檢驗(yàn)-尿常規(guī)報(bào)告解讀課件

UrinanalysisUrinanalysisQuestion

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

UrinalysisHingdusnamedtheurFormationofurineGlomerularfiltrationTubularreabsorptionTubularsecretionNormal:

Clean-catchurine

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

ThefunctionofurinemaintainClinicalsignificanceofurineanalysisRoutineurinalysisareperformedforseveralreasons:generalhealthscreeningtodetectrenalandmetabolicdiseasesdiagnosisofdiseasesordisordersofthekidneysorurinarytractsmonitoringofpatientswithdiabetesClinicalsignificanceofurine臨床上尿液可以進(jìn)行哪些項(xiàng)目的測(cè)定？你認(rèn)為什么最重要？臨床上尿液可以進(jìn)行哪些項(xiàng)目的測(cè)定？你認(rèn)為什么最重要？ACompleteurinalysishas4partsGrossexaminationSpecificgravityBiochemicalanalysisSedimentExaminationACompleteurinalysishas4pa目前使用全自動(dòng)儀器進(jìn)行尿液分析，大大提高了工作效率尿干化學(xué)分析儀尿有形成分分析儀目前使用全自動(dòng)儀器進(jìn)行尿液分析，大大提高了工作效率尿干化學(xué)分

干化學(xué)分析試劑條PHSGPROGLUKETBILUROBLDLEUNIT干化學(xué)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(biāo)本的保存冷藏法：不能超過(guò)8小時(shí)?；瘜W(xué)防腐法：防腐劑實(shí)用范圍甲苯化學(xué)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(jié)核桿菌尿液標(biāo)本的保存冷藏法：不能超過(guò)8小時(shí)。GoalofdiagnosticevaluationsusingurinalysisToruleoutincreasedurinaryexcretion(cells,proteins)TodifferentiatebetweenbenignandpathologicalsituationsTodistinguishbetweendifferentcausesToquantify(xx)inordertoassessdiseaseactivity.GoalofdiagnosticevaluationsGrossExaminationColorappearanceOdorGrossExaminationColordiabetesinsipidus

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