Transcript Clinical Significance of Urine Protein

Basic Examination of Urine
Physical Examination
Chemical Examination
Microscopic Examination
尿常规
Blood
潜血
Bilirubin
胆红素
Urobilinogen
尿胆原
Ketones
酮体
Protein
蛋白质
Nitrite
亚硝酸盐
Glucose
葡萄糖
PH
PH值
Specific Gravity 比重
Leucocytes
白细胞
Ascorbic Acid 抗坏血酸
BLD
BIL
URO
KET
PRO
NIT
GLU
PH
S.G
LEU
VTC
Case I
Urine sample obtained during normal voiding from a 7-year-old spayed yellow
Labrador Retriever.
Color Protein Turbidity –
RBC Specific gravity WBCpH Casts Glucose –
Epithelial cells –
Acetone –
Bacteria –
Bilirubin –
Crystals –
Occult blood -
light yellow
4+
clear
1 - 2 /hpf
1.025
0 - 1 /hpf
6.0
occasional hyaline/lpf.
negative
occasional
negative
none
negative
none
negative
The best interpretation of the results of this urinalysis is that the patient:
a. Is normal.
b. Has generalized glomerular disease.
c. Has an inflammatory process somewhere along the urinary tract.
d. Has generalized tubular disease.
e. Has findings indicative of congestive heart failure or fever.
Case II
A voided urine sample obtained from a 5-year-old neutered male Persian cat:
Color – yellow
Protein -trace
Turbidity - clear
RBC - 1 - 3 / hpf
Specific gravity - 1.045
WBC- 0 - 1/ hpf
pH - 7.0
Casts - none
Glucose - negative
Epithelial cells - occasional
Acetone - negative
Bacteria - none
Bilirubin - 1+
Crystals - few amorphous phosphates
Occult blood - negative
The best interpretation of the results of this urinalysis is that this feline
patient:
a. Has significant bilirubinuria.
b. Has inflammatory disease syndrome along the urinary tract.
c. Is normal.
d. Has acute renal failure.
e. Has lower urinary tract disease.
Physical Examination
Color
Appearance (Clarity)
Specific Gravity
Chemical Examination
pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen[ˌjuərəbaiˈlinədʒin] 尿胆原
Nitrite [ˈnaɪˌtraɪt]亚硝酸盐
Microscopic Examination
Urinary Sediments
Renal Tubular Cast
Red Blood Cells
White Blood Cells
Squamous Epithelial Cells
Transitional Epithelial Cells
Renal Tubular Cells
Oval[ˈəuvəl ] Fat Bodies
Granular Cast颗粒
Fatty Cast
Waxy Cast
Broad Cast
Hyaline[ˈhaɪəlɪn ]透明的 Cast
RBC Cast
WBC Casts
accumulate
Normal Urine Crystals(略）
Acid pH
Uric acid
Amorphous urates
Calcium oxalate
Alkaline pH
Amorphous phosphates
Calcium phosphate
Triple phosphate
Ammonium biurate
Calcium carbonates
Color
Normal random urine specimens
pale yellow
straw
light yellow
yellow
dark yellow
amber
Yellow-brown, yellow orange, yellow green
bilirubin胆红素, biliverdin胆绿素[ˌbiliˈvə:dn] ，
Red and cloudy
red blood cells (hematuria), menstrual contamination, beets甜菜
Red and clear, pink red or red-brown
hemoglobin or myoglobin is present (hemoglobinuria)
Dark brown, black urine
rhabdomyolysis横纹肌溶解， melanin
Appearance (Clarity)略
Normal random urine specimen
clear
hazy
slightly cloudy
cloudy
Turbidity
white blood cells
red blood cells
epithelial cells
bacteria
White cloudiness
Alkaline urine
precipitated amorphous phosphates
carbonates
Acidic urine
precipitated amorphous urates
calcium oxalate
Specific Gravity
A measure of the density of the dissolved
[diˈzɔlv ]chemicals in the urine
urea尿素
sodium
chloride [ˈklɔrˌaɪd]
Normal random urine specimen
SG range from 1.015 to 1.025
Specific Gravity
The specific gravity is a convenient index of urine
concentration. It measures density and is only an
approximate guide to true concentration.
Specific gravity between 1.002 and 1.035 on a
random sample should be considered normal if
kidney function is normal.
