Urine Analysis in systemic diseases

1. URINE ANALYSIS IN SYSTEMIC
DISEASES.

2. 1) NEPHRITIC SYNDROME.
1. Oliguria.
2. Marked haematuria – Smoky urine / Cola
coloured urine.
3. Proteinuria
4. Red blood cell cast and increased amount of
hyaline cast.
5. Dysmorphic Rbc
6. Epithelial casts.
7. Neutrophils.

3. HYALINE CAST
HYALINE CAST- PHASE
CONTRAST
MICROSCOPE

4. KOVA stained RTE cell cast
KOVA stained RTE cell cast under phase
contrast microscope.

5. Acute Glomerulonephritis
Rapid progressive glomerulonephritis
Goodpasture syndrome
Wegner’s granulomatosisP
Henoch-Schonlein purpura
• Macroscopic
Hematuria.
• Proteinuria.
• RBC cast.

6.  Membranous Glomerluonephritis.
Microscopic Hematuria.
Proteinuria.
 Membranoproliferative Glomerulonephritis.
Hematuria.
Proteinuria.

8. NEPHROTIC SYNDROME.
 Massive proteinuria ( >3.5g/dl)
 Lipiduria
 Urinary fat droplets.
 Oval fat bodies.
 Renal tubular epithelial cells.
 Fatty cast, waxy cast, cholesterol crystals.
 Microscopic haematuria.

9. Fatty cast Fatty cast under phase contrast microscopy

10. KOVA Stained – Waxy cast. KOVA Stained – Waxy cast.

11. CHOLESTEROL
CRYSTALS.

12.  Minimal Change Disease.
Heavy proteinuria.
Transient Hematuria.
Fat droplets.
 Focal segmental glomerulosclerosis.
Proteinuria
Macroscopic / microscopic hematuria.

13. CHRONIC GLOMERULONEPHRITIS
 Haematuria
 Proteinuria.
 Broad cast, Granular and waxy cast.
 Erythrocytes, leukocytes and epithelial cells.
 Occasional blood cast.
 Lipid droplets.

14. ACUTE TUBULAR NECROSIS
 Haematuria.
 Occasional proteinuria.
 Necrotic or degenerated Renal tubular epithelial cells.
 Renal tubular epithelial cell cast.
 Granular, dirty brown cast.
 Neutrophils and erythrocytes.
 Waxy cast, broad cast, granular and epithelial casts.

15. FANCONI SYNDROME
 Glycosuria.
 Mild proteinuria.
 Cystein crystals.

16. CYSTEIN
CRYSTALS

17. CYSTITIS.
 Hematuria.
 Numerous leukocytes.
 Erythrocytes.
 Deep Transitional epithelial cells.
 Histiocytes and giant cells.
 Bacteriuria
 Mild proteinuria

18. ACUTE PYELONEPHRITIS
 Turbid urine
 Numerous neutrophils
 Few lymphocytes and histiocytes.
 Renal epithelial cells and erythrocytes.
 WBC Casts and epithelial casts.
 Granular and waxy casts.
 Bacteria.

19. WBC Clumps.WBC Cast.

20. CHRONIC PYELONEPHRITIS.
 Occasional proteinuria.
 Leukocytes.
 Erythrocytes.
 Bacteria
 Broad waxy casts.
 Granular and epithelial casts.
 Occasional leukocyte casts.

21. ACUTE INTERSTITIAL NEPHRITIS.
 Macroscopic hematuria
 Proteinuria.
 Leukocyturia.
 Wbc cast.
 Eosinophils.

23. Eosinophils in urine.
 Acute interstitial nephritis
 ATN
 RPGN
 Post infectious GN
 Acute prostatitis
 Urinary tract infection
 Renal transplant rejection

24. ACUTE RENAL ALLOGRAFT
REJECTION.
 Hematuria.
 Occasional proteinuria.
 Renal epithelial cells.
 Lymphocytes , plasma cells, eosinophils and neutrophils.
 Renal epithelial casts, granular and waxy casts.

25. VIRAL INFECTION
 Hematuria.
 Occasional proteinuria.
 Enlarged mononuclear cells and/or multinucleate cells with prominent
intranuclear and/ or cytoplasmic inclusions.
 Neutrophils, lymphocytes, plasma cells.
 Erythrocytes.

26. DYSURIA-PYURIA SYNDROME.
 Slightly turbid urine.
 Numerous leukocytes.
 Eryhtrocytes
 Bacteria
 No casts.

27. CHRONIC RENAL FAILURE
 Isothenuric urine – Specific gravity 1.010.
 Proteinuria
 Glycosuria
 Granular, waxy, broad cast – Telescopic urine.

29. RENAL STONES
 Oliguria.
 Hematuria.
 Calcium oxalate monohydrate crystals.
 Calcium oxalate dihydrate crystals.
 Uric acid crystals.
 Tripple phosphate crystals.
 Cystein crystals..

