尿液检验.ppt

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1615251280解决。

　　1张

　　标题：尿液检验( Urinalysis and microscopy )

　　2张

　　其他占位符： 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)

　　标题： Clinical Purpose

　　3张

　　其他占位符：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)

　　标题：尿液检验内容

　　4张

　　其他占位符： 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

　　标题： 1. Collection and Preservation

　　5张

　　(Gp:) 表推荐使用的24小时尿防腐剂

　　(Gp:) 分析物

　　(Gp:) 冰箱 (2-8℃)

　　(Gp:) 冷冻 (-24—-16℃)

　　(Gp:) 盐酸

　　(Gp:) 硼酸

　　(Gp:) 醋酸

　　(Gp:) 其它

　　(Gp:) 白蛋白(微白蛋白)

　　(Gp:) 1,2,3,5

　　(Gp:) 2

　　(Gp:) ?

　　(Gp:) 6

　　(Gp:) ?

　　(Gp:) 酒精(乙醇)

　　(Gp:) ?

　　(Gp:) 醛固酮

　　(Gp:) 4

　　(Gp:) 7

　　(Gp:) 1,2,5a,7

　　(Gp:) 3,5,6,7

　　(Gp:) ?

　　(Gp:) 胺基酸

　　(Gp:) 5a

　　(Gp:) 3a,4

　　(Gp:) 1,5

　　(Gp:) 7

　　(Gp:) ?

　　(Gp:) 3t

　　(Gp:) 胺基乙酰丙酸

　　(Gp:) ?

　　(Gp:) 5a

　　(Gp:) 1,2,5,6,7

　　(Gp:) ?

　　(Gp:) 7

　　(Gp:) 3s,5s

　　(Gp:) 淀粉酶

　　(Gp:) 6

　　(Gp:) ?

　　(Gp:) 4rt

　　(Gp:) B-2-微球蛋白

　　(Gp:) 2

　　(Gp:) ?

　　(Gp:) 钙

　　(Gp:) ?

　　(Gp:) 1,2,3,4,5,6,7

　　(Gp:) ?

　　(Gp:) 儿茶酚胺，分馏

　　(Gp:) ?

　　(Gp:) 3,5a

　　(Gp:) 1,2,3,4,5,7

　　(Gp:) ?

　　(Gp:) 6,7

　　(Gp:) ?

　　(Gp:) 氯

　　(Gp:) 1,2,4,5,6

　　(Gp:) ?

　　(Gp:) 6

　　(Gp:) ?

　　(Gp:) 拘橼酸盐

　　(Gp:) 2

　　(Gp:) 2,3a

　　(Gp:) 4

　　(Gp:) 1,5,7

　　(Gp:) ?

　　(Gp:) 3t

　　(Gp:) 肾上腺皮质素

　　(Gp:) 1,4,,7

　　(Gp:) 5

　　(Gp:) ?

　　(Gp:) 2,6,7

　　(Gp:) 3,7

　　(Gp:) ?

　　(Gp:) C-肽

　　(Gp:) ?

　　(Gp:) 5

　　(Gp:) ?

　　(Gp:) 肌酸

　　(Gp:) 1,5

　　(Gp:) 3,4

　　(Gp:) 1u

　　(Gp:) 1u,6

　　(Gp:) ?

　　(Gp:) 肌酐

　　(Gp:) 1,2,5

　　(Gp:) 4,5a

　　(Gp:) 5a

　　(Gp:) 5a,6

　　(Gp:) ?

　　(Gp:) 胱胺酸

　　(Gp:) ?

　　(Gp:) 2,3a,7

　　(Gp:) 1,4,5,7

　　(Gp:) ?

　　(Gp:) 3t

　　(Gp:) 脱氢表雄甾酮

　　(Gp:) ?

　　(Gp:) 4

　　(Gp:) ?

　　(Gp:) 电解质

　　(Gp:) 1,4,5,6

　　(Gp:) ?

　　(Gp:) 1u

　　(Gp:) 1u,5a

　　(Gp:) ?

　　(Gp:) 钠钾

　　(Gp:) ?

　　6张

　　其他占位符： 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 1000~2000ml/24h 多尿(polyuria)：>2500ml/24h 少尿(oliguria)：<400ml/24h 或<17ml/h 无尿(anuria)：<100ml/24h 或12h内尿量=0

　　标题： 2. 尿液的一般检查

　　7张

　　其他占位符： (1)内分泌疾病： diabetes mellitus， diabetes mellitus， primary aldosteronismPrimary hyperparathyroidism等 (2)肾脏病：肾小管重吸收功能减退、肾间质性疾病如pyelonephritis、CRF、ARF等 (3)精神性多尿：psychogenic polyuria(polydipsia)

　　标题： 2.1.1 多尿(polyuria)

　　8张

　　其他占位符： (1)prerenal：有效循环血容量减少或肾血浆流量减少。 Acute glomerulonephritis、Shock、Heart Failure等 (2) renal parenchymal disease ：low GFR，ARF，Uremia (3)postrenal： obstruction of urinary tract

　　标题： 2.1.2 少尿或无尿

　　9张

　　其他占位符：血尿(hematuria) ：肉眼血尿镜下血尿如肾结石、结核、肿瘤、肾小球疾病等血红蛋白尿(hemoglobinuria)：严重的血管内溶血，游离血红蛋白>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

　　标题： 2.2 颜色(color)

