What are the 3 “best initial tests” in nephrology?
UA
BUN
creatinine
List the 7 components of UA
- protein
- white cells - direct micro examination
- leukocyte esterase - dipstick
- red cells
- specific gravity
- pH
- Nitrites - indicates the presence of gram negative bacteria on dipstick
What is damaged in the kidney when you see severe proteinuria?
glomerular damage
What does Tamm-Horsfall protein refer to? How much protein is this referring to?
Tamm- Horsfall refers to the minimal amount of protein that is secreted by the tubules.
protein levels range form 30-50 mg/hr
note: transient proteinuria is normal in 2-10% of the population
What should be done if prolonged proteinuria occurs in the absence of prolonged standing (orthostatic proteinuria)?
kidney biopsy
What are the 2 methods to determine total amount of protein in a day?
- single protein to creatinine ratio –> this is more accurate.
P/Cr 1 = 1 g/day, 2.5 = 2.5 g/day.
Faster and easier test than 24 hours collection - 24-h urine collection
What does urine dipstick for protein test for?
Albumin only
What is normal level of protein excretion from the kidney?
> 300 mg/24 hours
When assessing protienuria, what is the best initial test, and what is the more accurate test in determining the amount?
best initial test: UA
most accurate determination of protein in urine: protein to creatinine ratio
What can be done to determine the cause of proteinuria?
kidney biopsy
Tiny amounts of protein that are too small to detect on the UA are called what?
microalbuminuria
- this is important to detect in diabetics as long term microalbuniuria leads to worsening renal function in a diabetic pt and should be treated.
What is the best initial medication for any sort of proteinuria in a diabetic pt?
ACE inhibitor
ARB
they will delay the development of renal insufficiency
What test needs to be done in order to detect Bense Jones bodies seen in myeloma?
immunoelectrophoresis
White blood cells in urine indicate what 3 possible etiologies?
- inflammation
- Allergic interstitial nephritis
- infection
Are you able to distinguish between eosinophils and neutrophils on a UA?
NO
What does urinary eosinophils suggest?
allergic interstitial nephritis
Does NSAID niduced renal disease show eosinophils?
NO
What stains detect eosinophils in the urine?
Wright and Hansel - allergic interstitial nephritis
How many RBCs are normally found under hpf in a urinalysis?
> 5
List 7 reasons someone might have hematuria.
- Stones in bladder, ureter, kidney
- coagulopathy
- Infection - cystitis, pyelonephritis
- Cancer - bladder, ureters, kidney
- Trauma
- medications - cyclophosphamide = hemorrhagic cystitis
- Glomerulonephritis
What are 2 causes of false positive test for hematuria?
- hemoglobin
2. myoglobin
If dysmorphic RBCs are identified in the urine, what type of renal disorder is most likely present?
Glomerulonephritis
When would you perform a cystoscopy on a pt with hemauria?
When there is no infection and no prior trauma but there is blood in the urine
Cystoscopy is the most accurate test for the bladder
What disease is associated with the following urinary casts?
- red cell
- White cell
- Eosinophil
- Hyaline
- Broad, waxy
- Granular, muddy brown
- glomerulonephriris
- pyelonephritis
- acute (allergic) interstitial nephritis
- dehydration conentrate the urine and the normal Tamm-Horsfall protein precipitates or concentrates into a case
- chronic renal disease
- Acute tubular necrosis
