMATE
indirect test for presence of excess NH3 in CSF
CSF GLUTAMATE
CSF GLUTAMATE normal values
8-18 mg/dL
CSF lactate is increased in
- bacterial meningitis
- tubercular and fungal meningitis
- hypoxia
CSF lactate is normal in
viral meningitis = <25 mg/dL
CSF glutamate increased in
- disturbance of consciousness
- reye’s syndrome
ISOENZYMES IN CSF
LDH
brain tissues
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
b
lymphocytes
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
a
neutrophils
a. LD 2 & 3
b. LD 1 & 2
c. LD 4 & 5
c
Normal distribution LD isoenzymes IN SERUM
2>1>3>4>5
Normal distribution LD isoenzymes IN CSF
1>2>3>4>5
CSF pattern seen in serum (flipped pattern)
AMI/hemolytic anemia
If serum pattern seen in CSF this indicates
neurologic abnormalities
In CSF pattern: 5>4>3>2>1- indicates
BACTERIAL meningitis
Creatine kinase is increased in
Stroke
MS
Degenerative disorder
Brain tumor
Bacterial and viral meningitis
Epileptic seizure
Aspartate aminotransferase is increased in
intracerebral and subarachnoid hemorrhage
bacterial meningitis
BACTERIAL MENINGITIS COMMON AGENTS
- Group B strep- neonates
- E. coli and gram neg bacilli- NB to 1 y.o
- N. meningitidis- 3 mos. older
- S. pneumoniae- 3 mos. older
- H. influenzae- 3 mos. to 18 y.o
- L. monocytogenes-
TUBERCULAR MENINGITIS common agent
mycobacterium tuberculosis
(+) Gram Stain
(+) Culture
(+) Limulus Lysate Test
bacterial meningitis
(+) AFB Stain
(+) Pellicle/weblike clot formation after
tubercular meningitis
TUBERCULAR MENINGITIS common agent
Mycobacterium tb
(+) Gram Stain
(+) India Ink
(+) Latex Agglutination Test
FUNGAL MENINGITIS
AMOEBIC MENINGOENCEPHALITIS COMMON AGENTS
- Naegleria fowleri
- Acanthamoeba spp.
- Balamuthia mandrillaris
(+) RBCs
(+) Acridine Orange Stain
AMOEBIC MENINGOENCEPHALITIS
VIRAL MENINGITIS common agents
- enteroviruses (coxsackie, echo, polio)
- arboviruses
RT-PCR can detect
VIRAL MENINGITIS
2 types of SPIROCHETAL MENINGITIS
- Neurosyphilis
- Neuroborreliosis
diagnosis for SPIROCHETAL MENINGITIS
- nontreponemal tests- VDRL, FTA-Abs
- ELISA
- Western blot
function of amniotic fluid
- cushion
- allows fetal movement
- stabilize temp
- lung maturity
The _____________ is the ultimate source of
amniotic fluid water and solutes
placenta
normal volume of amniotic fluid during third trimester
800-1200 mL
Decrease fetal swallowing of urine
POLYHYDRAMNIOS
>1200 mL
Neural tube defects
Increased fetal swallowing of urine
OLIGOHYDRAMNIOS
<800 mL
Membrane leakage
Urinary tract deformities
amniocentesis is safe to perform on
14th week of gestation
Maximum amount in amniocentesis
30 mL, first 2-3 mL is discarded
16th week, chromosomal studies (Trisomy 21/DS)
a. 2ND TRIMESTER AMNIOCENTESIS
b. 1st TRIMESTER AMNIOCENTESIS
c. 3RD TRIMESTER AMNIOCENTESIS
a
fetal lung maturity, fetal hemolytic disease
a. 2ND TRIMESTER AMNIOCENTESIS
b. 1st TRIMESTER AMNIOCENTESIS
c. 3RD TRIMESTER AMNIOCENTESIS
c
TEST FOR FETAL LUNG MATURITY
(FLM)
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
b
TEST FOR CYTOGENETICS STUDIES/
MICROBIAL STUDIES
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
a
TEST FOR HEMOLYTIC DISEASE OF
THE NEWBORN (HDN)
a. kept at RT or body temp (37degC)
b. placed on ice during delivery, kept refrigerated
c. protect from light; use amber-colored bottle, foil, black plastic cover
c
AMNIOTIC FLUID vs MATERNAL URINE
Amniotic fluid
Protein: +
Glucose: +
Urea: <30 mg/dL
Creatinine: <3.5 mg/dL
Maternal urine
Protein: -
Glucose: -
Urea: >30 mg/dL
Creatinine: >10 mg/dL
Detects ruptured amniotic membranes
FERN TEST
specimen in FERN TEST
vaginal fluid
(+) result in fern test
fern-like crystals (protein and NaCl)
normal color of amniotic fluid
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
c
Traumatic tap, abdominal trauma, intra-amniotic hemorrhage
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
b
bilirubin- HDN
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
d
meconium (first fetal bowel movement)
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
a
fetal death/demise
a. DARK GREEN
b. BLOOD-STREAKED
c. colorless to pale yellow
d. YELLOW
e. DARK RED-BROWN
e
TEST FOR HEMOLYTIC DISEASE OF THE NEWBORN (HDN) aka _________________
Optical density 450 (OD450)
normal absorbance of amniotic fluid
increased at 365 nm
decreased at 550 nm
abnormal absorbance of amniotic fluid
increased at 450 nm (max. bilirubin absorbance)
in OD450 results are plotted in a
liley graph
OD450- Zone I
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
b
OD450- Zone II
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
a
OD450- Zone III
a. moderately affected fetus
b. nonaffected/mildly affected fetus
c. severely affected fetus
c