Clinical Significance of Urine
Specific Gravity is related to
Patient hydration(Drink so much water )and dehydration
Loss of renal tubular concentrating ability
Determination of unsatisfactory specimens due
to low concentration
测定
pH value of urine
Normal random specimen
pH range is 4.5 to 8.0
Ability of the kidneys to maintain normal hydrogen
ion[ˈhaɪdrədʒən ˈaɪən ] concentration in plasma and
extracellular fluid
(Reflect)
Aids in determining the existence of systemic acid-base
（帮助确定身体的酸碱度）
Aids in the management of urinary conditions that
require the urine to be maintained at a specific pH
Acid urine 酸性尿
1 High protein diet,
2 Pharmacologic agents like ammonium[əˈmoniəm]
chloride, methionine蛋氨酸 [meˈθaiəni:n ],
3 Metabolic/respiratory acidosis, diuretics,
prolonged vomiting, diabetic ketoacidosis
Alkaline [ˈælkəlaɪn] urine
1 diet high in fruits and vegetables
2 sodium bicarbonate, potassium citrate,
metabolic/respiratory alkalosis(causes of
metabolic alkalosis : 1. loss of hydrogen ion；2.
Excessive intake of alkaline substances； 3. potassium
deficiency)
Measurement of urine protein
 Specimen
 Timed 24-h is best
 Normal protein excretion is <150 mg/24h
 50-60% albumin
 Smaller proteins (1-, 2-microglobulins)
 Tamm-Horsfall (uromucoid尿粘蛋白, secreted by tubules)
 IgA, tubular epithelial enzymes肾小管上皮细胞酶
Dipstick method for urine
protein(略）
 Method is based on protein association with pH
indicator
 Test pad contains dye tetrabromphenol blue at
pH=3
 If protein binds to the pH indicator, H+ is
displaced and the color changes from yellow to
green (or blue)
 Most sensitive to albumin (poor method for
detecting tubular proteinuria)
What causes excess
protein?
[ˈɛkˌsɛs]
urinary
 Overload proteinuria
 Bence-Jones (multiple myeloma)
 Myoglobin (crush injury, rhabdomyolysis[ræbdoʊmaɪ‘oʊlɪsɪs 肌溶解)
 Hemoglobin
 Tubular proteinuria
 Mostly low molecular weight (MW) proteins (not albumin)
 pyelonephritis[paɪələʊnɪ‘fraɪtɪs]肾盂肾炎
 Glomerular [ɡ'lɒmrjʊlə]proteinuria
 Mostly albumin at first, but larger proteins appear as
glomerular membrane selectivity is lost.
Clinical Significance of Urine Protein
Glomerular membrane damage
systemic lupus erythematosus(SLE)
Amyloidosis[ˌæmilɔiˈdəusis] 淀粉样变
Toxic agents（gentamycin，amphotericin B，
streptomycin）
Impaired renal tubular re-absorption
Multiple myeloma[ˌmaɪəˈlomə]骨髓瘤
Diabetic nephropathy
Orthostatic or postural proteinuria
直立
Severe Proteinuria :Nephrotic syndrome is defined as
>3.5g/d of proteinuria
Glucose
In general the presence of glucose in urine
indicates that the filtered load of glucose
exceeds the maximal tubular reabsorptive
capacity
Glycosuria is usually occurs when the blood level
is more than 100 to 200 mg/dL
Less than 0.1% of glucose normally filtered by
the glomerulus appears in urine (< 130 mg/24 hr)..
Clinical Significance of Urine Glucose
Diabetes mellitus
Impaired tubular re-absorption
Central nervous system damage
（glucocorticoid
）
Thyroid disorders（hyperthyreosis[haɪpəθaɪr'ɪəʊsɪs]）
Pregnancy with possible latent diabetes mellitus
[ˌglu:koʊ‘kɔ:tɪˌkɔɪd]糖皮质H
Ketones
Formation of urine ketones occurs when the use
of carbohydrates as the major source of energy
becomes compromised and the body fat
metabolism is increase to supply energy
Ketones (acetone, aceotacetic acid, betahydroxybutyric acid) results from either diabetic
ketoacidosis or some other form of calorie
deprivation (starvation)
Clinical Significance of Urine Ketones
Diabetic acidosis
Insulin dosage monitoring
Starvation
Excessive carbohydrate loss
Blood
> 5 red blood cells/microliter of urine – is
clinically significant
Chemical tests for hemoglobin – accurate
means of detecting presence of blood
Microscopic examination – can differentiate
between hematuria and hemoglobinuria
Clinical Significance of Urine Blood
Hematuria [ˌhi:məˈtjuriə]
Renal calculi[ˈkælkjəˌlaɪ]结石
Glomerulonephritis/pyelonephritis
Tumors
Trauma
Exposure to toxic chemicals or drugs
Strenuous exercise
Hemoglobinuria
Transfusion reactions
Hemolytic anemia
Severe burns
Infections
Strenuous exercise/RBC trauma
Bilirubin胆红素
Bilirubin in urine can provide early indication of
liver disease
Conjugated bilirubin appear in the urine when the
normal degradation cycle is disrupted by the
obstruction of the bile[baɪl ] duct and or when the
integrity of the liver is damaged.
