Urinalysis
Colour
Spec Grav
pH
Leukocyte esterase
Nitrites
Protein: can be false pos if concentrated >order uPr:Cr
Glucose
Ketones
Urobilinogen
Bilirubin
Haematuria > send fresh centrifuge and microscopy
Microscopy
RBC
Differential slide for Haem
with sensorineural hearing loss, lenticonus, macular abnormality > Alports (x-linked, t4 collagen causing ear eye and kidney), thick basket weave appearance of GlomBaseMemb > micro haematuria > gross > proteinuria > end stage renal failure by 20y
UTI
Basement membrane separate the theliums (epi, meso or endo) from there underlying connective tissue
Podocytes are renal visceral epithelial cells on the glomerular side of bowman capsule
in nephrons: Bowman space > podocyte > MB > glomerular capillary endothelium
Thin Basement Membrane disease aka familial haematuria syndrome
10% of population
Isolated microscopic haematuria
Screen family
IgA nephropathy (deposits in mesangium)
Persistent Microscopic haematuria > frank when sick
Dx by immunoflurescence
Post infectious glomerulonephritis
(GAS other bacterial, viral) 1-2w prior (sent ASOT)
acute onset gross haematuria (cocacola urine)
oedema
HTN
depressed C3, if doesn't recover at 8 weeks ?membranoprolipherative GN
microscopic haematuria may persist for 2y, ok if not with protein
does not relapse
Order urine Ca:Cr ?
Stone / hypercalciuria Ca:Cr >0.6
US particularly <3y
?wilms
ANA/ dsDNA ?autoimmune i.e. antiGMB
BP
Haematuria is an emergency if
Rapidly progressive glomerulonephritis
Oedema ?allergy ?proteinuria
When intravascularly depleted (e.g. in nephrotic syndrome) haemoconcentrated
Hb and HCT
Alb
HTN more common in nephritic than nephrotic
Common and emergent nephritic GNs above, others
Wt loss
reduced appetite
fatigue
abdominal pain
nausea
nocturnal enuresis
oliguria
hypertensive
- Brown, black: bile, methaemoglobin, alkaptonuria, porphyrin
- Red/pink: RBC, Hb, myoglobin (rhabdo), porphyrin, Fe/deferoxamine/nitrofuritoin, beets/blackberries/food colouring, urates
- if bright red more lower tract, tea more likely glomerular
Spec Grav
pH
Leukocyte esterase
Nitrites
Protein: can be false pos if concentrated >order uPr:Cr
Glucose
Ketones
Urobilinogen
Bilirubin
Haematuria > send fresh centrifuge and microscopy
- well > ? thin BMD
- fever ? UTI ? can have some with fever
- abdominal pain and gross haematuria > ?stone > uti
- proteinuria and HTN or oedema > Glomerular
Microscopy
RBC
- dysmorphic, RC cast or with protein > glomerular
- eumorphic > ureter, bladder, urethra ?stone ?infection ?trauma
Differential slide for Haem
with sensorineural hearing loss, lenticonus, macular abnormality > Alports (x-linked, t4 collagen causing ear eye and kidney), thick basket weave appearance of GlomBaseMemb > micro haematuria > gross > proteinuria > end stage renal failure by 20y
UTI
- Bacterial
- Viral: adenoviral cystitis
Basement membrane separate the theliums (epi, meso or endo) from there underlying connective tissue
Podocytes are renal visceral epithelial cells on the glomerular side of bowman capsule
in nephrons: Bowman space > podocyte > MB > glomerular capillary endothelium
Thin Basement Membrane disease aka familial haematuria syndrome
10% of population
Isolated microscopic haematuria
Screen family
IgA nephropathy (deposits in mesangium)
Persistent Microscopic haematuria > frank when sick
Dx by immunoflurescence
Post infectious glomerulonephritis
(GAS other bacterial, viral) 1-2w prior (sent ASOT)
acute onset gross haematuria (cocacola urine)
oedema
HTN
depressed C3, if doesn't recover at 8 weeks ?membranoprolipherative GN
microscopic haematuria may persist for 2y, ok if not with protein
does not relapse
Order urine Ca:Cr ?
Stone / hypercalciuria Ca:Cr >0.6
US particularly <3y
?wilms
ANA/ dsDNA ?autoimmune i.e. antiGMB
BP
Haematuria is an emergency if
- HTN
- oedema
- oliguria
- proteinuria
Rapidly progressive glomerulonephritis
- p or c ANCA disease (Wegners)
- Good pastures (antiGBM) inflamation causes crescents which push across glomerulus compromising blood supply
- Rx steroids cyclophosphamide plasmaphoresis
Oedema ?allergy ?proteinuria
When intravascularly depleted (e.g. in nephrotic syndrome) haemoconcentrated
Hb and HCT
Alb
HTN more common in nephritic than nephrotic
- oliguric secondary to inflammation reducing glomerular flow > H20, Na, K retention > HTN and oedema
Common and emergent nephritic GNs above, others
- SLE, HSP,
Wt loss
reduced appetite
fatigue
abdominal pain
nausea
nocturnal enuresis
oliguria
hypertensive