1. CLS 1113 Introduction to Clinical Laboratory Practices
Renal Diseases

2. Urinary Tract Infections (UTI)
Upper Urinary Tract
Renal Pelvis alone
Renal Pelvis, Tubules and Interstitium (Pyelonephritis)
Lower Urinary Tract
Urethra (Urethritis)
Bladder (Cystitis)
BOTH

3. Cystitis Chemical/Physical Microscopic Leukocyte Esterase Nitrite
Blood
Protein
Microscopic
Increased WBC
3-4+ bacteria
Mucus
RBCs
Transitional Epi’s
NO CASTS
Dysuria
Lower Abdominal Pain

4. 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.

5. Acute Pyelonephritis Chemical/Physical Microscopic 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

6. 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

8. 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

9. Glomerulonephritis Acute Glomerulonephritis Chronic Glomerulonephritis
Post Streptococcal
Crescentic
Membranous
Etc.
Page
Chronic Glomerulonephritis
Table 9-5, Page 281

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

11. Acute Glomerulonephritis
Chemical/Physical
4+ blood
Protein
Microscopic
 RBC’s
 WBC’s
 RTE’s
Red Cell Casts
Hemoglobin Casts
Granular Casts

12. Nephrotic Syndrome
A complication of numerous disorders characterized by:
Proteinuria
Hypoalbuminemia
Hyperlipidemia
Lipiduria
Edema

13. Nephrotic “Syndrome” Chemical/Physical Microscopic 4+ protein Blood
Fatty Casts
Casts: All types
Waxy, RTE
Oval Fat Bodies
Free fat globules
RTE’s
RBC’s

14. Amino Acid Disorders Cystinuria Tyrosinuria Phenylketonuria
Maple Syrup Urine Disease

15. 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

16. 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.

17. 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?

18. 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.