30. PARASITES IN URINE.

31. URINARY TRACT NEOPLASIA.
 Hematuria.
 Atypical mononuclear cells with enlarged,
irregular hyperchromatic
nuclei and sometimes containing prominent
nucleoli.

32. LIVER DISORDERS.
HEMOLYTIC HEPATOCELLULAR OBSTRUCTIVE
BILE PIGMENTS - + ++
BILE SALTS - + ++
UROBILINOGEN ++/+++ +/- -

33. VIRAL HEPATITIS.
 Yellow colour.
 Conjugated Bilirubin.
 Urobilinogen +/-.
 Bilirubin cast.
 Bilirubin crystals.

34. Bilirubin cast. Bilirubin crystals.

35. CHYLURIA
 Passage of milky white urine.
 Etiology : Mainly parasitic
Wuchereria bancrofti.
Taenia echinococcus.
Taenia nana.
Ankylostomiasis.

38. DIABETES MELLITUS
 Proteinuria
 Glucosuria
 Ketonuria
 Prone to Candidia infections.

39. Candida
albicans.

40. LUPUS NEPHRITIS
 Proteinuria,
 Red blood cell casts.
 Red blood cells.
 White blood cells.

41. PHENYLKETONURIA.
 Defect in enzyme Phenylalanine hydroxylase.
 Phenylalanine hydroxylase converts phenylalanine to tyrosine.
 Mousy odour to urine.
 Ferric chloride tube test – Permanent blue green colour.

42. ALKAPTONURIA.
 Defect in enzyme Homogentisic acid oxidase.
 Homogentisic acid oxidase converts Homogentisic acid to
Methylacetoacetic acid.
 Urine gets darkened on standing at room temperature.
 Ferric chloride tube test – Transient blue colour.
 Addition of alkali to freshly voided urine – darkening of colour.
 Spectrophotometric analysis.

43. CYSTINURIA
 Failure of Renal tubules to reabsorb Cysteine.
 Sulphur odour .
 Cystein crystals- Colorless hexagonal plates.
 Cyanide nitroprusside test – Red- purple colour.

44. HOMOCYSTINURIA
 Defect in the metabolism of amino acids Methionine.
 Sulphur odour.
 Silver-nitroprusside test - Red-purple discolouration.

45. MAPLE SYRUP URINE DISEASE.
 Defect in enzyme necessary for oxidative decarboxylation of three amino
acids leucine, valine, isoleucine.
 Maple syrup odour.
 2,4 Dinitrophenylhydrazine test- Yellow precipitate.

46. PORPHYRIAS
 Defect in heme synthesis pathway.
 Red / Port wine colour to urine.
 Ehrlich reaction.
 Watson-Schwartz differentiation test.
 Fluorescence under ultraviolet in 550-600 nm range.

47. MUCOPOLYSACCHARIDOSES.
 Excretion of Dermatan sulfate, Keratan sulfate and heparin sulfate in urine.
 Acid albumin test.
 Cetyltrimethylammonium bromide test (CTAB).
 Metachromatic staining spot test – Blue spot i.e. not washed by addition of
acidified methanol solution.
White
precipitat
e.

48. LESCH- NYHAN DISEASE.
 Defective in enzyme hypoxanthine guanine phosphoribosyltransferase.
 Accumulation of uric acid throughout the body,
 Massive excretion of uric acid crystals in a paediatric patient.

49. Uric acid crystals
Uric acid crystals
in polarized light

50. QUESTION
S

51. Q. The presence of renal tubular epithelial cells
and casts is an indication of:
A. Acute interstitial nephritis
B. Chronic glomerulonephritis
C. Minimal change disease
D. Acute tubular necrosis

52. Q. Differentiation between cystitis and pyelonephritis is
aided by the presence of:
A. WBC casts
B. RBC casts
C. Bacteria
D. Granular casts

53. Q Dysmorphic RBC casts would be a significant finding
with all of the following except:
A. Goodpasture syndrome
B. Acute glomeruonephritis
C. Chronic pyelonephritis
D. Henoch-Schönlein purpura

54. Q. The presence of fatty casts is associated with all
of the following except:
A. Nephrotic syndrome
B. Focal segmental glomerulosclerosis
C. Nephrogenic diabetes insipidus
D. Minimal change disease

55. Q. Broad and waxy casts are most likely associated
with:
A. Nephrotic syndrome
B. Chronic renal failure
C. Focal segmental glomerulosclerosis
D. Acute renal failure

56. Q.The majority of casts are formed in the:
A. Proximal convoluted tubules
B. Ascending loop of Henle
C. Distal convoluted tubules
D. Collecting ducts

57. Q. Cylindroiduria refers to the presence of:
A. Cylindrical renal tubular cells
B. Mucus resembling casts
C. Hyaline and waxy casts
D. All types of casts

58. Q, A structure believed to be an oval fat body produced a
Maltese cross formation under polarized light but does
not stain with Sudan III. The structure:
A. Contains cholesterol
B. Is not an oval fat body
C. Contains neutral fats
D. Is contaminated with immersion oil