實(shí)驗(yàn)診斷學(xué)之尿液腎功能檢驗(yàn)課件

1、1(Normal Range of (Prerenal： heart failure、 dehydration，etc)Abnomal-Colored UrineACIDITY)(Normal Range of pH):Urine pH: Acidosis, high fever, gout and diabetes) Increased Urine pH: Alkali poisoning, urinary retention, cystitis, renal tubular acidosis)SPECIFIC GRAVITY) (the specific gravity measures

2、the kidneys to ability concentrate urine)(Normal Urine Specific Gravity Range:（Fasting and dehydration,glycosuria, Acute glomerulonephritis ） (Compulsive water drinking, acute/Interstitial nephritis ,diabetes insipidus)Urinary protein determination)Normally,only the smallest protein molecules can pa

3、ss the filtration barrier of the glomerulus,and most of these are reabsorbed by the tubules, Therefore normally urine protein content is low, the qualitative test negative, Quantitative detection 150mg 24h .) increased albumin in the urine,no large protein molecules appear,most foralbumin ,such as I

4、mmunoglobulin, The complement also appear in urine, In the most acute glomerulonephritis)Tubular injury limits reabsorption of filtered proteins.)the smallest protein molecules in plasma increased above the capacity for tubular reabsorption and protein appear in the urine，like hemoglobin,myoglogin.

5、Immunoglobulin light chain，ect)filtration of the glomerulus increase when body in injuryproduces measurable proteinuria, Glomerulonephritis or Pyelonephritis ,Glucosuria) (Glucose is normally filtered in the glomerulus and completely reabsorbed,mostly in the proximal tubule.Glucose in randomly colle

6、ctable fresh urine specimens is normally undetectable) (When the serum glucose rises above 8.88mmol/L,the filtered load will exceed the capacity for tubule reabsorption and glucose will appear in the urine. Dipsticks,impregnated with glucose oxidase and an indicator color)glucose glucosuria ) Hyperg

7、lycemia in diabetes mellitus) Glucosuria by stress: Craniocerebral trauma, Hemorrhage, Acute myocardial infarction)glucose glucosuria : proximal tubular dysfunction,and hereditary renal glycosuriaKetones are the products of fatty acid metabolism.Increased ketones in the urine indicate that cellular

8、metabolism is dependent upon fattyacid rather than glucose for energy. Progressively diminished glucose utilization in uncontrolled diabetes mellitus leads to lipolysis with increasing plasma and urinary concentration of acetoacetic acid,beta-hydroxybutyric acid,and ketones.Ketonuris uncontrolled di

9、abetes mellitus leads to lipolysis with increasing plasma and urinary concentration of acetoacetic acid,beta-hydroxybutyric acid,and ketones.Ketonuris :high fever, Severe vomiting, Diarrhea. Fast, Cirrhosis)： URINARY SEDIMENT)(Centrifuge 10ml of urine in a conical tube for 5 minutes,decant the super

10、natant,flick the tube to disperse formed elements in the remaining drop,and place it on a slide under a cover slipe to be examined with the high-power objective of a microscope(hpf).Abnormal numbers of cells and casts or any bacteria reveal the presence of disease.)Erythrocytes)Hematuria:Normal:0-3

11、red blood cells(RBCs)/hpf)Erythrocytes glomerulonephritis, Purpura nephritis,sle nephritis) Leukocytes and purulent cells) Normal:0-5 white blood cells(WBSs)/hpf.腎小管上皮細(xì)胞尾形、小圓、大圓上皮細(xì)胞扁平上皮細(xì)胞Casts (The tubular has ability to fully concentrated and acidify the urine )(hyaline casts: (Red cell casts: Acut

12、e glomerulonephritis)Leukocyte cast: Pyelonephritis (granular casts)granular castscell casts,indicate (Broad casts :occur in chronic renal failure. Indicate the poor prognosis)透明管型蠟樣管型寬幅管型phosphate may occur in Alkaline urine may occur in 尿酸鹽結(jié)晶草酸鈣結(jié)晶 a site of injury in the urinary tract or kidney sh

13、ould be sought.)尿淀粉酶測(cè)定尿淀粉酶測(cè)定(Urine amylase determination)參考值：參考值：1000U/L (Reference: 40mmol/LKidneys 2.腎前性少尿腎前性少尿 重吸收正常或增強(qiáng)，一次性尿鈉重吸收正?；蛟鰪?qiáng)，一次性尿鈉20mmol/L (before Kidneys RENAL FUNCTIONcreatinine ,CREATININE CLEARANCE,Ccr) Urea nitrogen,an end product of protein metabolism,is excreted by the kidney.BUN

14、is directly related to protein intake and nitrogen metabolismcreatinine（近端小管）（近端小管）2-微球蛋白測(cè)定微球蛋白測(cè)定 ( beta 2 - micro globulin determination)參考值：成人血清參考值：成人血清12mg/L, 尿液尿液0.3mg/L臨床意義：臨床意義： 1.靈敏的腎小球?yàn)V過功能受損指標(biāo)靈敏的腎小球?yàn)V過功能受損指標(biāo) Ccr80ml/min即可出現(xiàn)血即可出現(xiàn)血2-微球蛋白的升高。微球蛋白的升高。2.當(dāng)血當(dāng)血2-微球蛋白微球蛋白5mg/L,尿尿2-微球蛋白升高為近微球蛋白升高為近端腎小管損害。如血尿中端腎小管損害。如血尿中2-微球蛋白均升高，為微球蛋白均升高，為腎小球和腎小管均受損。腎小球和腎小管均受損。3. 應(yīng)用腎損害藥物的及腎移植排斥反應(yīng)監(jiān)測(cè)應(yīng)用腎損害藥物的及腎移植排斥反應(yīng)監(jiān)測(cè)（近端小管）（近端小管）1-微