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Lab Findings in Genitourinary Disease
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ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS NEPHRITIS DUE TO BACTERIAL ENDOCARDITIS NEPHROTIC SYNDROME DIABETIC NEPHROPATHY
DIABETIC NEPHROPATHY MYELOMA NEPHROPATHY LUPUS NEPHRITIS POLYARTERITIS RENAL DISEASE
SCLERODERMA RENAL DISEASE TOXEMIA OF PREGNANCY ACUTE RENAL FAILURE CHRONIC RENAL FAILURE
RENAL TUBULAR ACIDOSIS PYELONEPHRITIS RENAL AND PERINEPHRIC ABSCESSES RENAL CALCULI
RENAL INFARCTION RENAL-VEIN THROMBOSIS POLYCYSTIC KIDNEY DISEASE ADENOCARCINOMA OF THE KIDNEY
CYSTITIS BENIGN PROSTATIC HYPERPLASIA PROSTATITIS CARCINOMA OF THE PROSTATE
VAGINITIS ECTOPIC PREGNANCY HYDATIDIFORM MOLE SICKLE CELL NEPHROPATHY
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ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS
LABORATORY FINDINGS
Evidence of Streptococcal Infection
Throat culture - Group A streptococcus
Increased antistreptolysin O (ASO) titer appears 1-3 weeks after infection and peaks at 3-5 weeks: 50% of patients show no rise in ASO titer; height of the titer does not reflect severity of the renal disease
Increased DNase B - this streptococcal antibody is more frequently elevated than is ASO following streptococcal skin infections. Urine
Hematuria, gross or microscopic, occurs during the initial upper respiratory infection and then reappears with nephritis in 1-2 weeks. It lasts 2-12 months.
Leukocyturia
Casts - red blood cell (RBC), white blood cell (WBC), granular, fatty hyaline
Proteinuria (usually <3 g/day) disappears before hematuria occurs
Oliguria
Increased specific gravity occurs early in the disease.
Blood
Increased blood urea nitrogen (BUN), creatinine
Decreased creatinine clearance
Increased sedimentation rate
Leukocytosis with increased neutrophils
Mild normocytic anaemia due to hemodilution, marrow depression, or increased RBC destruction
Decreased albumin, increased alpha2 globulin; the former reflects urinary loss; the latter indicates acute inflammation.
Decreased serum complement occurs 24 hours before the onset of hematuria, rises to normal when hematuria subsides and lasts for 2-12 weeks. This reflects transient depletion of complement when immune complexes deposit in the kidney.
Histology slide

What is glomerulonephritis?


NEPHRITIS DUE TO BACTERIAL ENDOCARDITIS
LABORATORY FINDINGS
Proteinuria is usually present
Microscopic hematuria
Renal insufficiency - increased BUN and creatinine; decreased urine specific gravity
Decreased serum complement during the acute phase


RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS
LABORATORY FINDINGS BR Marked increase in serum BUN and creatinine
Urine - gross and microscopic hematuria, WBC, casts of all types
Proteinuria, usually > 3 g/day
Decreased urine specific gravity
Decreased urine volume - often <400 ml/day
Normocytic anaemia, may be severe
Renal biopsy shows characteristic glomerular crescents.



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NEPHROTIC SYNDROME
LABORATORY FINDINGS
Increased urine proteins, especially albumin (>3.5 g/24 hr; may be >20 g/24 hr)
Decreased serum albumin (usually < 2.5 g/d)
Increased serum cholesterol {> 350 mg/dl), triglycerides, lipoproteins; decreased or normal serum cholesterol occurs with poor nutrition and suggests a poor prognosis
Increased serum alpha2 and beta-globulins, marked; decreased y-globulin, especially IgG
Urine - free fat droplets, fatty casts, and oval fat bodies; when examined by polarized light, the lipids in casts are seen as being doubly refractile or birefringent and they display a symmetric "Maltese-cross" pattern. Oval fat bodies are lipid-containing renal tubular epithelial cells.
Increased sedimentation rate due to increased fibrinogen
Decreased serum calcium reflects fall in serum albumin; ionized calcium is usually normal.


