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62 Cards in this Set
- Front
- Back
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what can turbid urine be indicative of |
hematuria
leukocyturia bacteruiria |
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whats the problem
Protein +1 GLucose - Blood - Nitrates+ esterase + crystals: few Ca oxalate Casts: WBC +2 bacteria |
pyelonephritis
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whats the deal
protein +4 Glucose +2 blood - nitrate - esterasee - crystals none casts: fatty oval fat bodies |
nephrotic syndrome associated with DM
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wht does specific gravity measue
what is expected SG for first void what is low fixed SG and what is the significance |
measure of ability to conc urine (1.003-1.035)
Normal AM: 1.025 Low fixed SG: seen in end stage renal diase. SG will be about 1010 and will have polyuria, polydispia and nocutirs |
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end stage renal disease and tubulointerstitial disease shows wht on labs, whats presentation
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Low Foxed SG ~1.010
Sx: polyuria, polydipsia, nocturia |
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super alkaline urine is seen when
what is range for normal urine pH |
struvite stones
4.5-8 |
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urobilinogen normal is recorded as
when is it increased |
+1
high in: fever, hemolysis, intrinsic liver disease |
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is biliruben in the pee direct or indirect
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direct/conjungated
elevated inL intrinsic liver disease, hepatitis, biliary disease, obstriction |
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A 13 year old female noted an increase in
appetite and thirst over the past 6 months. She has lost 5 pounds and complains of polyuria but no associated dysuria. A midstream clean catch urine was obtained UA: SG 1.008 pH 5.5 protein - Glucose +4 Ketones +4 bili neg urobili +1 (normal) blood neg nitrate neg esterase neg 1-2 RBC hpf (normal) whats the dx |
DM I- 1 because of ketones
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what is the renal threshold of glucosuria
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when blood sigar >160 we get glycosuria. there is a lag from when blood sugar is that high adn we see sugar pee
140 is highest blood sugar we want to see |
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what causes glucosuria
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endstage kidney disease- glycosuria w.normal blood sugar, loose ability to reabs glucose
DM FEVER in kids drugs |
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if your kid is sick with a fever what UA abnormlaity is expected
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glycosuria, if its an infant you HAVE to get total reducing sugar exam
test for galatosemia bc its treatable |
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what thigns put ketones in the urine
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1. DM I
2. starvation 3. GI distress 4. prolonged vomit **indicated incomplete fat metabolism |
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what causes proteinuria
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renal disease:
-glomerular -tubulointerstitial -vascular NON DISEAE -exercise, cold temp, stress **protein is tamm horsfall and albumin. bence jones proteinuria tests - and is common in MM |
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the proteinuria in MM is unique why
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wont test + by UA
*bence jones protein |
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how is microalbunemia determines
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ration of albumin:creatanine
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A 3 y/o boy with puffy eyes presents to the ER.
He has become lethargic over the preceding 2 months and was treated for allergies without improvement. • On physical examination, he is noted to have generalized edema. • UA suggests what type of renal disease? • What physical findings support this? • What is the most likely cause? SG 1.020 pH 6 Protein +4 Glucose - ketones - bili - urobilinogen +1 (normal) blood - nitrite neg esterase trace oval fat bodies |
nephrotic syndrome, glomerular
supported by massive protein and oval fat body caused by minimal change disease |
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what is nephrotic urine
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proein >3.5
oval fat bodies, fatty casts Cause: minimal change disease in kids, henoch schonelien purpura |
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what causes nephrotic syndome in kids and adults
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kids: minimal change disease
adults: DM, focal segmental glomerulosclerosis Nsaids, penicillamine, carcinoma of lung/colon, hepatitis, syphalis, SLE, amyloids |
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in nephrotic syndrome we get oval fat bodies, how are they detected
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maltese cross, refractile polarized light
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proteinuria is present in WHAT renal tubule disease
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pyelonephritis
ischemic/toxic renal tubule injury acute tubular nectosis proteinuria is seen in HTN |
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An 8 y/o child presents with low‐grade fever,
arthritis, colicky abdominal pain and purpuric rash limited to lower extremities. He has a guaiac positive stool. Platelet count, PT and PTT are normal. • What type of renal disease is suggested by the UA? • What is the likely cause UA: SG 1.019 pH 6 Protein +3 glucose, ketones, bili, urobili all neg Blood +3 nitrate nef trace esterase RBC casts The UA suggests what type of disease? A) Tubulointerstitial B) Renovascular C) Nephritic pattern of glomerulonephritis D) Nephrotic syndrome |
protein, blood, RBC casts
Nephritic disease: henoch schone like palpable purpura |
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what causes + hematuria on dipstick
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blood
vit C hemoglobin myoglobin exercise vaginal bleeds prostatitis, late prosate cancer |
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what is the sig if you have + RBC and RBC CASTS
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renal disease, normally nephritic
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dysmorphic RBC are seen in...
