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Urinalysis
UrinalysisUrinarySystemUrinarySystemPurposeGeneralevaluationofhealthDiagnosisofdiseaseordisordersofthekidneysorurinarytractDiagnosisofothersystemicdiseasethataffectkidneyfunctionMonitoringofpatientswithdiabetesScreeningfordrugabuse(eg.Sulfonamideoraminoglycosides)PurposeGeneralevaluationofhCollectionofurinespecimensThefirstvoidedmorningurine(themostcommon)Randomurine(foremergency)Clean-catch,midstreamurine(forurineculture)AttentionNeedtobeexaminedwithin1hourCollectionofurinespecimensTContentsPhysicalexaminationChemicalexaminationMicroscopicexaminationContentsPhysicalexaminationPhysicalexaminationAppearanceUrinevolumeSpecificgravity(SG)PhysicalexaminationAppearanceAppearanceIncludingcolorandclarityColor:normally,paletodarkyellow(urochrome)Abnormalcolor:somedrugscausecolorchanges1.redurine
:causes:hematuriahemoglobinuriamyoglobinuria2.yellow-brownorgreen-brownurine:bilirubincause:obstructivejaundiceAppearanceIncludingcolorandRedUrineMicroscopicHematuria
UrinarytractsourceUrethraorbladderProstateUreterorkidneyNon-UrinarytractsourceVaginaAnusorrectumPseudohematuria(non-hematuriarelatedredurine)MyoglobinuriaHemoglobinuria
Phenolphthalein
LaxativesPhenothiazinesPorphyriaRifampin
PyridiumBilirubinuriaPhenytoin
PyridiumReddiapersyndromeFoods(Beets,Blackberries,Rhubarb)RedUrinePseudohematuria(non-RedUrineCausesofAsymptomaticGrossHematuriabyIncidence
AcuteCystitis(23%)BladderCancer(17%)BenignProstaticHyperplasia(12%)Nephrolithiasis(10%)Benignessentialhematuria(10%)Prostatitis(9%)Renalcancer(6%)Pyelonephritis(4%)ProstateCancer(3%)Urethralstricture(2%)RedUrineCausesofAsymptomatiAppearanceClarity:normally,clearAbnormalcolor:cloudyurineCauses:1.crystalsornonpathologicsaltsphosphate,carbonateinalkalineurine(dissolve---addaceticacid)uricacidinacidurine(dissolve---warmingto60℃)2.variouscellularelements:leukocytes,RBCs,epithelialcellsAppearanceClarity:normally,尿液分析課件(Urinalysis)UrinevolumeTheaverageadult:1000mlto2000ml/24hIncrease
polyuria---morethan2000mlofurinein24hours1.physiologicalstates:waterintake,somedrugs,intravenoussolutions2.pathologicstates:diabetesmellitus,diabetesinsipidusUrinevolumeTheaverageadultUrinevolumeDecrease
Oliguria---lessthan400mlofurinein24hours
Anuria---lessthan100mlofurinein24hours1.prerenal:hemorrhage,dehydration,congestiveheartfailure2.postrenal:obstructionoftheurinarytract(maybestones,carcinoma)3.renalparenchymaldisease:acutetubularnecrosis,chronicrenalfailureUrinevolumeDecreaseSpecificgravity(SG)ReflectthedensityoftheurineRangeof1.001to1.040
Increase:Dehydration、Fever、Vomiting
Diarrhea
DiabetesMellitusandothercausesofGlycosuria、CongestiveHeartFailure、SyndromeInappropriateADHSecretion(SIADH)、AdrenalInsufficiency
failure(urinevolume↓andSG↑)
Decrease:diabetesinsipidus(urinevolume↑andSG↓)Specificgravity(SG)ReflecttChemicalexaminationUrinePHProteinGlucoseKetonesOccultbloodBilirubinUrobilinogenNitritesChemicalexaminationUrinePHUrinePHNormalPHTheaverageisabout6Rangefrom5~9(dependsondiet)HigherPH---alkalineurine1.drugs:sodiumbicarbonate2.classicrenaltubularacidosis3.alkalosis(metabolicorrespiratory)LowerPH---acidurine1.drugs:ammoniumchloride2.acidosis(metabolicorrespiratory)UrinePHNormalPHProteininurineReferencevalueQualitativemethod:negativeQuantitativemethod:lessthan150mgofproteinin24hoursUrineproteinscomefromplasmaproteinandTamm-Horsfall(T-H)glycoproteinProteininurineReferencevaluProteinuria---morethan150mgproteinsinurinein24hoursorqualitativetestispositiveProteinuriaquantification(dependontheamountofprotein)heavyproteinuria----＞4.0g/24hoursmoderateproteinuria----1.0~4.0g/24hoursminimalproteinuria----＜1.0g/24hoursProteinuria---morethan150mgQualitativecategoriesofproteinuria
