Urinalysis CPC (Renal block) Thursday Sep 5, 10-12am Activities for this 2-hour session: Review Urinalysis CPC Student Handout , including the following information: CPC session explanation of activities General Urinalysis laboratory procedure Practice Questions (optional) Review You-Tube Videos Review Microscopic Image file Review Urinalysis CPC Cases for Interpretation (9 total) 10-question quiz at 11:30 am
URINALYSIS AND URINE CULTURE View the following videos on YouTube: “Clean Catch Urine”, 4:19 – This video explains how to obtain clean-catch urine samples on both male and female patients. “no intro Urinalysis”, 1:19 – This video explains how to use the urinalysis dipstick. C. “urine cultures”, 4:39 – This video gives an overview of urine cultures.
Dipsticks/reagent strips
Automated analyzer
Macroscopic analysis Chemical analysis Microscopic analysis
Nephrotic Syndrome Clinical syndrome: 1. Massive proteinuria ( > 3.5 gr/day in adult) 2. Hypoalbuminemia (plasma albumin < 3 gm/dL) 3. Generalized edema Hyperlipidemia and lipiduria Usually no azotemia, hematuria or hypertension at onset Can see fatty casts and oval fat bodies in urine microscopically
Causes of Nephrotic syndrome (Robbins 9th ed, Table 20-7, page 915)
Nephritic Syndrome Clinical syndrome with acute onset: hematuria (typically with dysmorphic RBCs and RBC casts) oliguria and azotemia mild to moderate hypertension May see proteinuria and edema, but not usually severe Unifying histologic picture of cellular proliferation in glomeruli, usually with leukocytic infiltration (hypercellularity) Inflammation injures capillary walls, leading to loss of RBCs into urine & RBC cast formation Hemodynamic changes lead to reduced GFR oliguria, azotemia, and some fluid retention Hypertension probably due to fluid retention and likely renin release due to decreased perfusion to glomeruli (ischemia) Can be due to primary glomerular disease or secondary to a systemic disorder Examples: Post-streptococcal (post-infectious) GN & Crescentic GN; see also Lupus GN (later)