PROTEINURIA

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PROTEINURIA

• Urine dipstick
• Sulfosalicylic acid test
• 0(0 mg/dl)
• Trace(1to 10 mg/dl)
• 1 (15to 3o mg/dl)
• 2(40 to 100mg/dl)
• 3 (150 to 350mg/dl)
• 4(gt500mg/dl)

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PROTEINURIA

• 24-hour urine protein measurement
• Protein-to-creatinine ratio (mg/mg) 210 and 43
  mg/dL represents a daily protein excretion of
  approximately 4.9 g/1.73m2

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PROTEINURIA

• Transient proteinuria
• Orthostatic proteinuria
• Persistent proteinuria

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PROTEINURIA

• Glomerular
• Tubular
• Overflow

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CAUSE OF HEME-NEGATIVE RED URINE

• Medication
• Doxorubicin
• Nitrofurantoin
• Phenazopyridine
• Rifampin
• Chloroquine
• Ibuprofen
• phenolphthalein

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CAUSE OF HEME-NEGATIVE RED URINE

• Food dyes
• Beets
• Black berries
• Food coloring

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CAUSE OF HEME-NEGATIVE RED URINE

• Metabolities
• Bile pigments
• Homogentisic acid
• Melanin
• Methemoglobin
• Porphyrin
• urates

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APPROACH TO THE PATIENT WITH RED OR BROWN URINE

• Centrifuge result

Supernatant red
Sediment red
Dipstick heme
positive
negative
Myoglobin hemoglobin
hematuria
clear
Beeturia Phenazopyridine other
red
Plasma color
hemoglobinuria
myoglobinuria
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PYURIA

• gt2 WBC /hpf
• Contamination
• Most are neutrophil
• Infection is the most common cause of pyuria
  alone
• Pyuria has less diagnostic value if it occurs in
  association with other cellular casts, additional
  cellular elements,and proteinuria

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CASTS

• Casts conform to the shape of the renal tubule in
  which they formed and are therefore cylindrical
  with regular margins
• All casts have an organic matrix composed
  primrily of tamm-horsfall mucoprotein
• Some can be found in normal individuals

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CASTS

• Hyaline castsare not indicative of disease and
  are primarily observed with small volumes of
  concentrated urine or with diuretic therapy
• Red cell castseven if only one is seen ,is
  virtually diagnostic of GN or vasculitis

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CASTS

• White cell castsis most consistent with a
  tubulointerstitial disease or acute
  pyelonephritis
• They may also be observed with many glomerular
  disorders

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CASTS

• Epithelial cell castsATN and acute GN
• Fatty castsamong patients with significant
  proteinuria, the degeneration of cells with
  epithelial casts may result in a characteristic
  MALTESE CROSS appearance and a fatty casts

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CASTS

• Granular castswhich are observed in numerous
  disorders, represent degenerating cellular casts
  or aggregated proteins
• Waxy castsare thought to be the last stage of
  the degeneration of a granular cast
• Waxy casts consistent with the presence of
  advanced renal failure

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CASTS

• Broad castsas with waxy casts, broad casts,
  which are wider than other casts and tend to have
  a granular or waxy appearance, are thought to
  form in the large tubules of nephrons with little
  flow
• They are most often observed in patients with
  advanced renal failure

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CRYSTALS

• Uric acid
• Calcium phosphate or calcium oxalate
• Cystine
• Magnesium ammonium phosphte

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