Glomerularproteinuria:1.glomerulardiseasesdamageglomerularbasementmembranebuttubularfunctionisnormal2.selectiveproteinuria---chieflyalbuminnonselectiveproteinuria3.heavyproteinuria4.disease:acuteglomerulonephritisQualitativecategoriesofprotTubularproteinuria1.Renaltubulardiseasedamagetubularfunctionbutglomerularisnormal2.Moderateproteinuria3.disease:pyelonephritisTubularproteinuriaOverflowproteinuriaExcesslevelsofaproteininthecirculation,hemoglobin,myoglobin,etc.Therenalfunctionisnormal
OverflowCausesHemoglobinuria
MyoglobinuriaMultipleMyeloma
Amyloidosis
OverflowproteinuriaProteinuriaCauses
GlomerularCauses(Increasedglomeruluspermeability)
PrimaryGlomerulonephropathyMinimalChangeDiseaseIgANephropathyIdiopathicmembranousGlomerulonephritis
FocalsegmentalGlomerulonephritis
MembranoproliferativeGlomerulonephritis
HeavymetalsTubularCauses(Decreasedtubularreabsorption)
HypertensivenephrosclerosisUricAcidnephropathyAcutehypersensitivityInterstitialNephritis
FanconiSyndrome
HeavymetalsSickleCellAnemia
NSAIDsAntibioticsSecondaryGlomerulonephropathyDiabetesMellitus(DiabeticNephropathy)SystemicLupusErythematosus(LupusNephritis)Amyloidosis
Preeclampsia(PregnancyInducedHypertension)InfectionHIVInfection
HepatitisB
HepatitisC
PoststreptococcalGlomerulonephritis
Syphilis
Malaria
EndocarditisLungCancer
GastrointestinalCancerLymphoma
RenaltransplantrejectionProteinuriaCausesGlomerularOverflowCauses(IncreasedlowMWproteinproduction)
Hemoglobinuria
MyoglobinuriaMultipleMyeloma
Amyloidosis
OverflowCauses(IncreasedlowGlucoseinurineReferencevalueQualitativemethod:negativeGlycosuria---qualitativetestispositive1.hyperglycemia:diabetesmellitusCushing’ssyndrom2.withouthyperglycemia:renaltubulardysfunction,suchaspyelonephritis
GlucoseinurineReferencevaluKetonesinurineIncludingthreeketonebodies:acetoaceticacid20%acetone2%β-hydroxybutyricacid78%TheproductsoffatmetabolismReferencevalue:qualitativemethod:negativeKetonuria---qualitativetestispositiveKetonesinurineIncludingthreKetonuria1.diabeticketonuria2.nondiabeticketonuria:HyperemesisofpregnancyPatientsaccompaniedbyvomitingordiarrheaKetonuriaUrinalysis
UrinalysisUrinarySystemUrinarySystemPurposeGeneralevaluationofhealthDiagnosisofdiseaseordisordersofthekidneysorurinarytractDiagnosisofothersystemicdiseasethataffectkidneyfunctionMonitoringofpatientswithdiabetesScreeningfordrugabuse(eg.Sulfonamideoraminoglycosides)PurposeGeneralevaluationofhCollectionofurinespecimensThefirstvoidedmorningurine(themostcommon)Randomurine(foremergency)Clean-catch,midstreamurine(forurineculture)AttentionNeedtobeexaminedwithin1hourCollectionofurinespecimensTContentsPhysicalexaminationChemicalexaminationMicroscopicexaminationContentsPhysicalexaminationPhysicalexaminationAppearanceUrinevolumeSpecificgravity(SG)PhysicalexaminationAppearanceAppearanceIncludingcolorandclarityColor:normally,paletodarkyellow(urochrome)Abnormalcolor:somedrugscausecolorchanges1.redurine
:causes:hematuriahemoglobinuriamyoglobinuria2.yellow-brownorgreen-brownurine:bilirubincause:obstructivejaundiceAppearanceIncludingcolorandRedUrineMicroscopicHematuria
UrinarytractsourceUrethraorbladderProstateUreterorkidneyNon-UrinarytractsourceVaginaAnusorrectumPseudohematuria(non-hematuriarelatedredurine)MyoglobinuriaHemoglobinuria
Phenolphthalein