Interferences in OD450
cells, meconium, debris, Hgb (peak abs 410 nm)
birth defect where there is incomplete closing of the backbone and
membranes around the spinal cord
Spina bifida/split spine
absence of major portion of the brain and scalp
Anencephaly
AFP is _____________ in spina bifida and Anencephaly
increased
AFP is _____________ in down syndrome
decreased
confirmatory test for neural tube defect
acetylcholinesterase (AChE)
do not perform AChE if bloody, could lead to _________
false increase
Most frequent complication of early delivery
RESPIRATORY DISTRESS SYNDROME
7th most common cause of morbidity and mortality among premature infants
RESPIRATORY DISTRESS SYNDROME
RESPIRATORY DISTRESS SYNDROME is caused by
lack of lung surfactants (phospholipids)
reference method for FETAL LUNG MATURITY (FLM)
LECITHIN/SPHINGOMYELIN (L/S) RATIO
<1.6 L/S Ratio
a. mature fetal lungs - > preterm delivery is safe
b. <35 wk
b
≥2.0 L/S Ratio
a. mature fetal lungs - > preterm delivery is safe
b. <35 wk
a
L/S Ratio false increase
blood and meconium
AMNIOSTAT-FLM
immunologic test for phosphatidylglycerol
phosphatidylglycerol’s production is ___________ to lecithin
parallel
microviscosity is _________________ to phospholipid
inversely proportional
MICROVISCOSITY measured by
fluorescence polarization
Surfactant-to-albumin (S/A) ratio is measured
MICROVISCOSITY
Dye bound to Surfactant
a. decreased fluorescence, high polarization
b. longer fluorescence, low polarization
b
Dye bound to Albumin
a. decreased fluorescence, high polarization
b. longer fluorescence, low polarization
a
stored form of phospholipid in fetus
LAMELLAR BODY COUNT
_________________ produce lung surfactants stored in the form of ___________________
Type II pneumocyte,
lamellar bodies
Methods in lamellar body count
impedance and optical scatter method
amount of adequate fetal lung maturity based on lamellar body count
> 32,000 / uL
Increased lamellar bodies = _______________ O.D.
increased
OD of __________ is equivalent to
- L/S Ratio of ______________
- Presence of _______________
≥ 0.150
≥2.0 - fetal lung is matured
phosphatidylglycerol not affected by blood and myconium
TEST FOR FETAL AGE
AMNIOTIC FLUID CREATININE
AMNIOTIC FLUID CREATININE
<36 weeks gestation
1.5 - 2.0 mg/dL
AMNIOTIC FLUID CREATININE
36 weeks gestation
> 2.0 mg/dL
in urine specimen preparation, warming @37 degC may
dissolve some crystals
standard amount of urine ____
______ is frequently used
10-15 mL
12 mL
urine centrifugation
5 mins @400rcf
Volumes of ____________________are frequently used (uniform
amount of urine and sediment)
0.5 mL and 1 mL
in Conventional Glass Slide Method: Recommended volume is _______________ covered by a _______ glass cover slip
20 uL
22x22 mm
this objective detects casts, ascertain the general composition of sediment
LPO
this objective identifies urinary sediments
HPO
in conventional glass slide method, _____ have a tendency to locate
near the edges of the coverslip
casts
point of reference in urine microscopic examination
epithelial cells
what is reported in average number per LPF
casts
what is reported in average number per 10 HPF
RBCs and WBCs
what is reported in Semi-quantitative
EC, crystals and other sediments
Most frequently used stain in urinalysis
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
c
component of sternheimer-malbin stain
crystal violet and safranin O
Sedi stain and KOVA stain
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
c
Use to confirm the presence of triglycerides, neutral fats and
cholesterol
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
a
Identification of bacterial casts, which can be confused from granular
casts
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
b
Preferred stain for urinary eosinophils (In cases of drug-induced
allergic reaction producing inflammation of the renal interstitium)
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
e
components of hansel stain
methylene blue and eosin Y
Stain for iron (Hemosiderin Granules: Blue)
a. Lipid stains
b. gram stain
c. sternheimer-malbin stain
d. Prussian blue stain
e. hansel stain
d
Objects appear dark against a light background, is most frequently
used in the clinical laboratory
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Phase-Contrast
Microscopy
d. Polarizing
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
a
Aids in identification of Treponema pallidum
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Phase-Contrast
Microscopy
d. Polarizing
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
b
Enhances visualization of elements with low refractive indices, such
as hyaline casts, mixed cellular casts, mucous threads, and
Trichomonas.