DIABETIC NEPHROPATHY
LABORATORY FINDINGS
Laboratory findings of diabetes mellitus
Diabetic Glomeruloscerosis
Proteinuria - often > 5 g/24 hr
Hyaline and granular casts and oval fat bodies in urine
Decreased serum protein
Azotemia, late
Papillary Necrosis
Sudden decrease in renal function
Hematuria
Renal tissue fragments in the urine Urinary-Tract Infection Increased urine WBC
Positive urine cultures

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SICKLE CELL NEPHROPATHY
LABORATORY FINDINGS
Laboratory findings of sickle-cell disease
Hematuria, gross and microscopic
Decreased renal concentrating ability
Proteinuria (in approximately 30% of patients)


MYELOMA NEPHROPATHY
LABORATORY FINDINGS
Laboratory findings of multiple myeloma
Proteinuria - albumin, globulins, and Bence Jones proteins
Azotemia and loss of urine concentrating ability
Increased serum calcium, seen in one third of patients, often accompanied by polyuria, and associated with rapidly progressive renal failure
Anemia, which is greater than expected for the degree of azotemia
Occasional proximal renal tubular acidosis - glycosuria, decreased serum uric acid, increased urine potassium, phosphaturia, decreased serum phosphorus, oliguria, aminoaciduria

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LUPUS NEPHRITIS

LABORATORY FINDINGS
Laboratory findings of lupus erythematosus
Antinuclear antibody in nearly 100% of cases with active SLE
Anti-DNA antibody, usually present in active SLE and active renal disease
Serum complement, usually depressed in active lupus nephritis
LE test - positive in most cases
There are four pathologic subgroups of lupus nephritis, each of which has particular clinical and laboratory features. The pathologic characteristics are seen in a renal biopsy by light, immunofluorescence, and electron microscopy.


POLYARTERITIS RENAL DISEASE
LABORATORY FINDINGS
Laboratory findings of polyarteritis nodosa
Proteinuria - always present
Hematuria, gross or microscopic, very common
Urine sediment - WBC casts and oval fat bodies
Leukocytosis and increased sedimentation rate reflect systemic inflammation.

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SCLERODERMA RENAL DISEASE

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.


TOXEMIA OF PREGNANCY

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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ACUTE RENAL FAILURE
LABORATORY FINDINGS
Table 5-1 shows the urinary indices that are commonly found in oliguric renal failure of prerenal and intrarenal origin. Findings of postrenal obstructive renal failure resemble those of intrarenal failure; administration of diuretics or mannitol may result in indices resembling acute tubular necrosis.
Urine volume - <400 ml/day for an average of 10 days, followed by a diuretic or recovery phase in which excretion is usually more than 1000 ml/day. In about 50% of cases of acute renal failure, urine volume is above 600 ml/day. This is termed nonoliguric or high-output renal failure.
Very rarely, complete anuria occurs; this usually indicates urinary-tract obstruction or bilateral renal cortical necrosis.
Urine - RBC, WBC, protein, and casts; renal tubular casts in ATN and red-cell casts in acute glomerulonephritis
Decreased creatinine clearance is the earliest predictor of postoperative renal failure.
Increased serum creatinine, urea nitrogen, magnesium, phosphorous, uric acid, amylase, lipase
Potassium - in the oliguric phase, serum concentration increases and urine concentration decreases; in the diuretic phase, increased urinary potassium excretion may result in decreased serum potassium.
Decreased serum C02 content, pH (metabolic acidosis), sodium, calcium
Normocytic anaemia appears during the second week.

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CHRONIC RENAL FAILURE
LABORATORY FINDINGS
Decreased creatinine clearance
Increased serum BUN, creatinine, phosphorus, magnesium (when GFR <30 ml/min), lipoproteins, and triglycerides (40% - 50% of patients)
Decreased serum calcium (due to increased serum phosphorus, decreased calcium absorption, and decreased serum albumin), albumin, and total protein (due to proteinuria)
Increased serum PTH occurs in response to increased serum phosphorus and decreased serum calcium.
Decreased pH and CO2 content (metabolic acidosis) due to failure to excrete acid as NH4+ and to reabsorb bicarbonate
Decreased PCO2 due to hyperventilation as compensation for metabolic acidosis
Normochromic, normocytic anaemia (hematocrit 20% - 30%), proportionate to the degree of axotemia
Decreased glucose tolerance due to impaired cellular utilization of glucose
Fixed urine volume (1 liter/day - 4 liters/day)
Decreased urine osmolality (250 mOsm/Kgt H20-400 mOsm/Kg H20); this becomes fixed close to normal plasma level of 280 m0sm/Kg H20-295 m0sm/Kg H20.
Decreased urine specific gravity, < 1.020; as renal impairment becomes more severe, specific gravity approaches 1.010
Increased urine sodium
Decreased urine calcium - occurs before hypocalcemia occurs



