Urinalysis: Renal Disease
Renal Lithiasis
kidney stones
Glomerular disorders: Immunoglobulin A (IgA) Nephropathy
known as Berger disease. Deposition of IgA on the glomerular membrane resulting from increasd levels of serum IgA. -urinary results= (early stages) macro/microscopic hematuria (late stages) same as chronic glomerulonephritis -tests= serum IgA
ischemia
lack of blood flow
Glomerular disorders: Acute Glomerulonephritis:
(AGN): deposition of immune complexes, formed in conjunction with group A Streptococcus infection, on the glomerular membranes. -Urinalysis results= macroscopic hematuria, proteinuria, RBC casts, and granular casts -Test= Anti-group A streptococcal enzyme test
azotemia
(excessive) urea and nitrogenous substances in the blood
Causes of acute renal failure: Renal
-Acute glomerulonephritis -Acute tubular necrosis -Acute pyelonephritis -Acute interstitial nephritis
Causes of acute renal failure: Postrenal
-Renal calculi -Tumors -Crystallization of ingested substances
Causes of acute renal failure: Prerenal
-decreased blood pressure/cardiac output -hemorrhage -burns -surgery -septicemia
Ischemia frequently produces: a. acute renal tubular necrosis b. minimal change disorder c. renal glycosuria d. goodpasture's syndrome
A. acute renal tubular necrosis
The most common composition of renal calculi is: a. calcium oxalate b. magnesium ammonium phosphate c. cystine d. uric acid
A. calcium oxalate
End-stage renal disease is characterized by all of the following EXCEPT: a. hypersthenuria b. isosthenuria c. azotemia d. electrolyte imbalance
A. hypersthenuria
Prerenal acute renal failure could be caused by: a. massive hemorrhage b. acute tubular necrosis c. acute interstitial nephritis d. malignant tumors
A. massive hemorrhage
Interstitial disorders: Acute interstitial nephritis (AIN)
Allergic inflammation of the renal interstitium in response to certain medications. -urinalysis results= hematuria, proteinuria, leukocyturia, WBC casts -tests= urine eosinophils, BUN, creatinine, eGFR
Glomerular disorders: Wegener Granulomatosis
Antineutrophilic cytoplasmic autoantibody binds to neutrophils in vascular walls producing damage to small vessels in the lungs and glomerulus. -urinalysis results= macroscopic hematuria, proteinuria, rbc casts -tests= Antineutrophilic peripheral or cytoplasmic antibody
Interstitial disorders: Cystitis
Ascending bacterial infection of the bladder. -urinalysis results= leukocyturia, bacteriuria, microscopic hematuria, mild proteinuria, increased pH -test= urine culture
Glomerular disorders: Goodpasture syndrome
Attachment of a cytotoxic antibody formed during viral respiratory infections to glomerular and alveolar basement membranes. -urinalysis results= macroscopic hematuria, proteinuria, rbc casts -tests= antiglomerular basement membrane antibody
Glomerular disorders: Nephrotic syndrome
Disruption of the shield of negativity and damage to the tightly fitting podocyte barrier resulting in massive loss of protein and lipids. -urinalysis results= heavy proteinuria, microscopic hematuria, RTE cells, oval fat bodies, fat droplets, and fatty/waxy casts -test= serum albumin, cholesterol, triglycerides
hemoptysis
spitting up blood
Antineutrophilic cytoplasmic antibody is diagnostic for:
Wegener granulomatosis
Glomerular disorders: Minimal Change Disease
aka lipid nephrosis: disruption of the podocytes occurring primarily in children following allergic reactions and immunizations. -urinalysis results= heavy proteinuria, transient hematuria, fat droplets -tests= serum albumin, cholesterol, triglycerides
Septicemia (sepsis)
bacteria growing and flourishing in the blood
thrombosis
blood clot
Dyspnea
difficulty breathing
mesangium
Specialized cells that hold together the renal capillary tufts.
