ANALYSIS OF URINE Herce, Jolan

AND BODY FLUIDS BSMT-3B

RENAL DISEASES

INTRODUCTION Goodpasture Syndrome

Three classifications: • Attachment of a cytotoxic antibody formed during viral
1. Glomerular respiratory infections to glomerular and alveolar
2. Tubular basement membranes
3. Interstitial Clinical course: Hemoptysis and dyspnea followed by
hematuria
GLOMERULAR DISORDERS Urinalysis findings:
• result from immunologic disorders throughout the • Macroscopic hematuria
body including the kidney • Proteinuria
Immune complexes: result of immunologic reactions and • RBC casts
increased serum immunoglobulins Other tests:
Nonimmunologic causes of glomerular damage include • Antiglomerular basement membrane antibody
the following:
• Exposure to chemicals and toxins that also affect the Granulomatosis With Polyangiitis
tubules • Antineutrophilic cytoplasmic autoantibody (ANCA)
• Disruption of the electrical membrane charges as binds to neutrophils in vascular walls, producing damage
occurs in nephrotic syndrome (NS) to small vessels in the lungs and glomerulus
• Deposition of amyloid material from systemic disorders Clinical course: Pulmonary symptoms, including
that may involve chronic inflammation and acute-phase hemoptysis, develop first, followed by renal involvement
reactants and possible progression to end-stage renal failure
• Thickening of the basement membrane associated Urinalysis findings:
with diabetic nephropathy • Macroscopic hematuria
• Proteinuria
GLOMERULONEPHRITIS • RBC casts
• a sterile, inflammatory process that affects the Other tests:
glomerulus and is associated with the finding of • Antineutrophilic peripheral or cytoplasmic antibody
blood, protein, and casts in the urine
Henoch-Schönlein Purpura
Acute Poststreptococcal Glomerulonephritis • Occurs primarily in children after viral respiratory
Symptoms: infections; a decrease in platelets disrupts vascular
• fever, edema, fatigue, nausea, hypertension integrity
Course of infection: nephrogenic strains of streptococci Clinical course: Initial appearance of purpura followed
form immune complexes with their corresponding by blood in sputum and stools and eventual renal
circulating antibodies and become deposited on the involvement
glomerular membranes Urinalysis findings:
Urinalysis findings: • Macroscopic hematuria
• hematuria • Proteinuria
• proteinuria • RBC casts
• oliguria Other tests:
• RBC, hyaline and granular casts • Stool occult blood
• dysmorphic RBCs
• white blood cells (WBCs) Membranous Glomerulonephritis
Other tests: • Thickening of the glomerular membrane after IgG
• Anti–group A streptococcal enzyme tests immune complex deposition associated with systemic
disorders
Rapidly Progressive (Crescentic) Glomerulonephritis Clinical course: Slow progression to nephrotic syndrome
• more serious form of acute glomerular disease or possible remission
• Deposition of immune complexes from systemic Urinalysis findings:
immune disorders on the glomerular membrane • Microscopic hematuria
Urinalysis findings: • Proteinuria
• macroscopic hematuria Other tests:
Other tests: • Stool occult blood
• Blood urea nitrogen • Hepatitis B surface antigen
• Creatinine • Fluorescent treponemal antibody-absorption test (FTA-
• eGFR ABS)

