NB1:q15 - kylie

[ArchivalUser]

A 5 year old boy is brought to the emergency department 30 minutes after he fainted at home after standing up from a sitting position.His symptoms began 3 days ago with diarrhea and vomiting.He has had no urine output for 18 hrs.His temperature is 99.5,BP is 75/45,pulse is 120/min,and RR is 28/min.Examination show dry lips and tenting of skin.There is no abdominal tenderness.Bowel sounda are hyperactive.The remainder of the exam is normal.His cappilary refill is 5 sec.IV bolus doses of 0.9% saline are administered.Bladder catheterization yields 5 ml of urine.Urinalysis is most likley to show which of the following?
a.blood
b.erythrocyte cast
c.hyaline cast
d.leukocyte cast
e.oxalate cast

[ArchivalUser]

My answer is hyaline casts.
reference is here
Abnormal results may include:

Hyaline casts -- these casts are made of the protein itself. They are usually caused by dehydration, exercise, or diuretic medicines.
Granular casts -- these casts include prominent granules and indicate an underlying kidney disease. However, they are non-specific and may be present with diverse kidney disorders.
Fatty casts -- these result when fatty (lipid) material is incorporated into the cast from lipid-laden tubular cells. Fatty casts are seen in the condition of lipiduria (lipids in urine), usually as a complication of nephrotic syndrome.
Red cell casts -- these signify bleeding into the tubule from the glomerulus. They are seen in many diseases affecting the glomerulus, such as IgA nephropathy, lupus nephritis, Goodpasture's syndrome , and Wegener's Granulomatosis. Red cell casts may degenerate and appear in the urine as reddish-brown, coarsely granular casts, called blood or hemoglobin casts.
White blood cell (WBC) casts -- these are more common in interstitial cell kidney disease, such as interstitial inflammation, pyelonephritis, and parenchymal infection.
Renal tubular epithelial cell casts -- these reflect damage to the tubules. They are seen in renal tubular necrosis (for example, caused by nephrotoxic drugs, heavy metal poisoning, or ethylene glycol), viral disease (such as CMV nephritis), and with transplant rejection.
Waxy casts -- these casts are associated with advanced kidney disease and chronic kidney failure.
http://www.nlm.nih.gov/medlineplus/ency/...003586.htm

[ArchivalUser]

C.

[ArchivalUser]

I think the choice should be B) RBC cast.

The patient is likely HUS, hematuria and proteinuria are often present in HUS. He is having acute renal failure.

[ArchivalUser]

...

[ArchivalUser]

why HUS and not just severe dehydrated: capilary refil 5 sec... bp75/45, hr 120, orthostatic hypotension, dry mucouse etc.

[ArchivalUser]

HUS occurs after recovery from the diarrhea, and the diarrhea is blood, this patient has diarhea and renal insufficiency at the same time, so unlikely to be HUS

[ArchivalUser]

My answer is hyaline casts. This is ARF secondary to hypovolaemia (diarrhoea/vomiting).

This is definitely not HUS. Where is the evidence for haemolysis?

[ArchivalUser]

Thank you for the correction, I got it. So C) should be the option.