Nephro-UA and Hematuria Flashcards
What are acanthocytes?
Acanthocytes or erythrocytes of different sizes and shapes, particularly with vesicle shaped protrusions
What do acanthocytes suggest about the pathology?
Glomerulonephritis, especially with RBC casts
What do leukocyte casts suggest?
Pyelo or another nephritis
Eosinophils in the urine?
Allergic reaction atheroembolic disease rapidly progress glomerulonephritis small vessel vasculitis parasite infection
Muddy brown casts?
ATN
Urine crystals: Morphology/shape? Associated conditions?
CALCIUM OXALATE
shape: envelope, dumbbell, needle
associated conditions: hypercalciuria, calcium oxalate stones, ethylene glycol poisoning
Urine crystals: Morphology/shape? Associated conditions?
CALCIUM PHOSPHATE
Shape/morph: prism, needle, star-like clumps
Associated conditions: Distal renal tubular acidosis, tumor lysis syndrome
Urine crystals: Morphology/shape? Associated conditions?
URIC ACID
Rhomboid; needle; rosette
Associated conditions: diabetes mellitus, obesity, gout, hyperuricemia, tumor lysis syndrome, urine pH<6
Urine crystals: Morphology/shape? Associated conditions?
MAGNESIUM AMMONIUM (struvite)
Coffin-lid
chronic UTI with urease producing organisms
Urine crystals: Morphology/shape? Associated conditions?
CYSTINE
Hexagonal
Associated conditions: Cystinuria
What pathology is suggested by isomorphic erythrocytes?
tumor, stone, infection
What are life-threatening and clinically urgent causes of hematuria?
Rapidly progressive glomerulonephritis, urinary tract malignancy
How should asymptomatic microhematuria be evaluated?
CT urography, except in patients with chronic kidney disease, pregnant patients, or patients allergic to contrast
Cystoscopy should be performed in patients over 35 years old or those with risk factors for a urologic malignancy
What is glomerular hematuria and what does it suggest?
Glomerular hematuria shows brown or tea colored urine with dysmorphic erythrocytes (or acanthocytes) and or erythrocyte casts on urine sediment exam. May suggest a vasculitis
In asymptomatic patients, should a UA be used to screen for bladder cancer?
No
Page 8, review the clinical evaluation of hematuria. What is the first step for evaluating hematuria
Retest to confirm the hematuria
What are causes of transient hematuria
exercise, trauma, menstruation
What is the evidence for glomerular hematuria?
Acanthocytes or erythrocyte casts, reduced kidney function, evidence of systemic illness (fever, rash, joint pain), proteinuria >+1
What is the evidence for nonglomerular hematuria?
isomorphic erythrocytes, passage of pure blood clots
If nonglomerular hematuria is expected, what do you test for first?
A UTI
If someone has glomerular bleeding what do you do?
Nephro evaluation and possible kidney biopsy, kidney ultrasound
If you have nonglomerular bleeding and a UTI has been ruled out.. then what?
1-you assess risk factors for malignancy
- no risk: follow-up evaluation and repeat UA
- low risk: upper tract imaging==US vs helical CT followed by cytology or cystoscopy depending on how aggressive you want to be
- high risk: perform complete evaluation with upper tract imaging, cytology, cystoscopy
What is usually the first imaging test of choice for evaluation of kidneys?
US
It is cheap, safe and gives info
When should a kidney biopsy be considered?
When a patient has glomerular hematuria, severely increased albuminuria, acute or chronic CKD of unclear cause, and kidney transplant dysfunction monitoring
