1. 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
CLS 426 Urine & Body Fluid Analysis Student Lab Rotation: Renal Disease

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

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

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

12. 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

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

14. 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

15. 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

16. 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

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

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

19. 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

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

21. 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

22. 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

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

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

25. 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

26. 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

27. 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

28. 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

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

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

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

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

33. 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

34. 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