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TCD 23 - Glomerulonephritis and PKD > Investigations for glomerular disease > Flashcards

Investigations for glomerular disease Flashcards

1
Q

What is an abnormal RBC count on urine microscopy?

A

≥3 RBCs/HPF

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2
Q

What would RBC look like on microscopy for glomerular disease and why?

A

Dysmorphic RBCs
• Distortion of RBC cytoskeleton occurs when the cells first pass through the glomerular membrane gaps and then along the renal tubules

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3
Q

What may cause RBCs on urine microscopy?

A
  • UTIs
  • Renal stones
  • Catheter
  • Coagulopathy
  • Glomerulonephritis
  • Haemolytic anaemias
  • Renal TB
  • Menstrual blood
  • Vigorous exercise
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4
Q

What is an abnormal WBC count on urine microscopy?

A

> 5 WBCs/HPF

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5
Q

What may cause WBCs on urine microscopy?

A
  • UTI
  • Catheter
  • Urologic malignancy
  • Chronic interstitial nephritis
  • Interstitial cystitis
  • Intra-abdominal inflammatory process adjacent to GU tract
  • Contamination with vaginal secretions
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6
Q

What is uric acid crystal formation promoted by?

A
  • Acidic urine
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7
Q

When are uric acid crystals seen?

A
  • Tumor lysis syndrome
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8
Q

What is calcium phosphate crystal formation promoted by?

A
  • Alkaline urine
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9
Q

What is struvite (magnesium ammonium phosphate) crystal formation promoted by?

A
  • Alkaline urine
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10
Q

When are struvite (magnesium ammonium phosphate) crystals seen?

A
  • UTIs by urease-producing enzymes (Proteus, Klebsiella)
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11
Q

What is calcium oxalate dihydrate crystal formation independent of?

A
  • Urine pH
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12
Q

What is calcium oxalate monohydrate crystal formation independent of?

A
  • Urine pH
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13
Q

When are calcium oxalate monohydrate crystals seen?

A
  • Ethylene glycol ingestion (antifreeze)
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14
Q

What is cystine crystal formation promoted by?

A
  • Acidic urine
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15
Q

When are cystine crystals seen?

A
  • Cystinuria
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16
Q

What are hyaline casts and when are they seen?

A
  • Only precipitated Tamm-Horsfell protein withou other constituents
  • Dehydration
17
Q

What are muddy brown casts indicative of?

A

Acute Tubular Necrosis (ATN)

18
Q

What are waxy casts indicative of?

A

Non-specific indication towards acute and chronic kidney diseases

19
Q

What are fatty casts and when are they seen?

A
  • Contain yellow-tan fat globules

- Nephrotic syndrome

20
Q

What are pigment casts?

A

Contains one of several coloured compounds (heme, bilirubin)

21
Q

What are granular casts?

A

From degeneration of a cellular cast

22
Q

When are RBC casts seen?

A

Glomerulonephritis

23
Q

When are WBC casts seen?

A

Interstitial inflammation

- Can be infectious or non-infectious

24
Q

What is normal excretion of protein?

A

<150mg

25
Q

What investigations would you order for suspected glomerular disease?

A
  • FBC
  • BP
  • Renal biopsy
  • Renal profile (U+Es, eGFR, PCR)
  • Bone profile (Ca2+, Phosphate, Vitamin D, PTH)
  • Lipid profile
  • Coagulation screen
  • HbA1c
  • ESR CRP
  • Immunology screen
  • Myeloma screen (Bence Jones protein)
  • Hepatitis serology

TCD 23 - Glomerulonephritis and PKD (6 decks)

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