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Polarizing
Microscopy
d. Phase-Contrast
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
d
Aids in identification of cholesterol in oval fat bodies, fatty casts, and
crystals
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Polarizing
Microscopy
d. Phase-Contrast
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
c
Allows visualization of naturally fluorescent microorganisms or those
stained by a fluorescent dye including labeled antigens and
antibodies.
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Polarizing
Microscopy
d. Phase-Contrast
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
e
Produces a three-dimensional microscopy image and layer by-layer
imaging of a specimen
a. Bright-Field
Microscopy
b. Dark-field
Microscopy
c. Polarizing
Microscopy
d. Phase-Contrast
Microscopy
e. Fluorescence
Microscopy
f. Interference
Contrast
f
Frequently performed independently of routine urinalysis for detection of malignancies
of the lower urinary tract
Cytodiagnostic Urine Testing
In cytodiagnostic urine testing, Preparation of permanent slides using cytocentrifugation followed by staining with ________________ provides an additional method for detecting and monitoring ________________.
Papanicolaou stain
Renal disease
In cytodiagnostic urine testing, Preparation of permanent slides using cytocentrifugation followed by staining with ________________ provides an additional method for detecting and monitoring ________________.
Papanicolaou stain
Renal disease
Appearance: smooth, non-nucleated biconcave disc
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
b
Hypersthenuric (Concentrated) RBC appears as
crenated
Hyposthenuric (Diluted) RBC appears as
ghost cells
In Glomerular Bleeding, RBC appears as
dysmorphic (cellular protrusions, fragmented)
RBC reported in
0-2 cells/10 HP
frequently associated with advanced glomerular damage but is also seen with damage to the vascular integrity of the urinary tract caused by trauma, acute infection or inflammation, and coagulation disorders
a. Microscopic Hematuria
b. Macroscopic Hematuria
b
can be critical to the early diagnosis of glomerular disorders and malignancy of the urinary tract and to confirm the presence of renal calculi (kidney stones)
a. Microscopic Hematuria
b. Macroscopic Hematuria
a
Movement: Appear as glitter cells
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
a
increased in urinary WBC is called
Pyuria
Hypotonic WBC exhibits
Brownian movement
predominant WBC in urine
neutrophil
drug-induced interstitial nephritis, UTI, renal-transplant rejection
a. neutrophil
b. basophil
c. eosinophil
d. lymphocyte
c
seen in increased numbers in the early stages of renal transplant rejection
a. neutrophil
b. basophil
c. eosinophil
d. lymphocyte
d
Primary concern in identification of WBC in urine
differentiation of mononuclear cells and disintegrating neutrophils from round renal tubular epithelial (RTE) cells
Normal, Sloughing Off, largest cells found in urine sediment
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
d
Point of Ref: represents normal cellular sloughing and have no pathologic significance
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
d
- urothelial cell, smaller than squamous and appear in several forms; spherical, polyhedral and caudate.
- these differences are caused by the ability of transitional ec to absorb large amounts of water
- originate from lining of renal pelvis, calyces, ureters and bladder and from the upper portion of male urethra
a. SEC
b. TEC
c. RTE
b
renal fragment cells
a. SEC
b. TEC
c. RTE
c
larger than any RTE cells, rectangular thus referred to as columnar or convoluted cells, resembles a cast
a. PCT
b. DCT
c. CD
d. Oval fat bodies
e. Bubble cells
a
smaller, round or oval, can be mistaken for WBC or spherical transitional EC
a. PCT
b. DCT
c. CD
d. Oval fat bodies
e. Bubble cells
b
cuboidal and are never round, if they appear in groups of three or more, they are called renal fragments.