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glomerularnephropathy
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smoky urine
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+ for blood
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does DM cause blood in urine? what are some UT causes of hemturia
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NO
1 tumors- RCC< urothelial 2. glomerulonephropathy- usually dysmorphic RBC 3. pyelonephritis 4. stones 5. polycystic kidney, medullary sponge kidney 6 thrombocytopenia, dic, anticoagulant tx |
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when does urine test + for blood but you have - RBC w//microscopy
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Myoglobin will make dipstick + for blood
-exercise, rhamdomyalysis hemoglobin -hemolysis in UT, intravascular hemolysis |
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if you have RBC w/o proteinuria where is hte bleed
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distal to kidney
**dysmorphic RBC are bc of glomerulonephropathy |
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recurrent hematuria is associated iwth what
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IgA glomerularnephropathy
IgA is in MESANGIUM |
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what disease is associated with
Hyaline/granular, few or rare RBC casts WBC casts RTE casts Fatty casts Waxy casts Bile casts Red casts, no RBCs |
Hyaline/granular: not renal disease, dehydration, stress, exercise
RBC casts WBC casts RTE casts Fatty casts Waxy casts Bile casts Red casts, no RBCs |
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what cast is NOT assocaited with renal diseasse
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hyaline, granular
assocaited w/dehydration, stress, exercise |
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what is nephritic syndrime
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mild pritein
blood HTN RBC casts indicate kidney causes: post strep glom henoch scholein purpura SLE |
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what are some common causes of nephritic syndrime (blood, prtoein, HTN)
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post strep glom- proliforative w/humps
SLE henoch schonlein purpura |
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A 22 year old African‐American female was
admitted to the hospital with swelling of the legs and a weight gain of 20 pounds over the past week. She feels extremely tired. A chest x‐ray shows bilateral pleural effusions. • UA suggest what type of renal disease? • What lab tests should be ordered? UA: protein, blood, RBC casts, NEPHRITIC syndrome |
SLE- pleural effusion, black
?? |
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waxy cast is what
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acute/chronic renal falire, severe tubular destriction
seen in advancess disease poor prognosis |
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is a waxy cast a good or bad prognosis
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bad. always end stage
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RBC casts are seen in what 3 diseases
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1 post strep
2. SLE 3. IgA nephropathy |
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RTE casts
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renal tubule epithelium
*8seen in toxic/ischemic ATN |
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post strep glomerulonephritis
SLE IgA all have what kind of cast |
RBC cast
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A large, muscular truck driver decided to have a
cigarette while unloading gasoline at a service station. • He sustained a large thigh burn with deep muscle necrosis in the explosion. • While hospitalized, he developed acute renal failure, though he was never in shock and fluids had been managed well. • The small amount of urinary output contained red casts; 3+ blood; no RBCs were seen. |
Acute renal failure caused by: ischemia, toxic, shock
UA blood but no micro blood means the UA detected hemoglobin or myoglobin from rhabdomyalysis |
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the characteristic eature og myoglobinuria is...
