LABORATORY FINDINGS
Laboratory findings of scleroderma
Proteinuria (about one third of patients) - may be minimal and is usually <2 g/day
Azotemia (about one fifth of patients) indicates advanced renal disease
Oliguria and renal failure are a terminal occurrence.

LABORATORY FINDINGS
Urine
Proteinuria, variable degree - this is a characteristic finding
Increased urine specific gravity
Most patients have normal urine sediment, although a few will have microscopic hematuria and RBC cats
Oliguria in severe disease
Serum
Increased serum uric acid (70% of patients) is the result of decreased tubular secretion and renal clearance of urates: the degree of increase correlates with the severity of the renal lesion.
Marked decrease in serum total protein and albumin is a common finding.
Decreased sodium excretion due to increased tubular reabsorption of sodium secondary to decreased effective circulating blood volume
Increased serum glutamic-oxaloacetic transaminase (SGOT) (AST [aspartate aminotransferase], serum glutamic-pyruvic transaminase (SGPT) (ALT [alanine aminotransferase]) due to ischemic damage to liver cells; the degree of abnormality parallels the severity of the disease
Normal serum creatinine and BUN - there is reduced GFR in toxemia, which normalizes the increased GFR occurring in normal pregnancy
Laboratory findings of disseminated intravascular coagulation (DIC)

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Link to image source: Pyelonephritis

Quantitative culture of properly collected clean midstream urine: > 100,000 colonies/ml urine indicates infection 10,000 colonies/ml urine - 100,000 colonies/ml urine probably indicates infection if only one organism is isolated or is predominant <10,000 colonies/ml urine usually indicates contamination It is important to note the following: 1. If a patient is asymptomatic, two positive cultures are needed to establish a diagnosis of infection. 2. If cultures are persistently negative in the presence of other evidence of pyelonephritis, three to five first morning urine specimens should be cultured for tubercle bacilli. Presence of bacteria on Gram's stain of properly collected uncentrifuged urine Pyuria is of greatest significance when it is associated with bacteriuria. When either urinary WBC or bacteria occur without the other, this is of less significance. WBC and bacteria are often intermittent and are usually absent in chronic pyelonephritis. WBC casts are diagnostic of renal, rather than bladder, infection. Proteinuria (>2 g/24 hr) Decreased urine specific gravity - concentrating ability is impaired relatively early Decreased creatinine clearance precedes increased BUN or serum creatinine. Leukocytosis - in acute pyelonephritis Markedly increased serum C-reactive protein indicates acute infection. Normocytic anaemia - in chronic pyelonephritis Laboratory findings of associated diseases, such as diabetes mellitus, bladder infection

Link to image source:Red and White Cell casts in urine sediments. This site has other images of urine sediments as well

Link to image sourceHematuria commonly occurs. Urinalysis is often normal, but might show pus cells, bacteria and crystals. Increased urine calcium (approximately 35% of patients) Leukocytosis indicates associated infection.

Link to image source In Children Hematuria Oliguria Leukocytosis Renal failure In Adults Nephrotic syndrome Increased serum creatinine and BUN

Laboratory Findings of Complications
Pyelonephritis
Renal calculi

Link to image source: Polycystic liver and kidney disease at autopsy; the liver was completely normal functionally (photograph courtesy of Chris Reuter, M.D.)

LABORTORY FINDINGS

Renal cell adenocarcinoma, Kidney Renal Cell Adenocarcinoma •The photograph shows multiple seemingly discontinuous yellowish nodules. •These nodules represent renal cell carcinoma (clear cell type) which has extensively permeated the venous channels of the kidney. •The lower portion of the specimen shows tumor thrombus in the renal vein. •In this particular case, tumor showed continuous intravenous growth to the inferior vena cava. Image Contrib. by: Hartford Hospital Description by: H. Yamase, M.D. ( 488-6216)

Link to image sourceRenal cell adenocarcinoma, Kidney Renal Cell Adenocarcinoma •Cut section of this kidney shows a renal cell carcinoma (white arrow). The tumor is spherical, well-circumscribed, and has a yellow-tan color. •This tumor measured 2.5 cm in diameter and was peripherally located. It stretched the renal capsule but did not penetrate through it. •A benign cyst is also present (black arrow). Image Contrib. by: UCHC Description by: H. Yamase, M.D. ( 246-7198)

