检验-尿常规报告解读课件

UrinanalysisUrinanalysisQuestion

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

UrinalysisHingdusnamedtheurFormationofurineGlomerularfiltrationTubularreabsorptionTubularsecretionNormal:

Clean-catchurine

1000-2000ml/24hFormationofurineGlomerularf检验-尿常规报告解读课件Thefunctionofurinemaintainwaterbalance;removewasteproducts;maintainnormalbloodchemistry.

ThefunctionofurinemaintainClinicalsignificanceofurineanalysisRoutineurinalysisareperformedforseveralreasons:generalhealthscreeningtodetectrenalandmetabolicdiseasesdiagnosisofdiseasesordisordersofthekidneysorurinarytractsmonitoringofpatientswithdiabetesClinicalsignificanceofurine临床上尿液可以进行哪些项目的测定？你认为什么最重要？临床上尿液可以进行哪些项目的测定？你认为什么最重要？ACompleteurinalysishas4partsGrossexaminationSpecificgravityBiochemicalanalysisSedimentExaminationACompleteurinalysishas4pa目前使用全自动仪器进行尿液分析，大大提高了工作效率尿干化学分析仪尿有形成分分析仪目前使用全自动仪器进行尿液分析，大大提高了工作效率尿干化学分

干化学分析试剂条PHSGPROGLUKETBILUROBLDLEUNIT干化学分析试剂条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尿液标本的保存冷藏法：不能超过8小时。化学防腐法：防腐剂实用范围甲苯化学检查福尔马林显微镜检查浓盐酸17-羟类固醇，儿茶酚胺等激素麝香草酚结核杆菌尿液标本的保存冷藏法：不能超过8小时。GoalofdiagnosticevaluationsusingurinalysisToruleoutincreasedurinaryexcretion(cells,proteins)TodifferentiatebetweenbenignandpathologicalsituationsTodistinguishbetweendifferentcausesToquantify(xx)inordertoassessdiseaseactivity.GoalofdiagnosticevaluationsGrossExaminationColorappearanceOdorGrossExaminationColordiabetesinsipidus

diabetesinsipidusBiochemicalanalysisBiochemicalanalysis检验-尿常规报告解读课件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氨基糖甙类,tetracycline四环素Ischemicinjury-shock,ATN急性肾小管坏死,EndotoxemiaObstructiveuropathy,Polycysticdisease

DecreasedtubularreabsorptionIncreasedsecretion-normallysomeproteinissecretedbutmayincreasewithexercise,acuterenalfailure,transplantrejection,andstones.

κλchainhaemoglobinmyoglobinIncreasedsecretion-normallyHowtodifferentiateproteinuiafromeachotherHowtodifferentiateproteinui检验-尿常规报告解读课件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(血管内溶血)Postrenalcauses:hemorrhageandexudationwithinthelowerurinarytract.Typesofproteinuria

（pathologNon-pathologicalcausesofproteinuria

Exercise-shouldrecheckafterafewdaysofinactivityFever-recheckwhenthechildisafebrilePostural(体位性）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检验-尿常规报告解读课件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大肠杆菌,NITpositive)PyuriaMorethan10whitebloodCasts

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

Casts

Formedinthedistaltub检验-尿常规报告解读课件检验-尿常规报告解读课件CastsHyalinecasts:foundinhealthypeopleaswellasinpatientswithrenaldisease.Granularcasts:excretedbothbyhealthypeopleaswellasbypatientswithrenaldisease,especiallyinthepresenceofproteinuria.Waxycasts:occurininchronicrenalinsufficiencyandduringthepolyuricphaseofacuterenalfailure.CastsHyalinecasts:foundinheCastsFattycasts:producedbydegeneratedtubularcells.observedinpatientswithnephroticsyndromeaninthosewithsevereproteinuria.RBCcasts:areliableindicatorofrenaloarenchymatousdiseaseandusuallysuggestthepresenceofglomerulopathy.WBCcast:foundinpatientswithinflammatoryrenaldisease.CastsFattycasts:producedbyd检验-尿常规报告解读课件检验-尿常规报告解读课件检验-尿常规报告解读课件颗粒管型颗粒管型检验-尿常规报告解读课件检验-尿常规报告解读课件蜡样管型蜡样管型检验-尿常规报告解读课件检验-尿常规报告解读课件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