Urinalysis

• Anything greater than 3 per high field

  • Repeat the test now

• Failed the test twice

  • Are there casts (formed in the tubular distribution) present

• CASTS

  • Check creatinine or BUN

    • If greater than 20 BUN

    • Then use the ASO titer (antistreptolysin)

    • If positive then

      • AGN - Acute glomerular nephritis

      • Treat as post streptococcal glomerularnephritis

• NO CLASTS

  • Urine culture positive - use AB

  • If urine culture is negative continue to IVP or sonography

    • Look at age

      • Greater than 40

        • Tumor? - Cystoscopy

      • Under 40

        • Monitor every 6 months

Screening Tests

• BUN

• Plasma Creatinine

• Creatinine clearance test

Quantitative Screening (glomerular filtration rate)

• Serum creatinine

• Creatinine clearance

Urinalysis

• Fluid biopsy

Tubular function

• Concentrating ability or acid base study

• Glucose reabsorption

• Special studies where indicated

Proteinuria

• The normal healthy glomerulus is going to produce an almost protein free urine (albumin can be in the urine naturally)

• Less than 200mg of protein is leaked daily

  • The lining of the tubular distribution is living cells. The fluid is actually touching the oldest layer

• The protein should not be larger than albumin -

  • If so it is the glomerulus that is having the issue

• Cannot rely on 1 urine test

  • You have to do a 24 hr collection of urine. This is how the study is done to test the glomerulus.

  • Tamm Horsfall protein - this finding requires us to do nothing as this is normal

Nephrotic Syndrome

• 2.5 grams a day is the least to diagnose this (2500mg) disease

Category: Medicine Notes