檢驗-尿常規(guī)報告解讀課件

UrinanalysisUrinanalysisQuestion

Ifagroupofantswereattractedbyurine,theurinecontains().QuestionIfagroupofantsweUrinalysisHingdusnamedtheurine“honeyurine”.thisistheoldesturinalysis.In1674,Thomaswillisfoundthesugarintheurinecanbedetectedbytestingurine.……Nowurinesugarcanbeexaminedbyurinalysissystem.

UrinalysisHingdusnamedtheurFormationofurineGlomerularfiltrationTubularreabsorptionTubularsecretionNormal:

Clean-catchurine

1000-2000ml/24hFormationofurineGlomerularf檢驗-尿常規(guī)報告解讀課件Thefunctionofurinemaintainwaterbalance;removewasteproducts;maintainnormalbloodchemistry.

ThefunctionofurinemaintainClinicalsignificanceofurineanalysisRoutineurinalysisareperformedforseveralreasons:generalhealthscreeningtodetectrenalandmetabolicdiseasesdiagnosisofdiseasesordisordersofthekidneysorurinarytractsmonitoringofpatientswithdiabetesClinicalsignificanceofurine臨床上尿液可以進行哪些項目的測定？你認為什么最重要？臨床上尿液可以進行哪些項目的測定？你認為什么最重要？ACompleteurinalysishas4partsGrossexaminationSpecificgravityBiochemicalanalysisSedimentExaminationACompleteurinalysishas4pa目前使用全自動儀器進行尿液分析，大大提高了工作效率尿干化學分析儀尿有形成分分析儀目前使用全自動儀器進行尿液分析，大大提高了工作效率尿干化學分

干化學分析試劑條PHSGPROGLUKETBILUROBLDLEUNIT干化學分析試劑條PHWhatinformationcanurinalysisgiveus?Routinetests

SGPHProGluBilUBOWBCRBCNITKETSpecifictestsMicroprotein(Alb,Β2MG，α1MG,IgG,TRF)LightchainEnzymeUrineelectrophoresis

Urinesediment

RBCWBCcastcrystalbacteriafungiWhatinformationcanurinalysiSamplecollectionSamplecollectionRandomspecimenThisisurinethathasbeenspontaneouslyvoidedwithina24-hperiod.Itoftenoriginatesinpatientswithanacutedisease.Itisnotknownforhowlongtheurinewaspresentinthebladder.Theinterpretationofthefindingsisdifficult.RandomspecimenThisisurinetFirstmorning(8-hspecimen)urine

Thebladderisemptiedimmediatelypriortobedtimeandthefirstmorningurineiscollected.Thisurinerepresentstherestingstate.Itrulesoutorthostaticallyinducesproteinuria.Thecellconcentrationishighsincetheurineisacidicthoughpreservingcellsandcastsfromdestructionandlysis.Thebacteriacontentishighwhichleadtoanimprovementinthebacteriologicaldiagnosis.(midstream)Firstmorning(8-hspecimen)urSecondmorningurineThisurineisusedinoutpatientswhotakelongertotraveltothemedicalfacilityanditusedforspecialexaminations,e.g.theclassificationofproteinuria,cytologicalexaminationsofthebladdermucosaorthedeterminationofdysmorphicerythrocytes.SecondmorningurineThisurine24-hurineUrinecollectedovera24-hperiodItismostlyemployedforthedeterminationofproteinuriaaspartofthediagnosisofrenaldisorder.24-hurineUrinecollectedoverSamplestorageandtransportThetransportofurinetotheclinicallaboratoryshouldbedoneasfastaspossible.1.After2hthepHmayhaverisenandautolysisoftheparticulatematerial(cells,casts)mayhaveoccurred.2.coolingisnotrecommendedbecauseoftheprecipitationofamorphousuratesofphosphatecrystal.Theuratesinterferwiththemicroscopicexamination.3.thespecimenmustbedeepfrozenorstabilizedbythechemicaladdictives.SamplestorageandtransportTh尿液標本的保存冷藏法：不能超過8小時。化學防腐法：防腐劑實用范圍甲苯化學檢查福爾馬林顯微鏡檢查濃鹽酸17-羥類固醇，兒茶酚胺等激素麝香草酚結核桿菌尿液標本的保存冷藏法：不能超過8小時。GoalofdiagnosticevaluationsusingurinalysisToruleoutincreasedurinaryexcretion(cells,proteins)TodifferentiatebetweenbenignandpathologicalsituationsTodistinguishbetweendifferentcausesToquantify(xx)inordertoassessdiseaseactivity.GoalofdiagnosticevaluationsGrossExaminationColorappearanceOdorGrossExaminationColordiabetesinsipidus

