A 60-year-old male is admitted to the hospital after a car accident. Due to a substantial loss of fluid, he receives a blood transfusion. Shortly after, he experiences symptoms of dizziness, fever, and chills, all associated with shock. His urinary output has declined to <400mL a day. A urinalysis was done and the results are reported below.

Physical and Chemical Results:

Color:	Yellow	Protein:	2+	Blood:	Moderate
Appearance:	Cloudy	Glucose:	Negative	Urobilinogen:	Normal
Specific Gravity:	1.005	Ketones:	Negative	Nitrite:	Negative
pH:	5.0	Bilirubin:	Negative	Leukocyte:	1+

Myoglobin was found in the urine. 

Microscopic Results:

RBC: 20-50/hpf
WBC:  15-20/hpf
Granular casts 0-5 /lpf
Renal tubular epithelial cells 5-10/hpf

Questions:

1. What term describes urinary output < 400mL a day? In what other instances can this condition be seen?

            Answer 1

2. What condition might this patient have?

            Answer 2

3. What form of the condition is this patient experiencing? Ischemic or toxic? How can you differentiate between the two?

            Answer 3

4. What image is seen here and how is it relevant to the patient?

             

            Answer 4

5. What image is this? What is the significance of its presence?

     

       Answer 5

***go to case study #1***

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