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Urinalysis, Acute Renal Failure & Atheroembolism

by Carlo Raj, MD
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    00:00 Let’s talk about urinalysis, acute renal failure.

    00:03 What are you gonna find? Evaluation; color, turbidity, protein, pH, specific gravity, sediment, all of this was talked about in great detail.

    00:13 We went through table after table, after table of different colors, turbidities, and sediments.

    00:18 Turbidity here, you have increased with crystals, blood cells, or even casts.

    00:24 What kind of casts would these be? The granular casts.

    00:27 The protein, foamy when shaken.

    00:29 So kinda, I’ll take my urine, shaken but not stirred.

    00:35 Foamy when shaken, protein.

    00:38 Sediments, RBCs and WBCs, normally absent you’ll find this.

    00:44 Problem? RBC’s, well what if you did find this? We talked about this being either urologic or glomerular.

    00:49 WBCs, infection, inflammation, and as we move in here further into acute renal failure, we’ll talk about eosinophils and go into acute interstitial nephritis.

    01:00 Do not confuse that with acute tubular necrosis.

    01:03 Our topic at this point is strictly acute renal failure.

    01:07 Terminology, big time important.

    01:10 Once again, acute renal failure could be divided into acute tubular necrosis, acute interstitial nephritis, under acute tubular necrosis, the most common cause would be, good, ischemia.

    01:22 Atheroembolism can also give you eosinophils, do not forget that, please do not forget about atheroemboli.

    01:30 The sediments that you expect to find with acute renal failure, well it all depends.

    01:35 Maybe cellular precipitates, RBC casts, more of a glomerular origin, WBC casts, here eosinophils, coarse granular, muddy brown cast that that to you, absolute pathognomonic for acute tubular necrosis.

    01:51 The bacteria, it depends.

    01:53 If you find an infection and you had supra pubic pain and you’re peeing a lot.

    01:59 And all that you find is bacteria on gram stain, all this means to you is an infection, most likely, a cystitis but you end up finding, we talked about this, a type of WBC cast that are neutrophils and there’s flank pain retroperitoneally and your pyelonephritis.

    02:19 Okay, now, atheroemboli, the cholesterol emboli, you expect to find embolization of cholesterol crystals to the kidney and that’s if I had a fever, rash, and peripheral eosinophilia with acute interstitial nephritis.

    02:37 And what you see in the picture here, are those crystals that I’m referring to, your cholesterol crystals.

    02:42 May be associated with cutaneous stigmata of peripheral embolism, and a second picture down below is in fact showing you of ulcerations, ulcers, blue or gangrenous because of decreased blood floor.

    02:55 All of this is just keep in mind please whenever you’re dealing with cholesterol, it’s a systemic issue isn’t it? From head to toe.

    03:01 And kidney is just a part of it, a kidney manifestation of acute renal failure would be acute interstitial nephritis and you expect to find peripheral eosinophilia.

    03:11 Often occurs following instrumentation of aorta, that’s important, for example, so it’s that you are now trying to assess, okay, your blockage and you do a catheterization.

    03:25 There’s every possibility that you might accidentally inadvertently disrupt the plaque, what happens? Boom, the cholesterols are now embolizing to distant sites, maybe kidney, maybe the digits, so on and so forth, are you getting the point now? What is my triad here that’s important? Definitely look for that peripheral eosinophilia, AIN, acute interstitial and perhaps, fever.


    About the Lecture

    The lecture Urinalysis, Acute Renal Failure & Atheroembolism by Carlo Raj, MD is from the course Tubulointerstitial Diseases.


    Author of lecture Urinalysis, Acute Renal Failure & Atheroembolism

     Carlo Raj, MD

    Carlo Raj, MD


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