檢驗?zāi)虺Ｒ?guī)報告解讀

Urinanalysis1檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Question

Ifagroupofantswereattractedbyurine,theurinecontains().2檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024UrinalysisHingdusnamedtheurine“honeyurine”.thisistheoldesturinalysis.In1674,Thomaswillisfoundthesugarintheurinecanbedetectedbytestingurine.……Nowurinesugarcanbeexaminedbyurinalysissystem.

3檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024FormationofurineGlomerularfiltrationTubularreabsorptionTubularsecretionNormal:

Clean-catchurine

1000-2000ml/24h4檢驗?zāi)虺Ｒ?guī)報告解讀5/8/20245檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Thefunctionofurinemaintainwaterbalance;removewasteproducts;maintainnormalbloodchemistry.

6檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024ClinicalsignificanceofurineanalysisRoutineurinalysisareperformedforseveralreasons:generalhealthscreeningtodetectrenalandmetabolicdiseasesdiagnosisofdiseasesordisordersofthekidneysorurinarytractsmonitoringofpatientswithdiabetes7檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024臨床上尿液可以進行哪些項目的測定？你認(rèn)為什么最重要？8檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024ACompleteurinalysishas4partsGrossexaminationSpecificgravityBiochemicalanalysisSedimentExamination9檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024目前使用全自動儀器進行尿液分析，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10檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024

干化學(xué)分析試劑條PHSGPROGLUKETBILUROBLDLEUNIT11檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Whatinformationcanurinalysisgiveus?Routinetests

SGPHProGluBilUBOWBCRBCNITKETSpecifictestsMicroprotein(Alb,Β2MG，α1MG,IgG,TRF)LightchainEnzymeUrineelectrophoresis

Urinesediment

RBCWBCcastcrystalbacteriafungi12檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Samplecollection13檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024RandomspecimenThisisurinethathasbeenspontaneouslyvoidedwithina24-hperiod.Itoftenoriginatesinpatientswithanacutedisease.Itisnotknownforhowlongtheurinewaspresentinthebladder.Theinterpretationofthefindingsisdifficult.14檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Firstmorning(8-hspecimen)urine

Thebladderisemptiedimmediatelypriortobedtimeandthefirstmorningurineiscollected.Thisurinerepresentstherestingstate.Itrulesoutorthostaticallyinducesproteinuria.Thecellconcentrationishighsincetheurineisacidicthoughpreservingcellsandcastsfromdestructionandlysis.Thebacteriacontentishighwhichleadtoanimprovementinthebacteriologicaldiagnosis.(midstream)15檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024SecondmorningurineThisurineisusedinoutpatientswhotakelongertotraveltothemedicalfacilityanditusedforspecialexaminations,e.g.theclassificationofproteinuria,cytologicalexaminationsofthebladdermucosaorthedeterminationofdysmorphicerythrocytes.16檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202424-hurineUrinecollectedovera24-hperiodItismostlyemployedforthedeterminationofproteinuriaaspartofthediagnosisofrenaldisorder.17檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024SamplestorageandtransportThetransportofurinetotheclinicallaboratoryshouldbedoneasfastaspossible.1.After2hthepHmayhaverisenandautolysisoftheparticulatematerial(cells,casts)mayhaveoccurred.2.coolingisnotrecommendedbecauseoftheprecipitationofamorphousuratesofphosphatecrystal.Theuratesinterferwiththemicroscopicexamination.3.thespecimenmustbedeepfrozenorstabilizedbythechemicaladdictives.18檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024尿液標(biāo)本的保存冷藏法：不能超過8小時?；瘜W(xué)防腐法：防腐劑實用范圍甲苯化學(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19檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024GoalofdiagnosticevaluationsusingurinalysisToruleoutincreasedurinaryexcretion(cells,proteins)TodifferentiatebetweenbenignandpathologicalsituationsTodistinguishbetweendifferentcausesToquantify(xx)inordertoassessdiseaseactivity.20檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024GrossExaminationColorappearanceOdor21檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024diabetesinsipidus

22檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Biochemicalanalysis23檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202424檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024UrinaryproteinsIncreasedexcretionofproteinsintheurine,i.e.proteinuria(＞120mg/24h),isthehallmarkofthealmostanykindofkidneydisease.Simpleandinexpensive.25檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Dipsticksdetect

proteinbyproductionofcolorwithanindicatordye,Bromphenolblue,whichismostsensitivetoalbuminbutdetectsglobulinsandBence-Jonesproteinpoorly.Precipitationbyheatisabettersemiquantitativemethod,butoverall,itisnotahighlysensitivetest.Thesulfosalicylicacidtestisamoresensitiveprecipitationtest.Itcandetectalbumin,globulins,andBence-Jonesproteinatlowconcentrations.26檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Inroughterms,tracepositiveresults(whichrepresentaslightlyhazyappearanceinurine)areequivalentto10mg/100mlorabout150mg/24hours(theupperlimitofnormal).1+correspondstoabout200-500mg/24hours,a2+to0.5-1.5gm/24hours,a3+to2-5gm/24hours,anda4+represents7gm/24hoursorgreater.

27檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024MechanismofProteinuria

28檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Increasedglomerularfiltration.Theproteinmustpassthroughtheglomerularcapillarywall.

NephroticSyndrome-minimalchangediseaseandfocalglomerulosclerosisGlomerulonephritisDrugs

29檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Thereasonofproteinuriaglomerularthesize-selectivebarrierleakslargeproteinmoleculesthecharge-selectivebarrierfailstoretainlowermolwtproteins.

30檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024ThereasonofproteinuriaApproximatesizecutoffofsubstancesforfiltrationis70kDa.substancessmallerthanthisareoftenretained,eitherduetochargeeffects(albumin)orbecausetheyaretightlyboundtootherproteinstogivethemalargereffectivesize31檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Decreasedtubularreabsorption.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

32檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Increasedsecretion-normallysomeproteinissecretedbutmayincreasewithexercise,acuterenalfailure,transplantrejection,andstones.

κλchainhaemoglobinmyoglobin33檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Howtodifferentiateproteinuiafromeachother34檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202435檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Routinetests

(proteinuria)Ⅱ.Theamountsof

smallmoleculesincreasedmorethantheabilityoftubularreabsorption.1.Multipomyelomalightchain↑,electrophoresisorimmunoassay2.intravascularhemorrhageHb↑，OB+，TB↑，IB↑，UBO+3.urineroutinetest:proteinnegativeortrace36檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Typesofproteinuria

（pathologic）Renalproteinuria:glomerula,tubular;thesytemicandgeneralizeddiseases(SLE,diabetes).Prerenalcauses:excretionofIglightchainintravascularhemolysis(血管內(nèi)溶血)Postrenalcauses:hemorrhageandexudationwithinthelowerurinarytract.37檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Non-pathologicalcausesofproteinuria

Exercise-shouldrecheckafterafewdaysofinactivityFever-recheckwhenthechildisafebrilePostural(體位性）ororthostaticproteinuria-verycommonespeciallyinadolescence.Pickeduponroutinescreenandpatientisasymptomatic,thephysicalexaminationincludingBPisnormal,andthereisnoredbloodcellsintheurine.38檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024TypesofproteinsandmarkerproteinsSelectiveglomerulaproteinuria

Increasedglomerularpermeabilityformidsizedanionic,50-70KD(mostlkyAlbandTRF),0.03-0.3g/24h.

Nonselectiveglomerulaproteinuria

Increasedglomerularpermeabilityforhighmolecularmassproteins,50->150KD,AlbandIgG,1.5-20g/24h.39檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024TypesofproteinsandmarkerproteinsTubularproteinuriaDecreasedtubularreabsorptionoflow-molecularmassproteins,10-70KD,0.15-15,α1MG,β2MG,retinol-bindingprotein,cystatinC,β-NAG.MixedproteinuriaIncreasedglomerularpermeabilityforhighmolecularmassproteinswithsecondarydamageorsaturation(overflowproteinuria)oftubularreabsorption.40檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024TypesofproteinsandmarkerproteinsPrerenalproteinuriaIncreasedplasmaticreleaseoflow-molecularmassproteins,tubularoverflow;increasedtotalproteinwithnormalalbumin

HemoglobinMyoglobinBJ-protein0.1-5g/24h.41檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024TypesofproteinsandmarkerproteinsPostrenalproteinuriaHemorrhageorexudationwithinthelowerurinarytract.Themaincontents:TammHorsfallprotein,IgA,plasmaproteins,thequantitiesarevariable,themarkerprotein:α2MG,apoAI42檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202443檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Whatisthedefinitionofhematuria?44檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024HematuriaPositivetestindicateseitherHematuria,haemoglobinuriaormyoglobulinuria.