Clinical Significance of Urine Bilirubin
Hepatitis
Cirrhosis
Other liver disorders
Biliary [ˈbiljəri ]胆汁obstruction (bile duct obstruction)
[sɪˈrosɪs ]
Urobilinogen[ˌjuərəbaiˈlinədʒin]尿胆素原
Appears in the urine because as it circulates into
the blood to the liver, it may pass through the
kidney and filtered by glomerulus
Normal – 0.5 to 2.5 mg or units/24 hrs.
Urine urobilinogen is increased in any condition
that causes an increase in production (hemolytic
disorders) or retention of bilirubin (liver disease).
Clinical Significance of Urine
Urobilinogen
Early detection of liver diseases
Hemolytic disorders
Nitrite
A positive nitrite test indicates that bacteria may
be present in significant numbers in urine.
Gram negative rods such as E. coli are more likely
to give a positive test.
If nitrite test is positive, a culture should be
considered provided that the specimen was
properly collected and stored prior to testing.
Clinical Significance of Urine Nitrite
Cystitis[sɪˈstaɪtɪs] 膀胱炎
Pyelonephritis
Evaluation of antibiotic therapy
Monitoring of patients at high risk for urinary
tract infection
Screening of urine culture specimens
Leucocyte Esterase（略）
A positive test results from the presence of white
blood cells either as whole cells or as lysed cells.
Pyuria can be detected even if the urine sample
contains damaged or lysed WBC's.
A negative test means that an infection is unlikely
and that, without additional evidence of urinary
tract infection, microscopic exam and/or urine
culture need not be done to rule out significant
bacteriuria.
Red Blood Cells
 Normal = 0 to 2 rbc/hpf (high power field)
 Presence of dysmorphic [dɪs'mɔ:fɪk]RBC's in urine
suggests a glomerular disease(Glomerular
Basement Membrane )
 Increased RBC - hemorrhage, inflammation,
necrosis, trauma or neoplasia somewhere
along the urinary tract (or urogenital[ˌjʊroˈdʒɛnɪtl
Phase contrast microscopy (PCM)
(Glomerular Basement Membrane )
dysmorphic RBCs< 30-50 %
non-glomerular hematuria
dysmorphic RBCs≥30-50%
glomerular hematuria
case 1
One 9 years old gril, with the complaint that burning
urination for 3 days associated with abnormal urine routine
test,no fever, no cough, no diarrhea .
PE: T: 37 。 R: 28 /min HR : 89/min BP: 110/70 mmHg
The throat was a little red, no significant findings in the chest
and abdominal examination , urethral orifice is red
laboratory tests: URT :RBC 20-25/HPF, WBC 1015/HPF,PRO 1+
BRT is normal
Phase contrast microscopy: dysmorphic RBCs< 30 %
Hypertension diagnosis standard
age
BP（mmHg）
<7 years
>120/80
>7years
>130/90
Step 1
hematuria
burning urination for 3 days
urethral orifice is red
BRT is normal
renal causes
PCM: dysmorphic RBCs< 30 %
non-glomerular
burning urination for 3 days
urethral orifice is red
URT: WBC 10-15/HPF
Step 2
suspected diagnosis of UTI
urine culture to confrim the diagnosis of UTI
URI：urinary tract infection
antibiotics
case 2
One 8 years old boy, with the complaint that gross
hematuria for 3 days, no fever, no cough, no diarrhea .he
got cold 2 weeks ago and has recovered now.
