泌尿系统教学课件：Urinalysis and microscopy.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,尿液检验,（,Urinalysis and microscopy,）,General evaluation of health,Diagnosis of disease or disorders of the kidneys or urinary tract,Diagnosis of other systemic disease that affect kidney function,Monitoring of patients with diabetes,Screening for drug abuse(eg.Sulfonamide or aminoglycosides),Clinical Purpose,尿液的收集与保存,（,collection and preservation of specimen,）,尿液的一般性状检查,（,general exam,）,尿液化学检查,（,chemical exam,）,尿液显微镜检查,（,microscopic exam,）,尿液检验内容,The performance of an accurate urinalysis begins with the proper collection technique.There are several methods available,depending on the type of specimen,.,The first voided morning urine(the most common),Random urine(for emergency),Clean-catch,midstream urine(for urine culture),Attention:,Need to be examined within 1 hour,1.,Collection and Preservation,表 推荐使用的,24,小时尿防腐剂,分析物,冰箱,(2-8),冷冻,(-24-16),盐酸,硼酸,醋酸,其它,白蛋白,(,微白蛋白）,1,2,3,5,2,6,酒精（乙醇）,醛固酮,4,7,1,2,5a,7,3,5,6,7,胺基酸,5a,3a,4,1,5,7,3t,胺基乙酰丙酸,5a,1,2,5,6,7,7,3s,5s,淀粉酶,6,4rt,B-2-,微球蛋白,2,2,钙,1,2,3,4,5,6,7,儿茶酚胺，,分馏,3,5a,1,2,3,4,5,7,6,7,氯,1,2,4,5,6,6,拘橼酸盐,2,2,3a,4,1,5,7,3t,肾上腺皮质素,1,4,7,5,2,6,7,3,7,C-,肽,5,肌酸,1,5,3,4,1u,1u,6,肌酐,1,2,5,4,5a,5a,5a,6,胱胺酸,2,3a,7,1,4,5,7,3t,脱氢表雄甾酮,4,电解质,1,4,5,6,1u,1u,5a,钠 钾,2.1,尿量（,urine volume),（,1,）正常人每日尿量取决于每日的引水量和其他途径排出的液体量。,（,2,）正常人,10002000ml/24h,多尿,(polyuria),：,2500ml/24h,少尿,(oliguria),：,400ml/24h,或,17ml/h,无尿,(anuria),：,1.3g/L,。如,PNH,脓尿（,pyuria),和,菌尿（,bacteriuria),：泌尿系统感染,乳糜尿（,chyluria,）,：丝虫病，肾周肿瘤,胆红素尿（,bilirubinuria),：结合型胆红素,2.2,颜色（,color,）,氨味：慢性膀胱炎，尿潴留,苹果样气味：糖尿病酮症酸中毒,蒜臭味：有机磷中毒,2.3,气味（,odor,）,Normal PH,The average is about 6,Range from 59(depends on diet),Higher PH,-alkaline urine,1.drugs:sodium bicarbonate,2.classic renal tubular acidosis,3.alkalosis(metabolic or respiratory),Lower PH,-acid urine,1.drugs:ammonium chloride,2.acidosis(metabolic or respiratory),2.4 pH,值,Specific gravity,is the ratio of the density(mass of a unit volume)of urine to the density(mass of the same unit volume)of water.,Range of 1.001 to 1.040,High SG=lacking in fluids or high secretion of ADH,Low SG=diluted urine,2.5,比重（,SG,）,尿蛋白,PRO,尿葡萄糖,GLU,尿酮体,KET,尿胆红素,BIL,尿亚硝酸盐,NIT,尿隐血,BLD,尿白细胞,LEU,尿胆原,URO,尿,pH,值,pH,尿比重,SG,尿,VitC VitC,3.,化学检查（,chemical exam,）,（,1,）,Proteinuria,：,more than 150mg proteins in,urine in 24 hours or qualitative test is,positive,（,2,）尿蛋白增高的机制：,a.,肾小球滤过增加：以,Albumin,为主,b.,肾小管重吸收能力减弱：以,2,-microglobin,为主,c.,血浆中蛋白成分增高：,Bence,Jones,蛋白,d.,肾小管自身分泌增多：,Tamm,Horsfall,蛋白为主,3.1,尿蛋白,肾小球性蛋白尿,glomerular proteinuria,肾小管性蛋白尿,tubular proteinuria,混合性蛋白尿,mixed proteinuria,溢出性蛋白尿,overflow proteinuria,组织性蛋白尿,histic proteinuria,偶然性蛋白尿,accidental proteinuria,体位性蛋白尿,postural proteinuria,蛋白尿的种类,Reference value,Qualitative method:negative,Glycosuria,-qualitative test is positive,1.hyperglycemia:diabetes mellitus,Cushings syndrom,2.without hyperglycemia:renal tubular,dysfunction,such as pyelonephritis,3.2,尿糖,(Glycosuria),血糖增高：,a.,甲状腺激素、生长激素、糖皮质激素、肾上腺素、胰高血糖素,-,分泌增多,b.,胰岛素,-,分泌减少,血糖正常：,a.,家族性糖尿,b.,慢性肾病,c.,妊娠,Including three ketone bodies:,acetoacetic acid 20%,acetone 2%,-hydroxybutyric acid 78%,The intermediate products of fat metabolism,Reference value:,qualitative method:negative,3.3,酮体,(Ketonuria),糖尿病性酮尿,血酮,2 mmol/L,酮血症,血酮,5mmol/L,血糖,16.6mmol/L,非糖尿病性酮尿：高代谢状态而不能及时补充能量,酮症酸中毒,尿中结合型胆红素（,SDB,）超过,340,510,mol/L,，出现胆红素尿。