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Renal -- Amanda > UA > Flashcards

UA Flashcards

1
Q

What are these?

A

Calcium oxlate crystals

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2
Q

How long after urine collection should UA be run to be considered fresh?

Why do you centrifuge the sample?

A

60 min

Produce supernatant for dipstick and sediment for light microscopy

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3
Q

Specific gravity vs. urine osmolarity

A

SG = weight and number of solutes in urine

Osm = number of solutes in urine

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4
Q

What is the max dilution possible for urine in SG and osm?

A

1.002

~50

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5
Q

What is the max concentration of urine in SG and osm?

A

1.030

1200

(urine can’t be more concentrated than medullary interstitium tonicity)

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6
Q

What is the normal pH range of urine?

Under what condition would be it be >7.5?

A

5.0-6.5

UTI with urea-splitting bacteria (Klebsiella, proteus)

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7
Q

What is the most common type of nephrolithiasis?

A

Calcium oxlate

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8
Q

What happens to urine pH in a pt with metabolic acidosis?

A

<5.3

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9
Q

Diagnosis for each pt?

Pt 1: UA shows glucose+ and BS is 190

Pt 2: UA shows glucose + and BS is 90

A

Pt 1 = DM

(Tm of glucose transporters exceeded when BS>185)

Pt 2 = Proximal tubular dysfunction

(normal BS with glucosuria = problem with PT)

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10
Q

Fanconi’s syndrome (multiple myeloma, heavy metal poisoning) is associated with which UA finding?

A

Glucosuria

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11
Q

What this is?

What causes this appearance?

A

Crenated RBCs

RBCs in concentrated supernatant = loss of cell volume

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12
Q

Three conditions causing ketonuria

A

Fasting

DKA

Alcoholic ketoacidosis (AKA)

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13
Q

What ketoacids are picked up by dipstick?

What would be the tonicity of urine of such a pt?

A

Acetate, acetoacetate

Hypotonic (ketoacids cause osmotic diuresis)

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14
Q

What would you see in the urine of pt with liver dz?

A

Unconjugated bilirubin, urobilinogen,

(conjugated bilirubin is water insoluble so not in urine)

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15
Q

What disease may cause this?

A

Homocystinuria

(flat, 6-sided crystals)

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16
Q

What would cause + nitrite on UA?

What other finding might you expect?

A

UTI by nitrate-reducing bacteria (Gram -)

pH 7.5-8

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17
Q

What organism is the most likely cause of a + urine nitrite?

A

E coli

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18
Q

What would you expect to see on a UA of a pt with SLE?

Can a UTI cause the same finding?

A

Leukocyte esterase

(+ when increased # of PMNs in urine)

Yes

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19
Q

What is this?

A

Fatty casts

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20
Q

The most excreted protein under normal conditions also make up what type of cast?

A

Hyaline cast

(Tamm-Horsfall protein)

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21
Q

Normal protein excretion is <___ mg/d of what types of protein?

A

< 150mg/day of Tamm-Horsfall protein, LMW protein, and micro-albumin

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22
Q

What would you order to get a qualitative measure of urine protein? Quantitative?

A

UA

24 hr urine collection

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23
Q

What can we use to estimate quantitative proteinuria since 24 hour collection is difficult?

What value suggests nephrotic syndrome?

A

Spot urine sample (urine protein:creatinine)

5g/24hr = nephrotic range

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24
Q

What disease can cause this?

A

ATN, nephrotic syndrome, chronic renal failure

(granular cast)

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25
Q

What protein is measured by dipstick?

How can you measure all protein?

A

Albumin

Sulfosalicyclic acid

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26
Q

+ sulfosalicyclic acid test means what?

Give an example of disease that could cause this.

A

Tubular proteinuria

(LMW proteins exceed reabsorptive capacity of PT)

Light chain proteinuria (Bence-Jones proteins) in multiple myelome

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27
Q

3+ dipstick proteinuria suggests what?

A

Glomerular proteinuria

(increased permeability of glomerulus so albumin can get through)

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28
Q

What is overflow proteinuria?

What would you see on UA?

A

Excess production of LMW proteins exceeds resorptive capacity of PT

  • dipstick (albumin can’t get through intact glomeruli), + sulfosalicyclic acid
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29
Q

How to tell glomerular vs tubular proteinuria

A

Glomerular = + dipstick, + sulf acid, albumin

Tubular = - dipstick, + sulf acid, LMW protein

30
Q

What is this composed of?

A

Tamm-Horsfall protein

(Hyaline cast)

31
Q

What would you measure on UA to assess kidney stones?

A

Calcium, phosphorus, uric acid

32
Q
  • urinary anion gap =

+ urinary anion gap =

A
  • = high urinary NH4+ = GI loss of bicarb

+ = low urinary NH4+ = RTA = unable to excrete acids

(NH3 binds H+ in lumen when acid is secreted)

33
Q

How do you calculate urinary anion gap and under what condition do you?

