Musty urine Phenylketonuria/ PKU.
Myoglobinuria Rhabdomyolysis. Red urine.
Dilute specific gravity 1.003 (dilute)
Concentrated specific gravity 1.030 (concentrated)
Isosthenuria specific gravity 1.010
Urine pH 4.5 – 7.8. If higher Urea splitting (urea -> ammonia) bacteria. Proteus or Klebsiella. OR distal RTA.
In super acidic urine what can form Uric acid.
In super alkaline urine what can form CaP, struvite.
Urobilinogen formed where SI and excreted in stool and urine from bile.
Normally bilirubin will be () in urine whereas urobilinogen will be () Negative urinary bilirubin and positive urobilinogen.
LE from from Lysed granulocytes.
Nitrates concerted to nitrite by what bacteria Gram negative.
Ketones in urine reflect Fasting state/ starvation, alcoholic ketoacidosis, DKA.
Normal protein excretion per day 30-150 mg/day. 300-500 = proteinuria.
Renal tubular cell in urine ATN.
Multi-lobar nuclei vs Unliobar nuclei in urine Multi-lobar – WBC, Pyuria. Unilobar – renal tubular epithleial cells.
Culture negative pyuria INTERSTITIAL NEPHRITIS.
WBC Casts in Pyelonephritis and intersitital nephritis.
Broad waxy casts Dilated atrophic tubules. CKD.
Maltese cross/ fatty casts nephrotic syndrome.
Oxalate Crystals in setting of metabolic acidosis and AKI Ethylene glycol.
Treating uric acid stones Alkalinize urine.
ADPKD genetics PKD1* and PKD2
ADPKD prognosis 50% develop end stage renal failure; 10% of all dialysis pts
ADPKD non kidney manifestations Intracranial arterial aneurysms and cysts in liver and or pancreas.
ADPKD everyone will get bilateral cysts by age 30. Diagnose with imaging.
ADPKD where in nephron Every segment of nephron but do not communicate with rest of nephron.
Alport extra renal Sensorineural hearing loss. Eye changes (protrusion of anterior portion of lens).
Alport X-linked. Collagen IV Alpha 5. Can be AR or AD.
Alport presentation Recurrent gross hematuria. By age 16-35.
REVIEW COLLAGEN AGAIN.
Alport on path Lamellated thickened BM -> progressive glomerulosclerosis from abnormal BM assembly.
Tubulo-interstitial disease Tubules, no proteinuria -> fibrosis/ collagen in interstitium. Increased space between tubules.
Renal failure with normal proteinuria? Tubulointerstitial disease. <1 g/ day.
AIN vs ATN vs CTID.
AIN classic signs and symptoms Rash, eosinophilia, fever. Eosinohpiliuria, WBC and sometimes RBC in urine as well and maybe acid-base or electrolyte abnormalities.
AIN usually allergic. Most often from Antibiotics (beta lactams, sulfonamides, rifampin), NSAIDs, Sulfa-containing drugs. Also infections – bacteria, viruses.
ATN will have dark brown granular casts AND ? Evidence of tubular dysfunction - inability to concentrate urine, etc. Also mimnimal proteinuria and decreased urine output.
Drug induced ATN Aminoglycosides, Amphotericin B, antivirals. CONTRAST.
Aminoglycoside risk of ATN Increases with cumulative dose. Much higher if > 2 weeks.
Amphotericin B and AKI 50% pts have acute renal failure. REVERSIBLE. A/w mortality. Electrolyte deranagements such as non-anion gap metabolic acidosis. May be from deoxycholate. Inserts into cell membranes and increases cell permeability.
Risk of contrast associated ARF is worse in DM and underlying renal insufficiency. Advanced heart failure. More ionic contrast.
Contrast associated ARF is thankfully Self-limited. Peaks a few days after administration.
HIV med that causes ARF Indinavir. Poor solubility. Nephrolithiasis, AKI, Chronic.
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