,尿胆原全部来自肠道的重吸收,尿三胆：尿胆红素、尿胆原、尿胆素,尿二胆：尿胆红素、尿胆原,3.5 urobilinogen or Bilirubin,Including nitrite and leukocyte esterase,Nitrite,Reference value:negative,Abnormal nitrite values may indicative of,Urinary tract infection,Bacterial infection,E Coli,Salmonella,Citrobacter,Proteus,Clebsiella,3.6 Indirect test for urinary tract infection,Leukocyte esterase,Commonly used as a marker for neutrophils,Reference value:negative,Positive-urinary tract infection,Cellular elements:erythrocytes,leucocytes,epithelial cells,Casts:,Crystals:,Brightfield microscopy can be performed unstained urine preparation,Microscopic examination,In normal urine,less than 3RBCs/hpf,More than 3RBCs/hpf is abnormal,Causes,:,1.renal diseases:glomerulonephritis,calculus,tumor,2.urinary tract diseases:acute and chronic,infection,calculus,tumor,hemorrhage cystitis,3.toxic reactions due to drugs:anticoagulant,therapy,Erythrocytes,RBCs in urine,Normally,RBCs appear as pale biconcave disks.,In hypertonic urine,RBCs become crenated.,In dilute urine,RBCs lyse and left only empty cell membranes refer to as“ghost cells”.,The predominant type of leukocyte is the polymorphonuclear leukocyte(neutrophils),In normal urine,less than 5 leukocytes/hpf,Pyuria,-more than 5 leukocytes/hpf,Causes,:urinary tract infection such as,pyelonephritis,cystitis,urethritis,Leukocytes,Leukocytes in urine,In fresh specimen,leukocytes appear as granular spheres with multilobated nuclei,Leukocytes degenerate,nuclear detail may be lost,Renal tubular epithelial cells,Transitional(urothelial)epithelial cells,Squamous epithelial cells,Epithelial cells,Renal tubular epithelial cells,In normal urine,seldom numbers of these cells may be seen,Increased number indicates tubular damage,such as acute tubular necrosis or certain drug toxicity,Larger than leukocytes with a large round nucleus,Transitional(urothelial)epithelial cells,Line the urinary tract from the renal pelvis to the bladder,In normal urine,a few these cells may be seen,Increased numbers of cells suggest urinary tract disorders such as infection,calculus,tumor or cancer.,Cells larger but nucleus smaller than renal tubular epithelial cells,Squamous epithelial cells,From urethra,most frequent epithelial cells seen in normal urine,Large clumps suggest urethritis,Large and flat with abundant cytoplasm and small round nuclei,Formed only in the distal convoluted tubule(DCT)or the collecting duct,Tamm-Horsfall protein(T-H glycoprotein)forms the matrix of all casts,Casts,Casts,The factors which favor protein cast formation are low flow rate,high salt concentration,and low pH(favor protein denaturation and precipitation),Casts,The protein forms a meshwork that trap any elements present in the tubular filtrate including cells,cell fragments,or