Ricki Otten MT(ASCP)SC uotten@unmc.edu CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Review the Objectives Those objectives marked with ‘*’ will not be tested over during the Student Lab Rotation CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Classification of Renal Disease Usually by specific structural component affected by disease Glomerular Disease Tubular Disease Interstitial Tissue Disease Vascular Disease CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Glomerular Disease Most often due to damage to glomerular basement membrane Immunologic disease Metabolic disease Hereditary disease Basement membrane damage leads to Morphologic changes Altered glomerular function Increased permeability allowing leakage of cells and protein into urine CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Glomerular Disease Classification Primary: specifically affects the kidney Acute glomerulonephritis Chronic glomerulonephritis Nephrotic syndrome Secondary: another disease process affects the health of the glomerulus Systemic disease (diabetes mellitus, SLE) Hereditary disorder CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Glomerular Injury Clinical features dependent upon Number of glomeruli involved Mechanism of injury Rapidity of disease onset CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Glomerular Injury Clinical findings: Urinalysis: proteinuria, hematuria Oliguria Physical findings: edema, hypertension Blood evaluation: hypoproteinemia, azotemia (increased urea, creatinine) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Glomerular Disease Acute glomerulonephritis Chronic glomerulonephritis Nephrotic syndrome Diabetes mellitus (nephropathy) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Acute post-streptococcal glomerulonephritis Relatively common, often in children, also adults Occurs 1-2 weeks post streptococcal infection Antibody mediated: blood cultures negative Clinical findings: Sudden onset, fever, malaise, nausea Oliguria Edema (lower extremities (ankles), eyes) Mild hypertension CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Urinalysis Physical Color? Clear? Chemical Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Urinalysis Physical yellow, hazy Chemical ? Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Urinalysis Physical yellow, hazy Chemical + Blood Proteinuria (mild) (<1.0 gram/24 hour) Microscopic: ? CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Urinalysis Microscopic: RBC (some dysmorphic) WBC RTE Casts: RBC  hemoglobin  granular CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Other testing: Blood ASO titer Decreased complement (Antigen-Antibody mediated) Increased BUN, increased creatinine Decreased albumin Urine Decreased CrCl = Decreased GFR Proteinuria (mild: <1.0 grams/24 hr) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Acute Glomerulonephritis Majority (>95%) of children recover Approx 60% of adults recover Only 1-2 % post-strep acute glomerulonephritis develop chronic glomerulonephritis CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Numerous glomerular diseases develop chronic glomerulonephritis Onset is slow and insiduous taking many years to develop clinical signs and symptoms If not treated, may result in death (uremia) Clinical findings: same as acute, but worse CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Urinalysis Physical Color? Clear? Chemical Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Urinalysis Physical yellow, hazy Chemical ? Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Urinalysis Physical yellow, hazy Chemical + Blood Proteinuria (mild-moderate) (>2.5 and < 3.5 grams/24 hr) Specific gravity: low and fixed (isosthenuric) Microscopic: ? CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Urinalysis Microscopic RBC WBC RTE Casts (RBC, hemoglobin, granular, waxy) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Chronic Glomerulonephritis Other testing: Blood: Increased BUN, increased creatinine Decreased albumin, decreased TSP Urine: Decreased CrCl = decreased GFR Proteinuria (moderate: >2.5 grams/24 hr) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Selective filtering capability of glomerulus is lost Many conditions may lead to NS Clinical findings: ‘pitting edema’, azotemia, hypertension, oliguria CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Urinalysis Physical Color? Clear? Chemical Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Urinalysis Physical yellow, hazy (cloudy ?) Chemical ? Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Urinalysis Physical: yellow, hazy (cloudy ?) Chemical: + Blood Proteinuria (severe) (>3.5 grams/24 hour) Microscopic: ? CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Urinalysis Microscopic RBC WBC RTE Oval Fat Bodies (OFB) Free fat droplets Casts (granular, fatty, waxy, RTE) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Nephrotic Syndrome Other testing: Blood: Urine: hypoproteinemia (decr albumin, decr TSP) Increased lipids Increased sodium Urine: Decreased CrCl = decreased GFR Proteinuria (severe: > 3.5 grams/24 hr) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Disorder of carbohydrate metabolism Renal disease is a major cause of death in the diabetic patient Diabetes is leading cause of Blindness End-stage renal disease Limb amputations CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Clinical findings: Polyuria Polydipsia Nocturia CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Urinalysis Physical Color? Clear? Chemical Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Urinalysis Physical Yellow, hazy Chemical ? Microscopic CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Urinalysis Physical Yellow, hazy Chemical + Glucose Proteinuria (mild-moderate) Microscopic ? CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Urinalysis Microscopic RBC Casts Yeast, possibly Depends on extent of renal involvement (disease) CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

Diabetes Mellitus (Nephropathy) Other testing: Blood Increased glucose Increased ketones (diabetes mellitus, type 1) Urine Proteinuria: leads to chronic renal failure and death CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease