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Unit 7 > Renal Syndromes and Urinalysis > Flashcards

Renal Syndromes and Urinalysis Flashcards

1
Q

the kidney size is considered large if it is what size and what about small

A

Large if greater than 12 cm and small if less than 9 cm.

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2
Q

What are some diseases related to large kidney size

A

-solitary kidney
-polycystic kidney disease
-diabetes
-amyloidosis
acute renal failure
-infiltrative kidney (lymphoma)
-AIDs nephropathy

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3
Q

What are some diseases associated with small kidney size

A
  • chronic GN
  • chronic hypertension
  • bilateral renal artery stenosis
  • congenital hypoplasia
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4
Q

the kidney can become too thin in what conditions and what manifestations can it present with

A

in chronic renal disease and obstruction. the cortex contains glomeruli and if the cortex is very thin, the number of glomeruli is reduced and there will be irreversible renal dysfunction

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5
Q

what are some common abnormalities of renal disease

A
  1. Urine abnormaities
  2. Edema (preorbital or generalized)
  3. Disturbances of micturition: such as oliguria, anuria, nocturia, polyuria
  4. Uremia(leads to fatigue, weakness, anorexia, bone or abd pain, poor appetite)
  5. Hypertension
  6. Renal colic
  7. Urinary tract infection (dysuria)
  8. Electrolyte disorders (increase in creatinine)
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6
Q

what are the two asymptomatic urinary abnormalities?

A

isolated hematuria and orthostatic proteinuria

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7
Q

if your abnormality of renal disease is uremia, you will need

A

dialysis

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8
Q

Patient who is 19-20 years old comes in for a routine checkup and is diagnosed with the most common glumerulonephritis in the world. WHat is it and what can it lead to?

A

IgA nephropathy and it is due to isolated hematuria

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9
Q

What are the some of the common causes of isolated hematuria?

A
  • IgA nephropathy
  • Alport’s syndrome
  • Thin basement membrane
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10
Q

In this patient, the creatinine level may be around 18 and they can also present with deafness as a child

A

Alport’s syndrome

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11
Q

What is the normal width compared to the width of the basement membrane in someone suffering from the genetic disease thin membrane (also causes isolated hematuria)

A

from normal 270 to a range of 100-120 nm.

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12
Q

Patient around the age 18-30 presents wth proteinuria in the upright position but no prooteinuria in the supine position. What is your suggestion for the patient?

A

These patients might be totally healthy except for the orthostatic proteinuria. Young patients may present with this abnormality.

Here is the recommended suggestion:

  1. Collect the urine in daytime(upright) and night time(suppine) in two different containers. If the daytime collection is higher than night then they have orthostatic proteinuria
  2. Patients do not need a nephrology consult. No renal biopsy or treatment is needed. Follow these patients is all you need to do. Very few end up developing end stage renal disease requiring dialysis or transplantation.
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13
Q

what does the Tubulointerstitial disease affect mostly? What is generally spared?

A

The TIDs affects both the renal interstitium and tubules. The glomeruli and renal vasculature are generally spared

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14
Q

What are the two types of Tubulointerstitial disease and which presentation leads to acute tubulointerstitial disease

A
  • acute tubulointerstitial disease usually seen in the hospital setting. Becuase the patient is receiving antibiotics and other drugs can give this to them.
  • chronic tubulointerstitial disease- usually irreversible
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15
Q

What levels go up in acute tubulointerstitial disease and what is the treatment?

A

Levels in creatinine rise acutely and you can treat the patient with prednisone and it usually resolves.

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16
Q

What are the characteristics of chronic tubulointerstitial disease?

A
  • It is usually caused by antibiotics, metals, and diseases (sarcoidosis and TB). Even analegics such as tylenol can cause chronic tubulointerstitial disease after years of use.
  • It is irreversible and may not respond to prednisone
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17
Q

What does chronic tubulointerstitial disease lead to and what will be the final stage of the patient

A

Chronic TID will lead to chronic kidney disease. These patients can die from infections and other complications of CKD but few progress to end stage renal disease

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18
Q

what vascular diseases affect the kidneys discussed in this lecture?

A
  • atherosclerotic renal vascular disease (renal artery stenosis)
  • hypertensive renal vascular disease (hypertensive nephrosclerosis)
  • Systemic vasculitis (Wegners granulomatosis)
  • Microangiopathic diseases (Hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, can also have renal involvement. Treatment of choice for TTP is plasmapheresis.
  • Renal vein thrombosis
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19
Q

what lab value increase would you expect to see in a patient with a systemic vasculitis and what can be its association

A

rise in creatinine with a rapidly progressive glomerulonephritis

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20
Q

what is the treatment of choice for microangiopathic diseases such as thrombotic thrombocytopenic purpura?

A

Plasmapheresis, without it they will die

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21
Q

What causes renal vein thrombosis as discussed in this lecture?

A

Nephrotic syndrome. These patients are prone to develop thrombosis (i.e. renal vein thrombosis, pulmonary embolism)

22
Q

what should a normal urine analysis look like

A

light yellow to amber

23
Q

what are the causes of red color urine

A

hematuria, hemoglobin, myoglobin, beets, rifampin

24
Q

what are the causes of orange color urine

A

bilirubin, pyridium (drug to treat cystitis)

25
Q

what are the causes of black color urine

A

malignant melanoma (due to melanin), black water fever(malaria)

26
Q

what are the causes of blue color urine

A

pseudomonas infection, methylene blue

27
Q

what are the causes of white color urine

A

chyle (filariaiss, pulmonary TB, obstruction of thoracic duct) Phosphates, pyuria (WBCs)

28
Q

how much can the kidney dilute the urine down to and how much can it concentrate it up to

A

50 milliosmoles and concentrate it up to 1200 milliosmoles

29
Q

A 12 year old child presents with back pain due to calcium oxalate stones. According to this lecture what can you find in this childs urine

A

alkaline urine with a urine pH above 6.5. Even if you hydrate the patient, the urine pH stays constantly above 7. This is distal renal tubular acidosis due to kidney stone formation.