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Link to image source: Presence of bacteria on Gram's stain of properly collected and uncentrifuged urine Increased neutrophils in the urine Quantitative culture of properly collected clean midstream urine: >> 100,000 colonies/ml urine indicates infection. 10,000 colonies/ml urine - 100,000 colonies/ml urine probably indicates infection if only one organism is isolated or is predominant. << 10,000 colonies/ml urine usually indicates contamination. It is important to note the following: 1. If a woman has symptoms suggesting bladder infection, the presence of coliform organisms > 100 colonies/ml urine in the presence of pyuria is significant. This should not be considered to be contamination. 2. If a patient is asymptomatic, two positive cultures are needed to establish diagnosis of infection. 3. If cultures are persistently negative in the presence of other evidence of cystitis, three to five first morning urine specimens should be cultured for tubercle bacilli.

LABORATORY FINDINGS

Transurethral Resection	Department of Biomedical and Agricultural Sciences, James Cook University of North Queensland, Townsville, Australia

Acute Prostatitis
Following prostatic massage, the last portion of voided urine shows increased numbers of WBC when compared to the first portion of voided urine.

The last portion of voided urine also shows a positive culture and higher colony count when compared to the first portion of voided urine, which is usually sterile.

Culture usually yields E. coli. Other less common organisms include Proteus, Pseudomonas, Klebsiella, and Enterobacter.

Chronic Prostatitis
Prostatic fluid shows > 10 WBC per high-power field
Cultures usually show only 500-1000 bacteria/ml.

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Increased serum acid phosphatase indicates local extension or distant metastases of the tumor. Elevated levels show a marked fall within 3 days to 4 days after castration or within 2 weeks after oestregen therapy has begun.
Normal levels may occur with prostatic cancer.

Increased serum alkaline phosphatase reflects new bone formation, which occurs with bone metastases. The enzyme increases when there is a favourable response to therapy, reaches a peak in 3 months, and then declines. Recurrence of bone metastases causes the enzyme to increase again.

Gram's stain and culture might show G. vaginalis, Neisseria gonorrhoeae, c. albicans

Wet mount or Gram's stain might show masses of gram-negative rods clustered about vaginal epithelial cells. these so-called clue cells are suggestive of G. vaginalis infection.

Saline suspension or Pap smear might show T. vaginalis.

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Link to Cornell University	Link to Fertile Thoughts page	Image Source

LABORATORY FINDINGS

Pregnancy tests - latex and hemagglutination-inhibition tests are positive in only 50% of these patients. Radioimmunoassay tests on serum are required to detect the very low levels of human chorionic gonadotropin (HCG) which occur in ectopic pregnancy. Decreasing levels of HCG indicate loss of viability of an ectopic pregnancy.

Ruptured Tubal Pregnancy
Leukocytosis, which usually returns to normal in 20 hours; 50% of patients have normal WBC, 75% have WBC < 15,000/µul
Anaemia may or may not be present; progressive anaemia indicates continued bleeding.
Increased serum amylase
Increased sedimentation rate

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LABORATORY FINDINGS

Increased serum HCG - normally, from the 7th to the 10th week of the average pregnancy, there is a sharp rise in HCG; this occurs especially with multiple pregnancies and is similar to the amount seen with hydatidiform mole. After the 10th to 12th week of a normal pregnancy there is a fall in HCG. In the presence of hydatidiform mole, HCG continues to rise. After removal of the mole, the HCG levels should normally become negative within 60 days. If an elevated titer persists or continues to increase, then an invasive mole or choriocarcinoma probably exists.

Hydatiform (closeup)	Hydatiform (macro)	Hydatiform (complete)	Hydropic villi	Trophoblast hyperplasia

Increased urine HCG, often markedly elevated, parallels serum levels.
Quantitative titers are important for diagnosis and for following the course of the disease and response to treatment.
Laboratory findings of disseminated intravascular coagulation (DIC) , which may occur with hydatidiform mole.

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