Dysmorphic RBCs

Had an awesome day in clinic the other day, there were a ton of interesting patients. One of had a good example of dysmorphic red blood cells on her urinalysis. Nephrologists, you see, love to look at pee. "The urine is a window to the soul," as I've heard said before. Anyways, if somebody has blood in the urine (a relatively common problem), one of the first steps is to determine whether that blood is coming from the kidneys (an "upper tract" problem) or coming from the ureters, bladder, or urethra (a "lower tract" problem, aka a plumbing problem). One way to do this is by looking at the red blood cells in the urine under a microscope. If the red blood cells are normal-looking with smooth counters, they are probably coming from the plumbing. However, if the red blood cells are deformed with little blebs and "Mickey Mouse ears" (see photo), they are passing through the defective filter in the kidneys, and there is a strong change that there is an inflammatory disorder of the ol' beans.

By the way, how to do a urinalysis on yourself: (1.) pee into a cup. (2.) take 10 milliliters of urine and put it into a tube. (3.) centrifuge the urine for about 5 minutes. (4.) there will be a small pellet at the bottom of the tube. Pour out the liquid on top (the supernatant) so that only a tiny amount of liquid remains in the tube. (5.) tap the tube several times with your finger to resuspend the pellet. (6) take a drop of the urine and put it onto a slide. (7.) look under a microscope and let the fun begin!!

Nate's Line Count (the # of dialysis catheters he's inserted thus far during fellowship) is up to 15. Yowza.

Sophie Pics of the Day: leg lifts!