4. PROTEINURIA PROTEINURIA  Urine dipstick  Sulfosalicylic acid test 0=(0 mg/dl)0=(0 mg/dl) Trace=(1to 10 mg/dl)Trace=(1to 10 mg/dl) 1+ =(15to 3o mg/dl)1+ =(15to 3o mg/dl) 2+=(40 to 100mg/dl)2+=(40 to 100mg/dl) 3+ =(150 to 350mg/dl)3+ =(150 to 350mg/dl) 4+=(>500mg/dl)4+=(>500mg/dl)

5. PROTEINURIA  24-hour urine protein measurement  Protein-to-creatinine ratio (mg/mg) :210 and 43 mg/dL represents a daily protein excretion of approximately 4.9 g/1.73m2

6. PROTEINURIA  Transient proteinuria  Orthostatic proteinuria  Persistent proteinuria

7. PROTEINURIA  Glomerular  Tubular  Overflow

16. CAUSE OF HEME-NEGATIVE RED URINE MedicationDoxorubicinNitrofurantoinPhenazopyridineRifampinChloroquineIbuprofenphenolphthalein

17. Food dyes Beets Black berries Food coloring

18. CAUSE OF HEME-NEGATIVE RED URINE Metabolities Bile pigments Homogentisic acid Melanin Methemoglobin Porphyrin urates

19. APPROACH TO THE PATIENT WITH RED OR BROWN URINE Centrifuge result Sediment red hematuria Supernatant red Dipstick heme negative Beeturia Phenazopyridine other positive Myoglobin hemoglobin Plasma color myoglobinuria hemoglobinuria clear red

23. PYURIA >2 WBC /hpf Contamination Most are neutrophil Infection is the most common cause of pyuria alone Pyuria has less diagnostic value if it occurs in association with other cellular casts, additional cellular elements,and proteinuria

25. CASTS Casts conform to the shape of the renal tubule in which they formed and are therefore cylindrical with regular margins All casts have an organic matrix composed primrily of tamm-horsfall mucoprotein Some can be found in normal individuals

26. CASTS  Hyaline casts:are not indicative of disease and are primarily observed with small volumes of concentrated urine or with diuretic therapy  Red cell casts:even if only one is seen,is virtually diagnostic of GN or vasculitis

27. CASTS  White cell casts:is most consistent with a tubulointerstitial disease or acute pyelonephritis  They may also be observed with many glomerular disorders

28. CASTS  Epithelial cell casts:ATN and acute GN  Fatty casts:among patients with significant proteinuria, the degeneration of cells with epithelial casts may result in a characteristic “MALTESE CROSS” appearance and a fatty casts

29. CASTS  Granular casts:which are observed in numerous disorders, represent degenerating cellular casts or aggregated proteins  Waxy casts:are thought to be the last stage of the degeneration of a granular cast  Waxy casts consistent with the presence of advanced renal failure

30. CASTS  Broad casts:as with waxy casts, broad casts, which are wider than other casts and tend to have a granular or waxy appearance, are thought to form in the large tubules of nephrons with little flow  They are most often observed in patients with advanced renal failure

46. CRYSTALS  Uric acid  Calcium phosphate or calcium oxalate  Cystine  Magnesium ammonium phosphte