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urinalisis.pptx

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This document provides information about urinalysis tests. It discusses the types of urine samples that can be collected, including early morning, random, 24-hour, and midstream samples. The document describes microscopic and chemical examinations of urine, including normal and abnormal colors, volumes, and presence of crystals, casts, glucose, bilirubin, ketones, specific gravity, blood, pH, and protein. Abnormal results can indicate conditions such as urinary tract infections, diabetes, liver and kidney diseases.

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Urinalysis Urinalysis tests Introduction Urine is formed in the kidneys, is a product of ultra filtration of plasma by the renal glomeruli.
Urine sample Early morning sample-qualitative Random sample- routine 24hrs sample- quantitative Midstream sample-UTI Post prandial sample-D.M
Urine examination Macroscopic examination Chemical examination Microscopic examination
Color & appearance Normal= clear & pale yellow 1. Colourless- dilution, diabetes mellitus, diabetes insipidus, diuretics 2. Milky-purulent genitourinary tract infection 3. Orange-fever, excessive sweating 4. Red-haematuria 5. Brown/ black- melanin
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)
Causes of polyuria Diabetes mellitus Diabetes insipidus Polycystic kidney Chronic renal failure Diuretics Intravenous saline/glucose
oliguria Dehydration-vomiting, diarrhoea, excessive sweating Renal ischemia Acute tubular necrosis Obstruction to the urinary tract Acute renal failure
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
2. Bilirubin Test- fouchets test. Causes Liver diseases-injury,hepatitis Obstruction to biliary tract 3. Urobilinogen est- ehrlich test Causes-hemolytic anemia's Bile salts- Hays test Cause- obstruction to bile flow (obstructive jaundice)
3. Urobilinogen Test- ehrlich test Causes-hemolytic anemia's Bile salts- Hays test Cause- obstruction to bile flow (obstructive jaundice)
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
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
Different crystals (indicative of renal disfunction)
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
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
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.
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
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
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
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)
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
Negative Moderate Trace + (weak) ++ (moderate) +++ (strong) The Urine Blood Dipstick: Significance - Hematuria Renal problem Glomerulonephritis Tumors
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
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

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urinalisis.pptx

  • 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 1. Colourless- dilution, diabetes mellitus, diabetes insipidus, diuretics 2. Milky-purulent genitourinary tract infection 3. Orange-fever, excessive sweating 4. Red-haematuria 5. 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- fouchets test. Causes Liver diseases-injury,hepatitis Obstruction to biliary tract 3. Urobilinogen est- ehrlich test Causes-hemolytic anemia's Bile salts- Hays test Cause- obstruction to bile flow (obstructive jaundice)
  • 10. 3. Urobilinogen Test- ehrlich test Causes-hemolytic anemia's Bile salts- Hays 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