Renal - Pathology (Casts in urine & Glomerular disorders)

Question 1

What does the presence of casts in urine indicate?

Answer 1

Presence of casts indicates that hematuria/pyuria is of renal (vs. bladder) origin

Question 2

Name 6 different kinds of casts that can be found in urine.

Answer 2

(1) RBC casts (2) WBC casts (3) Fatty casts (“oval fat bodies” (4) Granular (“muddy brown”) casts (5) Waxy casts (6) Hyaline casts

Question 3

What 2 conditions cause hematuria but no casts?

Answer 3

(1) Bladder cancer (2) Kidney stones

Question 4

What condition causes pyuria but no casts?

Answer 4

Acute cystitis

Question 5

What are 3 conditions associated with RBC casts in urine?

Answer 5

(1) Glomerulonephritis (2) Ischemia (3) Malignant hypertension

Question 6

What are 3 conditions associated with WBC casts in urine?

Answer 6

(1) Tubulointerstitial inflammation (2) Acute pyelonephritis (3) Transplant rejection

Question 7

What condition is associated with fatty casts (“oval fat bodies”) in urine?

Answer 7

Nephrotic syndrome

Question 8

What condition is associated with granular (“muddy brown”) casts in urine?

Answer 8

Acute tubular necrosis

Question 9

What condition(s) is/are associated with waxy casts in urine?

Answer 9

Advanced renal disease/chronic renal failure

Question 10

What condition is associated with hyaline casts in urine?

Answer 10

Nonspecific, can be a normal finding; often seen in concentrated urine samples

Question 11

What is the defining characteristic of a focal glomerular disorder? What is an example?

Answer 11

<50% of glomeruli are involved; Focal segmental glomeruloscleroosis

Question 12

What is the defining characteristic of a diffuse glomerular disorder? What is an example?

Answer 12

> 50% of glomeruli are involved; Diffuse proliferative glomerulonephritis

Question 13

What is the defining characteristic of a proliferative glomerular disorder? What is an example?

Answer 13

Hypercellular glomeruli; Mesangial proliferative

Question 14

What is the defining characteristic of a membranous glomerular disorder? What is an example?

Answer 14

Thickening of glomerular basement membrane; Membranous nephropathy

Question 15

What is the defining characteristic of a primary glomerular disease? What is an example?

Answer 15

Involves only glomeruli, thus a primary disease of the kidney; Minimal change disease

Question 16

What is the defining characteristic of a secondary glomerular disease? What are 2 examples?

Answer 16

Involves glomeruli and other organs, thus a disease of another organ system, or a systemic disease that has impact on the kidney; SLE, diabetic nephropathy

Question 17

Which 2 glomerular diseases are considered to be both nephritic and nephrotic syndromes?

Answer 17

(1) Diffuse proliferative glomerulonephritis (2) Membranoproliferative glomerulonephritis

Question 18

What 4 glomerular diseases are considered to be only nephritic syndromes?

Answer 18

(1) Acute poststreptococcal glomerulonephritis (2) Rapidly progressive glomerulonephritis (3) Berger’s IgA glomerulonephropathy (4) Alport syndrome

Question 19

What 5 glomerular diseases are considered to be only nephrotic syndromes?

Answer 19

(1) Focal segmental glomerulosclerosis (2) Membranous nephropathy (3) Minimal change disease (4) Amyloidosis (5) Diabetic glomerulonephropathy

Question 20

What is important to consider about the clinical findings of classic nephritic disorders?

Answer 20

Classic nephritic disorders can exhibit nephrotic features