CLS 1113 Introduction to Clinical Laboratory Practices

1. CLS 1113Introduction to Clinical Laboratory Practices Renal Diseases

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

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

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. 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 Chronic Pyelonephritis

9. Acute Glomerulonephritis Post Streptococcal Crescentic Membranous Etc. Page 277-281 Chronic Glomerulonephritis Table 9-5, Page 281 Glomerulonephritis

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

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

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

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

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.