LaxativesPhenothiazinesPorphyriaRifampin
PyridiumBilirubinuriaPhenytoin
PyridiumReddiapersyndromeFoods(Beets,Blackberries,Rhubarb)RedUrinePseudohematuria(non-RedUrineCausesofAsymptomaticGrossHematuriabyIncidence
AcuteCystitis(23%)BladderCancer(17%)BenignProstaticHyperplasia(12%)Nephrolithiasis(10%)Benignessentialhematuria(10%)Prostatitis(9%)Renalcancer(6%)Pyelonephritis(4%)ProstateCancer(3%)Urethralstricture(2%)RedUrineCausesofAsymptomatiAppearanceClarity:normally,clearAbnormalcolor:cloudyurineCauses:1.crystalsornonpathologicsaltsphosphate,carbonateinalkalineurine(dissolve---addaceticacid)uricacidinacidurine(dissolve---warmingto60℃)2.variouscellularelements:leukocytes,RBCs,epithelialcellsAppearanceClarity:normally,尿液分析課件(Urinalysis)UrinevolumeTheaverageadult:1000mlto2000ml/24hIncrease
polyuria---morethan2000mlofurinein24hours1.physiologicalstates:waterintake,somedrugs,intravenoussolutions2.pathologicstates:diabetesmellitus,diabetesinsipidusUrinevolumeTheaverageadultUrinevolumeDecrease
Oliguria---lessthan400mlofurinein24hours
Anuria---lessthan100mlofurinein24hours1.prerenal:hemorrhage,dehydration,congestiveheartfailure2.postrenal:obstructionoftheurinarytract(maybestones,carcinoma)3.renalparenchymaldisease:acutetubularnecrosis,chronicrenalfailureUrinevolumeDecreaseSpecificgravity(SG)ReflectthedensityoftheurineRangeof1.001to1.040
Increase:Dehydration、Fever、Vomiting
Diarrhea
DiabetesMellitusandothercausesofGlycosuria、CongestiveHeartFailure、SyndromeInappropriateADHSecretion(SIADH)、AdrenalInsufficiency
failure(urinevolume↓andSG↑)
Decrease:diabetesinsipidus(urinevolume↑andSG↓)Specificgravity(SG)ReflecttChemicalexaminationUrinePHProteinGlucoseKetonesOccultbloodBilirubinUrobilinogenNitritesChemicalexaminationUrinePHUrinePHNormalPHTheaverageisabout6Rangefrom5~9(dependsondiet)HigherPH---alkalineurine1.drugs:sodiumbicarbonate2.classicrenaltubularacidosis3.alkalosis(metabolicorrespiratory)LowerPH---acidurine1.drugs:ammoniumchloride2.acidosis(metabolicorrespiratory)UrinePHNormalPHProteininurineReferencevalueQualitativemethod:negativeQuantitativemethod:lessthan150mgofproteinin24hoursUrineproteinscomefromplasmaproteinandTamm-Horsfall(T-H)glycoproteinProteininurineReferencevaluProteinuria---morethan150mgproteinsinurinein24hoursorqualitativetestispositiveProteinuriaquantification(dependontheamountofprotein)heavyproteinuria----＞4.0g/24hoursmoderateproteinuria----1.0~4.0g/24hoursminimalproteinuria----＜1.0g/24hoursProteinuria---morethan150mgQualitativecategoriesofproteinuria
Glomerularproteinuria:1.glomerulardiseasesdamageglomerularbasementmembranebuttubularfunctionisnormal2.selectiveproteinuria---chieflyalbuminnonselectiveproteinuria3.heavyproteinuria4.disease:acuteglomerulonephritisQualitativecategoriesofprotTubularproteinuria1.Renaltubulardiseasedamagetubularfunctionbutglomerularisnormal2.Moderateproteinuria3.disease:pyelonephritisTubularproteinuriaOverflowproteinuriaExcesslevelsofaproteininthecirculation,hemoglobin,myoglobin,etc.Therenalfunctionisnormal
OverflowCausesHemoglobinuria
MyoglobinuriaMultipleMyeloma
Amyloidosis
OverflowproteinuriaProteinuriaCauses
GlomerularCauses(Increasedglomeruluspermeability)
PrimaryGlomerulonephropathyMinimalChangeDiseaseIgANephropathyIdiopathicmembranousGlomerulonephritis
FocalsegmentalGlomerulonephritis
MembranoproliferativeGlomerulonephritis
HeavymetalsTubularCauses(Decreasedtubularreabsorption)
HypertensivenephrosclerosisUricAcidnephropathyAcutehypersensiti
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