a. PCT
b. DCT
c. CD
d. Oval fat bodies
e. Bubble cells
c
lipid containing RTE cells
a. PCT
b. DCT
c. CD
d. Oval fat bodies
e. Bubble cells
d
RTE cells containing non-lipid filled vacuoles (acute tubular necrosis)
a. PCT
b. DCT
c. CD
d. Oval fat bodies
e. Bubble cells
e
squamous EC covered with Gardnerella coccobacillus (bacterial vaginosis)
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
e
not normally present in urine
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Epithelial Cell
e. Clue Cells
c
gram-negative rods, most frequent associated w/ UTI
Enterobacteriaceae
Small Refractile oval structures (may or may not contain bud)
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Yeast
e. Clue Cells
d
opportunistic pathogenic yeast that can be seen in DM, Vaginal Moniliasis,
Immunocompromised Individual
Candida albicans
most frequent parasite encountered in
the urine
Trichomonas vaginalis
bladder parasite (ova)
Schistosoma haematobium
most common fecal contaminant
E. vermicularis
Routine UA in spermatozoa
do not report
major constituent of mucus
uromodulin
only elements found only in urine which is unique to the kidney
casts
in casts, this indicates presence of urinary cast
cylinduria
true geometrically structure or amorphous materials
a. White Blood Cell
b. Red Blood Cell
c. Bacteria
d. Yeast
e. Crystals
e
highly refractile sphere with dimpled center
a. fibers/hair
b. pollen grains
c. starch
d. Fecal Contamination
c
appear as spheres with a cell wall and occasional
concentric circles
a. fibers/hair
b. pollen grains
c. starch
d. Fecal Contamination
b
may resemble casts however these polarized while casts do not
a. fibers/hair
b. pollen grains
c. starch
d. Fecal Contamination
a
appear as plant and meat fibers or as
brown amorphous material
a. fibers/hair
b. pollen grains
c. starch
d. Fecal Contamination
d
Most frequently seen urinary casts
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
c
Normally Increased in: strenuous exercise, dehydration, heat exposure, emotional stress
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
c
Hyaline casts are pathologically increased in
P- pyelonephritis
A- acute glomerulonephritis
C- CHF
C- chronic renal disease
greater stasis of urine
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
b
Glomerular damage (glomerulonephritis) is associated with proteinuria and dysmorphic erythrocytes
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
b
blood casts is indicative of
bleeding with the nephron
In WBC casts, acute interstitial nephritis is indicative of
a. bacterial inflammation
b. non-bacterial inflammation
b
In WBC casts, pyelonephritis is indicative of
a. bacterial inflammation
b. non-bacterial inflammation
a
Primary marker for distinguishing pyelonephritis from cystitis
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
a
Containing bacilli both within and bound to the protein matrix are seen in pyelonephritis.
a. WBC Casts
b. RBC Casts
c. Hyaline Casts
d. Bacterial Casts
d
_________ may resemble granular cast, confirmation is _______
bacterial cast
GRAM STAIN
Cast containing RTE Cells
a. WBC Casts
b. Epithelial Cell Casts
c. Hyaline Casts
d. Bacterial Casts
b
epithelial cell casts is indicative of
advance tubular obstruction
frequently associated with nephrotic syndrome, toxic tubular necrosis, DM, crush
a. fatty casts
b. Epithelial Cell Casts
c. Hyaline Casts
d. Bacterial Casts
a
Casts with multiple cell types, include RBC & WBC casts in glomerulonephritis and WBC and RTE, or WBC and bacterial casts in pyelonephritis.
a. fatty casts
b. Epithelial Cell Casts
c. Mixed Cellular Casts
d. Bacterial Casts
c
result of cellular disintegration
a. fatty casts
b. Granular Casts
c. Mixed Cellular Casts
d. Bacterial Casts
b
increased cellular metabolism occurring during periods of strenuous exercise accounts for the transient increase of these casts that accompany the increased hyaline cast
a. fatty casts
b. Granular Casts
c. Mixed Cellular Casts
d. Bacterial Casts
b
fragmented with jagged ends and have notches on sides
a. fatty casts
b. Granular Casts
c. waxy Casts
d. Bacterial Casts
c
indicative of extreme urine stasis (chronic renal failure)
a. fatty casts
b. Granular Casts
c. waxy Casts
d. Bacterial Casts
c
“renal failure casts”
a. Broad Casts
b. Granular Casts
c. waxy Casts
d. Bacterial Casts