PE: T: 36.9。 R: 34 /min HR : 94/min BP: 140/90
mmHg
The throat was a little red, no significant findings in the
chest and abdominal examination , mild edema around
the eyes.
laboratory tests: URT :RBC >50/HPF, WBC 3- 5/HPF,
PRO 1+
BRT is normal
Phase contrast microscopy: dysmorphic RBCs 90 %
Step 1
Haematuria
gross haematuria for 3 days
mild edema around the eyes
BRT is normal
Renal causes
PCM: dysmorphic RBCs 90 %
glomerular
Step 2
catched cold 2 weeks ago
mild edema around the eyes
URT: RBC>50/HPF, PRO 1+
suspected diagnosis of
PSAGN
Serum C3 etc, to confrim the diagnosis of PSAGN
rest,
poststreptococcal acute glomerulonephritis
is one self-limited disease
antibiotics, etc
grupa A streptococcal infection
formation of IC(immune complex)
Glomerular local immune reaction
endocapillary proliferation
GFR↓
hematuria
oliguria
output of fulid↓
blood volume↑
GBM injury
edema
hypertension
proteinuria
The total plasma volume
filtered by the glomeruli per
unit time is called Glomerular
filtration rate (GFR)
laboratory tests
● urinalysis: hematuria and proteinuria
● blood test:C3 ↓ ASO(antistreptolysin O)↑
● kidney biopsy: not necessary
ASO
normal
C3
1 2 3 4 5 6 7 8
16
time (weeks)
ASO: begin to raise in the 10-14th day,climb to the peak in 3-5th
week,and recover normal in 3-6th month
C3: decrese within 2weeks after the onset of disease and recover
normal within 8 weeks
HEMATURIA
Important questions to ask in patients History
•Has there been any signs of a UTI such as dysuria and frequency?
Any suprapubic pain?
•Has there been any recent URI symptoms or sore throat?
•Has there been any type of skin rashes or sores?
•Any abdominal pain or colicky pain绞痛?
•Are the stools loose or bloody?
•Has there been any recent trauma?
•Has there been any joint pains or swellings?
•Is there any history of sickle cell disease or trait?
•Is there any family history of renal disease, transplants, or dialysis?
•What medications does the child take?
HEMATURIA
Important areas to check on the physical examination
•Blood Pressure
•Check for edema, especially around the eyes
•Careful inspection of the external genitalia
•Look for any rashes, evidence of trauma and bruising,
petechiae
•Exam all joints for signs of arthritis-red, warm, or swollen
•Feel the abdomen carefully for any masses or tenderness.
Try to feel for enlarged kidneys.
•Check for evidence of paleness or jaundice （hemolytic？）
--Approaching to the patient–
HEMATURIA
(Harrison’s Principle of Internal
Medicine,14th Ed)
proteinuria (>500mg/24h)
Dysmorphic RBC or RBC casts
(-)
Pyuria,WBC casts
(-)
(+)
urine culture
eosinophils
Hb electrophoresis, urine cytology,
UA of family member, 24h urinary
calcium/uric acid
(-)
IVP+/-renal
ultrasound
(+)
(-)
cystoscopy
(-)
CT scan
(-)
follow
(+)
As indicated:
retrograde
pyelography or
arteriogram of cyst
aspiration
(+)
serologic and hematologic
evaluation: blood culture,
anti-GBM Ab, ANCA,
complement, cryoglobulin
HBV,HCV,VDRL,HIV, ASO
renal biopsy
biopsy
(+)
open renal biopsy
ANCA:antineutrophil cytoplasmic
antibody, VDRL:venereal dis. research
laboratory, ASO: antisteptolysin O,
IVP: intravenous pyelography
question
1. In the case 1, why does the patient have the proteinuria?
2. In the case 2, the URT indicate WBC 3-5/HPF, what is the
reason?
White Blood Cells
 Normal <5 wbc/hpf
 Greater numbers (pyuria[paiˈjuəriə ]) generally
indicate the presence of an inflammatory
process somewhere along the course of the
1、Nephropyelitis 肾盂肾炎
urinary tract.
2、tuberculosis of kidney
3、cystitis [sɪˈstaɪtɪs] 膀胱炎
4、urethritis[ˌjʊrɪˈθraɪtɪs]
尿道炎
Cells in UA
WBC : number seen per high
power field (HPF)
none seen; <5, 5-20, 20100, or >100.
WBC are normal in urine in
low numbers  Up to 5
WBC/HPF
nucleus
RBC : number seen per high power
field (HPF):
none seen; <5, 5-20, 20-100, or
>100.
