MICRO
KIDNEY.pptx

They form via precipitation of tamm horsfall

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THEY FORM VIA PRECIPITATION OF TAMM HORSFALL MUCOPROTEIN WHICH IS SECRETED BY RENAL TUBULE CELLS, AND SOMETIMES ALSO BY ALBUMIN IN CONDITIONS OF PROTEINURIA. CASTS ARE FORMED THROUGH THE SOLIDIFICATION OF MATERIALS IN THE TUBULES OF NEPHRONS. 14
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WHICH OF THE FOLLOWING IS PATHOGNOMONIC OF RENAL DISEASE - (AIIMS MAY 2001) A) HYALINE CASTS B) COARSE GRANULAR CASTS C) CYSTINE OXALATE CELLS D) EPITHELIAL CELLS ANS. IS ‘B’ I.E., COARSE GRANULAR CAST [REF: CMDT2002/EP. 920, HARRISON 18,H/EP. 339, 340, 2301, 2302; 16
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Q) PRESENCE OF WHICH OF THE FOLLOWING IN THE URINE IS DIAGNOSTIC OF GLOMERULAR INJURY – (AIIMS JUNE 99) A) BRIGHT RED CELLS B) 20% DYSMORPHIC RBC’S C) 100 RBC PER HIGH POWER FIELD D) BETA 2 MICRO GLOBULIN 17
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“DYSMORPHIC R. B. C.’S HAVE ODD SHAPES AS A CONSEQUENCE OF BEING DISTORTED VIA PASSAGE THROUGH THE ABNORMAL GLOMERULAR STRUCTURE. BETA2 - MICROGLOBULIN - BETA2 MICROGLOBULIN IS A PROTEIN OF SMALL SIZE. THIS AND THE OTHER SMALL SIZED, PROTEINS ARE NORMALLY FILTERED FROM THE GLOMERULUS, BUT ARE REABSORBED BY THE TUBULAR EPITHELIUM. THUS PRESENCE OF BETA 2 MICROGLOBULIN IN THE URINE INDICATES TUBULAR INJURY. 18
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Q) PRESENCE OF WHICH OF THE FOLLOWING IN THE URINE IS DIAGNOSTIC OF GLOMERULAR INJURY – (AIIMS JUNE 99) A) BRIGHT RED CELLS B) 20% DYSMORPHIC RBC’S C) 100 RBC PER HIGH POWER FIELD D) BETA 2 MICRO GLOBULIN ANS. IS ‘B’ I.E., 20% DYSMORPHIC RBC’S [REF: HARRISON 18'H/EP. 339, 340; LTH/EP. 273] PRESENCE OF DYSMORPHIC R.B.C. IN URINE SUGGESTS GLOMERULAR DISEASE SUCH AS GLOMERULONEPHRITIS. 19
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IN RENAL DISEASE, ALBUMIN IS FIRST TO APPEAR IN URINE BECAUSE - (AIIMS MAY 04) A) OF ITS HIGH CONCENTRATION IN PLASMA B) HAS MOLECULAR WEIGHT SLIGHTLY GREATER THAN THE MOLECULES NORMALLY GETTING FILTERED C) HIGH ALBUMIN: GLOBULIN RATIO D) TUBULAR EPITHELIAL CELLS ARE SENSITIVE TO ALBUMIN 20
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PLASMA PROTEIN IS MAINLY COMPOSED OF THREE PROTEINS:- A) ALBUMIN B) GLOBULIN C) FIBRINOGEN NORMALLY THE GLOMERULAR FILTRATION LAYER DOES NOT ALLOW ANY PLASMA PROTEIN TO PASS THROUGH IT ,BUT WHEN SOME RENAL PATHOLOGY OCCURS IT ALLOWS PROTEIN MOLECULES TO PASS THROUGH IT. “ALBUMIN IS THE FIRST PROTEIN TO APPEAR IN THE URINE”. SO PROTEINURIA IS ALSO SOMETIMES CALLED ALBUMINURIA. 21
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WE NEED TO ANSWER TWO QUESTIONS – WHY THE GLOMERULAR FILTRATION LAYER DOES NOT ALLOW THE PROTEINS TO PASS THROUGH IT AND WHY ALBUMIN IS FIRST AMONG THE PLASMA PROTEINS TO APPEAR IN THE URINE? 22
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THE EXPLANATION IS - THE FILTRATION OF ANY SUBSTANCE THROUGH GLOMERULAR FILTRATION LAYER DEPENDS ON TWO FACTORS. A) SIZE OF THE SUBSTANCE. B) CHARGE OF THE SUBSTANCE. 23
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A) SIZE OF THE SUBSTANCE – ANY NEUTRAL SUBSTANCE < 4A DIAMETER FREELY FILTERS THROUGH THIS LAYER.
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