a
destruction “widening” of tubular walls
a. Broad Casts
b. Granular Casts
c. waxy Casts
d. Bacterial Casts
a
Acidic, rhombic, four-sided flat plates (whetstones), wedges, rosettes
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
d
Highly birefringent; distinguishing feature from cystine crystals
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
d
Significantly increased in gout, lesch-nyhan syndrome
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
d
Acidic, yellow-brown granules, becomes pink when refrigerated
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
a
Alkaline, similar to amorphous urates
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
b
Dihydrate (most common form): colorless, octahedral envelope or as two pyramids joined at their base
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
c
Monohydrate: oval or dumbbell shaped (ethylene glycol “anti-freeze” poisoning
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
c
Majority of renal calculi is composed of ____
a. Amorphous Urates
b. Amorphous Phosphates
c. Calcium Oxalate
d. Uric Acid
c
Alkaline, colorless, flat rectangular plates, thin prisms in rosette form
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
d
Confused with
sulfonamide crystals (when urine pH is neutral)
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
d
Distinguished by addition of DILUTE ACETIC ACID
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
d
In addition of dilute acetic acid in calcium phosphate, which of the following dissolves
a. calcium phosphate
b. sulfonamide
a
In addition of dilute acetic acid in calcium phosphate, which of the following does not dissolves
a. calcium phosphate
b. sulfonamide
b
alkaline, also known as ammonium magnesium phosphate
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
b
prism shape, resembles “coffin-lid”
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
b
acidic, thorny apples, spicule covered shapes
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
c
Most often encountered in old specimen, ammonia-urea splitting bacteria
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
c
ammonium biurate dissolves at ____ and convert into ____ when ________ is added
60degC
Uric acid crystals
Glacial acetic acid
alkaline, small, colorless, dumbbell of spherical shapes
a. Calcium Carbonate
b. Triple Phosphate
c. Ammonium Biurate
d. Calcium Phosphate
a
resemble amorphous material
a. Calcium Carbonate
b. Calcium Oxalate
c. Uric Acid
d. Calcium Phosphate
a
calcium carbonate distinguished by addition of _________
acetic acid (formation of gas)
Most often found in ACIDIC URINE or rarely in NEUTRAL URINE
Abnormal Urinary Crystals
colorless, hexagonal plates (thick or thin)
a. Cholesterol
b. Tyrosine
c. Ampicillin
d. Cystine
d
Distinguished from uric acid
a. Cholesterol
b. Tyrosine
c. Ampicillin
d. Cystine
d
confirmation for cystine
cyanide-nitroprusside test
Metabolic disorder that prevents reabsorption of
cysteine by renal tubules
cystinuria
rectangular plates with notch on one or more corners
a. Cholesterol
b. Tyrosine
c. Ampicillin
d. Cystine
a
can be seen in nephrotic syndrome in conjunction with fatty casts and oval fat bodies
a. Cholesterol
b. Tyrosine
c. Ampicillin
d. Cystine
a
colorless flat plates, similar to cholesterol
a. Sulfonamides
b. Tyrosine
c. Radiographic Dye
d. Cystine
c
SG is markedly elevated
a. Sulfonamides
b. Tyrosine
c. Radiographic Dye
d. Cystine
c
colorless to yellow-brown, needles, rhombic, whetstones, “sheaves of wheat” and rosettes
a. Sulfonamides
b. Tyrosine
c. Radiographic Dye
d. Cystine
a
Distinguished from calcium phosphate
a. Sulfonamides
b. Tyrosine
c. Radiographic Dye
d. Cystine
a
Does not dissolve upon addition of dilute acetic acid
a. Sulfonamides
b. Tyrosine
c. Radiographic Dye
d. Cystine
a
colorless needles (tend to form bundles following refrigeration)
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
c
indication: precipitation of antibiotics following massive dosage of this penicillin compound without adequate hydration
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
c
Abnormal urinary crystals indicative of liver disorder
leucine
tyrosine
bilirubin
yellow-brown spheres (concentric circles
with radial striations)
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
a