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RENAL TUBULAR ACIDOSIS
LABORATORY FINDINGS
Proximal RTA
Decreased blood pH, serum bicarbonate (metabolic acidosis)
Alkaline urine in the presence of low serum bicarbonate
Acid urine in the presence of very low serum bicarbonate
Increased serum chloride - normal anion gap
Normal or decreased serum potassium, sodium
Increased urine sodium, potassium
Increased urine glucose, phosphorus, amino acids, and uric acid in Fanconi syndrome.
Distal RTA
Decreased blood pH, serum bicarbonate (metabolic acidosis)
Alkaline urine (pH > 6.0), regardless of serum bicarbonate level and even with an acid load test (ammonium chloride 100 mg/kg orally)
Increased serum chloride - normal anion gap
Decreased serum potassium, calcium, phosphorus: some cases are associated with hyperkalemia
Increased urine sodium, potassium, calcium phosphate; the last two account for an increased frequency of calculus formation



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PYELONEPHRITIS
LABORATORY FINDINGS

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



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RENAL AND PERINEPHRIC ABSCESSES
LABORATORY FINDINGS
Leukocytosis (often > 30,000/ul)
Increased sedimentation rate reflects acute inflammation.
Urine - trace of protein, few RBC, many bacteria; culture usually yields Staphylococcus, if the infection is of bloodstream origin, or gram-negative organisms, if the infection is of renal origin.
If urinalysis is normal and sterile, acid-fast smear and culture should be done.
Normocytic anaemia due to chronic infection


RENAL CALCULI
LABORATORY FINDINGS
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.



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RENAL INFARCTION
LABORATORY FINDINGS
Hematuria, proteinuria, and leukocytosis commonly occur.
Increased SGOT (AST), lactate dehydrogenase (LDH), and C-reactive protein if the infarct is large; LDH isoenzymes show no specific tissue localization
Normal creatinine phosphokinase (CPK)


RENAL-VEIN THROMBOSIS
LABORATORY FINDINGS
Link to image source
In Children
Hematuria
Oliguria
Leukocytosis
Renal failure

In Adults
Nephrotic syndrome
Increased serum creatinine and BUN



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POLYCYSTIC KIDNEY DISEASE
LABORATORY FINDINGS
Increased urine volume commonly occurs.
Hematuria - there are episodes of gross haemorrhage or microscopic bleeding
Proteinuria is progressive.
Pyuria is common, even in the absence of bacteriuria.
Increased BUN and creatinine
Anaemia is chracteristic, reflecting blood loss or azotemia.

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.)


ADENOCARCINOMA OF THE KIDNEY

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)
Hematuria is common
Anaemia is due to impairment of erythropoientin formation by the kidney and to bone-marrow depression.
Increased RBC, haemoglobin, and hematocrit occasionally occur due to erythropoietin formation by the tumour.
Leukemoid reaction (up to 100,000/l)
Abnormal liver function tests in the absence of hepatic metastases - increased alkaline phosphatase, prolonged prothrombin time; decreased albumin and increased alpha2 - globulin.
Increased sedimentation rate (up to 150 mm/hr)


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CYSTITIS
LABORATORY FINDINGS

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.



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BENIGN PROSTATIC HYPERPLASIA
LABORATORY FINDINGS
Urine - normal or showing changes of infection: proteinuria, pyuria, hematuria, bacteriuria
Increased serum creatinine occurs when urinary-tract obstruction impairs renal function; this is an example of postrenal acute renal failure.


PROSTATITIS

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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CARCINOMA OF THE PROSTATE
LABORATORY FINDINGS

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.


VAGINITIS
LABORATORY FINDINGS

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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ECTOPIC PREGNANCY
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/ul
Anaemia may or may not be present; progressive anaemia indicates continued bleeding.
Increased serum amylase
Increased sedimentation rate


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HYDATIDIFORM MOLE

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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