1.Commonly Renal Diseases associated with urine elements Kridsada Sirisabhabhorn, M.MT. Division of Cilnical Microscopy and Parasitology, Medical Technology Laboratory, Thammasat Charlermprakiet Hospital Pathumtani, Thailand July 12th 2013

2. Clinical guide line on urine strip Color : DI, Hepatic disease, GM, GN Sp.gr. : DI, RTN pH : Calculi, Stone Leuk. : Bacterial infection / Immune ?? / Allergy Protein : GM, GN, NS, RF, Sperm Nitrite : Bacterial infection Glucose : DM Ketone : DM, MS Bilirubin : Hepatic disease Urobilinogen : Large intestinal disorder Erythrocyte : Inflammation, bleeding, GM, GN, CA 3. Major groups of commonly renal disease 1. Cystitis / Urethritis 2. Pyelonephritis 3. Uroliths / Renal calculi / Nephroliths 4. Glomerulonephritis [GN] 5. Nephrotic syndrome [NS] 6. Renal failure [RF] & End stage of renal failure 7. Renal tubular necrosis [RN] 8. Carcinomas / Malignant or Tumor 9. Neurogenic bladder disorder 10. Disorder associated with hepatic diseases 11.Polycystic kidney disease 4. Acute phase: remaining symptom < 3 weeks Urine elements presented : Cell cast Chronic phase : remaining symptom > 4 weeks Urine elements presented : Broad cast, Granular cast and Waxy cast, Macrophage 5. 1. Cystitis & Urethritis Etiology Bacterial, Fungal infection Symptom and appearance Greenish, cloudy, bloody with foul smelling of urine, dysuria Microscopic finding Pyuria, WBCs, Bacteria numerous no cast Treatment Antibiotics 6. 2. Pyelonephritis Etiology Bacterial or yeast infection at renal pelvis Symptom & appearance Lumbar pain, fever, chills, nausea, vomitting urine greenish, urine cloudy, Proteinuria Microscopic finding Pyuria, WBCs, Bacteria numerous with WBC cast Treatment Antibiotics 7. 3. Renal calculi Etiology Calcium oxalate, uric acid, cystine, struvite Hyperparathyroidism, Gout, Neoplasm, UTI Symptom and appearance Flank pain, Hematuria, Nausea, Vomitting, Fever Microscopic finding Crystaluria & Hematuria on cast Isomorphic RBCs 8. 4. Glomerulonephritis [GN] Etiology Damaged of glomerulus due to - Ag-Ab complex reaction - Virus : HIV, Hepatitis - DM - Hypertension Clinical sign & Symptoms - Smoky brown hematuria, Oliguria, Adema, Lumbar pain, Proteinuria, High BUN Creatinine, GFR Microscopic finding ***Dysmorphic rbc, RBC cast, Hb cast Renal biopsy positive with immune complex 9. Glomerular filtration rate (GFR) 10. 5. Nephrotic syndrome [NS] Etiology GM, GN, DM, hypertension, SLE, Drugs, CA Symptom & appearance Edema, shortness of breath, High BUN, Creatinine, K+, Heavy proteinuria, Low level of serum albumin, urine cloudy, GFR Microscopic finding **Oval fat body, Fatty cast, Cholesterol crystal** many hyaline cast, High count of RBCs, WBCs and Casts. Remaining long term of NS can progress to end stage renal disease. 11. Pathogenesis of NS 12. 6. Renal Failure [RF] Etiology Long term standing of kidney disease Microscopic finding Telescopic urine sediment with Broad waxy cast and very low of GFR value [< 15] High level of BUN & Creatinine 13. 7. Renal tubular necrosis [RTN] Etiology RTE dysfunction, Hypoxia, Chemical toxic agent Symptom & appearance Diluted urine sp.gr. < 1.010, BUN, Crea. Microscopic finding High count of renal epithelial & renal epithelial cast, RBCs 14. 8. Neoplasm / CA / Tumor Etiology : Diversity factors Appearance : Urine bloody Microscopic finding - Abnormal cell presented in atypical morphology ex. Glandular, Ball, Signet ring formation etc. - Should be report that Abnormal cell found 15. 9. Neurogenic bladder disorder Etiology Bladder nerve or spinal cord damaged Appearance Urinary incontinence Difficultly to control urine flowing Microscopic finding Some case found spermatozoa 16. 10. Hepatic disease Etiology Ex. expose hazard chemical or toxic agent congenital hepatitis virus bile obstruction or entero hepatic tract obstruction etc. Appearance : Bilirubinuria, Urobilinogenuria, Dark yellow or Brown urine color Microscopic finding Bilirubin, Leucine crystal, bilirubin granule, hemosiderin granule, pigment cast, bile cast, bilirubin cast Often, appear with many count of renal tubular epithelial and renal epithelial cast. 17. 11. Polycystic kidney disease Etiology Genetic defect Symptom & appearance Mutiple, grapelike, fluid-filled cysts Lumbar pain Hypertension Microscopic finding Hematuria 18. 1. Polycystic kidney disease : Hematuria 2. Pyelonephritis : Wbc casts & caudate cells 3. Renal calculi : Isomorphic rbc & crystal 4. Tubular necrosis [TN] : Renal epthelial cast & renal epithelial 5. Glomerulonephritis : Dysmorphic rbc & rbc cast 6. Nephrotic syndrome : Oval fat bodies, fatty cast & cholesterol crystal 7. Renal failure [RF] : Broad granular, Broad waxy and waxy cast with telescopic urine sediments 8. Neoplasm of kidney : Abnormal cells, maybe with sheet cause of over cell perforation. 9. Cystitis : Numerous of wbc and bacteria, but no cast present. Conclusions of clinical specific urine elements with major types of kidney diseases 19. Reference Manual of training in Urinalysis : Intergration and Validation of Laboratory Results by Assis. Prof. Dr. Yupin Aniwatangkoora and Assoc. Prof. Dr. Nattaya Sae-ung. Faculty of Associated Medical Sciences, Khon Kaen University, Thailand