30
Q

The body generates hydrogen ions which need to be excreted and so it can alter the pH of the urine. What is the normal range of the pH of the urine

A

about 4.5-6.5

31
Q

Glucose should not appear in the urine. The three conditions discussed in this lecture that may give you glucose in the urine are?

A
  1. Diabetes mellitus
  2. Fanconi syndrome
  3. Normal pregnancy. This is because the GFR is increased in pregnancy causing more glucose to be filtered. Saturation of the tubules leads to this
32
Q

Patient with amyloidosis, Bence Jones proteinuria, or multiple myeloma comes in and you measure their urine with a dipestick. What should be your expected results?

A

The presence of dipstick negative protein but sulfosalycic acid precipitation of protein is an indication of proteins other than albumin in the urine. Adding sulfrosalycic acid to the urine will cuase the formation of a white precipitate. The dipstick only measures albumin and not light chains.

33
Q

Cocaine and heroin Patient comes in and has a creatinine of 4 and a creatine kinase of 100,000 after exercise with a 4+ for blood on the urine dipstick, but you only see 2-3 RBCs. What are the associated diseases and what can you rule out

A

It is not hematuria. Instead this is hemoglobinuria or myoglobinuria and its due to rhabdomyoloysis, Rhabdomyolysis can be caused by statins, cociane, heroin use or exercise.

34
Q

what results lead to a diagnosis of hematuria

A

2+ on dipstick, lots of RBCs present on microscopy

35
Q

it is normal to see larger amount of squamous epithelial cells in the urine of

A

females compare to males

36
Q

Patient comes in and has a large number of ear-shaped cells in the urine sediment what will you consider the patient to have most of the time and presentation will confirm your diagnosis. What can be your differential diagnosis

A

If you see a larger number of pear-shaped cells then the most common diagnosis is cystitis. Furthermore you can conclude that if they present with burning sensation when urinating. IF they do not have the burning sensation then it may be bladder carcinoma

37
Q

You find about 3-5 transitional cells in your urine sediment, where did they come from and what is your diagnosis

A

Normal to have transitional cells coming from the bladder that are pear-shaped.

38
Q

Patient comes in with 6 renal epithelial cells on urine sediment what would you expect the patient to have and what additional tests can you perform and what is the renal epithelial cells

A

Renal epithelial cells are larger than RBCs and WBCs and have a large nucleus. Renal epithelial cells come from the tubular epithelium and they can be present in the urine. 2-3 renal epithelial cells are common in the urine because of turnover. But if you see 6 renal epithelial cells in the urine, the patient has acute tubular necrosis. If a patient has a creatinine of 2-16 and has a large number of renal epithelial cells in the urine, they have acute tubular necrosis

39
Q
  • Most common type of cast
  • Have refractile index as glass.
  • Can be present in normal or abnormal urine
  • Form via precipitation of Tamm-Horsfall mucoproteins
  • The tamm-horsfall mucoproteins are rounded up into a cylindrical shape and are excreted in the form of a ______
A

Hyaline cast

40
Q
  • Second most common type of cast
  • Result from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (albumin) or immunoglobulin light chains
  • Seen in normal patients with normal creatinine
  • Can be seen in dehydrated patients
  • both present in abnormal or normal urine
A

granular casts

41
Q
  • not normal to see in urine
  • usually present in patients with UTI or interstitial nephritis
  • Patients with both glomerular disease and interstitial disease exhibit this
A

WBC casts

42
Q
  • signifies acute tubular injury or necrosis.
  • not in normal urine
  • have tamm-horsfall mucoproteins
A

renal tubular epithelial cell casts

43
Q

-small anucleate bodies commonly seen with glomeruar nephritis as well as Hypertension

A

RBC casts

44
Q
  • seen in glomerular nephritis

- when the urine is dilute, the RBCs are lysed and they impart these casts in the urine

A

hemoglobin casts in the urine

45
Q
  • larger than RBCs
  • Under polarized light they exhibit a maltese cross pattern
  • embedded in Tamm-horsfall mucoproteins
  • seen in patients with nephrotic syndrome due to lipiduria
A

oval fat bodies

46
Q
  • composed of Tamm-horsfall mucoproteins formed in the collecting duct
  • present in the urine of patients with chronic kidney disease
  • have a creatinine of 2
A

Waxy cast

47
Q
  • present in abnormal and normal urine
  • patient can possibly present with ethylene glycol (antifreeze) toxicity with severe osmolal gap and high anion gap metabolic acidosis
  • envelope-like crystals on microscopy
A

calcium oxalate

48
Q

-indicative of an infectious process
-triple phosphate crystals containing ammonium, magnesium, and phsophate
-occur in urine of UTI because of gram negative bacteria
-

A

coffin lid crystals

49
Q

-hexagonal shape

A

cystine crystals

50
Q

Respectively, Rod shape, Clump, Chains

A

E.coli, staph, strep

Unit 7 (13 decks)

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