Urinalysis PPT - Renal Block 2017 PDF

Urinalysis  Urine: Ø Urine is a fluid excreted by most of mammals including humans. Ø It is formed in the kidneys (renal glomeruli).   Ø The fluid undergoes chemical changes before it is excreted as urine. Ø Normal urine excretion by a healthy person is about 1.5 L per d...

Urinalysis  Urine: Ø Urine is a fluid excreted by most of mammals including humans. Ø It is formed in the kidneys (renal glomeruli).   Ø The fluid undergoes chemical changes before it is excreted as urine. Ø Normal urine excretion by a healthy person is about 1.5 L per day. Physical Properties of urine PARAMETER NORMAL ABNORMAL POSSIBLE CAUSES Polyuria Diabetes, chronic renal failure Volume 0.4-2.0 L/day Oligouria Dehydration, Acute renal failure Presence of pus cells, bacteria, salt or epithelial Appearance Clear Cloudy cells Excessive fluid intake, uncontrolled DM, DI, chronic Colorless renal failure Orange Dehydration, carotenoid ingestion Yellow-Green Jaundice Colour Pale Yellow Red Blood, drugs etc Dark brown- Methemoglobin, alkaptonuria, melanoma, black black water fever smoky glomerulonephritis Fruity Diabetic ketoacidosis Ammoniacal Contaminated and long standing exposed urine Odor Urineferous Mousy Phenylketonuria Burnt sugar Maple syrup urine disease Crystals, salts or Deposits None Blood clots, necrotic tissues and urinary stones cells ketosis (diabetes mellitus & starvation), severe Acidic diarrhea, metabolic and respiratory acidosis, Reaction excessive ingestion of meat and certain fruits 4.6 - 7.0 (pH) Respiratory and metabolic alkalosis, Urinary tract Alkaline infection, Vegetarians Chemical Properties of urine PARAMETER   NORMAL   ABNORMAL   POSSIBLE CAUSES   Nephrotic syndrome, glomerulonephritis,, Protein   < 200mg/day   Proteinuria   multiple myeloma, lower UTI, tumors or stones Uncontrolled DM, gestational diabetes, Glucose   None   Glucosuria   Fanconi’s syndrome   Diabetic ketoacidosis, Glycogen storage Ketones   None   Ketonuria   disease, starvation, Prolonged vomiting, Unbalanced diet: high fat & Low CHO diet   Nitrite   None   Detected   UTI   Bilirubin   None   Detected   Hepatic and post-hepatic jaundice Normal Trace Urobilinogen   (1mg/dl)   > 2 mg/dl   Jaundice   Acute & chronic glomerulonephritis, Trauma , cystitis , renal calculi and tumors, Bleeding Hematuria   disorders (Hemophilia).   Blood   None   Hemoglobinopathies, Malaria, Transfusion Hemoglobinuria   reaction (Blood Incompatibility)    Proteins Normally less than 200 mg protein is excreted in the urine daily; more than this level leads to a condition called “Proteinuria”. ØGlomerular proteinuria: It is due to ↑ glomerular permeability → filtration of high molecular weight proteins ( e.g. glomerulonephritis). ØTubular proteinuria: It occurs as a result of ↓ tubular reabsorption with normal glomerular permeability → excretion of low molecular weight proteins (e.g. chronic nephritis) Nephrotic syndrome: Ø Large amounts of protein are lost in the urine and hypoproteinaemia develops. Ø Increase protein excretion in urine can be one of the following two types: A: High molecular weight protein excretion: Glomerular proteinuria due to increase glomerular permeability leading to filtration of high molecular weight proteins B: Low molecular weight protein excretion: Tubular proteinuria due to decrease reabsorption with normal glomerular permeability Urinalysis (using dipstick): Principle: v Dipsticks are plastic strips impregnated with chemical reagents which react with specific substances in the urine to produce color-coded visual results. v They provide quick determination of pH, protein, glucose, ketones, urobilinogen, bilirubin, blood, hemoglobin, nitrite, and specific gravity. The depth of color produced relates to the concentration of the substance in urine. v Color controls are provided against which the actual color produced by the urine sample can be compared.The reaction times of the impregnated chemicals are standardized. Procedure: v Dip the strip in the urine sample provided then remove it immediately. v Remove the excess urine and keep the strip in a horizontal position. v Read the color produced within 30-60 seconds v Match the color changes to the color scale provided. v Give a full report about: - Physical examination - Chemical examination  Case I(Urine Sample I) A 12-year-old girl, a known patient with T1DM, presented to Emergency drowsy with short history of vomiting and abdominal pain. On examination: - Tachycardia - Tachypnea with a fruity smell of breath. - BP: 85/50 mmHg (Ref range: 100/66-135/85 mmHg) - Blood sugar: 26.7 mmol/L (Ref range: 3.9-5.6 mmol/L) - HbA1C: 9.9% (Ref range: 5.7-6.4%) - Blood pH: 7.1 (Ref range: 7.35–7.45) - Circulating Ketone bodies: positive A mid stream Urine sample was collected for complete urinalysis. 1- Do urinalysis using dipsticks and give a full report regarding: A- Physical examination. B- Chemical examination. 2- What is the most likely diagnosis?  Case II (Urine Sample II) ❚ A 49-old woman with a history of DM came to hospital with fever, weakness and dysuria (pain during urination) for the last three days. ❚ The results of her laboratory tests were as follows: Test Result Reference range Fasting blood glucose 7.5 3.9-5.8 mmol/L Creatinine 75 55-120 mmol/L Urea 3.7 2.5-6.4 mmol/L Sodium 140 135-145 mmol/L Potassium 3.9 3.5-5.1 mmol/L A mid stream Urine sample was collected for complete urinalysis. ❚ Microscopic examination of urine showed:- ❙ WBCs: > 100/HPF (Ref range: 2-3/HPF ) ❙ RBCs: 50 /HPF (Ref range: 0-2/HPF ) 1- Do urinalysis using dipsticks and give a full report regarding: A- Physical examination. B- Chemical examination. 2- What is the most likely diagnosis?  Case III (Urine Sample III) A 6-year-old boy, developed marked edema over a period of few days. His mother had noticed puffiness around the eyes, characteristically in the morning. She also noticed that his urine had become frothy. His general practitioner ordered the following investigations: Test Result Reference range Creatinine 58 55-120 mmol/L Urea 3.4 2.5-6.4 mmol/L Sodium 136 135-145 mmol/L Potassium 4.0 3.5-5.1 mmol/L Total protein 34 60-80 g/L Albumin 14 35-50 gmL Cholesterol 11 3.2-5.2 mmol/L Triglycerides 15 0.5-2.27 mmol/L A mid stream Urine sample was collected for complete urinalysis. 1- Do urinalysis using dipsticks and give a full report regarding: A- Physical examination. B- Chemical examination. 2- What is the most likely diagnosis? Task I. Physical Examination : Appearance ………………………………………… Color ……………………………………………. Odor ……………………………………………. Deposits ……………………………………………. Specific gravity …………………………………. Reaction ( pH) …………………………………… Task II. Chemical Examination: Item Observation Comment Protein Glucose Ketones Nitrite Bilirubin Urobilinogen Blood