diabetesinsipidusBiochemicalanalysisBiochemicalanalysis檢驗-尿常規(guī)報告解讀課件UrinaryproteinsIncreasedexcretionofproteinsintheurine,i.e.proteinuria(＞120mg/24h),isthehallmarkofthealmostanykindofkidneydisease.Simpleandinexpensive.UrinaryproteinsIncreasedexcrDipsticksdetect

proteinbyproductionofcolorwithanindicatordye,Bromphenolblue,whichismostsensitivetoalbuminbutdetectsglobulinsandBence-Jonesproteinpoorly.Precipitationbyheatisabettersemiquantitativemethod,butoverall,itisnotahighlysensitivetest.Thesulfosalicylicacidtestisamoresensitiveprecipitationtest.Itcandetectalbumin,globulins,andBence-Jonesproteinatlowconcentrations.DipsticksdetectproteinbyprInroughterms,tracepositiveresults(whichrepresentaslightlyhazyappearanceinurine)areequivalentto10mg/100mlorabout150mg/24hours(theupperlimitofnormal).1+correspondstoabout200-500mg/24hours,a2+to0.5-1.5gm/24hours,a3+to2-5gm/24hours,anda4+represents7gm/24hoursorgreater.

Inroughterms,tracepositiveMechanismofProteinuria

MechanismofProteinuriaIncreasedglomerularfiltration.Theproteinmustpassthroughtheglomerularcapillarywall.

NephroticSyndrome-minimalchangediseaseandfocalglomerulosclerosisGlomerulonephritisDrugs

IncreasedglomerularfiltratioThereasonofproteinuriaglomerularthesize-selectivebarrierleakslargeproteinmoleculesthecharge-selectivebarrierfailstoretainlowermolwtproteins.

ThereasonofproteinuriaglomeThereasonofproteinuriaApproximatesizecutoffofsubstancesforfiltrationis70kDa.substancessmallerthanthisareoftenretained,eitherduetochargeeffects(albumin)orbecausetheyaretightlyboundtootherproteinstogivethemalargereffectivesizeThereasonofproteinuriaApproDecreasedtubularreabsorption.Mostfilteredproteinisreabsorbedproximally.Withtubulardamage,therewillbeincreasedproteinintheurineTransportdefects-Fanconi'sSyndrome,CystinosisToxins-Penicillins,Heavymetals,Aminoglycosides氨基糖甙類,tetracycline四環(huán)素Ischemicinjury-shock,ATN急性腎小管壞死,EndotoxemiaObstructiveuropathy,Polycysticdisease

DecreasedtubularreabsorptionIncreasedsecretion-normallysomeproteinissecretedbutmayincreasewithexercise,acuterenalfailure,transplantrejection,andstones.

κλchainhaemoglobinmyoglobinIncreasedsecretion-normallyHowtodifferentiateproteinuiafromeachotherHowtodifferentiateproteinui檢驗-尿常規(guī)報告解讀課件Routinetests

(proteinuria)Ⅱ.Theamountsof

smallmoleculesincreasedmorethantheabilityoftubularreabsorption.1.Multipomyelomalightchain↑,electrophoresisorimmunoassay2.intravascularhemorrhageHb↑，OB+，TB↑，IB↑，UBO+3.urineroutinetest:proteinnegativeortraceRoutinetests

(proteinuria)Ⅱ.TTypesofproteinuria

（pathologic）Renalproteinuria:glomerula,tubular;thesytemicandgeneralizeddiseases(SLE,diabetes).Prerenalcauses:excretionofIglightchainintravascularhemolysis(血管內溶血)Postrenalcauses:hemorrhageandexudationwithinthelowerurinarytract.Typesofproteinuria

（pathologNon-pathologicalcausesofproteinuria

Exercise-shouldrecheckafterafewdaysofinactivityFever-recheckwhenthechildisafebrilePostural(體位性）ororthostaticproteinuria-verycommonespeciallyinadolescence.Pickeduponroutinescreenandpatientisasymptomatic,thephysicalexaminationincludingBPisnormal,andthereisnoredbloodcellsintheurine.Non-pathologicalcausesofproTypesofproteinsandmarkerproteinsSelectiveglomerulaproteinuria

Increasedglomerularpermeabilityformidsizedanionic,50-70KD(mostlkyAlbandTRF),0.03-0.3g/24h.

