Chemical Examination of Urine Ricki Otten MT(ASCP)SC [email protected].
CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten...
-
Upload
melina-morrison -
Category
Documents
-
view
218 -
download
3
Transcript of CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten...
![Page 1: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/1.jpg)
CLS 426 Urine & BodyFluid Analysis
Renal Disease – Part IGlomerular Disease
Ricki Otten MT(ASCP)SC
![Page 2: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/2.jpg)
2
Review the Objectives
• Those objectives marked with ‘*’ will not be tested over during the Student Lab Rotation
![Page 3: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/3.jpg)
3
Classification of Renal Disease
Usually by specific structural component
affected by disease
1. Glomerular Disease
2. Tubular Disease
3. Interstitial Tissue Disease
4. Vascular Disease
![Page 4: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/4.jpg)
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
![Page 5: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/5.jpg)
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
![Page 6: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/6.jpg)
6
Glomerular Injury
• Clinical features dependent upon– Number of glomeruli involved– Mechanism of injury– Rapidity of disease onset
![Page 7: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/7.jpg)
7
Glomerular Injury• Clinical findings:
– Urinalysis: proteinuria, hematuria
– Oliguria
– Physical findings: edema, hypertension
– Blood evaluation: hypoproteinemia, azotemia
(increased urea, creatinine)
![Page 8: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/8.jpg)
8
Glomerular Disease
• Acute glomerulonephritis
• Chronic glomerulonephritis
• Nephrotic syndrome
• Diabetes mellitus (nephropathy)
![Page 9: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/9.jpg)
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
![Page 10: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/10.jpg)
10
Acute Glomerulonephritis• Urinalysis
– Physical Color? Clear?– Chemical– Microscopic
![Page 11: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/11.jpg)
11
Acute Glomerulonephritis• Urinalysis
– Physical yellow, hazy– Chemical ?– Microscopic
![Page 12: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/12.jpg)
12
Acute Glomerulonephritis• Urinalysis
– Physical yellow, hazy
– Chemical + Blood
Proteinuria (mild)
(<1.0 gram/24 hour)
– Microscopic: ?
![Page 13: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/13.jpg)
13
Acute Glomerulonephritis• Urinalysis
– Microscopic:
RBC (some dysmorphic)
WBC
RTE
Casts: RBC hemoglobin granular
![Page 14: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/14.jpg)
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)
![Page 15: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/15.jpg)
15
Acute Glomerulonephritis• Majority (>95%) of children recover
• Approx 60% of adults recover
• Only 1-2 % post-strep acute glomerulonephritis develop chronic glomerulonephritis
![Page 16: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/16.jpg)
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
![Page 17: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/17.jpg)
17
Chronic Glomerulonephritis
• Urinalysis– Physical Color? Clear?– Chemical– Microscopic
![Page 18: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/18.jpg)
18
Chronic Glomerulonephritis
• Urinalysis– Physical yellow, hazy– Chemical ?– Microscopic
![Page 19: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/19.jpg)
19
Chronic Glomerulonephritis
• Urinalysis– Physical yellow, hazy
– Chemical+ BloodProteinuria (mild-moderate)
(>2.5 and < 3.5 grams/24 hr)Specific gravity: low and fixed
(isosthenuric)
– Microscopic: ?
![Page 20: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/20.jpg)
20
Chronic Glomerulonephritis• Urinalysis
– Microscopic
RBC
WBC
RTE
Casts (RBC, hemoglobin, granular, waxy)
![Page 21: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/21.jpg)
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)
![Page 22: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/22.jpg)
22
Nephrotic Syndrome
• Selective filtering capability of glomerulus is lost
• Many conditions may lead to NS
• Clinical findings: ‘pitting edema’, azotemia, hypertension, oliguria
![Page 23: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/23.jpg)
23
Nephrotic Syndrome
• Urinalysis– Physical Color? Clear?– Chemical– Microscopic
![Page 24: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/24.jpg)
24
Nephrotic Syndrome
• Urinalysis– Physical yellow, hazy (cloudy ?)– Chemical ?– Microscopic
![Page 25: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/25.jpg)
25
Nephrotic Syndrome
• Urinalysis– Physical: yellow, hazy (cloudy ?)
– Chemical: + Blood
Proteinuria (severe)
(>3.5 grams/24 hour)
– Microscopic: ?
![Page 26: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/26.jpg)
26
Nephrotic Syndrome
• Urinalysis– Microscopic
RBC
WBC
RTE
Oval Fat Bodies (OFB)
Free fat droplets
Casts (granular, fatty, waxy, RTE)
![Page 27: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/27.jpg)
27
Nephrotic Syndrome
• Other testing:– Blood:
• hypoproteinemia (decr albumin, decr TSP)• Increased lipids• Increased sodium
– Urine: • Decreased CrCl = decreased GFR• Proteinuria (severe: > 3.5 grams/24 hr)
![Page 28: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/28.jpg)
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
![Page 29: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/29.jpg)
29
Diabetes Mellitus (Nephropathy)
• Clinical findings:– Polyuria– Polydipsia– Nocturia
![Page 30: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/30.jpg)
30
Diabetes Mellitus (Nephropathy)
• Urinalysis– Physical Color? Clear?– Chemical– Microscopic
![Page 31: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/31.jpg)
31
Diabetes Mellitus (Nephropathy)
• Urinalysis– Physical Yellow, hazy– Chemical ?– Microscopic
![Page 32: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/32.jpg)
32
Diabetes Mellitus (Nephropathy)
• Urinalysis– Physical Yellow, hazy– Chemical
+ Glucose
Proteinuria (mild-moderate)
– Microscopic ?
![Page 33: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/33.jpg)
33
Diabetes Mellitus (Nephropathy)
• Urinalysis– Microscopic
RBC
Casts
Yeast, possibly
Depends on extent of renal involvement (disease)
![Page 34: CLS 426 Urine & Body Fluid Analysis Renal Disease – Part I Glomerular Disease Ricki Otten MT(ASCP)SC uotten@unmc.edu.](https://reader035.fdocuments.in/reader035/viewer/2022062314/56649e4c5503460f94b42373/html5/thumbnails/34.jpg)
34
Diabetes Mellitus (Nephropathy)
• Other testing:– Blood
• Increased glucose• Increased ketones (diabetes mellitus, type 1)
– Urine• Proteinuria: leads to chronic renal failure and death