Silent Hours (2021 Movie Cast)

[Donavan Rajawi]

Privatedetective John Duval, an ex-lieutenant commander in the Royal Navy and Naval Intelligence, finds himself the prime suspect in a police hunt for a sexual killer stalking the rain-grey dockyard city of Portsmouth during the silent hours.

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Urinalysis plays a crucial role in diagnosing and monitoring various health conditions in a way that is cost-effective and noninvasive. It provides valuable insights into kidney function, urinary tract infections, metabolic disorders, and other underlying diseases. Urine is collected midstream or by catheterization and is examined within one hour after collection to avoid destruction of formed elements.1 Urine typically then undergoes chemical testing, using reagent test strips, and microscopic evaluation. Additional tests may include microbiology and cytology.

Findings on urinalysis can also indicate certain patterns of kidney disease and whether the disease is likely to be acute versus chronic in nature. Acute kidney injury (AKI) is the deterioration of kidney function over hours or days, resulting in the retention of nitrogenous wastes and creatinine in the blood. Chronic kidney disease (CKD) results from the gradual loss of kidney function over months or years. The presence of heavy proteinuria and lipuria are consistent with nephrotic syndrome.1

Kidney function declines with age, and kidney diseases are more common in patients with existing comorbidities such as diabetes and high blood pressure.2 Unfortunately, many people do not have physical symptoms until the damage is severe,3 with symptoms often being overlooked, making kidney disease a silent killer. Between 2000 and 2019, kidney disease moved from the 13th leading cause of death to the 10th.4

Casts and crystals especially may provide evidence of significant renal disease in patients. Urine microscopy is vital to aiding in the diagnoses of many asymptomatic cases and for those that are unable to verbalize their symptoms to their physician due to conditions like dementia or apraxia. Some common renal diseases include urinary tract infection (UTI), urinary tract tumors, kidney disease, and nephrotic syndrome.6

Casts are cylindrical particles that clump together and are formed either in the distal convoluted tubules or the collecting ducts of the kidney. The walls of the tubules act as a mold for cast formation, and the width of the tubule determines the width of the cast. Thus, narrow casts are formed in the distal tubules, while broad casts are formed in the collecting ducts.7

Casts are formed by the accumulation of uromodulin (formerly known as the Tamm-Horsfall mucoprotein). Uromodulin entraps cells and materials within the kidney tubules resulting in formation of protein casts. Elements that favor protein cast formation are low flow rate, high salt concentration, and low pH, resulting in protein denaturing and precipitation.8

Very few casts are seen in the urine of a person without renal disease. A common exception is hyaline casts, which may be seen in low numbers in healthy patients or can, like blood cells, be present after strenuous exercise or after diuretic use. A significant number of urinary casts, including hyaline casts, usually indicates the presence of renal disease.7

Urine crystals form when excessive minerals are present. Different types of urine crystals form for different reasons. Underlying health conditions, eating a diet too high in protein or salt, or dehydration can cause urine crystals to form. Consequently, when there is an excessive buildup of one or more minerals, urine crystals can form into stones.9

Figure 2. When there is an excessive buildup of one or more minerals, a urine crystal can form into a stone. Kidney stones do not usually cause symptoms unless they move around within the kidney or passes into the ureters. If they become lodged in the ureters, they may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful.

This is especially important with CKD as many patients have no idea that their kidneys are failing. Damaged kidneys leak protein into the urine from the bloodstream, and it is the presence of casts and/or crystals on a urinalysis that may be one of the first early indicators of underlying kidney disease.3

In addition to providing numeric counts and digital image results, integrated automated urinalysis systems with automated urine microscopy and auto-particle recognition software can auto-classify particles based on size, shape, contrast, and texture and can assist with particle sub-categorization. The DxU Iris urine microscopy analyzer automatically identifies 12 particle classifications and 27 sub-classifications.11

With Edit-Free Release (EFR) technology that automatically sends results to the LIS based on user-defined parameters to reduce time-consuming steps and increase lab efficiency, the DxU Iris analyzer creates user-defined reports that laboratorians need.11

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