How does this compare to the calculation for plasma anion gap?

A

UAG = Na + K - Cl; to determine hyperchloremic MA

PAG = Na - HCO3 - Cl

34
Q

What finding is pathognomonic for nephrotic syndrome?

A

Fatty casts

Maltese crosses on bifringence

35
Q

How do you determine if + blood on UA is due to RBC or myoglobin/Hb?

A

Look for RBC in sediment, which will be absent if due to myoglobin/Hb

36
Q

UA + for blood most likely due to:

A

Presence of RBC in sediment

37
Q

Are RBC normally found in urine?

What would cause myoglobin or Hb to show up in urine?

A

Yes, 0-2 RBC/hpf

Rhabdo or hemolysis, respectively

38
Q

What is causing the + blood on dipstick?

No RBC casts, normal RBCs in sediment, clots in urine, albumin -

A

Extra-renal cause (i.e. hemorrhagic cystitis, bladder CA, menstruation)

39
Q

UA findings of pt with glomerulonephritis:

Blood?

RBC casts in sediment? If so, shape?

Protein?

Clots?

A

+

+, dysmorphic

+

-

40
Q

Why is proteinuria associated with glomerular cause of hematuria but not extra-renal causes?

A

Duh! If glomerulus is messed up enough that blood gets through, protein will get through, too. If blood is extra-renal, the glomerulus is fine and won’t filter blood or protein!

41
Q

What is pathognomonic for renal dysfunction?

A

RBC casts

(if absent, look for extra-renal cause of hematuria)

42
Q

Name some causes of RBC casts.

A

Glomerulonephritis (IgA nephropathy, PSGN, Goodpasture)

Malignant HTN

Renal ischemia

Vasculitis

43
Q

Why are RBCs dysmorphic in the sediment of pt with renal origin hematuria?

A

They get beat up as the pas through the glomerulus

44
Q

What is this?

A

WBC cast

(Granular cytoplasm, irregular nuclei)

45
Q
A
46
Q

What type of cell in urine is called “glitter cell”? Why?

Causes of this finding?

A

WBC, intracellular components shine in fresh specimen

Anything inflammatory = UTI, pyelonephritis, allergic interstitial nephritis, intense glomerulonephritis, Lupus

47
Q

What is the largest cell in the field?

A

Tubular epithelial cell

(hard-boiled egg; not a great example)

48
Q

What does this finding tell you about renal function?

A

Nothing! This is a squamous epithelial cell (abundant cytoplasm) and is found lining the lower urinary tract = nothing to do with kidney

49
Q

What is hallmark finding of ATN?

A

Tubular epithelial cell

(hard-boiled egg; think: if tubule is necrotizing, you should see the cells in the urine)

50
Q

A marathon runner is likely to have what cast after finishing a race?

A

Hyaline cast

(Volume depletion = hyaline cast)

51
Q

What is the matrix of all casts? Where is this produced?

A

Tamm-Horsfall protein in TALH

52
Q

Dx?

A

Chronic kidney disease

(waxy cast = large, white outline, sometimes cracked, acellular, sharp broken ends)

53
Q

What are the arrows pointing to?

What would cause this finding?

A

WBCs, inflammation

54
Q

Name two conditions that could cause this finding

A

Tumor lysis syndrome, gout

(uric acid cystals = rhomboid)

55
Q

What are “coffin-lid crystals”?

Cause?

A

Triple phosphate

Infection

56
Q

Dx?

A

ATN (ethylene glycol, acute transplant rejection, heavy-metal poisoning)

(hard-bolied egg)

57
Q

Dx?

A

Nephrotic syndrome

(fatty casts are pathognomonic for nephrotic synd)

58
Q

Why do these casts form?

A

Breakdown of cellular debris

Very non-specific finding, can be ATN, nephrotic syndrome, chronic renal failure

59
Q
A

Ca ox crystals

60
Q

Casts associated with ATN?

A

Tubular epithelial (hard-bolied egg)

Granular

61
Q

Name a condition in which you would see these in urine?

A

WBC

62
Q

Dx?

A

Chronic renal failure

63
Q

Dx:

Urine with protein and lipid

A

Nephrotic syndrome

64
Q

Dx:

Protein, hematuria, RBC casts

A

Nephritic syndrome

65
Q

Dx:

Hematuria, heavy proteinuria, RBC casts, lipiduria

A

Mixed nephrotic/nephritic syndrome

66
Q

Dx:

Granular casts, SG 1.010, hematuria

A

Tubular damage

(can also have tubular epithelial cells)

67
Q

Why does tubular injury cause SG of 1.010?

A

Lose ability to concentrate urine so it matches osmolarity of plasma, 300 mOsm ~ 1.010

68
Q

What is pyuria?

A

Pus in urine

69
Q

Sterile pyuria

A

Inflammatory tubulitis

70
Q

Dx:

Pyuria, bacturia, hematuria, SG 1.010

A

Pyelonephritis

Renal -- Amanda (4 decks)

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