URINARY CASTS-REVIEW

URINARY CASTS

Normal RBCS excretion == 2 millions RBCs/day

Hematuria == 2--5 RBCs Per HPF.

GRANULAR CAST === Significant renal disease (ARF)

Hyaline cast === most frequently (M.C.)==normal/mild renal disease.

Epithelial cast ==== disease affecting tubules/ ATN.

Broadcast / Waxy cast === chronic renal disease/CRF, Malignant HTN,

Diabetic nephropathy.RBCs/Dysmorfic RBCs cast == Glomerular injury (kidney) / PSGN

WBCS cast == PyelonephritisLipid cast == Nephrotic synd.

TUMOUR MARKERS

MODERN MEDICINE's TUMOUR MARKERS

AFP: --raised—in-- ENDODERMAL SINUS TUMOUR (yolk sac tumors), hepatoma, Teratoma.
(Note in down’s synd. AFP. is decreased)

Alpha-HCG: --Pituitary tumour & zollinger-ellison synd.

ACTH, ADH:- small cell bronchial carcinoma

Beta 2 microglobulin =for multiple myeloma,
B2M (Beta-2 microglobulin)---- Multiple myeloma and lymphomas Present in many other conditions, including Crohn’s disease and hepatitis; often used to determine cause of renal failure Determine prognosis
Beta-HCG: --in CHORIOCARCINOMA

BRCA-1 and BRCA-2 ---- Breast Cancer Gene 1 and Breast Cancer Gene 2 ---- breast or ovarian cancer
Bence Jones Proteins---Multiple myeloma,

CA 15-3----in BREAST Ca.

CA 19-9 is a tumour marker---used in pancreatic carcinoma
CA 19-9 IS ALSO RAISED IN HEPATOMA, GB & BILLIARY TRACT MALIG, CIRROCIS, STOMACH & COLORECTAL CARCINOMA. ALSO IN PANCREATITIS (CHR)

CA 72-4--- Gastric CA.

CA 125—in OVARIAN Ca., EPITHELIAL (ESPECIALLY SEROUS)
Calcitonin ---in medullary thyroid carcinoma

CEA ---- Carcinoembryonic Antigen ---- To determine whether cancer is present in the body and to monitor cancer treatment (colorectal ca.)

CALLA---B cell ALL and AML in Blast phase.

ESTRADIOL: --in ADULT GRANULOSA CELL TUMOUR, THECOMAS
Her-2/neu ---- Human epidermal growth factor receptor ---- To determine whether a breast cancer tumor is positive for Her-2/neu, which helps to guide treatment and determine prognosis.

INHIBIN --IS SECRETED BY SOME GRANULOSA CELL TUMOUR AND IS A USEFUL MARKER

LDH: ---in DYSGERMINOMA

Neuron Specific Enolase-(NSE)-----neuroblastoma, small cell carcinoma lung...

PSA -- Prostate specific antigen ---- Prostate cancer

Prostatic acid phosphatase (PAP)---- Metastatic prostate cancer, myeloma, lung cancer----not widely used anymore, elevated in prostatitis and other conditions----Help diagnose

S-100----Metastatic melanoma----Not widely used ---Help diagnose
TA-90----Metastatic melanoma---- Not widely used, being studied -----Help diagnose
Thyroglobulin----Thyroid------Used after thyroid is removed to evaluate treatment----Determine recurrence
HTg human thyroid thyroglobin is a tumour marker 4 differentiated tumour only.

TESTOSTERONE: --in SERTOLI CELL TUMOUR, LEYDIG CELL T, HILUS CELL Tumour

ACID –BASE FUNDA’S---by Dr.K.B.RAVVA

MODERN MEDICINE's ACID –BASE FUNDA’S---by Dr.K.B.RAVVA

-----Acidosis-----------------à
(Lt.side) CO2 + H2O--------à H2CO3--------à H+ + HCO3- (Rt.side)
<----Alkalosis------------------

EXPECT FOR THE COMPENSATION, THE
BASIC RULE = ACIDOSIS= DECREASED PH / INCREASE [H+] / LOSS OF HCO3-
= ALKALOSIS= INCREASED PH / DECREASED [H+] / Decreased PCO2

Lung Compensate for==
(1) For Metabolic Acidosis by Decreasing PCO2 (by Hyperventilation)
(2) For Metabolic Alkalosis by Increasing PCO2 (by Hypoventilation)

Kidney Compensate for==
(1) For Respiratory Acidosis by Increasing HCO3- Reabsorption.
(2) For Respiratory Alkalosis by Decreasing HCO3- Reabsorption.

