After several days of aggressive treatment for acute renal failure, John J., from Hematology Case 3, had the following lab results. Selected Chemistry Panel Results John J. Reference Range Creatinine 2.1 0.5-1.4 mg/dL BUN 33 5-25 mg/dL Total Protein 8 5.5-7.5 g/dL Albumin 2.2 3.4-4.5 mg/dL Calcium 8.2 8.5-10.5 mg/dL Phosphorus 6.4 2.5-4.5 mg/dL Cholesterol 370 <200 mg/dL Urinalysis Results Patient Reference Range Macroscopic Color Yellow Appearance Cloudy/Frothy Clear Specific Gravity 1.020 1.001 – 1.035 pH 7.0 5 – 7 Protein 3+ (500 mg/dL) Neg Glucose Neg Neg Ketones Neg Neg Bilirubin Neg Neg Blood 1+ Neg Urobilinogen Normal Normal Nitrite Neg Neg Leukocyte esterase Neg Neg Microscopic WBC’s 0-3/HPF 0 - 5/HPF RBCs 0-1/HPF 0 - 2/HPF Epithelial cells Rare renal epithelial/HPF Casts 0-3 hyaline/LPF 0-1 renal tubular epithelia/LPF 0 - 2 granular/LPF 0-1 waxy/LPF 0-2 fatty/LPF Few hyaline Other 0-1 oval fat bodies None
Questions: 1. What are the abnormal or discrepant urinalysis results?
2. What type of disease/condition would be characterized by this urinalysis result?
3. What is the primary defect or problem found in this condition?
4. What urinalysis result (s) led to your probable diagnosis?
5. a. What confirmatory test could be performed to identify the oval fat bodies? b. What is the source of oval fat bodies?
6. Explain the reason for the frothy urine.
7. List five conditions that may progress to this disease.
8. List five risk factors for this disease.
9. Are the abnormal chemistry tests consistent with the probably diagnosis? Explain why or why not.
10. What other renal function tests could be performed on a 24 hour urine? Would you expect the results to be decreased, normal, or elevated?
11. In a more typical newly diagnosed patient with multiple myeloma, the urinalysis result was negative for protein, in spite of the fact that urine immunoelectrophoresis indicated light chains were being excreted in the urine. Can you explain these seemingly discrepant results?
12. What type of protein was detected in John J.’s urinalysis result?