RENAL PATHOLOGY 1

Question 1

Red colored urine suggests the presence of?

Answer 1

hemoglobin, myoglobin, or red blood cells

Question 2

Cloudy or turbid urine suggests the presence of?

Answer 2

Protein, crystals, cells or casts

Question 3

hematuria from hemolysis

Answer 3

hemoglobinuria

Question 4

hematuria from skeletal muscle injury or rhabdomyolysis

Answer 4

myoglobinuria

Question 5

Dysmorphic RBC

Answer 5

Glomerular injury

Question 6

the higher specific gravity of urine indicates?

Answer 6

Likely SIADH

Question 7

Urine protein +4 protein

Answer 7

More than 3.5 gm/24 hours; likely nephrotic syndrome

Question 8

Bence-Jones and LARGE hyalin cast in kidney

Answer 8

multiple myeloma

Question 9

Interpreting the dipstick for blood requires comparison with the microscopic exam and generally there should be (1) on microscopic exam when there is positive blood on dipstick

Answer 9

red cells (erythrocytes)

Question 10

If the dipstick shows blood without red cells present, then this could be (1), indicating that hemolysis has occurred (for (2) or muscle injury (for (3).

Answer 10

1. hemoglobulinuria or myoglobinuria 2. hemoglobulinuria 3. myoglobin

Question 11

If nitrite is present in urine by dipstick, it may be an indication that (1) are present

Answer 11

1. nitrite producing bacteria

Question 12

Another dipstick test for urinary tract infection is the detection of (1) which is not normally found in urine unless the white cells which express (1) are present

Answer 12

1. leukocyte esterase

Question 13

pyuria- disease

Answer 13

cystitis/acute pyelonephritis

Question 14

Waxy cast

Answer 14

ESKD

Question 15

The most important concept in urinalysis is that casts indicate (1)

Answer 15

1. renal location of disease

Question 16

form when cells or protein are trapped in tubules and form molds of their surroundings

Answer 16

casts

Question 17

24-hour urine collection

Answer 17

Check for total protein loss

Question 18

Red cells, either alone or within casts, lack nuclei so can generally be readily distinguished from (1) casts

Answer 18

white cell or epithelial cell

Question 19

White cells are usually?

Answer 19

neutrophils

Question 20

Eosinophils in Urine

Answer 20

Drug-induced allergy

Question 21

Red blood cell casts generally indicate (1) and white blood cell casts indicate (2)

Answer 21

1. glomerular inflammation/type of glomerulonephritis 2. infection within the kidney which is called pyelonephritis

Question 22

Epithelial cell casts are found in (1) but often degenerate into (2)

Answer 22

1. acute kidney injury (previously called acute tubular necrosis or ATN) 2. granular casts (muddy brown)

Question 23

Protein can form casts in the renal tubules in patients with (1) which is also useful for diagnosis (if too many)

Answer 23

1. Chronic Pyelonephritis

Question 24

Stone - kidney

Answer 24

crystals in urine

Question 25

(1) crystals tend to form in acidic urine while (2) crystals tend to form in alkaline urine

Answer 25

1. Uric acid and cystine 2. triple phosphate

Question 26

one strategy to try and prevent crystal formation is?

Answer 26

making urine pH more or less alkaline in order to decrease crystal formation

Question 27

RBC cast

Answer 27

Glomerular disease

Question 28

Urinalysis can be \_\_\_, \_\_\_\_, and \_\_\_\_

Answer 28

Macroscopic; chemical; or microscopic`

Question 29

Black urine (on standing)

Answer 29

Alkaptonuria

Question 30

Sp Gravity 1.010

Answer 30

CRF

Question 31

Red urine: centrifuge it to differentiate RBCs from Hbemia/myoglobinuria

Answer 31

centrifuge the urine to see if the red color moves into the heavier pellet (indicates RBCs, i.e. hematuria) or stays in the supernatant (Hbemia or myoglobinemia)

Question 32

Suger in urine

Answer 32

Diabetes

Question 33

\_\_\_\_\_\_ detects esterase enzyme present in certain WBCs (neutrophils and monocytes) --\> indicates urinary tract infection, since seeing host response

Answer 33

Leukocyte esterase

Question 34

Mixed flora in urine

Answer 34

Fistula- Crohn's disease

Question 35

Hematuria (RBC) causes

Answer 35

Stone, papillary necrosis, RCC, APKD, trauma, TCC, Nephritic syndrome, Infarct

Question 36

Painless hematuria

Answer 36

TCC

Question 37

Intact RBC

Answer 37

Likely infarct

Question 38

* Result of bleeding at any point in the urinary system. * No nuclei

Answer 38

) RBCs

Question 39

* (b) WBCs --\> Indicates \_\_\_ * Usually ____ (type of cell) * Presence of a few is normal * High numbers indicate inflammation or infection. See nuclei and cytoplasm—so more internal structure

Answer 39

infection; neutrophils (poly-lobed nuclei)

Question 40

RBCs vs. WBCs on histo- ID Urine cast

Answer 40

RBCs have NO nuclei; WBCs have nuclei and are multi-lobed

Question 41

necrotic papilla in urine

Answer 41

Acute pyelonephritis/Analgesic/Sickle cell disease

Question 42

\_\_\_\_ --\> indicate glomerulonephritis (both acute and chronic; this is a more severe disorder than pyelonephritis)

Answer 42

RBC Casts;

Question 43

\_\_-\>indicate acute pyelonephritis; suggests acute inflammation (if \_\_\_\_) or chronic (if \_\_\_)

Answer 43

WBC Casts; neutrophils; lymphocytes/hyalin casts;

Question 44

* Cells are large and flat. * Normal cells that line the urinary and genital tract or renal tubules + transitional cells (bladder)

Answer 44

Epithelial cells

Question 45

Atypical epithelial cells

Answer 45

transitional cells carcinoma

Question 46

Granular cast

Answer 46

Chronic kidney diseases

Question 47

indicate nephrotic syndrome

Answer 47

Massive proteinuria/4+

Question 48

Hyaline casts (appearance)\_\_\_\_\_ * A few are normal; a lot indicates \_\_\_. * Large hyaline casts indicated \_\_\_\_\_\_

Answer 48

Colorless; Chronic pyelonephritis, Myeloma

Question 49

Stone in the kidney

Answer 49

Likely Ca-oxalate Crystals

Question 50

•colorless; octahedron; found in acidic urine

Answer 50

Calcium oxalate crystals

Question 51

•in cystinuria in small children; hexagon (6 sides); acidic urine

Answer 51

Cystine Crystals- Hexagonal

Question 52

This is a crystal of\_\_\_\_\_

Answer 52

Calcium phosphate

Question 53

•colorless; coffin-lid prism; common finding and not usually significant (pH info).; alkaline urine

Answer 53

Triple Phosphate Crystals

Question 54

Acidic urine (Crystal types) (1) \_\_\_: colorless; octahedron. (2) \_\_\_: sharper borders, diamond

Answer 54

Calcium Oxalate Crystals; Uric Acid Crystals;

Question 55

(1) Triple Phosphate Crystals: colorless; coffin-lid prism; common finding and not usually significant (pH info).

Answer 55

alkaline urine