urinalysis power point presentation
TRANSCRIPT
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URINALYSIS
Dr. Samuel Adegoke
WGH, Ilesa.
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Introduction
The Human urine is the effluent fluid
that is disposed from the kidney.
Thus, It is highly reflective in its
properties, of the state of health of
each individual.
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Urinalysis
A routine/ basic investigation.
Involves: Physical & chemical examination of urine.
Complete urinalysis: Includes microscopic exam.
Cheap, Fast & Simple.
Evaluation, diagnoses & monitoring health status.
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Indications:
To:1. Evaluate the general health status (Routine test)
2. Diagnose & monitor renal disorders.
3. Monitor for hyperglycemia/ Diabetes Mellitus.
4. Screen for drug abuse (e.g. steroids in athletes).
5. Pregnancy test
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Analysis
Can be performed:
Bedside.
Side laboratory.
Chemical pathology laboratory.
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How is urinalysis done?
1. Obtain Consent & Cooperat ion o f Pat ient & Parent.
2. Urine co l lect ion :
a) Freshly voided urine
b) Timing: Any time of the day.
Early morning is most valuable: Being most concentrated, it is more
reliably measures kidney function.
c) Clean the genitalia: cotton wool, water.
i. *Soap & disinfectant may contaminate urine.
ii. *Methylated spirit is astringent & kills germs in urine.
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Procedure:a) Collect mid-stream (clean
catch) or terminal urinesamples.
b) Other methods of collection:
i. Catheterisation.ii. Supra-pubic aspiration.
Collect sample in a clean,
transparent containers:
i. Urinalysis
ii. MCS
Precautions:
Read immediately (Max: 15
min) as Chemistry changes.
Otherwise refrigerate urine.
Put the dipstick into the urine
May use Urinometer to
measure S.G
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The Normal Urine Vs Abnormality:
Colour & Clarity Normal Appearance:
Colour: Colourless
Amber
Straw-coloured.
Clarity: Clear (i.e. not turbid).
Abnormalities: Dark-coloured:
Dehydration.
Haematuria:
Schistosomiasis, Hb SS.
Haemoglobinuria: G6PD Def
Bilirubinuria: Hepatitis
Foods & drugs: Rifampicin.
Amino-acidurias. In-born errors of
Metabolism.
Cloudy/ Turbid : Suggest UTI.
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Normal Urine Vs. Coca-Cola Urine
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The Normal Urine Vs Abnormality
Odour & Sediments
Normal Appearance:
Odour: Slight ammonical odour.
Sediments: Nil.
Abnormalities:
Odour: Has fishy odour in UTIparticularly in Proteus Sp.
Sediments:
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The Normal Urine Vs Abnormality
Volume, S.Gravity & pH Vol: 1 - 2mls/ Kg/ hour.
S. Gravity: a simplemeasure of concentrating
ability of kidneys = 1.0151.025.
pH: 4.58.0 (i.e. Slightlyacidic)
Oliguria: < 0.5 -1.0 mL/ kg. ARF, Dehydration, Shock
Persistently 1.010 CRF.
DI.
> 1.035: Shock, Severe dehydration
pH: If Alkaline = UTI
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Urinometer (Hygrometer)
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Urine Chemistry: Proteinuria
Proteinuria:
About 150mg/ 24hours,
(usually Albumin).
This amount is usuallynot dipstix detectable.
Trace, 1+, 2+
ARF, CRF, UTI,
Exercise
3+/ 4+
Nephrotic Syn.
Trace: 1029 mg/ dL
1+: 3099 mg/ dL
2+: 100299 mg/ dL
3+: 300999 mg/ dL
4+: 1 g/ dL
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Dipsticks (Combi-9 Dipstix)
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Urine Chemistry: Sugar
Glucose: Nil.
Glycosuria reflects
hyperglycemia:
DM
Monitor Patients on IVglucose infusion
Other Reducing
Substances:
Usually absent. E.g. Galactosuria.
Clinitest: ROYGBIV
Normal (0%): Blue
Glycosuria:
Green: %
Yellow: %
Orange: 1%
Red: 2% suggestive of
(RBS 15 mmol/ L)
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Urine Chemistry: Normal Vs AbN
Bilirubin:
Nil.
Conjugatedhyperbilirubinaemia.
Urobilinogen:
Trace.
Unconjugated hyperbil.
Haemoglobin: Nil.
Haemoglobinuria: intra-vascular haemolysis.
Ketones:
Nil.
Ketonuria: Starvation, DKA.
Nitrite:
Not usually detectable.
Presence indicative of UTI(Proteussp).
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Urine Microscopy Cells:
RBC: 02/ hpf
WBC: 05/ hpf but > 5/ hpf: Pyuria.
Epithelial Cells: Few, more in newborn
Organisms: Nil.
Casts: Small fibrous objects formed when protein &
other materials deposit in the kidney tubules & coll. ducts. Hyaline cast: 0-1/ hpf; found in Nephrotic Syn.
Red cell/ granular: Nil; found in AGN.
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Limitation
A limitless test, Simple, Cheap, Easil
reproducible.
Protein + Glucose: N50
Protein + Glucose + pH: N75
Combi-9: N150
Microscopy: N225
Full Urinalysis: N375.
Limitation: We often forget to do it.
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Conclusion
Must be done on all patients.
The findings must be followed with
appropriate investigations.
Best combined with other tests .e.g. E/ U + Cr &
24Hour urinalysis.
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Thank
you!