Should be accompanied by: tyrosine crystals
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
a
fine, colorless to yellow needles (clumps or rosettes)
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
b
Seen in conjunction with: leucine crystals and (+) chemical test for bilirubin
a. Leucine
b. Tyrosine
c. Ampicillin
d. Cystine
b
yellow, clump needles or granules
a. Leucine
b. Tyrosine
c. Ampicillin
d. Bilirubin
d
Glomerular
a. Most often are IMMUNE-MEDIATED
b. Result from INFECTIOUS or TOXIC SUBSTANCES
c. Causes a renal perfusion that subsequently induces both
MORPHOLOGIC & FUNCTIONAL changes in the kidney
a
Tubular
a. Most often are IMMUNE-MEDIATED
b. Result from INFECTIOUS or TOXIC SUBSTANCES
c. Causes a renal perfusion that subsequently induces both
MORPHOLOGIC & FUNCTIONAL changes in the kidney
b
Interstitial
a. Most often are IMMUNE-MEDIATED
b. Result from INFECTIOUS or TOXIC SUBSTANCES
c. Causes a renal perfusion that subsequently induces both
MORPHOLOGIC & FUNCTIONAL changes in the kidney
b
Vascular
a. Most often are IMMUNE-MEDIATED
b. Result from INFECTIOUS or TOXIC SUBSTANCES
c. Causes a renal perfusion that subsequently induces both MORPHOLOGIC & FUNCTIONAL changes in the kidney
c
Nephrotic syndrome is what type of disease
glomerular disease
INCREASED permeability of the GLOMERULI to the passage of plasma proteins (ALBUMIN)
a. Acute Tubular
Necrosis
b. Acute Glomerulonephritis
c. Nephrotic Syndrome
d. Focal Segmental
Glomerulonephritis
c
Heavy proteinuria, hypoproteinemia and hyperlipidemia can be seen in
a. Acute Tubular
Necrosis
b. Acute Glomerulonephritis
c. Nephrotic Syndrome
d. Focal Segmental
Glomerulonephritis
c
TYPES OF GLOMERULONEPHRITIS
AFMIC
acute
focal segmental
membranoproliferative
IgA nephropathy
Chronic
One cause: Post-Streptococcal Infection → known as: ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS (Group A βhemolytic Streptococci – those with M PROTEIN in their cell wall induces this type of nephritis)
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
c
ELEVATED ASO Titer
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
c
NON-AGN: non-streptococcal agent in acute glomerulonephritis
Bacteria: pneumococci
Viruses: mumps, Hepa B
Parasitic infection: malaria
SCLEROSIS of the GLOMERULI
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
b
Predominant Feature: PROTEINURIA
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
b
Cellular Proliferation of the MESANGIUM along with LEUKOCYTE INFILTRATION & THICKENING OF THE GLOMERULAR BASEMENT MEMBRANE
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
a
Development: Slow and Silent
80%: have previously some form of glomerulonephritis
20%: form of glomerulonephritis that has been unrecognized
a. IgA Nephropathy
b. Focal Segmental
Glomerulonephritis
c. Acute Glomerulonephritis
d. Membranoproliferative
Glomerulonephritis
e. Chronic
Glomerulonephritis
e
Destruction of RENAL TUBULAR Epithelial Cells
Acute Tubular
Necrosis
2 types of Acute Tubular
Necrosis
Ischemic ATN
Toxic ATN
follows a HYPOTENSIVE event that result in decrease perfusion of the kidneys followed by renal tissue ischemia
a. Toxic ATN
b. Ischemic ATN
b
3 principal cause of Ischemic ATN
Sepsis
Shock
Trauma
results from exposure to NEPHROTOXIC AGENTS, caused by variety of agents
a. Toxic ATN
b. Ischemic ATN
a
give examples of endogenous nephrotoxin
hemoglobin
myoglobin
uric acid
immunoglobulin light chain
give examples of exogenous nephrotoxin
therapeutic agents
anesthetics
radiographic contrast media
chemotherapeutic drugs
recreational drugs
industrial chemicals
Alkaptonuria (Homogentesic Acid)
MSUD
Melanoma (Melanin)
PKU
a. Ammoniacal Silver
Nitrite
b. Ferric Chloride Test
c. Nitrosonaphthol Test
d. Hoesch Test
e. Watson-Schartz Test
f. Benedict’s Test
b
Alkaptonuria (Homogentesic Acid)
a. Ammoniacal Silver
Nitrite
b. Ferric Chloride Test
c. Nitrosonaphthol Test
d. Hoesch Test
e. Watson-Schartz Test
f. Benedict’s Test
a or f
Tyrosinuria
a. Ammoniacal Silver
Nitrite
b. Ferric Chloride Test
c. Nitrosonaphthol Test
d. Hoesch Test
e. Watson-Schartz Test
f. Benedict’s Test
c
Porphyria (Porphobilinogen)
a. Ammoniacal Silver
Nitrite
b. Ferric Chloride Test
c. Nitrosonaphthol Test
d. Hoesch Test
e. Watson-Schartz Test
f. Benedict’s Test
d or e
Actively involved in the metabolism of Amino Acids
