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Advice on acute tubular necrosis diagnosis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
User :   I am a med tech lab student that has a case study that is stumping me. A 25-year-old man was brought to the er with severe crush injuries from a car accident, he had a broken pelvis and right femur and numerous abrasions and contusions, a routine urinalysis was ordered the results were
color brown
protein 1+
Blood 3+
urobilinogen normal
nitrite negative Creatine kinase 170,000 IU/L
lactate dehydrogenase 2500 IU/L
everything else on urinalysis normal or negative
question: what two substances can give a positive reagent strip for blood and a negative microscopic finding?
question: list five causes for each of these two conditions
question: how would you explain the presence of casts and renal epithelial cells
question: what additional lab tests would be helpful
Doctor :   Hi'
Doctor :   Let me read it
User :   hello
Doctor :   Ascorbic acid in urine can interfere with reagent-strip reactions & give a positive test
Doctor :   The patient is having ATN
User :   okayyyy what is ATN
Doctor :   Hence there is presence of casts and renal epithelial cells
Doctor :   Acute Tubular Necrosis
User :   why would blood not show up on microscope examination that is what really really stumps me
Doctor :   Then what is 1+ Blood ?
Doctor :   But no blood on Microscopic examination?
User :   so are you saying about ascorbic acid in urine that the reagent strip really did not read blood so therefore there is no blood for the microscope to see but what about the brown color of the urine, the 1+ was for protein
User :   blood was 3+
Doctor :   What would you look for on microscope
Doctor :   when you are looking for blood?
User :   red blood cells, lysis of red blood cells, hematuria, hemoglobinuria?
Doctor :   Is it possible to visualize
Doctor :   all the above or only the former two?
User :   visulize the microscope slide, no, this is just a written case study
Doctor :   Yes,
Doctor :   what I mean is
Doctor :   One can visualise RBCs & lysed RBCs
Doctor :   on microscope,
User :   yes I can visualize those on a microscope, but no blood was seen on the microscope
Doctor :   In case of a crush injury, there is hematin & myoglobin in the blood which can give positive on strip, without actual RBCs being seen initially
Doctor :   RBCs will definitely be seen later when there
Doctor :   is further damage
User :   and what is the high creatine kinase level of 170,00 IU/L and the Lactate dehydrogenase 2500 IU/L mean
Doctor :   to the Glomerular membrane
Doctor :   Those are released from damaged RBCs, muscle & other tissues
Doctor :   Tissue damage
User :   what additional tests should be done
Doctor :   1. Renal function tests
Doctor :   2. Electrolyte level
Doctor :   3. BUN
Doctor :   4. S. Creatinine
Doctor :   5. Urine protein
User :   so this type of injury and its pathophysiology would be ATN
User :   and this due to the crushed pelvis not really the broken femur or any abrasions and contusions
Doctor :   Yes
User :   thank you so very much for your help
Doctor :   Thanks for consulting me. Bye for now.
User :   I am sure I will be back, lol bye
Doctor :   Here to help
Doctor :   Bye
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