From the Guidelines
A typical urinalysis for a patient with Stage IV Chronic Renal Failure (CRF) would show significant proteinuria, hematuria, fixed specific gravity, low pH, and presence of cellular casts, reflecting severe kidney dysfunction. The urine would likely contain significant proteinuria (protein in urine), often exceeding 3+ on dipstick or >3.5g/24hr if quantified, indicating damaged glomerular filtration barriers 1.
Key Urinalysis Findings
- Proteinuria: significant, often exceeding 3+ on dipstick or >3.5g/24hr
- Hematuria: may be present, appearing as red or brown-tinged urine with red blood cells visible under microscopic examination
- Specific gravity: typically fixed around 1.010, demonstrating the kidneys' inability to concentrate urine properly
- pH: low (acidic), reflecting metabolic acidosis common in advanced kidney disease
- Cellular casts: particularly granular and waxy casts, indicating tubular damage
- Leukocytes: might be elevated if there's concurrent infection or inflammation
- Glucose: may appear in the urine (glucosuria) despite normal blood glucose levels due to impaired tubular reabsorption
- Urine volume: typically reduced (oliguria), though some patients might have normal or increased output depending on the underlying cause These findings collectively reflect the severe compromise of both glomerular filtration and tubular function characteristic of Stage IV CRF, where only 15-29% of normal kidney function remains, as defined by the staging system outlined in the National Kidney Foundation guidelines 1.
From the Research
Urinalysis Contents for Stage IV CRF Patients
- Proteinuria: a common finding in patients with chronic kidney disease (CKD), including those with stage IV CRF 2
- Hematuria: may be present in some patients with CKD, although the prevalence is not well-established in stage IV CRF patients
- Hyperkalemia: a potential complication in patients with stage IV CRF, particularly those taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) 3, 4
- Renal insufficiency: characterized by a glomerular filtration rate (GFR) below 30 mL/min/1.73 m2 in stage IV CRF patients
Laboratory Findings
- Serum potassium levels: may be elevated in patients with stage IV CRF, particularly those taking ACE inhibitors or ARBs 3, 4
- Estimated GFR: an important measure of renal function, which is typically below 30 mL/min/1.73 m2 in stage IV CRF patients 2
- Urine protein-to-creatinine ratio: may be elevated in patients with proteinuria, which is a common finding in CKD patients 2