TRANSCRIBED BY: JOLAN HERCE BSMT-3B

ANALYSIS OF URINE Herce, Jolan

AND BODY FLUIDS BSMT-3B

Membranoproliferative Glomerulonephritis Minimal Change Disease

• Cellular proliferation affecting the capillary walls or the • Disruption of the podocytes occurring primarily in
glomerular basement membrane, possibly immune children after allergic reactions and immunizations;
mediated dysfunction of T-cell immunity
Clinical course: Slow progression to chronic Clinical course: Frequent complete remission after
glomerulonephritis (CGN) or nephrotic syndrome (NS) corticosteroid treatment
Urinalysis findings: Urinalysis findings:
• Hematuria • Heavy proteinuria
• Proteinuria • Transient hematuria
Other tests: • Fat droplets
• Serum complement levels Other tests:
• Serum albumin
Chronic Glomerulonephritis • Cholesterol
• Marked decrease in renal function resulting from • Triglycerides
glomerular damage precipitated by other renal disorders
Clinical course: Noticeable decrease in renal function Focal Segmental Glomerulosclerosis
progressing to renal failure • Disruption of podocytes in certain areas of glomeruli
Urinalysis findings: associated with heroin and analgesic abuse and with HIV
• Hematuria and hepatitis viruses
• Proteinuria Clinical course: May resemble nephrotic syndrome (NS)
• Glucosuria or minimal change disease (MCD)
• Cellular and granular casts Urinalysis findings:
• Waxy and broad casts • Proteinuria
Other tests: • Microscopic hematuria
• BUN • Macroscopic or microscopic
• Serum creatinine • hematuria
• eGFR Other tests:
• Electrolytes • Drugs of abuse
• HIV tests
Immunoglobulin A Nephropathy
• Deposition of IgA on the glomerular membrane TUBULAR DISORDERS
resulting from increased levels of serum IgA • Disorders affecting the renal tubules include
Clinical course: Recurrent macroscopic hematuria after those in which tubular function is disrupted as a
exercise with slow progression to chronic result of actual damage to the tubules, as well
glomerulonephritis (CGN) as those in which a metabolic or hereditary
Urinalysis findings: disorder affects the intricate functions of the
• Macroscopic or microscopic hematuria tubules.
Other tests:
• Serum IgA Acute tubular necrosis (ATN)
• Damage to renal tubular cells caused by ischemia or
Nephrotic Syndrome toxic agents
• Disruption of the shield of negativity and damage to Clinical course: Acute onset of renal dysfunction usually
the tightly fitting podocyte barrier, resulting in massive loss resolved when underlying cause is corrected
of protein and lipid Urinalysis findings:
Clinical course: Acute onset after systemic shock • Microscopic hematuria
Urinalysis findings: • Proteinuria
• Heavy proteinuria • Renal tubular epithelial (RTE) cells
• Microscopic hematuria • RTE cell casts
• Renal tubular cells • Hyaline, granular, waxy, broad casts
• Oval fat bodies Other tests:
• Fat droplets • Hemoglobin
• Fatty and waxy casts • Hematocrit
Other tests: • Cardiac enzymes
• Serum albumin
• Cholesterol
• Triglycerides

TRANSCRIBED BY: JOLAN HERCE BSMT-3B

ANALYSIS OF URINE Herce, Jolan

AND BODY FLUIDS BSMT-3B

Fanconi syndrome Nephrogenic Diabetes Insipidus

• Inherited in association with cystinosis and Hartnup • Inherited defect of tubular response to ADH or
disease or acquired through exposure to toxic agents acquired from medications
Clinical course: Generalized defect in renal tubular Clinical course: Requires supportive therapy to prevent
reabsorption requiring supportive therapy dehydration
Urinalysis findings: Urinalysis findings:
• Glucosuria • Low specific gravity
• Possible cystine crystals • polyuria
Other tests: Other tests:
• Serum and urine electrolytes • ADH testing
• Amino acid chromatography
Renal Glycosuria
Alport Syndrome • Inherited autosomal recessive trait
• Genetic disorder showing lamellated and thinning Clinical course: Benign disorder
glomerular basement membrane Urinalysis findings:
Clinical course: Slow progression to nephrotic syndrome • Glucosuria
(NS) and end-stage renal disease Other tests:
Urinalysis findings: • Blood glucose
• Heavy proteinuria
• Microscopic hematuria INTERSTITIAL DISORDERS
• Renal tubular cells • disorders affecting the interstitium also affect
• Oval fat bodies the tubules, resulting in the condition commonly
• Fat droplets called tubulointerstitial disease
• Fatty and waxy casts
• Microalbuminuria Urinary Tract Infection
Other tests: • Ascending bacterial infection of the bladder
• Genetic testing Clinical course: Acute onset of urinary frequency and
burning; resolved with antibiotics
Uromodulin-Associated Kidney Disease Urinalysis findings:
• Inherited defect in the production of normal • Leukocyturia
uromodulin by the renal tubules and increased uric acid • Bacteriuria
causing gout • Microscopic
Clinical course: Continual monitoring of renal function • hematuria
for progression to renal failure and possible kidney • Mild proteinuria
transplantation • Increased pH
Urinalysis findings: Other tests:
• RTE cells • Urine culture
• Hematuria
• Proteinuria Acute Pyelonephritis
• Glucosuria • Infection of the renal tubules and interstitium related to
• Cellular and granular casts interference of urine flow to the bladder, reflux of urine
• Waxy and broad casts from the bladder, and untreated cystitis
Other tests: Clinical course: Acute onset of urinary frequency,
• Serum uric acid burning, and lower back pain; resolved with antibiotics
Urinalysis findings:
Diabetic Nephropathy • Leukocyturia
• most common cause of ESRD • Bacteriuria
•increased proliferation of mesangial cells and • WBC casts
increased deposition of cellular and noncellular material • Bacterial casts
within the glomerular matrix, resulting in accumulation of • Microscopic
solid substances around the capillary tufts • hematuria
• This glomerular damage is believed to be associated • Proteinuria
with deposition of glycosylated proteins resulting from Other tests:
poorly controlled levels of blood glucose. • Urine culture
• The vascular structure of the glomerulus also develops
sclerosis.

