CLS 426 Urine & BodyFluid Analysis

Renal Disease – Part IGlomerular Disease

Ricki Otten MT(ASCP)SC

uotten@unmc.edu

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Review the Objectives

• Those objectives marked with ‘*’ will not be tested over during the Student Lab Rotation

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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

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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

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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

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Glomerular Injury

• Clinical features dependent upon– Number of glomeruli involved– Mechanism of injury– Rapidity of disease onset

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Glomerular Injury• Clinical findings:

– Urinalysis: proteinuria, hematuria

– Oliguria

– Physical findings: edema, hypertension

– Blood evaluation: hypoproteinemia, azotemia

(increased urea, creatinine)

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Glomerular Disease

• Acute glomerulonephritis

• Chronic glomerulonephritis

• Nephrotic syndrome

• Diabetes mellitus (nephropathy)

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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

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Acute Glomerulonephritis• Urinalysis

– Physical Color? Clear?– Chemical– Microscopic

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Acute Glomerulonephritis• Urinalysis

– Physical yellow, hazy– Chemical ?– Microscopic

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Acute Glomerulonephritis• Urinalysis

– Physical yellow, hazy

– Chemical + Blood

Proteinuria (mild)

(<1.0 gram/24 hour)

– Microscopic: ?

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Acute Glomerulonephritis• Urinalysis

– Microscopic:

RBC (some dysmorphic)

WBC

RTE

Casts: RBC hemoglobin granular

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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)

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Acute Glomerulonephritis• Majority (>95%) of children recover

• Approx 60% of adults recover

• Only 1-2 % post-strep acute glomerulonephritis develop chronic glomerulonephritis

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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

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Chronic Glomerulonephritis

• Urinalysis– Physical Color? Clear?– Chemical– Microscopic

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Chronic Glomerulonephritis

• Urinalysis– Physical yellow, hazy– Chemical ?– Microscopic

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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: ?

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Chronic Glomerulonephritis• Urinalysis

– Microscopic

RBC

WBC

RTE

Casts (RBC, hemoglobin, granular, waxy)

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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)

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Nephrotic Syndrome

• Selective filtering capability of glomerulus is lost

• Many conditions may lead to NS

• Clinical findings: ‘pitting edema’, azotemia, hypertension, oliguria

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Nephrotic Syndrome

• Urinalysis– Physical Color? Clear?– Chemical– Microscopic

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Nephrotic Syndrome

• Urinalysis– Physical yellow, hazy (cloudy ?)– Chemical ?– Microscopic

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Nephrotic Syndrome

• Urinalysis– Physical: yellow, hazy (cloudy ?)

– Chemical: + Blood

Proteinuria (severe)

(>3.5 grams/24 hour)

– Microscopic: ?

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Nephrotic Syndrome

• Urinalysis– Microscopic

RBC

WBC

RTE

Oval Fat Bodies (OFB)

Free fat droplets

Casts (granular, fatty, waxy, RTE)

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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)

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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

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Diabetes Mellitus (Nephropathy)

• Clinical findings:– Polyuria– Polydipsia– Nocturia

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Diabetes Mellitus (Nephropathy)

• Urinalysis– Physical Color? Clear?– Chemical– Microscopic

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Diabetes Mellitus (Nephropathy)

• Urinalysis– Physical Yellow, hazy– Chemical ?– Microscopic

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Diabetes Mellitus (Nephropathy)

• Urinalysis– Physical Yellow, hazy– Chemical

+ Glucose

Proteinuria (mild-moderate)

– Microscopic ?

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Diabetes Mellitus (Nephropathy)

• Urinalysis– Microscopic

RBC

Casts

Yeast, possibly

Depends on extent of renal involvement (disease)

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Diabetes Mellitus (Nephropathy)

• Other testing:– Blood

• Increased glucose• Increased ketones (diabetes mellitus, type 1)

– Urine• Proteinuria: leads to chronic renal failure and death