granular material,In normal urine,very few casts(hyaline casts)are seen in the urinary sediment,Increased numbers or different forms of casts indicate that kidney disease is widespread,Casts may be classified according to their matrix,inclusion and cell present,Casts,Hyaline casts,Translucent,In normal urine,02 hyaline casts/lpf,Increased numbers-renal disease or transiently with exercise,fever,congestive heart failure,Erythrocyte(RBC)casts,Leukocyte(WBC)casts,Renal tubular epithelial cell casts,Cellular casts,RBC casts,Red blood cells stick together in the cast,RBCs casts are indicative of glomerulonephritis or severe tubular damage(severe pyelonephritis),WBC cast,White blood cells stick together,WBC casts presence indicates inflammation of the kidney.,1.The most common disease-pyelonephritis,2.Also present with glomerulonephritis,Renal tubular epithelial cell casts,The most reliable distinguishing characterize is their singular round nuclei,These casts presence suggests tubular injury,such as acute tubular necrosis,exposure to some drugs,Granular casts,Granules may originate from plasma protein aggregates or from cellular remnants of WBCs,RBCs,and damaged renal tubular cells,Granular casts presence-chronic renal disease,Waxy casts,Homogeneously smooth with sharp margins,blunted ends and cracks along the margins,Reflect the final phrase of dissolution of the granular casts,waxy casts appear most frequently in patients with chronic renal failure,Form by the precipitation of urinary salts.,In vivo,increased solute concentration is typically responsible for crystal formation.,Most crystals in the urine are of limited clinical significance.,Proper identification of few abnormal crystals is associated with various pathologic conditions.,Appearance of most crystals are geometric drawing,Crystals,Crystals in normal urine,Calcium Oxalate Dihydrate crystals,Calcium Oxalate Monohydrate crystals,Crystals in normal urine,Triple phosphate crystals,Crystals in normal urine,Uric acid crystals,Crystals in abnormal urine,Sulfadiazine crystals are a common finding with administration of Trimethoprim-sulfadiazine.,1.A ideal specimen of urine for routine urinalysis should be,A.At least 60 ml,B.The first voided morning urine,if possible,C.Random midstream urine,D.Put into a sterile container,Questions,2.The definition of“anuria”is,A.more than 2000ml of urine in 24 hours,B.less than 400ml of urine in 24 hours,C.less than 100ml of urine in 24 hours,D.more than 2500ml of urine in 24 hours,3.the most common cause of overflow proteinuria is,A.glomerular diseases,B.Renal tubular disease,C.glomerular and renal tubular diseases,D.intravascular hemolysis,4.which of the following epithelial cells is the most frequent epithelial cells seen in normal urine?,A.Squamous epithelial cells,B.Renal tubular epithelial cells,C.Transitional epithelial cells,D.urothelial epithelial cells,5.which of the following protein forms the matrix of all casts?,A.albumin,B.globulin,C.Tamm-Horsfall protein,D.microalbumin,Key,1.b 2.c 3.d 4.a 5.c,