Nephrology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Urinary casts – renal tubular cell casts:1 ATN.2 Interstitial nephritis.
Clinical Assessment, Investigation and Treatment of Renal Disease in Africa: A Practical Guide for Primary Care Physicians
Meguid El Nahas in Kidney Diseases in the Developing World and Ethnic Minorities, 2005
Urinary casts are formed from the aggregation of cellular debris and glyco-proteins (for example Tamm–Horsfall protein) deposited in the tubule and may appear in urine. The different types of urinary casts seen provide some idea of the underlying pathology.
The Analyzed Body
Roger Cooter, John Pickstone in Medicine in the Twentieth Century, 2020
The reductionist impulse to analyze ever smaller bits of bodily structures can be traced not only in the history of pathological examinations of solid tissues, but also in the development of analytical techniques for the study of a variety of bodily fluids (including blood, urine, and sputum). Although the examination of urine for pathognomic signs is an ancient medical procedure, the technical development of many aspects of twentieth-century urinalysis grew out of nineteenth-century research. In the course of the nineteenth century, direct visual inspection of urine for color, turbidity, and sediment, reaction to litmus, and measurement of specific gravity were supplemented by both microscopic examinations for pus, casts, and crystals, and chemical analyses for traces of albumin (protein), sugar, and other substances. At the basis of these new methods of analyzing urine was the mid-nineteenth century work of Bright and his colleagues, many of them chemists, who established a relationship between kidney disease and the presence of protein in urine. New chemical tests for urinary sugar, long associated with diabetes, were developed in the same period. Microscopic examination of urinary casts associated with different types of morphological changes of the kidney served as a basis for the diagnosis and classification of different types of nephritis. In the late nineteenth and early twentieth centuries, a number of German investigators and American clinical biochemists such as Otto Folin and Stanley Benedict extended these chemical methods of urinalysis by adapting newer chemical laboratory techniques to clinical applications and by emphasizing quantitative measurements of a variety of substances (for example, urea, creatine, uric acid, ammonia, and sugar). However, as Howell shows for two American hospitals, the adoption of many of these more sophisticated chemical techniques was very gradual, even though simple urinalysis was performed routinely on almost all hospital patients. The test changed its meaning in the early decades of the twentieth century when instead of being performed only on admission it came to serve as a way to monitor the clinical course of diseases such as diabetes or nephritis.
Investigation of treatment-time differences in colistin-induced nephrotoxicity in Wistar rats
Published in Chronobiology International, 2021
Joshua E. Eronmosele, T. O. Olurishe, A. B Olorukooba
The histological findings confirmed the presence of CIN, as the photomicrographs of renal tissue showed tubular damage and urinary cast formation with glomerular architecture mostly preserved in all the treated groups (Figure 3). This is consistent with the findings of other research investigations where acute tubular damage at the proximal-convoluted tubules of the nephron, was found to be the primary event in CIN (Gai et al. 2019; Ghlissi et al. 2013). Glomerular involvement was, however, observed in photomicrographs obtained from some animals treated with CMS alone at 18:00 h, and this has been associated with a more severely progressing nephrotoxic feature (Yousef et al. 2012). The images obtained from the rats treated in the rest phase (12:00 and 18:00 h) had the most severe presentation of nephrotoxicity, and this histological distinction, across the different time frames of CMS administration and the observation of heightened toxicity at the rest time period supports the data obtained from the biomarkers.
A Phase 2, Double-Blind, Randomized, Dose-Ranging Trial Of Reldesemtiv In Patients With ALS
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Jeremy M. Shefner, Jinsy A. Andrews, Angela Genge, Carlayne Jackson, Noah Lechtzin, Timothy M. Miller, Bettina M. Cockroft, Lisa Meng, Jenny Wei, Andrew A. Wolff, Fady I. Malik, Cynthia Bodkin, Benjamin R. Brooks, James Caress, Annie Dionne, Dominic Fee, Stephen A. Goutman, Namita A. Goyal, Orla Hardiman, Ghazala Hayat, Terry Heiman-Patterson, Daragh Heitzman, Robert D. Henderson, Wendy Johnston, Chafic Karam, Matthew C. Kiernan, Stephen J. Kolb, Lawrence Korngut, Shafeeq Ladha, Genevieve Matte, Jesus S. Mora, Merrilee Needham, Bjorn Oskarsson, Gary L. Pattee, Erik P. Pioro, Michael Pulley, Dianna Quan, Kourosh Rezania, Kerri L. Schellenberg, David Schultz, Christen Shoesmith, Zachary Simmons, Jeffrey Statland, Shumaila Sultan, Andrea Swenson, Leonard H. Van Den Berg, Tuan Vu, Steve Vucic, Michael Weiss, Ashley Whyte-Rayson, James Wymer, Lorne Zinman, Stacy A. Rudnicki
The safety and tolerability of reldesemtiv also appear supportive of further development. While clinical AEs were frequent, they were primarily mild and, for the most part, balanced across treatment groups. Nausea and fatigue occurred slightly more frequently in active treatment arms but did not limit continued use of the drug. The reduction in eGFR (based on cystatin C) was clearly related to dose. However, it was not progressive over time, and tended toward resolution by 4 weeks after stopping the study drug. The lack of indicators of renal toxicity such as urinary casts or elevated protein suggests that the eGFR change may be a pharmacodynamic effect rather than true nephrotoxicity. Similarly, elevations of transaminases more than five times the upper limit of normal were rare and normalized after the drug was withdrawn. Overall, the safety findings do not appear limiting to further development of reldesemtiv.
A case of pulmonary arterial hypertension complicated by anti-neutrophil cytoplasmic antibody-associated vasculitis and systemic sclerosis
Published in Immunological Medicine, 2021
Hajime Yoshifuji, Sumika Kagebayashi, Hideyuki Kinoshita, Takao Fujii, Yoshiaki Okano, Masao Katsushima, Tsuneyo Mimori
This case report had two limitations. First, the kidney lesion was not histologically confirmed due to a technical problem, although the diagnosis of MPA seemed to be certain because of positive MPO-ANCA, proteinuria, microhematuria, urinary casts, and their response to GC. Second, the maximal dose of PSL (30 mg/day) was relatively low and the immunosuppressive agent (MZB) that was used was mild. There was a possibility that high-dose GC and IVCY might have improved PAH associated with AAV. However, we hesitated to increase the dose of PSL to 1 mg/kg/day because steroid psychosis emerged after treatment and cancer was discovered when we were planning to start IVCY.
Related Knowledge Centers
- Albumin
- Collecting Duct System
- Distal Convoluted Tubule
- Microscopy
- Nephron
- Proteinuria
- Urine
- Kidney
- Uromodulin
- Mucoprotein