Nonselectiveglomerulaproteinuria

Increasedglomerularpermeabilityforhighmolecularmassproteins,50->150KD,AlbandIgG,1.5-20g/24h.TypesofproteinsandmarkerpTypesofproteinsandmarkerproteinsTubularproteinuriaDecreasedtubularreabsorptionoflow-molecularmassproteins,10-70KD,0.15-15,α1MG,β2MG,retinol-bindingprotein,cystatinC,β-NAG.MixedproteinuriaIncreasedglomerularpermeabilityforhighmolecularmassproteinswithsecondarydamageorsaturation(overflowproteinuria)oftubularreabsorption.TypesofproteinsandmarkerpTypesofproteinsandmarkerproteinsPrerenalproteinuriaIncreasedplasmaticreleaseoflow-molecularmassproteins,tubularoverflow;increasedtotalproteinwithnormalalbumin

HemoglobinMyoglobinBJ-protein0.1-5g/24h.TypesofproteinsandmarkerpTypesofproteinsandmarkerproteinsPostrenalproteinuriaHemorrhageorexudationwithinthelowerurinarytract.Themaincontents:TammHorsfallprotein,IgA,plasmaproteins,thequantitiesarevariable,themarkerprotein:α2MG,apoAITypesofproteinsandmarkerp檢驗-尿常規(guī)報告解讀課件Whatisthedefinitionofhematuria?WhatisthedefinitionofhemaHematuriaPositivetestindicateseitherHematuria,haemoglobinuriaormyoglobulinuria.

Freehaemoglobinormyoglobincausefieldchange;intactredbloodcells(RBC)arebrokendownoncontactwiththereagentpadandreleaselocalhaemoglobin,producingadot.Thesecoalescewhen>250RBCs/ml.HematuriaPositivetestindicatHematuriaFalsepositivereadingsaremostoftenduetocontaminationwithmenstrualblood.IncidenceoffalsepositivescanbeincreasedbydehydrationwhichconcentratesthenumberofRBCsproducedandexercise.Haematuriaisdefinedas>3RBC/highpowerfield(hpf)ofcentrifugedsedimentundermicroscope.HematuriaFalsepositivereadinOthercausesofdarkurineincludebeets,blackberries,pyridium,rifampin,uratecrystals,Myoglobinuriamaybeseenafterburns,crushinjuries,myositis,andprolongedgeneralizedseizures.Hemoglobinuriaismostcommonlyassociatedwithhemolyticanemias.

OthercausesofdarkurineincHowtoconfirmtherealhematuria?1.urinedipstick2.urinesediment3.TB,DB4.myoglobinHowtoconfirmtherealhematuHowtoanalyzetheresultsofurinalysis?HowtoanalyzetheresultsofWBCpositive

probableurinarytractinfection;urinaryproteinsnotassessable;urineRepeatexaminationaftertreatmentcultureofinfection.

ifnegative

WBCpositiveHemoglobin/myoglobinpositivehematuria,hemeglobinuria,myoglobinuria;differentiatebetweenrenal/postrenaloriginbymeansofAlb/α2MGratio.ratio<0.02PostrenalproteinuriaRBCmorphologyUrinaryproteinanalysisnotindicated

ratio>0.02

Hemoglobin/myoglobinpositiveTheratio>0.02,AlbpositiveRenalproteinuria;Differentiationbetweenselectiveglomerular,nonselectiveglomerular,tubularproteinuriabySDSor

quantitativedeterminationofIgGandα1MG.Monitoringbymeansoftotalproteinorselectedmarkerproteins.Theratio>0.02,AlbpositiveAlb(-)Hb(-)Leu(-)Probablynopathologicalproteinuria;However:purelytubularproteinuriaandB-Jproteinuriaarenotdetectedbytheteststrip;Incaseofclinicalsuspiciontotalproteinshouldbeanalyzedusingamethodwithhigheranalyticalsensitivity.Alb(-)Hb(-)Leu(-)ProbablynoUrinesedimentWhat’surinesediment？

referstotheformedelementsoftheurineinacentrifugedspecimen.Theseincluderedbloodcells,whitebloodcells,epithelialcells,casts,crystals,bacterial,andfungiUrinesedimentWhat’surineseNormalClean-catchurine,lightyellowLessthan3redbloodcells/hpLessthan5whitebloodcells/hpAfewepithelialcells,occasionalhyalinecasts,occasionalcrystal,andnobacteriaorfungiNormalClean-catchurine,lighthematuriaMorethan3redbloodcells/hphematuriaMorethan3redbloodPyuriaMorethan10whitebloodcells/hpIndicaterenalorgenitourinaryinflammationunlessthereiscontaminationofthespecimenPlusNITand(or)urineculture(65%Escherichiacoli大腸桿菌,NITpositive)PyuriaMorethan10whitebloodCasts

