RENAL PATHOLOGY 1 Flashcards
Red colored urine suggests the presence of?
hemoglobin, myoglobin, or red blood cells
Cloudy or turbid urine suggests the presence of?
Protein, crystals, cells or casts
hematuria from hemolysis
hemoglobinuria
hematuria from skeletal muscle injury or rhabdomyolysis
myoglobinuria
Dysmorphic RBC
Glomerular injury
the higher specific gravity of urine indicates?
Likely SIADH
Urine protein +4 protein
More than 3.5 gm/24 hours; likely nephrotic syndrome
Bence-Jones and LARGE hyalin cast in kidney
multiple myeloma
Interpreting the dipstick for blood requires comparison with the microscopic exam and generally there should be (1) on microscopic exam when there is positive blood on dipstick
red cells (erythrocytes)
If the dipstick shows blood without red cells present, then this could be (1), indicating that hemolysis has occurred (for (2) or muscle injury (for (3).
- hemoglobulinuria or myoglobinuria 2. hemoglobulinuria 3. myoglobin
If nitrite is present in urine by dipstick, it may be an indication that (1) are present
- nitrite producing bacteria
Another dipstick test for urinary tract infection is the detection of (1) which is not normally found in urine unless the white cells which express (1) are present
- leukocyte esterase
pyuria- disease
cystitis/acute pyelonephritis
Waxy cast
ESKD
The most important concept in urinalysis is that casts indicate (1)
- renal location of disease
form when cells or protein are trapped in tubules and form molds of their surroundings
casts
24-hour urine collection
Check for total protein loss
Red cells, either alone or within casts, lack nuclei so can generally be readily distinguished from (1) casts
white cell or epithelial cell
White cells are usually?
neutrophils
Eosinophils in Urine
Drug-induced allergy
Red blood cell casts generally indicate (1) and white blood cell casts indicate (2)
- glomerular inflammation/type of glomerulonephritis 2. infection within the kidney which is called pyelonephritis
Epithelial cell casts are found in (1) but often degenerate into (2)
- acute kidney injury (previously called acute tubular necrosis or ATN) 2. granular casts (muddy brown)
Protein can form casts in the renal tubules in patients with (1) which is also useful for diagnosis (if too many)
- Chronic Pyelonephritis
Stone - kidney
crystals in urine
(1) crystals tend to form in acidic urine while (2) crystals tend to form in alkaline urine
- Uric acid and cystine 2. triple phosphate
one strategy to try and prevent crystal formation is?
making urine pH more or less alkaline in order to decrease crystal formation
RBC cast
Glomerular disease
Urinalysis can be ___, ____, and ____
Macroscopic; chemical; or microscopic`
Black urine (on standing)
Alkaptonuria
Sp Gravity 1.010
CRF
Red urine: centrifuge it to differentiate RBCs from Hbemia/myoglobinuria
centrifuge the urine to see if the red color moves into the heavier pellet (indicates RBCs, i.e. hematuria) or stays in the supernatant (Hbemia or myoglobinemia)
Suger in urine
Diabetes
______ detects esterase enzyme present in certain WBCs (neutrophils and monocytes) –> indicates urinary tract infection, since seeing host response
Leukocyte esterase
Mixed flora in urine
Fistula- Crohn’s disease
Hematuria (RBC) causes
Stone, papillary necrosis, RCC, APKD, trauma, TCC, Nephritic syndrome, Infarct
Painless hematuria
TCC
Intact RBC
Likely infarct
- Result of bleeding at any point in the urinary system.
- No nuclei
) RBCs
- (b) WBCs –> Indicates ___
- Usually ____ (type of cell)
- Presence of a few is normal
- High numbers indicate inflammation or infection.
See nuclei and cytoplasm—so more internal structure
infection;
neutrophils (poly-lobed nuclei)
RBCs vs. WBCs on histo- ID Urine cast
RBCs have NO nuclei; WBCs have nuclei and are multi-lobed
necrotic papilla in urine
Acute pyelonephritis/Analgesic/Sickle cell disease
____ –> indicate glomerulonephritis (both acute and chronic; this is a more severe disorder than pyelonephritis)
RBC Casts;
__->indicate acute pyelonephritis; suggests acute inflammation (if ____) or chronic (if ___)
WBC Casts; neutrophils; lymphocytes/hyalin casts;
- Cells are large and flat.
- Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder)
Epithelial cells
Atypical epithelial cells
transitional cells carcinoma
Granular cast
Chronic kidney diseases
indicate nephrotic syndrome
Massive proteinuria/4+
Hyaline casts (appearance)_____
- A few are normal; a lot indicates ___.
- Large hyaline casts indicated ______
Colorless; Chronic pyelonephritis,
Myeloma
Stone in the kidney
Likely Ca-oxalate Crystals
•colorless; octahedron; found in acidic urine
Calcium oxalate crystals
•in cystinuria in small children; hexagon (6 sides); acidic urine
Cystine Crystals- Hexagonal
This is a crystal of_____
Calcium phosphate
•colorless; coffin-lid prism; common finding and not usually significant (pH info).; alkaline urine
Triple Phosphate Crystals
Acidic urine (Crystal types)
(1) ___: colorless; octahedron.
(2) ___: sharper borders, diamond
Calcium Oxalate Crystals;
Uric Acid Crystals;
(1) Triple Phosphate Crystals: colorless; coffin-lid prism; common finding and not usually significant (pH info).
alkaline urine
