urinalisis.pptx

use it really it is parts of clinical laboratory

1. Urinalysis Urinalysis tests Introduction Urine is formed in the kidneys, is a product of ultra filtration of plasma by the renal glomeruli.

2. Urine sample Early morning sample-qualitative Random sample- routine 24hrs sample- quantitative Midstream sample-UTI Post prandial sample-D.M

3. Urine examination Macroscopic examination Chemical examination Microscopic examination

4. Color & appearance Normal= clear & pale yellow Colourless- dilution, diabetes mellitus, diabetes insipidus, diuretics Milky-purulent genitourinary tract infection Orange-fever, excessive sweating Red-haematuria Brown/ black- melanin

5. Urinary volume Normal = 600-1550ml/day Polyuria - >2000ml Oliguria - <400ml Anuria - complete cessation of urine(<200ml) Nocturia - excretion of urine by a adult of >500ml with a specific gravity of <1.018 at night (characteristic of chronic glomerulonephritis )

6. Causes of polyuria Diabetes mellitus Diabetes insipidus Polycystic kidney Chronic renal failure Diuretics Intravenous saline/glucose

7. oliguria Dehydration-vomiting, diarrhoea, excessive sweating Renal ischemia Acute tubular necrosis Obstruction to the urinary tract Acute renal failure

8. Chemical tests- 1. Protein Causes of proteinuria Prerenal causes-Heavy exercise,Fever,hypertension, multiple myeloma, ecalmpsia Renal –acute & chronic glomerulonephritis,Renal tubular dysfunction,Polycystic kidney, nephrotic syndrome Post renal- acute & chronic cystitis, tuberculosis cystitis

9. 2. Bilirubin Test - fouchet’s test. Causes Liver diseases- injury,hepatitis Obstruction to biliary tract 3. Urobilinogen est - ehrlich test Causes-hemolytic anemia's Bile salts- Hay’s test Cause- obstruction to bile flow (obstructive jaundice)

10. 3. Urobilinogen Test- ehrlich test Causes-hemolytic anemia's Bile salts- Hay’s test Cause- obstruction to bile flow (obstructive jaundice)

11. 4. Blood RBCs-Causes of hematuria Pre renal - bleeding diathesis, hemoglobinopathies , malignant hypertension. Renal - trauma, acute & chronic glomerulonephritis , renal tumors Post renal – severe UTI, calculi, trauma, tumors of urinary tract

12. Crystals in urine Crystals in acidic urine Uric acid Calcium oxalate Cystine Leucine Crystals in alkaline urine Ammonium magnesium phosphates(triple phosphate crystals) Calcium carbonate

13. Different crystals (indicative of renal disfunction )

14. Types of casts Acellular casts Hyaline casts Granular casts Waxy casts Fatty casts Pigment casts Crystal casts Cellular casts Red cell casts White cell casts Epithelial cell cast

15. Fatty casts Formed by the breakdown of lipid-rich epithelial cells, these are hyaline casts with fat globule inclusions They can be present in various disorders, including nephrotic syndrome, diabetic or lupus nephropathy, Acute tubular necrosis

16. Red cell casts The presence of red blood cells within the cast is always pathologic, and is strongly indicative of glomerular damage. They are usually associated with nephritic syndromes .

17. White blood cell casts Indicative of inflammation or infection (especially when there is a pus), pyelonephritis acute allergic interstitial nephritis , nephrotic syndrome, or post-streptococcal acute glomerulonephritis

18. Negative Trace (100 mg/dL) + (250 mg/dL) ++ (500 mg/dL) +++ (1000 mg/dL) ++++ (2000+ mg/dL) The Urine Glucose Dipstick: Significance Diabetes mellitus Renal glycosuria Normal concentration: 15 mg/dl

19. Negative + (weak) ++ (moderate) +++ (strong) The Urine Bilirubin Dipstick: Bilirubin : is a break down of aged RBC or hemoglobin-result in yellowish color-it is excretd in urine and bile Significance -jaundice (direct bilirubin) Hepatitis, cirrhosis, other liver disorders Biliary obstruction

20. Negative Trace (5 mg/dL) + (15 mg/dL) ++ (40 mg/dL) +++ (80 mg/dL) ++++ (160+ mg/dL) The Urine Ketones Dipstick: Ketones : are produced by the liver as part of fatty acid metabolism/when lack of glucose occured Significance - Diabetic ketoacidosis - Prolonged fasting ( starvation)

21. 1.000 1.005 1.010 1.015 1.020 1.025 1.030 It measures the concentration of all chemical particles of urine Normal -1.016-1.022 Significance - Diabetes insipidus (a disorder of the pituitary gland that causes the body to produce large amounts of urine). Urine Specific Gravity

22. Negative Moderate Trace + (weak) ++ (moderate) +++ (strong) The Urine Blood Dipstick: Significance - Hematuria Renal problem Glomerulonephritis Tumors

23. 5.0 6.0 6.5 7.0 7.5 8.0 8.5 The Urine pH Dipstick: Significance - Acidic (less than 4.5) - Alkaline (greater than 8.0): renal tubular acidosis (>5.5) respiratory or metabolic acidosis/ketosis respiratory or metabolic alkalosis renal tubular acidosis renal calculi /renal stoneformation

24. Negative Trace + (30 mg/dL) ++ (100 mg/dL) +++ (300 mg/dL) ++++ (2000 mg/dL) The Urine Protein Dipstick: Significance - Proteinuria:- indicative of early kidney damage Tubular damage Glomerular damage