Freehaemoglobinormyoglobincausefieldchange;intactredbloodcells(RBC)arebrokendownoncontactwiththereagentpadandreleaselocalhaemoglobin,producingadot.Thesecoalescewhen>250RBCs/ml.45檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024HematuriaFalsepositivereadingsaremostoftenduetocontaminationwithmenstrualblood.IncidenceoffalsepositivescanbeincreasedbydehydrationwhichconcentratesthenumberofRBCsproducedandexercise.Haematuriaisdefinedas>3RBC/highpowerfield(hpf)ofcentrifugedsedimentundermicroscope.46檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Othercausesofdarkurineincludebeets,blackberries,pyridium,rifampin,uratecrystals,Myoglobinuriamaybeseenafterburns,crushinjuries,myositis,andprolongedgeneralizedseizures.Hemoglobinuriaismostcommonlyassociatedwithhemolyticanemias.

47檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Howtoconfirmtherealhematuria?1.urinedipstick2.urinesediment3.TB,DB4.myoglobin48檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Howtoanalyzetheresultsofurinalysis?49檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024WBCpositive

probableurinarytractinfection;urinaryproteinsnotassessable;urineRepeatexaminationaftertreatmentcultureofinfection.

ifnegative

50檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Hemoglobin/myoglobinpositivehematuria,hemeglobinuria,myoglobinuria;differentiatebetweenrenal/postrenaloriginbymeansofAlb/α2MGratio.ratio<0.02PostrenalproteinuriaRBCmorphologyUrinaryproteinanalysisnotindicated

ratio>0.02

51檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Theratio>0.02,AlbpositiveRenalproteinuria;Differentiationbetweenselectiveglomerular,nonselectiveglomerular,tubularproteinuriabySDSor

quantitativedeterminationofIgGandα1MG.Monitoringbymeansoftotalproteinorselectedmarkerproteins.52檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Alb(-)Hb(-)Leu(-)Probablynopathologicalproteinuria;However:purelytubularproteinuriaandB-Jproteinuriaarenotdetectedbytheteststrip;Incaseofclinicalsuspiciontotalproteinshouldbeanalyzedusingamethodwithhigheranalyticalsensitivity.53檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024UrinesedimentWhat’surinesediment？

referstotheformedelementsoftheurineinacentrifugedspecimen.Theseincluderedbloodcells,whitebloodcells,epithelialcells,casts,crystals,bacterial,andfungi54檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024NormalClean-catchurine,lightyellowLessthan3redbloodcells/hpLessthan5whitebloodcells/hpAfewepithelialcells,occasionalhyalinecasts,occasionalcrystal,andnobacteriaorfungi55檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024hematuriaMorethan3redbloodcells/hp56檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024PyuriaMorethan10whitebloodcells/hpIndicaterenalorgenitourinaryinflammationunlessthereiscontaminationofthespecimenPlusNITand(or)urineculture(65%Escherichiacoli大腸桿菌,NITpositive)57檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Casts

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

58檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202459檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202460檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024CastsHyalinecasts:foundinhealthypeopleaswellasinpatientswithrenaldisease.Granularcasts:excretedbothbyhealthypeopleaswellasbypatientswithrenaldisease,especiallyinthepresenceofproteinuria.Waxycasts:occurininchronicrenalinsufficiencyandduringthepolyuricphaseofacuterenalfailure.61檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024CastsFattycasts:producedbydegeneratedtubularcells.observedinpatientswithnephroticsyndromeaninthosewithsevereproteinuria.RBCcasts:areliableindicatorofrenaloarenchymatousdiseaseandusuallysuggestthepresenceofglomerulopathy.WBCcast:foundinpatientswithinflammatoryrenaldisease.62檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202463檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202464檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202465檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024顆粒管型66檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202467檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202468檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024蠟樣管型69檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202470檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202471檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Questions

1.Whatfactorscaninfluencetheresultsofurinalysis?2.PleasetellustheapplicationsofurineOBtestandusesthetestsyouhavestudiedtodifferOBpositivesituationsfromeachother.72檢驗?zāi)虺Ｒ?guī)報告解讀5/8/202413-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?73檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Glomerulardiseasesmaybeprimaryorsecondarytosystemicdisease.Themajorpathogeniccategoriesareinflammatory(nephriticsyndrome)andhemodynamic(nephroticsyndrome).andlaboratoryfindingsduetoincreasedglomerularcapillarywallpermeability.

74檢驗?zāi)虺Ｒ?guī)報告解讀5/8/2024Theclassicnephriticsyndromeincludeshematuria,hypertension,renalinsufficiency,andedema.Frequently,individualcomponentsofthesyndromeareabsent.Nephriticsyndromemaybeacuteandtransient(eg,postinfectiousGN),fulminan