URINARY CASTS-REVIEW

Normal RBCS excretion == 2 millions RBCs/day

Hematuria == 2--5 RBCs Per HPF.

GRANULAR CAST === Significant renal disease (ARF)

Hyaline cast === most frequently (M.C.)==normal/mild renal disease.

Epithelial cast ==== disease affecting tubules/ ATN.

Broadcast / Waxy cast === chronic renal disease/CRF, Malignant HTN, Diabetic nephropathy.

RBCs/Dysmorfic(>5%) RBCs cast == Glomerular injury (kidney) / PSGN.

WBCS cast == Pyelonephritis

Lipid cast == Nephrotic synd.

NOTE--->
For UTI infec.-------->
Diagnosis in uncentrifused urine---- in females---> pus cells > 10 per HPF--->UTI
& 3-10------->doughtfull
<3------>insignificant
and in males ------->pus cells > 3 per HPF----->UTI

Diagnosis in centrifused urine -----in males and females---->pus cells >5 per HPF---->UTI.

ACID –BASE FUNDA’S

-----Acidosis-----------------(
(Lt.side) CO2 + H2O--------( H2CO3--------( H+ + HCO3- (Rt.side)
(----Alkalosis------------------

EXPECT FOR THE COMPENSATION, THE
BASIC RULE = ACIDOSIS= DECREASED PH / INCREASE [H+] / LOSS OF HCO3-
= ALKALOSIS= INCREASED PH / DECREASED [H+] / Decreased PCO2

Lung Compensate for==

1. For Metabolic Acidosis by Decreasing PCO2 (by Hyperventilation)

(2) For Metabolic Alkalosis by Increasing PCO2 (by Hypoventilation)

Kidney Compensate for==
(1) For Respiratory Acidosis by Increasing HCO3- Reabsorption.
(2) For Respiratory Alkalosis by Decreasing HCO3- Reabsorption.

Always look for [HCO3-] / [PCO2]==

(1) Uncompensated / simple conditions==( any one of these can be the fes. But only one of these…)
= Normal/ Increase
= Normal/ Decrease
= Increase/ Normal
= Decrease/ Normal

1. Compensated conditions==

= Increase/ Increase
= Decrease/ Decrease

1. Mixed i.e. (Both Respiratory and metabolic Acidosis or Alkalosis)==

i.e. Metabolic Acidosis and Respiratory Acidosis=[HCO3-]/ PCO2== Decrease/ Increase
Metabolic Alkalosis and Respiratory Alkalosis=[HCO3-]/ PCO2== Increase/ Decrease
Things to look for (in order)=

1. PH (N=7.38-7.44)


2. PCO2 (N=35—45)


3. [HCO3-] (N=21—30)


4. [HCO3-]/ PCO2

Respiratory Acidosis=simple/uncompensated

1. PH (N=7.38-7.44) == Decrease


2. PCO2 (N=35—45)== Increase


3. [HCO3-] (N=21—30)== Normal


4. [HCO3-]/ PCO2== Normal/ Increase

Respiratory Acidosis= compensated

1. PH (N=7.38-7.44)== Normal


2. PCO2 (N=35—45)== Increase


3. [HCO3-] (N=21—30)== Increase


4. [HCO3-]/ PCO2== Increase/ Increase

Respiratory Alkalosis=simple/uncompensated

1. PH (N=7.38-7.44)== Increase


2. PCO2 (N=35—45)== Decrease


3. [HCO3-] (N=21—30)== Normal


4. [HCO3-]/ PCO2== Normal/ Decrease

Respiratory Alkalosis= compensated

1. PH (N=7.38-7.44)== Normal


2. PCO2 (N=35—45)== Decrease


3. [HCO3-] (N=21—30)== Decrease


4. [HCO3-]/ PCO2== Decrease/ Decrease

Metabolic Acidosis=simple/uncompensated

1. PH (N=7.38-7.44)== Decrease


2. PCO2 (N=35—45)== Normal


3. [HCO3-] (N=21—30)== Decrease


4. [HCO3-]/ PCO2== Decrease/ Normal

Metabolic Acidosis= compensated

1. PH (N=7.38-7.44)== Normal


2. PCO2 (N=35—45)== Decrease


3. [HCO3-] (N=21—30)== Decrease


4. [HCO3-]/ PCO2== Decrease/ Decrease

Metabolic Alkalosis=simple/uncompensated

1. PH (N=7.38-7.44)== Increase


2. PCO2 (N=35—45)== Normal


3. [HCO3-] (N=21—30)== Increase


4. [HCO3-]/ PCO2== Increase/ Normal

Metabolic Alkalosis=Compensated

1. PH (N=7.38-7.44)== Normal


2. PCO2 (N=35—45)== Increase


3. [HCO3-] (N=21—30)== Increase


4. [HCO3-]/ PCO2== Increase/ Increase

MEDICAL DISORDERS AND NAILS

Beau's lines- are indentations that run across your nails.They are seen in injury or severe illness, such as a heart attack & as a sign of malnutrition

Terry's nails- nails look opaque, but the tip has a dark band.Seen in aging & serious illness, such as: Cancer Congestive heart failure Diabetes Liver disease

Yellow nail syndrome- seen in respiratory condition, such as chronic bronchitis, or from swelling of your hands (lymphedema). In yellow nail syndrome, nails thicken and new growth slows. Yellow or green nails may also result from any condition that causes the growth of your nails to slow down.

Pitting- Seen in people with psoriasis or nail injuries. Pitting is also associated with conditions that can damage your nail's cuticle, such as chronic dermatitis of your fingers or alopecia areata.

Clubbing- This condition results from low oxygen levels in your blood and is a sign of lung disease.

Spoon nails- (koilonychia) is a sign of iron deficiency anemia

Thickened toenails:- seen in an injury, skin conditions such as psoriasis, tight or poorly fitting shoes, and fungal infections-onychomycosis- is the most common cause of thickened toenails.

Nail separates from nail bed- this is known as onycholysis.seen in Injury,Thyroid disease,Fungal disease,Drug reactions or acrylic nails Psoriasis