Liver & Kidney
TRANSAMINATION
Interconvertion of AA
DEAMINATION
Degradation of AA
INCREASE in the plasma levels of AA
a. No-Threshold Aminoaciduria
b. Overflow Aminoaciduria
c. Renal Aminoaciduria
b
AA not reabsorbed by the tubules
a. No-Threshold Aminoaciduria
b. Overflow Aminoaciduria
c. Renal Aminoaciduria
a
Plasma levels of AA: NORMAL
Cause: Defect in tubules (congenital/acquired) → NOT Reabsorbed by
the tubules = INCREASE amount in URINE
a. No-Threshold Aminoaciduria
b. Overflow Aminoaciduria
c. Renal Aminoaciduria
c
a.k.a. “inborn errors of metabolism”
a. Primary Aminoaciduria
b. Secondary Aminoaciduria
c. Cystinosis
d. Nephropathic
Cystinosis
a
2 types of defect in primary aminoaciduria
- enzyme is defective
- tubular reabsorptive dysfunction
Induced by: SEVERE LIVER DISEASE or GENERALIZED TUBULAR
DYSFUNCTION (e.g. Fanconi Syndrome)
a. Primary Aminoaciduria
b. Secondary Aminoaciduria
c. Cystinosis
d. Nephropathic
Cystinosis
b
MOI: Autosomal Recessive
Lysosomal Storage Disease
a. Primary Aminoaciduria
b. Secondary Aminoaciduria
c. Cystinosis
d. Nephropathic
Cystinosis
c
Most common & SEVERE FORM
Accumulated CYSTINE CRYSTALLIZES within the PROXIMAL
TUBULAR CELLS of the NEPHRONS (Fanconi syndrome)
a. Primary Aminoaciduria
b. Secondary Aminoaciduria
c. Cystinosis
d. Nephropathic
Cystinosis
d
Nephropathic
Cystinosis evident in
: FIRST YEAR OF LIFE
Intermediate
Cystinosis evident in
ADOLESCENCE
RARE FORM
Clinical Features: SAME with Nephropathic Cystinosis
a. Ocular Cystinosis
b. Intermediate
Cystinosis
c. Cystinosis
d. Cystinuria
b
RARE FORM
CYSTINE DEPOSITION in the CORNEA → Ocular Impairment
a. Ocular Cystinosis
b. Intermediate
Cystinosis
c. Cystinosis
d. Cystinuria
a
MOI: Autosomal Recessive
Due to: NEPHRONES (PTC) = UNABLE to REABSORBED AA
(cysteine, dibasic AA e.g. arginine, lysine, ornithine)
a. Ocular Cystinosis
b. Intermediate
Cystinosis
c. Cystinosis
d. Cystinuria
d
MOI: Autosomal Recessive
Accumulation of branched-chain AA (leucine, isoleucine, valine) and
their corresponding α-keto acids in BLOOD, URINE & CSF
a. Melanuria
b. Phenylketonuria
c. Tyrosinuria
d. Maple Syrup Urine
Disease
e. Alkaptonuria
d
MOI: Autosomal Recessive INCREASED urinary excretion of PHENYLPYRUVIC ACID (a ketone) and its metabolites
a. Melanuria
b. Phenylketonuria
c. Tyrosinuria
d. Maple Syrup Urine
Disease
e. Alkaptonuria
b
MOI: Autosomal Recessive Excretion of large amount of HOMOGENTISIC ACID (HGA) in the urine
Unusual darkening of the urine when ALKALI is ADDED
a. Melanuria
b. Phenylketonuria
c. Tyrosinuria
d. Maple Syrup Urine
Disease
e. Alkaptonuria
e
Deficient enzyme in Maple Syrup Urine
Disease
a. PHENYLALANINE HYDROXYLASE
b. Branched-Chain α-Keto Acid Dehydrogenase
(BCKD)
c. HOMOGENTISIC ACID OXIDASE
b
Deficient enzyme in Phenylketonuria
a. PHENYLALANINE HYDROXYLASE
b. Branched-Chain α-Keto Acid Dehydrogenase
(BCKD)
c. HOMOGENTISIC ACID OXIDASE
a
Deficient enzyme in Alkaptonuria
a. PHENYLALANINE HYDROXYLASE
b. Branched-Chain α-Keto Acid Dehydrogenase
(BCKD)
c. HOMOGENTISIC ACID OXIDASE
c
high SG
a. Diabetes Insipidus
b. Diabetes Mellitus
b
low SG
a. Diabetes Insipidus
b. Diabetes Mellitus
a
Enzymes Responsible for Galactosemia
1.Galactose 1-phosphate uridylyltransferase (GALT)
2.Galactokinase (GALK)
3.Uridine diphosphate galactose-4-epimerase (GALE)
Impaired ability to REABSORBED GLUCOSE
a. Hartnup Disease (Monoamino – Monocarboxylic AA)
b. Bartter’s Syndrome
c. Renal Glucosuria
d. Renal Tubular
Acidosis Type II
c
Impaired ability to REABSORBED SPECIFIC AMINO ACIDS
a. Hartnup Disease (Monoamino – Monocarboxylic AA)
b. Bartter’s Syndrome
c. Renal Glucosuria
d. Renal Tubular
Acidosis Type II
a
Impaired ability to REABSORBED SPECIFIC AMINO ACIDS
a. Cystinuria (Cystine
and Dibasic AA)
b. Bartter’s Syndrome
c. Renal Glucosuria
d. Renal Tubular
Acidosis Type II
a
Impaired ability to REABSORB SODIUM
a. Cystinuria (Cystine
and Dibasic AA)
b. Bartter’s Syndrome
c. Renal Glucosuria
d. Renal Tubular
Acidosis Type II
b
Impaired ability to REABSORB BICARBONATE
a. Cystinuria (Cystine
and Dibasic AA)
b. Bartter’s Syndrome
c. Renal Glucosuria
d. Renal Tubular
Acidosis Type II
d
Impaired ability to REABSORB CALCIUM
a. Cystinuria (Cystine
and Dibasic AA)
b. Bartter’s Syndrome
c. Idiopathic
Hypercalciuria
d. Renal Tubular
Acidosis Type II
c
Excessive REABSORPTION of CALCIUM
