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Endocrine Extraordinary Sample

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Sample A0
The urine sample provided was clear and yellow with no frothing indicating that there was little or no protein in the urine. The sample contained no cells or crystals but did contain a small number of hyaline casts. The lack of cells indicates the filtration membrane is at least partially intact, the casts are not necessarily associated with pathology and are more likely due to exercise or dehydration although can be due to renal failure (Serafini-Cessi, Malagolini and Cavallone 2003). Dehydration and exercise decrease the urine output due to vasoconstriction of the renal arteries, stimulating the release of Tamm-Horsfall protein to help protect against calcium crystallisation and UTIs (Serafini-Cessi, Malagolini and Cavallone 2003). …show more content…

We were told the patient had oliguria which is low urine output, the patient passed 100ml in 24 hours which is well below the normal 750ml. This indicates some serious damage somewhere in the genitourinary system but this does necessarily indicate a kidney prognosis and could be due to other organ pathologies which cause low urine output such as prostatitis or a UTI (Klahr and Miller 1998). Microscopic analysis of the urine revealed high numbers of red blood cells both burst and intact and red blood cell casts but no crystals. This is evidence for damage to the kidneys as bleeding further down the urinary tract e.g. the bladder would be less likely to result in burst cells in the urine plus the formation of red blood cell casts is an indicator of glomerular damage such as inflammation (Sigala, Biava and Hulter 1978). The dipstick confirmed the presence of protein at 30mg/dL and also showed there were 250 ERY/uL with normal glucose levels. While the protein level is not that high, the number of red blood cells is huge, this is a clear indicator of glomerular damage as the filtration membrane is clearly not functional, as there are blood cells in the urine, the fenestrated endothelium is likely damaged. The GFR of 20 ml/min/1.73m2 is extremely low, indicating severely decreased function (Medsci 301 Course Guide 2015), providing further evidence for damage to the glomerulus as this is where filtration occurs. When observing the photomicrographs, the glomeruli are hard to see amongst large amounts of hyaline material, there is clearly an exudate in capsular space and there are large numbers of inflammatory cells. All these factors point to inflammation as the cause of the damage as this would cause the deposition of the hyaline material, lead to the exudate as vascular permeability is increased and also lead to the infiltration of immune cells into the reactive tissue.

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