　　10张

　　其他占位符：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

　　标题： 2.3 气味(odor)

　　11张

　　其他占位符： Normal PH The average is about 6 Range from 5~9 (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)

　　标题： 2.4 pH值

　　12张

　　其他占位符： 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

　　标题： 2.5 比重(SG)

　　13张

　　其他占位符：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

　　其他占位符：尿白细胞 LEU 尿胆原 URO 尿pH值 pH 尿比重 SG 尿VitC VitC

　　标题： 3. 化学检查(chemical exam)

　　14张

　　其他占位符： (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β2-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

　　标题： 3.1 尿蛋白

　　15张

　　其他占位符：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

　　标题：蛋白尿的种类

　　16张

　　其他占位符： Reference value Qualitative method: negative Glycosuria--- qualitative test is positive 1.hyperglycemia: diabetes mellitus Cushing’s syndrom 2.without hyperglycemia: renal tubular dysfunction, such as pyelonephritis

　　标题： 3.2 尿糖(Glycosuria)

　　17张

　　其他占位符：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

　　18张

　　其他占位符： Including three ketone bodies: acetoacetic acid 20% acetone 2% β-hydroxybutyric acid 78% The intermediate products of fat metabolism Reference value: qualitative method: negative

　　标题： 3.3 酮体(Ketonuria)

　　19张

　　其他占位符：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

　　20张

　　其他占位符：尿中结合型胆红素(SDB)超过340～510μmol/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

　　标题： 3.5 urobilinogen or Bilirubin

　　21张

　　其他占位符： 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

　　标题： 3.6 Indirect test for urinary tract infection

　　22张

　　其他占位符： Leukocyte esterase Commonly used as a marker for neutrophils Reference value: negative Positive--- urinary tract infection

　　23张

　　其他占位符： Cellular elements: erythrocytes leucocytes epithelial cells Casts: Crystals: Brightfield microscopy can be performed unstained urine preparation

　　标题： Microscopic examination

　　24张

　　其他占位符： 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

　　标题： Erythrocytes

　　25张

　　标题： RBCs in urine

　　正文： 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”.

　　26张

　　其他占位符： 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

　　标题： Leukocytes

　　27张

　　标题： Leukocytes in urine

　　正文： In fresh specimen, leukocytes appear as granular spheres with multilobated nuclei Leukocytes degenerate, nuclear detail may be lost

　　28张

　　其他占位符： Renal tubular epithelial cells Transitional (urothelial) epithelial cells Squamous epithelial cells

　　标题： Epithelial cells

　　29张

　　标题： Renal tubular epithelial cells

　　正文： 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

　　30张

　　标题： Transitional (urothelial) epithelial cells

　　正文： 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

　　31张

　　标题： Squamous epithelial cells

　　正文： From urethra most frequent epithelial cells seen in normal urine Large clumps suggest urethritis Large and flat with abundant cytoplasm and small round nuclei

　　32张

　　其他占位符： Formed only in the distal convoluted tubule (DCT) or the collecting duct Tamm-Horsfall protein (T-H glycoprotein) forms the matrix of all casts

　　标题： Casts

　　33张

　　标题： Casts

　　正文： The factors which favor protein cast formation are low flow rate, high salt concentration, and low pH (favor protein denaturation and precipitation)

　　34张

　　标题： Casts

　　正文： The protein forms a meshwork that trap any elements present in the tubular filtrate including cells, cell fragments, or granular material

　　35张

　　其他占位符： 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

　　标题： Casts

　　36张

　　标题： Hyaline casts

　　正文： Translucent In normal urine, 0~2 hyaline casts/lpf Increased numbers --- renal disease or transiently with exercise, fever, congestive heart failure

　　37张

　　其他占位符： Erythrocyte (RBC) casts Leukocyte (WBC) casts Renal tubular epithelial cell casts

　　标题： Cellular casts

　　38张

　　标题： RBC casts

　　正文： Red blood cells stick together in the cast RBCs casts are indicative of glomerulonephritis or severe tubular damage (severe pyelonephritis)

　　39张

　　标题： WBC cast

　　正文： White blood cells stick together WBC casts’ presence indicates inflammation of the kidney. 1. The most common disease--pyelonephritis 2.Also present with glomerulonephritis

　　40张

　　标题： Renal tubular epithelial cell casts

　　正文： 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

　　41张

　　标题： Granular casts

　　正文： 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

　　42张

　　标题： Waxy casts

　　正文： 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

　　43张

　　其他占位符： 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

　　标题： Crystals

　　44张

　　标题： Crystals in normal urine

　　正文： Calcium Oxalate Dihydrate crystals Calcium Oxalate Monohydrate crystals

　　45张

　　标题： Crystals in normal urine

　　正文： Triple phosphate crystals

　　46张

　　标题： Crystals in normal urine

　　正文： Uric acid crystals

　　47张

　　标题： Crystals in abnormal urine

　　正文： Sulfadiazine crystals are a common finding with administration of Trimethoprim-sulfadiazine.

　　48张

　　其他占位符： 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

　　标题： Questions

　　49张

　　其他占位符： 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

　　50张

　　其他占位符： 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

　　51张

　　其他占位符： 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

　　52张

　　其他占位符： 5. which of the following protein forms the matrix of all casts ? A. albumin B. globulin C. Tamm-Horsfall protein D. microalbumin

　　53张

　　其他占位符： Key 1. b 2. c 3. d 4. a 5. c