Kristine Joy D.

Galvez
Diagnostic Work-Ups URINALYSIS Transparency Result Day 1 Turbid Result Day 2 Turbid Normal Values Clear ABNORMAL Possible Significance urine commonly becomes turbid on standing because of precipitation of phosphates. hematuria makes urine slightly cloudy when RBCs not quite sufficient to produce visible color change in chyluria, urine milky and laden with fat and leukocytes; implies a fistula between lymphatic system and the bladder (most common cause is filariasis) Nitrofurantoin can also cause yellow colored urine Increased markedly by proteinuria and glycosuria value of >1.030 in the absence of proteinuria, glycosuria is usually due to radiocontrast agent Volume depletion SG usually >1.020 Fixed SG 1.010 (isosthenuria) characteristic of chronic renal impairment. Fixed SG 1.000-1.005 in DI may rise to 7 on vegetarian diet 5.0 in uric acid stones 7-8 in infection stones Present in DM Specific loss of proteins into the urine such as in nephrotic syndrome occurs on a molecular weight basis, with smaller proteins being lost more rapidly than larger ones. The presence of increased numbers of erythrocytes in the urine may indicate a variety of urinary tract and systemic conditions. These include: (1) renal disease glomerulonephritis, lupus nephritis, interstitial nephritis associated with drug reactions, calculus, tumor, acute infection, tuberculosis, infarction, renal vein thrombosis, trauma (including renal biopsy), hydronephrosis, polycystic kidney, and occasionally acute tubular necrosis and malignant nephrosclerosis; (2) lower urinary tract disease acute and chronic infection, calculus, tumor, stricture, and hemorrhagic cystitis following cyclophosphamide therapy; (3) extrarenal disease acute appendicitis, salpingitis, diverticulitis, acute febrile episodes, malaria, subacute bacterial endocarditis, polyarteritis nodosa, malignant hypertension, blood dyscrasias, scurvy, and tumors of the colon, rectum, and pelvis; (4) toxic reactions due to drugs, such as sulfonamides, salicylates, methenamine, and anticoagulant therapy; and (5) physiologic causes, including exercise. Increased numbers of leukocytes (principally neutrophils) in the urine is termed pyuria, and indicates the presence of infection or inflammation in the urinary tract. When accompanied by leukocyte casts or mixed leukocyteepithelial cell casts, increased urinary leukocytes are considered to be renal in origin. Infection, either bacterial or nonbacterial, may be centered in the renal parenchyma (pyelonephritis), or may be localized as cystitis, prostatitis, urethritis, or balanitis.

Color Specific Gravity

Yellow 1.025

Yellow 1.030

Yellow 1.002-1.030

NORMAL NORMAL

pH

5.0

7.0

4.5-8

NORMAL

Glucose Albumin

Negative +2

Negative +4

Negative Negative

NORMAL ABNORMAL

RBC

>50/hpf

TNTC

0-2/hpf

ABNORMAL

WBC

1-3/hpf

10-15/hpf

0-2/hpf

ABNORMAL

Epithelial cells

occasional

rare

Occasional

NORMAL

a. Squamous Epithelial Cells. These cells are the most frequent epithelial cell seen in normal urine, and likewise the least

Kristine Joy D. Galvez

significant b. Transitional (Urothelial) Epithelial Cells A few urothelial cells are present in normal urine, reflecting normal desquamation; like squamous cells, they are rarely of pathologic significance c. Renal Tubular Epithelial Cells. These are the most significant types of epithelial cells found in urine because the finding of an increased number indicates tubular damage Amorphous urates will precipitate upon standing in concentrated urine of a slightly acid pH. Amorphous urates will convert to uric acid crystals with acidification with acetic acid, and dissolve with heat (60 C) and with dilute alkali. Finding bacteria in urine may or may not be significant, depending on the method of urine collection and how soon after collection of the specimen the examination takes place. Most commonly, rod-shaped bacteria are seen, since the enteric organisms are the causative agents in the majority of urinary tract infections Leukocytes will usually be seen in the sediment as well.

Amorphic Urates

occasional

rare

Occasional

NORMAL

Bacteria

few

few

NORMAL

Result BUN 7.27

Normal Values 1.8-6.4 mmol/L ABNORMAL

Possible Significance There are two possible reasons for this. The first is prerenal where renal plasma flow is reduced, from such lesions as renal artery stenosis, renal vein thrombosis and the like. This causes a reduction in the GFR. The second cause of elevated BUN is true renal disease. Low serum creatinine values are rare; they almost always reflect low muscle mass. Theoretically, low values may also reflect increased glomerular filtration rates (GFRs). Serum creatinine increases with decreases in GFR (acute kidney injury or chronic kidney disease) Increased in acute bacterial infection, cancer, infectious disease, numerous inflammatory states Decreased in polycythemia vera and sickle cell anemia Increased in Liver disease with biliary obstruction, nephrotic stage of glomerulonephritis and DM. Decreased in pernicious anemia, hemolytic anemia, malnutrition, extensive liver disease and hyperthyroidism Increased plasma triglyceride levels are indicative of a metabolic abnormality and, along with elevated cholesterol, are considered a risk factor for atherosclerotic disease. Hyperlipidemia may be inherited or be associated with biliary obstruction, diabetes mellitus, nephrotic syndrome, renal failure, or

Creatinine

64.28

88-133 mmol/L

NORMAL

ESR

42mm/hr

M F C

0-20 mm/hr 0-30 mm/hr 0-10 mm/hr

ABNORMAL

Total Cholesterol

4.39 mmol/L

Desirable <200mg/dL (<5.2 mmol/L) Borderline Risk 200-239mg/dL (5.2-6.21mmol/L) High Risk Level 240mg/dL( 6.24mmol/L) 60-150mg/dL (0.70-1.7 mmol/L)

NORMAL

Triglycerides

0.70 mmol/L

NORMAL

Kristine Joy D. Galvez

Serum Na 143.3 138-146 mmol/L NORMAL metabolic disorders related to endocrinopathies. Increased triglycerides may also be medication-induced (eg, prednisone).

Serum K

3.71

3.5-5.0 mmol/L

NORMAL

C3 Determination

Increased in increased intake, either orally or parentally Decreased in Addisons, sodium-losing nephropathy, vomiting, diarrhea, fistulas, tube drainage burns, renal insufficiency with acidosis, starvation with acidosis, paracentesis, ascites Increased in DKA, renal failure, Addisons Decreased in Thiazide diuretics, Cushings syndrome, cirrhosis with ascites, hyperaldosteronism, steroid therapy, malignan HPN, poor dietary habits, chronic diarrhea, diaphoresis, renal tubular necrosis malabsorption syndrome,vomiting Increased complement activity may be seen in:

Cancer Ulcerative colitis

Decreased complement activity may be seen in:

Bacterial infections (especially Neisseria) Cirrhosis Glomerulonephritis Hepatitis Hereditary angioedema Kidney transplant rejection Lupus nephritis Malnutrition Systemic lupus erythematosus

Chest X-ray

Pneumonia, Bilateral McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright 2006 W. B. Saunders Company

Twenty-First Edition