TRANSCRIBED BY: JOLAN HERCE BSMT-3B

ANALYSIS OF URINE Herce, Jolan

AND BODY FLUIDS BSMT-3B

Chronic Pyelonephritis CAUSES OF ACUTE RENAL FAILURE

• Inherited autosomal recessive trait Prerenal
Clinical course: Benign disorder • Decreased blood pressure/cardiac output
Urinalysis findings: • Hemorrhage
• Leukocyturia • Burns
• Bacteriuria • Surgery
• WBC casts • Septicemia
• Bacterial casts Renal
• Granular, waxy, • Acute glomerulonephritis (AGN)
• broad casts • Acute tubular necrosis (ATN)
• Hematuria • Acute pyelonephritis
• Proteinuria • Acute interstitial nephritis (AIN)
Other tests: Postrenal
• Urine culture • Renal calculi
• BUN • Tumors
• Creatinine
• eGFR
RENAL LITHIASIS
Acute Interstitial Nephritis Renal calculi (kidney stones): may form in the calyces
• Allergic inflammation of the renal interstitium in and pelvis of the kidney, ureters, and bladder
response to certain medication Lithiasis: calculi vary in size from barely visible to large,
Clinical course: staghorn calculi resembling the shape of the renal pelvis
Acute onset of renal dysfunction often accompanied by and smooth, round bladder stones with diameters of 2 or
a skin rash more inches
Resolves after discontinuation of medication and 1. Small calculi - may be passed in the urine,
treatment with corticosteroids subjecting the patient to severe pain radiating
Urinalysis findings: from the lower back to the legs
• Hematuria 2. Larger stones - cannot be passed and may not
• Proteinuria be detected until patients develop symptoms of
• Leukocyturia urinary obstruction
• WBC casts Lithotripsy: a procedure using high-energy shock waves,
Other tests: can be used to break stones located in the upper urinary
• Urine tract into pieces that then can be passed in the urine
• eosinophils Calcium oxalate or Calcium phosphate: Approx. 75% of
• BUN the renal calculi are composed of these stones and are
• Creatinine associated with metabolic calcium and phosphate
• eGFR disorders and, occasionally, diet
Magnesium ammonium phosphate: often are
RENAL FAILURE accompanied by urinary infections involving urea-
exists in both acute and chronic forms splitting bacteria
The progression to ESRD is characterized as follows: Uric acid: may be associated with increased intake of
• Marked decrease in the glomerular filtration rate (less foods with high purine content and with uromodulin-
than 25 mL/min) associated kidney disease
• Steadily rising serum BUN and creatinine values Cystine: seen in conjunction with hereditary disorders of
(azotemia) cystine metabolism
• Electrolyte imbalance
• Lack of renal concentrating ability, producing an
isosthenuric urine
• Proteinuria
• Renal glycosuria
• Abundance of granular, waxy, and broad casts, often
referred to as a telescoped urine sediment

TRANSCRIBED BY: JOLAN HERCE BSMT-3B