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CLS 426 Urine & Body Fluid Analysis Renal Disease – Part II Tubular Disease

CLS 426 Urine & Body Fluid Analysis Renal Disease – Part II Tubular Disease. Ricki Otten MT(ASCP)SC uotten@unmc.edu. Tubular Disease. Altered tubular function Necrosis of tubular epithelium. Altered Tubular Function. Caused by Reabsorption-secretion capability lost

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CLS 426 Urine & Body Fluid Analysis Renal Disease – Part II Tubular Disease

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  1. CLS 426 Urine & BodyFluid AnalysisRenal Disease – Part IITubular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu

  2. Tubular Disease • Altered tubular function • Necrosis of tubular epithelium

  3. Altered Tubular Function • Caused by • Reabsorption-secretion capability lost • Concentrating-diluting capability lost • Results in • Build up of waste products in bloodstream • Loss of essential substances into urine

  4. Altered Tubular Function • Renal glycosuria • Glucose in urine, renal threshold not exceeded • Cystinuria • Cystinosis • Renal tubular acidosis • Tubules unable to secrete adequate H+ despite systemic acidosis Inherited disorders Cystine crystals in urine

  5. Urinalysis Findings • Renal glycosuria: + glucose • Cystinuria, cystinosis: cystine crystals • Renal tubular acidosis: pH not as acid as is needed to compensate for systemic acidosis

  6. Necrosis of Tubular Epithelium • Destruction of tubular epithelial cells • Toxin • Ischemic event • Most common cause of renal failure

  7. Necrosis of Tubular Epithelium • Clinical presentation: 3 phases • Onset • Renal failure • Azotemia • Hyperkalemia • Metabolic acidosis • Oliguria • Recovery

  8. Acute Tubular Necrosis • Toxic ATN • Drugs: Aminoglycosides Anesthetics Radiographic dyes Chemotherapy Anti-rejection drugs • Toxins: Mercury Lead Cadmium Ethylene glycol Pesticides Mushrooms

  9. Acute Tubular Necrosis • Ischemic ATN: decreased perfusion of kidneys as a result of hypotensive events • Sepsis: bacterial infection of bloodstream • Shock • Trauma

  10. Acute Tubular Necrosis • Urinalysis • Physical: Yellow, hazy • Chemical: Proteinuria (mild), +blood, low specific gravity • Microscopic: RBC, WBC, RTE Casts: RTE, granular, waxy, broad

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