CLS 1113 Introduction to Clinical Laboratory Practices - PowerPoint PPT Presentation

CLS 1113Introduction to Clinical Laboratory Practices

Renal Diseases

Renal Pelvis alone

Renal Pelvis, Tubules and Interstitium (Pyelonephritis)

Lower Urinary Tract

Urethra (Urethritis)

Bladder (Cystitis)

BOTH

Leukocyte Esterase

Nitrite

Blood

Protein

Microscopic

Increased WBC

3-4+ bacteria

Mucus

RBCs

Transitional Epi’s

NO CASTS

Dysuria

Lower Abdominal Pain

• Acute bacterial infection of the kidney
• Hematogenous or Ascending
• Infections involve the interstitial tissues and tubules (Rarely involve the glomeruli)
• Usually sudden onset with flank pain, fever, mailaise, dysuria, frequency and urgency.

Leukocyte Esterase

Protein

Nitrite

Blood

Specific Gravity

Microscopic

TNTC WBC

2-4+ bacteria

RBC’s

Renal Epi’s

WBC Casts

RTE Casts

Granular Casts

Waxy Casts

• Chronic Tubulointerstitial Inflammation
• Scarring of renal tissue
• Pathologic involvement of renal calyces and renal pelvis
• Two forms of CPN
• Chronic Obstructive – recurrent infections
• Chronic reflux – gradual onset – Most common form

Leukocyte Esterase

Most likely Nitrite neg.

Protein – Moderate

Blood

Specific Gravity 

Polyuria & Nocturia develop as disease progresses

Microscopic

10-15 WBC

1-2+ bacteria

Granular Casts

Waxy Casts

Broad Casts

Post Streptococcal

Crescentic

Membranous

Etc.

Page 277-281

Chronic Glomerulonephritis

Table 9-5, Page 281

• Inflammatory alterations of the glomeruli: Immune mediated glomerular injury.
• Azotemia
• Mild to moderate hypertension
• Oliguria
• Edema

4+ blood

Protein

Microscopic

 RBC’s

 WBC’s

 RTE’s

Red Cell Casts

Hemoglobin Casts

Granular Casts

• A complication of numerous disorders characterized by:
• Proteinuria
• Hypoalbuminemia
• Hyperlipidemia
• Lipiduria
• Edema

4+ protein

Blood

Microscopic

Fatty Casts

Casts: All types

Waxy, RTE

Oval Fat Bodies

Free fat globules

RTE’s

RBC’s

• Cystinuria
• Tyrosinuria
• Phenylketonuria
• Maple Syrup Urine Disease

• Autosomal Recessive Inheritance
• Proximal tubules are unable to reabsorb certain amino acids:
• Cystine, arginine, lysine and ornithine
• Cystine readily ppt’s in acid pH
• Often have calculi – Cytine make up
• Table 9-8

• Overflow of Tyrosine from blood
• Several mechanism’s
• Microscopic
• Tyrosine crystals and Leucine crystals may be present in acid urine
• Confirmation made by quantitative procedures of serum.

• Autosomal Recessive inheritance
• Increased urinary excretion of phenylpyruvate (ketone) and its metabolites
• Page 296: Metabolism of Phenylalanine
• PKU’s: done on blood of newborns. Why?

• Autosomal Recessive inheritance: Rare
• Accumulation of branched chain amino acids: leucine, isoleucine and valine and their -keto acids in the blood, CSF and urine
• Distinct maple syrup or carmelized sugar odor.