Transcript Urinalysis 3

尿液分析
對腎臟病的診斷
尿液分析
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許多腎臟病人在臨床上並没
有任何症狀只能由血中
creatinine異常或尿液分析
異常才能發現
檢體採集
應於收集尿液後30 to 60
minutes內檢查
 Clean catch
 男性病人可採中段尿送檢
 女性病人則需必免外陰部污染
並避開月經週期
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尿液分析
小便收集後先經2000 rpm
for 3 to 5 minutes 離心
 上清液倒入另一支試管
 將少量沈澱物置於在載玻片
上以備鏡檢
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尿液分析
上清液用於物理及化學特
性檢查
 沈澱物則對成形物(cells,
casts, crystals, and
bacteria)做顯微鏡檢
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尿液分析
物理特性:直接觀察
 化學特性:試紙
 沈澱物:顯微鏡檢
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物理特性
外觀
 氣味
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化學特性
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酸鹼度pH
蛋白質Protein
血液Blood
比重Specific gravity
葡萄糖Glucose
酮體Ketones
Urobilirubin
胆紅素Bilirubin
Nitrite
白血球Leucocyte
蛋白尿
試紙對於白蛋白albumin
有高度敏感性,但對於
globulin, Hb, or light
chain則較不敏感.
 sulfosalicylic acid
(SSA)可偵測所有的蛋白質
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蛋白尿
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There are three basic types of
proteinuria: glomerular,
tubular, and overflow.
Only glomerular proteinuria (ie,
albuminuria) is identified on a
urine dipstick.
血液
當尿液為紅色時首先需將尿液
離心,區分紅色部分為上清液
或沈澱物.
 血尿(Hematuria):只有沈澱物
是紅色.
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血尿
若上清液為紅色則需用試
紙檢查是否含血色素.
 含血色素之紅色上清液需
區分myoglobinuria or
hemoglobinuria.
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比重
與同體積水的重量.
 A convenient but
inaccurate surrogate of
osmolality.
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血糖
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高血糖或腎性尿糖
Hyperglycemia or
renal glycosuria
Urobilinogen
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A colorless pigment produced in the
gut from metabolism of bilirubin.
Some is excreted in feces and the
rest reabsorbed and excreted in the
urine.
In obstructive jaundice, bilirubin
does not reach the bowel and urine
excretion of urobilinogen is
diminished. In other types of
jaundice, urobilinogen is increased.
Nitrite
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The screening test for
bacteriuria relies on the
ability of G(-) bacteria to
convert urinary nitrate to
nitrite.
白血球
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尿液中有過量白血球代表:
1.泌尿系統發炎: including:
glomerulonephritis,
interstitial nephritis,
2.泌尿道感染
3.輸尿管旁發炎: such as
regional ileitis, acute
appendicitis
顯微鏡檢
顯微鏡檢
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細胞: 紅血球
白血球
腎小管上皮細胞
扁平上皮細胞
圓柱體
細菌,黴菌及其它
晶體
血尿
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紅血球可由腎小球至尿道
口之間任何一點進入泌尿
系統
肉眼可見 vs.顯微血尿
Gross hematuria
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Gross hematuria is suspected
because of red or brown urine.
Hematuria is responsible if
the red color is seen only in
the urine sediment, with the
supernatant being clear.
顯微血尿
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The urine sediment is the
gold standard for the
detection of microscopic
hematuria.
血尿:
Glomerular vs. extraglomerular bleeding
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紅血球型態: 腎小球外出血時
紅血型狀正常;腎小球出血則為
變形紅血球
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Dysmorphic: marked variability
in red cell shape and a
reduction in mean red cell
size
血尿:
Glomerular vs. extraglomerular bleeding
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Red cell injury in this setting
may be due both to mechanical
trauma as the cells pass
through rents in the glomerular
basement membrane and
osmotic trauma as the cells
flow through the different
nephron segments.
血尿:
Glomerular vs. extraglomerular bleeding
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血塊(blood clot), if present,
are almost indicative of
extraglomerular bleeding.
Clots are not seen with
glomerular lesions
血尿:
Glomerular vs. extraglomerular bleeding
腎小球出血的特徵有
 1.紅血球圓柱體 (essentially
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pathognomonic for glomerular
disease),
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2. 蛋白質的排出量超過500
mg/day at a time when there is
no gross bleeding,
血尿:
Glomerular vs. extraglomerular bleeding
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3.變形紅血球
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4.
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可樂色尿液
Although helpful if present, the
absence of these findings does
not exclude glomerular disease.
白血球
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尿液中有過量白血球代表:
1.泌尿系統發炎:
glomerulonephritis, interstitial
nephritis,
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2.
泌尿道感染
3.輸尿管旁發炎: regional ileitis,
acute appendicitis
腎小管上皮細胞
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Size varies in different
segments and with urine
osmolality.
A few tubular cells may be
seen in a normal urine, but
more commonly imply tubular
damage or inflammation.
圓柱體
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圓柱體是以Tamm-horsfall
mucoprotein為基質有明的外
緣 with straight margin with or
without cellular components
embedded
圓柱體
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玻璃狀圓柱體.
顆粒狀圓柱體
 Waxy casts (broad casts)
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紅血球圓柱體
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白血球圓柱體
脂質尿
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發生於腎病症候群
Oval fat body: sloughed tubular
cells containing fat droplets
脂肪圓柱體: lipid laden
tubular cells or free lipid droplet
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脂質小滴Lipid droplet showed
Maltese cross under polarized
light
晶體
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3 most distinctive crystal forms:
Cystine: hexagonal plate
resembling benzene ring
Calcium oxalate: classically as
envelop shapes or bipyramidal
magnesium ammonium
phosphate: rectangular with
beveled ends as coffin-lid