ANALYSIS OF URINE AND BODY FLUIDS

WEEK 8 ACTIVITY "RENAL DISEASES"

INSTRUCTION: Provide the correct answers for the following questions accordingly.
1. Differentiate among renal diseases of glomerular, tubular, interstitial, and vascular origin.
➔ Glomerular –The majority of glomerular diseases are brought on by immunologic issues in various
parts of the body, including the kidney. Immune complexes, such as immunoglobulin A (IgA), circulate
in the bloodstream and are deposited on the glomerular membranes as a result of immunologic
responses and elevated serum immunoglobulin levels. The immune system's complement, neutrophils,
lymphocytes, monocytes, and cytokines are subsequently drawn to the region, causing the membranes
to alter and become damaged. Damage may include cellular infiltration or proliferation that thickens the
glomerular basement membrane as well as complement-mediated harm to the capillaries and
basement membrane, depending on the immune system mediators involved.
➔ Tubular – Disorders affecting the renal tubules include those in which the complex activities of the
tubules are impacted by a metabolic or genetic disorder as well as those in which tubular function is
compromised as a result of real injury to the tubules.
➔ Interstitial – Given the proximity of the renal interstitium to the renal tubules, diseases of the
interstitium also affect the tubules, leading to the condition known as tubulointerstitial disease. In most
cases, these illnesses are accompanied by inflammation and infections. Urinary tract infections are the
most typical kidney disease (UTI). Both the upper and lower urinary tracts may be infected, including
the urethra and bladder (renal pelvis, tubules, and interstitium). Cystitis, an infection of the bladder, is
most frequently observed.
➔ Vascular –The most common cause of renal artery blockages is arteriosclerosis, which is the
thickening and hardening of arterial walls caused by cholesterol and plaque buildup. This is identical to
what is seen in the coronary arteries of the heart, carotid arteries leading to the brain, and veins in the
legs. Renal vascular disease affects the blood flow into and out of the kidneys. Possible negative
effects include kidney damage and high blood pressure. The vascular disease renal artery stenosis is
one of them (RAS).
2. Describe the processes by which immunologic damage is caused to the glomerular basement
membrane.
Anti-GBM illness is the name of the autoimmune disorder. It occurs when the immune system mistakenly
assaults and decimates healthy body tissues. In this illness, the lungs' collagen protein and the kidneys'
glomeruli's filtering cells are attacked by chemicals. Nonimmunologic causes of glomerular damage include
exposure to toxins and chemicals that also harm the tubules, interference with electrical membrane charges as
seen in the nephrotic syndrome, amyloid material deposition from systemic diseases that may involve chronic
inflammation and acute-phase reactants, and thickening of the basement membrane linked to diabetic
nephropathy.

3. Describe the characteristic clinical symptoms, etiology, and urinalysis findings in acute post-
streptococcal and rapidly progressive glomerulonephritis, Goodpasture syndrome, Wegener
granulomatosis, and Henoch-Schönlein purpura.
 DISORDER CLINICAL SYMPTOMS ETIOLOGY URINALYSIS FINDINGS

Acute Rapid onset of hematuria Deposition of immune ● Macroscopic

Poststreptococcal and edema, permanent complexes, formed in hematuria
Glomerulonephritis renal damage seldom conjunction with group A ● Proteinuria
occurs. Streptococcus infection, ● RBC casts
on the glomerular ● Granular casts
membranes.

Rapidly Progressive Rapid onset with Deposition of immune ● Macroscopic

Glomerulonephritis glomerular damage and complexes from systemic hematuria
possible progression to immune disorders on the ● Proteinuria
end-stage renal failure. glomerular membrane. ● RBC casts

Goodpasture syndrome Hemoptysis and dyspnea Attachment of a cytotoxic ● Macroscopic

followed by hematuria. antibody formed during hematuria
viral respiratory ● Proteinuria
infections to glomerular ● RBC casts
and alveolar basement
membranes.

Wegener Pulmonary symptoms Antineutrophilic ● Macroscopic

granulomatosis including hemoptysis cytoplasmic autoantibody hematuria
develop first followed by binds to neutrophils in ● Proteinuria
renal involvement and vascular walls producing ● RBC casts
possible progression to damage to small vessels
end-stage renal failure. in the lungs and
glomerulus.

Henoch-Schonlein Initial appearance of Occurs primarily in ● Macroscopic

purpura purpura followed by children following viral hematuria
blood in sputum and respiratory infections; a ● Proteinuria
stools and eventual renal decrease in platelets ● RBC casts
involvement. Complete disrupts vascular
recovery is common, but integrity.
may progress to renal
failure.

4. Differentiate among causes of laboratory results associated with prerenal, renal, and postrenal
acute renal failure.
➔ Pre-renal – hemorrhages, burns, surgery, and septicaemia together with a low blood pressure and
cardiac output.
➔ Renal – acute glomerulonephritis, pyelonephritis, tubular necrosis, and interstitial nephritis.
➔ Post-renal – renal calculi, tumors, and the crystallization of ingested substances.
5. Discuss the formation of renal calculi, composition of renal calculi, and patient management
techniques.
Renal calculi (kidney stones) may form in the calyces and pelvis of the kidney, ureters, and bladder. In renal
lithiasis, the calculi vary in size from barely visible to large, staghorn calculi resembling the shape of the renal
pelvis and smooth, round bladder stones with diameters of 2 or more inches. Small calculi may be passed in
the urine, subjecting the patient to severe pain radiating from the lower back to the legs. Larger stones cannot
be passed and may not be detected until patients develop symptoms of urinary obstruction. Lithotripsy, a
procedure using high-energy shock waves, can be used to break stones located in the upper urinary tract into
pieces that can then be passed in the urine. Stones can also be removed surgically. Conditions favoring the
formation of renal calculi are similar to those favoring the formation of urinary crystals, including pH, chemical
concentration, and urinary stasis. Numerous correlation studies between the presence of crystalluria and renal
calculi formation have been conducted with varying results. The finding of clumps of crystals in freshly voided
urine suggests that conditions may be right for calculus formation. However, owing to the difference in
conditions that affect the urine within the body and in a specimen container, little importance can be placed on
the role of crystals in predicting calculi formation. Increased crystalluria has been noted during the summer
months in persons known to form renal calculi.

COMPOSITION OF RENAL CALCULI

Analysis of the chemical composition of renal calculi plays an important role in patient management. Analysis
can be performed chemically, but examination using x-ray crystallography provides a more comprehensive
analysis. Approximately 75% of the renal calculi are composed of calcium oxalate or calcium phosphate.
Magnesium ammonium phosphate (struvite), uric acid, and cystine are the other primary calculi constituents.
Calcium calculi are frequently associated with metabolic calcium and phosphate disorders and occasionally
diet. Magnesium ammonium phosphate calculi are frequently accompanied by urinary infections involving
urea-splitting bacteria. The urine pH is often higher than 7.0. Uric acid calculi may be associated with
increased intake of foods with high purine content and with uromodulin-associated kidney disease. The urine
pH is acidic. Most cystine calculi are seen in conjunction with hereditary disorders of cystine metabolism.

PATIENT MANAGEMENT TECHNIQUES

Patient management techniques include maintaining the urine at a pH incompatible with the crystallization of
the particular chemicals, maintaining adequate hydration to lower chemical concentration, and suggesting
possible dietary restrictions. Urine specimens from patients suspected of passing or being in the process of
passing renal calculi are frequently received in the laboratory. The presence of microscopic hematuria resulting
from irritation to the tissues by the moving calculus is the primary urinalysis finding.