Formedinthedistaltubulesandthecollectingducts.Canbeclassifiedinto:cell-freecasts,e.g.hyalinecasts,granularcasts,waxycasts,fattycasts;Cellcasts,e.g.epitheliacasts,redbloodcellcasts,whitebloodcellcasts,andbacteriacasts.

Casts

Formedinthedistaltub檢驗-尿常規(guī)報告解讀課件檢驗-尿常規(guī)報告解讀課件CastsHyalinecasts:foundinhealthypeopleaswellasinpatientswithrenaldisease.Granularcasts:excretedbothbyhealthypeopleaswellasbypatientswithrenaldisease,especiallyinthepresenceofproteinuria.Waxycasts:occurininchronicrenalinsufficiencyandduringthepolyuricphaseofacuterenalfailure.CastsHyalinecasts:foundinheCastsFattycasts:producedbydegeneratedtubularcells.observedinpatientswithnephroticsyndromeaninthosewithsevereproteinuria.RBCcasts:areliableindicatorofrenaloarenchymatousdiseaseandusuallysuggestthepresenceofglomerulopathy.WBCcast:foundinpatientswithinflammatoryrenaldisease.CastsFattycasts:producedbyd檢驗-尿常規(guī)報告解讀課件檢驗-尿常規(guī)報告解讀課件檢驗-尿常規(guī)報告解讀課件顆粒管型顆粒管型檢驗-尿常規(guī)報告解讀課件檢驗-尿常規(guī)報告解讀課件蠟樣管型蠟樣管型檢驗-尿常規(guī)報告解讀課件檢驗-尿常規(guī)報告解讀課件Questions

1.Whatfactorscaninfluencetheresultsofurinalysis?2.PleasetellustheapplicationsofurineOBtestandusesthetestsyouhavestudiedtodifferOBpositivesituationsfromeachother.Questions

1.Whatfactorscani13-year-oldboy,withbloodyurineofoneday'sduration.Hehadbeenwelluntil1weekbeforeadmissionwhenhedevelopedasorethroatwithfeverthatlastedfor2or3days.Thefeverandthethroatsymptomsdisappearedwithouttreatment.However,hecontinuedtofeelgenerallyfatigued.Thedaybeforeadmission,hisurinebecamesmokybrown;themorningofadmissionhismothernoticedfacialpuffiness,pallorandnoisybreathing.PET37.8,P90/min,R20/min,BP150/95mmHg.HEENT:Slightswellingoftheeyelidsandperiorbitaledemawerepresent.Fundiwerenormal.Throatandeardrumswerenormal.Chest:Raleswereheardatbothlungbases.Cardiac:Thejugularveinswerenotdistended.Thepointofmaximalimpulsewasdisplacedslightlylaterally.AnS3washeard.Therewerenomurmurs.Abdomen:Therewerenomassesorabdominaltenderness.Thekidneyscouldnotbefelt.Neurologic,rectal:Normal.LabfindingsBloodroutine:hematocrit35%,WBCnormal.Urinalysisprotein2+,RBC100/hpf,WBC20/hpf,BUN25mg/dl.Creatinine1.6mg/dl.Electrolytesnormal.Questions1.What’sthediagnosisandwhat’syourevidences?2.Whichotherdiseaseswillyouconsidertodifferentiate?3.Inordertoconfirmyourdiagnosis,whichtestswillyoudoandwhy?13-year-oldboy,withbloodyuGlomerulardiseasesmaybeprimaryorsecondarytosystemicdisease.Themajorpathogeniccategoriesareinflammatory(nephriticsyndrome)andhemodynamic(nephroticsyndrome).andlaboratoryfindingsduetoincreasedglomerularcapillarywallpermeability.

GlomerulardiseasesmaybeprimTheclassicnephriticsyndromeincludeshematuria,hypertension,renalinsufficiency,andedema.Frequently,individualcomponentsofthesyndromeareabsent.Nephriticsyndromemaybeacuteandtransient(eg,postinfectiousGN),fulminantwithrapid