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CLS 1113 Introduction to Clinical Laboratory Practices. Renal Diseases. Upper Urinary Tract Renal Pelvis alone Renal Pelvis, Tubules and Interstitium (Pyelonephritis). Lower Urinary Tract Urethra (Urethritis) Bladder (Cystitis) BOTH. Urinary Tract Infections (UTI). Chemical/Physical

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urinary tract infections uti
Upper Urinary Tract

Renal Pelvis alone

Renal Pelvis, Tubules and Interstitium (Pyelonephritis)

Lower Urinary Tract

Urethra (Urethritis)

Bladder (Cystitis)

BOTH

Urinary Tract Infections (UTI)
cystitis
Chemical/Physical

Leukocyte Esterase

Nitrite

Blood

Protein

Microscopic

Increased WBC

3-4+ bacteria

Mucus

RBCs

Transitional Epi’s

NO CASTS

Cystitis

Dysuria

Lower Abdominal Pain

acute pyelonephritis
Acute Pyelonephritis
  • 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.
acute pyelonephritis5
Chemical/Physical

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

Acute Pyelonephritis
chronic pyelonephritis cpn
Chronic Pyelonephritis (CPN)
  • 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
chronic pyelonephritis
Chemical/Physical

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

Chronic Pyelonephritis
glomerulonephritis
Acute Glomerulonephritis

Post Streptococcal

Crescentic

Membranous

Etc.

Page 277-281

Chronic Glomerulonephritis

Table 9-5, Page 281

Glomerulonephritis
glomerulonephritis10
Glomerulonephritis
  • Inflammatory alterations of the glomeruli: Immune mediated glomerular injury.
  • Azotemia
  • Mild to moderate hypertension
  • Oliguria
  • Edema
acute glomerulonephritis
Chemical/Physical

4+ blood

Protein

Microscopic

 RBC’s

 WBC’s

 RTE’s

Red Cell Casts

Hemoglobin Casts

Granular Casts

Acute Glomerulonephritis
nephrotic syndrome
Nephrotic Syndrome
  • A complication of numerous disorders characterized by:
    • Proteinuria
    • Hypoalbuminemia
    • Hyperlipidemia
    • Lipiduria
    • Edema
nephrotic syndrome13
Chemical/Physical

4+ protein

Blood

Microscopic

Fatty Casts

Casts: All types

Waxy, RTE

Oval Fat Bodies

Free fat globules

RTE’s

RBC’s

Nephrotic “Syndrome”
amino acid disorders
Amino Acid Disorders
  • Cystinuria
  • Tyrosinuria
  • Phenylketonuria
  • Maple Syrup Urine Disease
cystinuria
Cystinuria
  • 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
tyrosinuria
Tyrosinuria
  • 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.
phenylketonuria pku
Phenylketonuria (PKU)
  • 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?
maple syrup urine disease
Maple Syrup Urine Disease
  • 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.