RBC are normal in urine in low
numbers Up to 5 RBC/HPF
The patient，female，34 years, was hospitalized
with edema of the lower limb for one month.
Urinalysis and microscopy：
Pro
300mg/dl
+++ （Nomal<150 mg/24h）
BLD （urine occult blood） 250 /ul
++++
24h urinary protein：3.4g
urinary sediments：ERY 25-30 /HPF,
irregular shape 90%
What is the primary diagnosis?
Nephrotic syndrome
Nephropyelitis？肾盂肾炎
Transitional Epithelial Cells(略）
Originate from the renal pelvis, ureters, bladder
and/or urethra.
Seldom pathologically important unless with
unusual morphology
Renal Tubular Cells
Most significant – increased number indicate
tubular necrosis and renal graft rejection
Hyaline
['haɪəlɪn]
Cast
Normal = 0-2/lpf
Physiologic - strenuous[ˈstrɛnjuəs ] exercise, heat
exposure, dehydration脱水, emotional stress
Pathologic – acute glomerulonephritis[gloʊˌmerjəloʊnə'fraɪtɪs]
（GN） , acute pyelonephritis
chronic renal disease, congestive heart disease
Casts in UA
B
Casts : A: Hyaline cast; B: Fatty cast; C: Hyaline to finely
granular cast; D: Cellular cast; E: Cellular to coarsely
granular cast; F: Coarsely granular cast; G: Finely granular
cast; H: Granular to waxy cast, I: Waxy cast.
Casts in UA
Cylinduria
Significance of RBC casts in
urine
 Indicative of blood crossing the GBM （glomerular
basement membrane）
 Casts form in the distal tubules
 Stasis produces brown, granular casts
 RBC casts almost always reflect glomerular disease
WBC Casts
 Signifies infection or inflammation within the
nephron
 Most frequently seen in
pyelonephritis[pailonfraitis] and acute
interstitial[ˌɪntɚˈstɪʃəl ] nephritis.
Renal Tubular Cast
 Tubular cells usually seen in cast are from collecting
tubules
 A very few hyaline RTC casts or RTC casts can
occasionally be encountered in a healthy person's
urinary sediment
 Among the disorders associated with the presence of
increase of this cast are:
 acute interstitial nephritis
 acute transplant rejection
 tubular necrosis.
Granular Cast
 Rare finding is physiologically due to stress and
exercise
 Pathologically due to GN and pyelonephritis,
Waxy[ˈwæksi] Cast
 Found especially in chronic renal diseases,
and are associated with chronic renal failure;
they occur in diabetic nephropathy,
malignant hypertension and
glomerulonephritis.
Broad Cast
 Formation in collecting ducts or distended
renal tubules
 The finding of many broad waxy casts
suggests a serious prognosis
 Referred to as “renal failure casts”
Uric Acid Crystals
 pH
-- acidic
 Color -- colorless, yellow brown or reddish
brown; highly birefrigent
 Shape -- variety (rhombic plates, spears,
wedges, needles)
 May indicate increased nucleoprotein metabolism
when found in freshly voided urine
Calcium Oxalate Crystals
 pH
-- acid, neutral
 Color -- colorless
 Shape -- octahedral, dumbbell, oval
“envelop”
High potential for forming renal stones
Abnormal Urine Crystals
 Cystine
 Cholesterol
 Leucine
 Tyrosine
 Bilirubin
 Sulfonamides
 Radiographic dyes
 Ampicillin
Cystine Crystals
 pH
--
 Color
-- colorless (cannot polarize)
acidic
 Shape -- thin hexagonal plates
 Significance -- metabolic defect; cystinuria
Leucine Crystals
 pH
-- acid, neutral
 Color -- yellow brown bodies
 Shape -- spheroids with concentric striations
and radial structures; dense, highly refractive
(Maltese-cross pattern under polarize light)
Significance -- severe liver disease
Tyrosine Crystals
 pH
-- acid, neutral
 Color
-- colorless, yellow brown
 Shape -- needle shaped, single or arranged
in sheaves or rosettes, with fine silky
appearance.
 Significance -- severe liver disease
Bilirubin Crystals
 pH
--
 Color
--
 Shape --
acid
bright yellow
clumped needles or spheres
 Significance -- liver disease
Cholesterol Crystals
 pH
--
 Color --
acid
colorless, polarized
 Shape -- irregular transparent to rectangular
plate with notch or one or more curve (“stair step
crystals”).