Always look for [HCO3-] / [PCO2]==

(1) Uncompensated / simple conditions==( any one of these can be the fes. But only one of these…)
= Normal/ Increase
= Normal/ Decrease
= Increase/ Normal
= Decrease/ Normal

(1) Compensated conditions==
= Increase/ Increase
= Decrease/ Decrease

(2) Mixed i.e. (Both Respiratory and metabolic Acidosis or Alkalosis)==
i.e. Metabolic Acidosis and Respiratory Acidosis=[HCO3-]/ PCO2== Decrease/ Increase
Metabolic Alkalosis and Respiratory Alkalosis=[HCO3-]/ PCO2== Increase/ Decrease
Things to look for (in order)=

(1) PH (N=7.38-7.44)
(2) PCO2 (N=35—45)
(3) [HCO3-] (N=21—30)
(4) [HCO3-]/ PCO2

Respiratory Acidosis=simple/uncompensated
(1) PH (N=7.38-7.44) == Decrease
(2) PCO2 (N=35—45)== Increase
(3) [HCO3-] (N=21—30)== Normal
(4) [HCO3-]/ PCO2== Normal/ Increase

Respiratory Acidosis= compensated
(1) PH (N=7.38-7.44)== Normal
(2) PCO2 (N=35—45)== Increase
(3) [HCO3-] (N=21—30)== Increase
(4) [HCO3-]/ PCO2== Increase/ Increase

Respiratory Alkalosis=simple/uncompensated
(1) PH (N=7.38-7.44)== Increase
(2) PCO2 (N=35—45)== Decrease
(3) [HCO3-] (N=21—30)== Normal
(4) [HCO3-]/ PCO2== Normal/ Decrease

Respiratory Alkalosis= compensated
(1) PH (N=7.38-7.44)== Normal
(2) PCO2 (N=35—45)== Decrease
(3) [HCO3-] (N=21—30)== Decrease
(4) [HCO3-]/ PCO2== Decrease/ Decrease

Metabolic Acidosis=simple/uncompensated
(1) PH (N=7.38-7.44)== Decrease
(2) PCO2 (N=35—45)== Normal
(3) [HCO3-] (N=21—30)== Decrease
(4) [HCO3-]/ PCO2== Decrease/ Normal

Metabolic Acidosis= compensated
(1) PH (N=7.38-7.44)== Normal
(2) PCO2 (N=35—45)== Decrease
(3) [HCO3-] (N=21—30)== Decrease
(4) [HCO3-]/ PCO2== Decrease/ Decrease

Metabolic Alkalosis=simple/uncompensated
(1) PH (N=7.38-7.44)== Increase
(2) PCO2 (N=35—45)== Normal
(3) [HCO3-] (N=21—30)== Increase
(4) [HCO3-]/ PCO2== Increase/ Normal

Metabolic Alkalosis=Compensated
(1) PH (N=7.38-7.44)== Normal
(2) PCO2 (N=35—45)== Increase
(3) [HCO3-] (N=21—30)== Increase
(4) [HCO3-]/ PCO2== Increase/ Increase

MEDICAL DISORDERS AND NAILS--by DR.K.B.RAVVA

Beau's lines Beau's lines are indentations that run across your nails.They can appear when growth at the area under your cuticle is interrupted by injury or severe illness, such as a heart attack. Beau's lines may also be a sign of malnutrition

Terry's nails With the condition known as Terry's nails, your nails look opaque, but the tip has a dark band.Sometimes this can be attributed to aging. In other cases, it can be a sign of serious illness, such as: Cancer Congestive heart failure Diabetes Liver disease


Yellow nail syndrome Yellow or green discoloration in your fingernails may result from a respiratory condition, such as chronic bronchitis, or from swelling of your hands (lymphedema). In yellow nail syndrome, nails thicken and new growth slows. Nails affected with this condition may lack a cuticle and may detach from the nail bed in places.The discoloration occurs because of the slow growth of your nails. Although this condition is often a sign of respiratory disease, it's possible to have yellow or green nails and not have a respiratory condition. Yellow or green nails may also result from any condition that causes the growth of your nails to slow down.


Pitting Small depressions in the nails are common in people with psoriasis — a skin condition that produces scaly patches — or nail injuries. Pitting may cause your nails to crumble. Pitting is also associated with conditions that can damage your nail's cuticle, such as chronic dermatitis of your fingers or alopecia areata.


Clubbing Clubbing occurs when the tips of your fingers enlarge and your nails curve around your fingertips. This condition results from low oxygen levels in your blood and could be a sign of lung disease.


Spoon nails Spoon nails (koilonychia) are soft nails that look scooped out. The depression usually is large enough to hold a drop of liquid. Spoon nails may be a sign of iron deficiency anemia


Thickened toenails: What causes them? Your toenails can thicken for many reasons. These include an injury, skin conditions such as psoriasis, tight or poorly fitting shoes, and fungal infections — as shown in this picture.Among these, a fungal nail infection — onychomycosis (on-i ko-mi-KO-sis) — is the most common cause of thickened toenails.


Nail separates from nail bed With a condition known as onycholysis, your fingernails become loose and can separate from the nail bed. If your nails show signs of detaching, this may be associated with:Injury Thyroid disease Fungal disease Drug reactions Reactions to nail hardeners or acrylic nails Psoriasis