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UA + for blood but there is no RBC on micro
*8can have red casts but NOT RBC seen in exercise, EtOH, statins, crush injury |
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myoglobin in urine
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shows as blood on UA but NO RBC at micro
red casts caused by: exercise, EtOH, statins, CRUSH injury |
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whats nitrate
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detects bacteruria:
+ for e coli, klebsiella, proteus, staph, pseudomonas will NOT Test + for yeast and enterococci |
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can you have a UTI w/- nitrate
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ya,
nitrates dont detect yeast or enterococci |
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what does esterase
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pyuria,
+ seen in: UTI genitourinary infection |
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if esterase is - and nitrate is - whats the liklihood you have a UTI
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slim
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when do you see WBC in urine as indicated by + esterase (mainly detects PMN)
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UTI
renal disease- glomerulonephropithies stones tumors protatitis, urethritis |
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when do you see eosinophiles in urine
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drug indiced interstitial nephritits
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An afebrile 23 year old, recently married
female presents to the emergency room with suprapubic pain, dysuria, increased frequency of urination. • What is your diagnosis? • What is the most common etiologic agent? nitrate, esterase + WBC and rod shaped bacteria • What would you do next? |
honeymoon cycstitis (UTI)
caued by e coli test for nitrates, esterase |
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A 14 year old boy was brought to the family
physician because of fever of 40.6º C and shaking chills for the past day. On physical examination, he had mild costovertebral angle tenderness. • What is your diagnosis? • What should you do next? UA: ketones esterase +2 WBC RBC WBC casts, glitter cells |
pyelonephritis
**must be caused by yeast or enterococci bc nitrate is neg this young kid shoudl NOT be getting UTI, w/o for congenital abnormalities- double ureter, post valves, horseshoe kidney etc |
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This 87 year old female with Alzheimer’s
disease was brought to the emergency room from a nursing home with fever and deteriorating condition. She had been unable to take fluids by mouth for about 4 days. She has received no IV therapy. • What is the diagnosis? Creat, Bun, high albumin low Na HIGH Cl HIGH Ketones esterase+2, Nitrate lots of WBC and bacteria |
DEHYDRATED
pyelonephritis- bc of fever |
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A 30 y/o male presents to the ER with acute
onset of severe, colicky left flank pain radiating down the abdomen into the groin. He has been sleepless all night due to pain in waves. It is unrelieved by aspirin, tylenol, a six pack of beer, standing or lying. He has increased frequency of urination. • What is the likely diagnosis? • How does the UA support this? • What test is indicated next? blood oxalate crystal |
kideny stone
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what do the following crystals look like
uric acid calcium oxalate cystine triple phos |
uric acid- paralleogram or cross
calcium oxalate- look like envelopes. MUST KNOW. often not clinically sig. seen in gout and Ca calculi. seen in antifreeze poision cystine- hexagone triple phos- rectabgular |
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This 58 y/o male was found unconscious in a
ditch by cyclists and brought to the ER. • Lab: CBC: WBC 10,900; Hct 54% • Chemisties: • BUN 9 7‐22 mg/dl • Creatinine 11 <1.2 mg/dl • Uric acid 11.2 <7 mg/dl • T.protein 3.8 5.5‐8 mg/dl • Albumin 2.1 3.5‐5.0 mg/dl • Blood gases • pO2 249 receiving O2 91+7 • pH 7.13 L 7.42+.04 • pCO2 10.8 L 35‐40 • HCO3 3.1 21‐28 • Base excess 26.8 ‐3.3 to + 1.2 • Specific gravity 1.012 • pH 5 • Protein 3+ • Blood trace • Glucose 1+ • Ketone neg • Esterase trace • Nitrite neg • Many RTE cells, numerous calcium oxalate crystals |
antifreeze poision
oxolate casts and RTE cast |
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when you drink antifreeze what does UA look like
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lots of Ca oxalate crystas
RTE casts |
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what do the triple phos crystals look like
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long rectangles with three sides like
triangle seen in alkaline urine |
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if you see 8 transitional epitehlial cells per hpf in a urine sample whats the deal
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contaminatino- get a new sample
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• 57 year old male had a routine urinalysis as
part of his company’s yearly required physical examination. He has a chronic cough and a 50 pack year smoking history. His only complaints referable to the urinary tract are some mild dysuria and hesitancy but otherwise he feels fine. • What diagnosis should be considered? RBC +2, lots of transitional epithelium some is ATYPICAL |
CANCER- painless hematuria is most common presentation
Renal cell carcioma (prbly not if we see abnormal cells in UA) urothelial SMOKE is HUGE risk factor |
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• A 55 year old woman was admitted to the
hospital complaining of nosebleeds and severe headache. • She has a history of alcohol abuse and excessive use of NSAIDs and Excedrin. • What does her UA show? • What is the probable cause? BUN 122 H 7‐22 mg/dL Glucose 72 70‐110 mg/dL Creatinine 11.7 H <1.2 mg/dL Sodium 135 135‐145 mmol /L Potassium 5.6 H 3.5‐5.0 mmol /L Chloride91 H 96‐108 mmol /L CO2 19 L 22‐29 Phosphorus 6.5 H 2.6‐4.5 mg/dL Calcium 8.1 L 8.4‐10.2 mg/dL • Specific gravity 1.011 • Protein 2+ • Glucose 1+ • Blood trace • Negative or normal: Ketones, bilirubin, nitrite, esterase, urobilinogen • Micro: WBCs rare, RBC 2‐4, Waxy casts 3‐5/hpf |
waxy cast, end stage
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what does end stage renal disease look like on UA
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low volume
low FIXED specific gravity 1.010 protein glucose trace blood, WBC waxy casts |
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your pt has low volume, low SG, protin, glucose, and waxy casts, whats the deal
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end stage renal disease
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