Glomerular disorders: Membranous glomerulonephritis
Thickening of the glomerular membrane following IgG immune complex deposition assoc. with systemic disorders. -urinalysis results= microscopic hematuria, proteinuria -tests= antinuclear antibody, Hep B surface antigen, FTA-ABS, serum complement levels
Respiratory and renal symptoms are associated with all of the following EXCEPT: a. IgA nephropathy b. Wegener granulomatosis c. Henoch-Schonlein purpura d. Goodpasture syndrome
D. Goodpasture syndrome
The presence of RTE cells and cast is an indication of: a. acute interstitial nephritis b. chronic glomerulonephritis c. minimal change disease d. acute tubular necrosis
D. acute tubular necrosis
Urinalysis on a patient with severe back pain being evaluated for renal calculi would be most beneficial if it showed: a. heavy proteinuria b. low specific gravity c. uric acid crystals d. microscopic hematuria
D. microscopic hematuria
The highest levels of proteinuria are seen with: a. Alport syndrome b. diabetic nephropathy c. IgA nephropathy d. Nephrotic syndrome
D. nephrotic syndrome
Tubular disorders: Acute tubular necrosis (ATN)
Damage to renal tubular cells caused by ischemia or toxic agents -urinalysis results= Microscopic hematuria, proteinuria, RTE cells, RTE cast, hyaline, granular, waxy, and broad cast -test= hemoglobin, hematocrit, cardiac enzymes
Occasional episodes of macroscopic hematuria over periods of 20 or more years are seen with:
IgA nephropathy
Interstitial disorders: Acute pyelonephritis
Infection of the renal tubules and interstitium related to interference of urine flow to the bladder, reflux of urine from the bladder, and untreated cystitis. -urinalysis results= leukocyturia, bacteriuria, WBC casts, bacterial casts, microscopic hematuria, proteinuria -tests= urine culture
Tubular disorders: Renal glucosuria
Inherited autosomal recessive trait -urinalysis results= glucosuria -tests= blood glucose
Tubular disorders: Uromodulin-associated kidney disease
Inherited defect in the production of normal uromodulin by the renal tubules and increased uric acid causing gout. -urinalysis results= RTE cells -tests= serum uric acid
Tubular disorders: Nephrogenic diabetes insipidus
Inherited defect of tubular response to ADH or acquired from medications. -urinalysis results= low specific gravity, polyuria -test= ADH testing
Tubular disorders: Fanconi syndrome
Inherited in assoc. with cystinosis and Hartnup disease or acquired through exposure to toxic agents. -urinalysis results= glucosuria, possible cystine crystals -tests= serum and urine electrolytes, amino acid chromatography
Differentiation between cystitis and pyelonephritis is aided by the presence of: a. WBC casts b. RBC casts c. bacteria d. granular casts
A. WBC casts
Most glomerular disorders are caused by: a. sudden drops in blood pressure b. immunologic disorders c. exposure to toxic substances d. bacterial infections
B. immunologic disorder
The only protein produced by the kidney is: a. albumin b. uromodulin c. uroprotein d. globulin
B. uromodulin
The presence of WBCs and WBC casts with no bacteria is indicative of: a. chronic pyelonephritis b. acute tubular necrosis c. acute interstitial nephritis d. both b and c
C. acute interstitial nephritis
Dysmorphic RBC casts would be a significant finding with all of the following EXCEPT: a. goodpasture syndrome b. acute glomerulonephritis c. chronic pyelonephritis d. henoch-schonlein purpura
C. chronic pyelonephritis
An inherited disorder producing a generalized defect in tubular reabsorption is: a. alport syndrome b. acute interstitial nephritis c. fanconi syndrome d. renal glycosuria
C. fanconi syndrome
A disorder associated with polyuria and low specific gravity is: a. renal glucosuria b. minimal change disease c. nephrogenic diabetes insipidus d. focal segmental glomerulosclerosis
C. nephrogenic diabetes insipidus
The presence of fatty casts is associated with all of the following EXCEPT: a. nephrotic syndrome b. focal segmental glomerulosclerosis c. nephrogenic diabetes insipidus d. minimal change disease
C. nephrogenic diabetes insipidus
A teenage boy who develops gout in his big toe and has a high serum uric acid should be monitored for: a. fanconi syndrome b. renal calculi c. uromodulin-associated kidney disease d. chronic interstitial nephritis
C. uromodulin-associated kidney disease
Glomerular disorder: Focal Segmented Glomerulosclerosis (FSGS)
Disruption of podocytes in certain areas of glomeruli assoc. with heroin and analgesic abuse and AIDS. -urinalysis results= proteinuria, micro/macroscopic hematuria -test= drugs of abuse, HIV tests
Glomerular disorders: Membranoproliferative glomerulonephritis (MPGN)
Cellular proliferation affecting the capillary walls or the glomerular basement membrane, possibly immune-mediated. -urinalysis results= Hematuria, proteinuria -tests= serum complement levels
Glomerular disorders: Alport syndrome
Genetic disorder showing lamellated and thinning glomerular basement membrane. -urinalysis results= Micoalbuminuria -test= genetic test
Antiglomerular basement membrane antibody is seen with:
Goodpasture syndrome
Glomerular disorders: Chronic Glomerulonephritis
Marked decrease in renal function resulting from glomerular damage precipitated by other renal disorders. -urinary results= hematuria, proteinuria, glucosuria, cellular/granular casts, waxy and broad casts -tests= BUN, serum creatinine, eGFR, electrolytes
Glomerular disorders: Rapidly progressive (crescentic) glomerulonephritis
More serious form of AGN. Deposition of immune complexes from systemic immune disorders on the glomerular membrane. -Urinalysis results= Macroscopic hematuria, proteinuria, rbc casts -tests= Bun, creatinine, eGFR
Interstitial disorders: Chronic pyelonephritis
Recurrent infection of the renal tubules and interstitium caused by structural abnormalities affecting the flow of urine. -urinalysis results= leukocyturia, bacteriuria, WBC casts, Bacterial casts, granular/waxy/broad casts, hematuria, proteinuria -test= urine culture, BUN, Creatinine, eGFR
Glomerular disorders: Henoch-Schonlein Purpura (HSP)
Occurs primarily in children following viral respiratory infections; a decrease in platelets disrupts vascular integrity. -urinalysis results= macroscopic hematuria, proteinuria, rbc casts -tests= stool occult blood
