Discover and read the best of Twitter Threads about #urinarysediment
Most recents (3)
1/n young adult presents to the ED with weakness, fatigue & LE edema. Cr 2.8 (base 1.0). Reports tarry stools. Initial clinical impression: ischemic ATN 2/2 GIB. #UrineMicroscopy is performed: crisp RBC casts and acanthocytes are identified in #UrinarySediment. Time to regroup. 
2/n pt had a bioprosthetic pulmonic valve from a remote tetralogy of Fallot repair. Radar now centered in the connection between heart valve disease and endocarditis-associated glomerulonephritis (SBE-GN). A transthoracic echocardiogram: no vegetations, no valvular insufficiency
3/n as part of the nephritic work up, PR3 returns with low titer positivity. Primary AAV? Actually, that finding strengthened the case for SBE-GN since it’s known that 20-40% of them are PR3+ link.springer.com/content/pdf/10… this @arkanalabs @renalpathdoc review is a must read
Inspired by the beautiful #urinemicroscopy pictures posted by @dani_nephron and recent posts by @DShadowgazer + @CatchTheBaby ...
I present to you Taylor Swift as #urinarysediment 🔬findings ...
1/ Bilirubin pigmented RTEC (renal epithelial cell cast)
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I present to you Taylor Swift as #urinarysediment 🔬findings ...
1/ Bilirubin pigmented RTEC (renal epithelial cell cast)
🧵
1/x pt w/o polysubstance abuse, MSSA bacteremia 1-month ago, recent heroin/meth use, arrives to ED with 3 weeks of n/v. Vitals normal. Found to be “dry”. BUN/Cr on arrival 135/23 mg/dL. K 7. Anuric, Foley in. Got IVF boluses, shifted. Not better after that, RRT is ordered.
2/x next am post HD, K better. 5-ml urine are obtained and reportedly showed “ATN” urine, granular casts. A renal US is obtained: Left (“baseline” scan, 11.2 cm), right (new scan, 15.2 cm). Report states no hydro, medical renal dz.
3/x before the US, cognitive bias may lead to conclude early that we were dealing with just a bad ATN, not unreasonable in a pt who vomited and consumed drugs for several days. However, nephromegaly and remarkable ⬆️parenchymal echogenicity seems out of proportion for just an ATN
