CLS 1113 Introduction to Clinical Laboratory Practices

1
CLS 1113Introduction 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
• Leukocyte Esterase
• Nitrite
• Blood
• Protein

• Microscopic
• Increased WBC
• 3-4 bacteria
• Mucus
• RBCs
• Transitional Epis
• 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
• Leukocyte Esterase
• Protein
• Nitrite
• Blood
• Specific Gravity

• Microscopic
• TNTC WBC
• 2-4 bacteria
• RBCs
• Renal Epis
• 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

7
(No Transcript)
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
• Post Streptococcal
• Crescentic
• Membranous
• Etc.
• Page 277-281

• 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
• ?? RBCs
• ? WBCs
• ? RTEs
• 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
• 4 protein
• Blood

• Microscopic
• Fatty Casts
• Casts All types
• Waxy, RTE
• Oval Fat Bodies
• Free fat globules
• RTEs
• RBCs

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 ppts in acid pH
• Often have calculi Cytine make up
• Table 9-8

16
Tyrosinuria

• Overflow of Tyrosine from blood
• Several mechanisms
• 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
• PKUs 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.