a. Cystinuria (Cystine
and Dibasic AA)
b. Bartter’s Syndrome
c. Idiopathic
Hypercalciuria
d. Hypocalciuric Familial
Hypercalcemia
d
Excessive REABSORPTION of SODIUM
a. Gordon’s Syndrome
b. Bartter’s Syndrome
c. Idiopathic
Hypercalciuria
d. Hypocalciuric Familial
Hypercalcemia
a
EXCESSIVE REABSORPTION of PHOSPHATE
a. Gordon’s Syndrome
b. Bartter’s Syndrome
c. Pseudohypo
parathyroidism
d. Hypocalciuric Familial
Hypercalcemia
c
Generalized LOSS OF PROXIMAL TUBULAR FUNCTION
a. Gordon’s Syndrome
b. Bartter’s Syndrome
c. Pseudohypo
parathyroidism
d. Fanconi Syndrome
d
NOT REABSORBED form the ULTRAFILTRATE & EXCRETED in the
URINE
WAGCPP
water
AA
glucose
calcium
phosphorous
potassium
Impaired ability to REABSORB PHOSPHATE
a. Renal Salt-Losing Disorder
b. Familial Hypophosphatemia
(Vitamin D Resistant
Rickets)
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Idiopathic Hypercalciuria
b
Impaired ability to REABSORB CALCIUM
a. Renal Salt-Losing Disorder
b. Familial Hypophosphatemia
(Vitamin D Resistant
Rickets)
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Idiopathic Hypercalciuria
c
Impaired ability to ACIDIFY URINE
a. Renal Salt-Losing Disorder
b. Familial Hypophosphatemia
(Vitamin D Resistant
Rickets)
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Renal Tubular Acidosis (Types I and IV)
e
Impaired ability to RETAIN SODIUM
a. Renal Salt-Losing Disorder
b. Familial Hypophosphatemia
(Vitamin D Resistant
Rickets)
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Renal Tubular Acidosis (Types I and IV)
a
Impaired ability to CONCENTRATE URINE
a. Renal Salt-Losing Disorder
b. Familial Hypophosphatemia
(Vitamin D Resistant
Rickets)
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Renal Tubular Acidosis (Types I and IV)
d
Excessive reabsorption of SODIUM
a. Renal Phosphaturia
b. Liddle’s Syndrome
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Renal Tubular Acidosis (Types I and IV)
b
Inability to REABSORB INORGANIC PHOSPHATES
a. Renal Phosphaturia
b. Liddle’s Syndrome
c. Idiopathic Hypercalciuria
d. Nephrogenic Diabetes
e. Renal Tubular Acidosis (Types I and IV)
a
- Urethra (Urethritis)
- Bladder (Cystitis)
Painful Urination (Dysuria)
Burning Sensation
Frequent urge to urinate
a. Upper UTI
b. Chronic Pyelonephritis
c. Lower UTI
d. Yeast Infections
c
- Renal Pelvis Alone (Pyelitis)
- Renal Pelvis including Interstitium (Pyelonephritis)
a. Upper UTI
b. Chronic Pyelonephritis
c. Lower UTI
d. Yeast Infections
a
bacterial infection that involves the renal tubules, interstitium, & renal pelvis
a. Upper UTI
b. Chronic Pyelonephritis
c. Lower UTI
d. Acute Pyelonephritis
d
develops when permanent inflammation of renal tissue causes permanent scarring that involves the renal calyces and pelvis
a. Upper UTI
b. Chronic Pyelonephritis
c. Lower UTI
d. Acute Pyelonephritis
b
allergic response to the interstitium of the
kidney
a. Yeast Infections
b. Chronic Pyelonephritis
c. Acute Interstitial Nephritis
d. Acute Pyelonephritis
c
Candida species (e.g. Candida albicans) – normal flora of GIT & vagina
a. Yeast Infections
b. Chronic Pyelonephritis
c. Acute Interstitial Nephritis
d. Acute Pyelonephritis
a
most common cause of Acute Interstitial Nephritis
Acute Allograft Rejection of a transplanted kidney
Types of vascular diseases
Acute Renal Failure
Chronic Renal Failure
Calculi
Acute renal failure clinically sudden in:
DAO
1. DECREASE of GFR
2. Azotemia
3. Oliguria (Urine Output <400Ml)
Acute renal failure mechanism: result from DECREASE renal blood flow (25% of cases)
a. Pre-renal
b. Renal
c. Post-renal
a
Acute renal failure mechanism: (Approx. 65% of cases) renal damage, can result from glomerular, tubular or vascular disease process
a. Pre-renal
b. Renal
c. Post-renal
b
Acute renal failure mechanism: – (Approx. 10% of cases) obstruction in the urine flows
a. Pre-renal
b. Renal
c. Post-renal
c
Progressive LOSS of RENAL FUNCTION caused by: IRREVERSIBLE & INTRINSIC RENAL DISEASE
chronic renal failure
Decreasing GFR slowly but continuously DECREASES
chronic renal failure
“END-STAGE RENAL DISEASE” / “END-STAGE KIDNEYS”
chronic renal failure
these can be seen in renal calyces, pelvis, bladder, ureter
Stones
Stones/calculi percentage
Calcium- 75%
w/ oxalate- 35%
w/ phosphate- 15%
w/ others- 25%
Magnesium ammonium phosphate- 15%
Uric acid- 6%
Cystine- 2%