 Significance -- always considered pathological
and can be found in various renal diseases.
Sulfadiazine crystals
 pH
--
 Color - Shape
acid, neutral
variable
-- rosettes, fan
 Significance -- tend to form renal calculi that
may damage renal tubules.
Sulfonamide Crystals
 pH
-- acid
 Color
--
 Shape
-- resemble uric acid crystals
yellow
Other Urine Elements
 Fungal elements
 Trichomonas vaginalis
 Bacteria
 Spermatozoa
 Mucus
 Starch or Talc powder
 Fiber
Fungal elements(略）
 The presence of yeast in the urine sediment
may indicate an infection. A frequently seen
yeast in urine is Candida.
 Yeast containing casts have a very high
clinical value; these are pathognomonic of
pyelonephritis.
Trichomonas vaginalis（略）
 usually comes from genital secretions
contaminating the specimen.
 Identification of the living cell is quite easy
owing to its spectacular motility.
Bacteria
 Bacteria associated with urinary tract
infection are mostly bacillus (E. Coli)
(E. Coli)
summary
preservation of urine specimen
 Toluene
 Formaldehyde
 Concentrated hydrochloric acid
 Acetic acid glacial
 Thyme camphor
summary
Routine Urinalysis
physical characteristics
 volume
-polyuria
-oliguria
-anuria
 color
-hematuria
-hemoglobinuria
-bilirubinria
-chyluria
summary
 Appearance and turbidity
- urate
- phosphate and carbonate
- pyuria
 pH
 Specific gravity
summary
Chemical examination
1. protein
2. glucose
summary
Microscopy examination
 Cellular



Red cell
White cell
Epithelium
 Cast







hyaline cast
cellular cast
granular cast
fatty cast
renal failure cast
waxy cast
paracylinder
 Crystals
summary
Other Urine Test
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ketone bodies
bilirubin
urobilinogen
nitrite
lysozym
β2-microglobin
fibrin degradation product
Ig、C3
amylase
hemosiderin
Tamm-Horsfall
Case III
A voided urine sample obtained from a 10-year-old domestic neutered shorthair cat.
Color yellow
Protein negative
Turbidity clear
RBC negative
Specific gravity 1.010
WBC negative
pH 6.0
Casts negative
Glucose negative
Epithelial cells negative
Acetone negative
Bacteria negative
Occult blood negative
Crystals negative
Bilirubinnegative
The best interpretation of the specific-gravity value of this urinalysis is that:
a. The patient's kidneys have lost the ability to concentrate and dilute urine.
b. The patient's kidneys have lost the ability to concentrate urine.
c. The patient's kidneys have lost the ability to dilute urine.
d. No conclusions can be established about the ability of the patient's kidneys to concentrate and
dilute urine.
e. The patient has a fixed urine specific gravity, probably as a result of primary renal failure.
A fresh urine sample obtained by cystocentesis from a 10-year-old spayed
Pomeranian dog.
Color yellow
Protein 2+
Turbidity cloudy
RBC numerous / hpf
Specific gravity - 1.035
WBC numerous / hpf
pH 8.0
Casts none
Glucose negative
Epithelial cells many
Acetone negative
Bacteria many cocci
Bilirubin negative
Crystals moderate struvite
Occult blood - 4+
The best interpretation of the results of this urinalysis is that the patient:
Case IV
a. Has an inflammatory process somewhere along the urinary tract caused by bacterial infection.
b. Has an inflammatory process somewhere along the genitourinary tract caused by bacterial
infection.
c. Has an inflammatory process somewhere along the urinary tract caused or complicated by
bacterial infection.
d. Is normal, and the sample was contaminated during the process of analysis.
e. Has struvite uroliths associated with urinary-tract infection.
The patient，female，34 years, was hospitalized
with edema of the lower limb for one month.
Urinalysis and microscopy：
Pro
300mg/dl
+++ （Nomal<150 mg/24h）
BLD （urine occult blood） 250 /ul
++++
24h urinary protein：3.4g （Nomal<150
mg/24h）
urinary sediments：ERY 25-30 /HPF, irregular
shape 90%
What is the primary diagnosis?
Nephrotic syndrome
Nephropyelitis？肾盂肾炎