Anda di halaman 1dari 13




 Blood glucose report
 Kidney function report
 Liver function report
 Blood report
 Urine report


Blood glucose report

Fasting blood glucose 2 hours postprandial blood
Normal 70-110 mg/dl Up to 120 mg/dl
Diabetes milletus 126 mg/dl >200 mg/dl

Glucose tolerance curve



renal threshold
100 normal
0 normal
renal threshold
2 hours

In diabetic: ascends above 200 mg/dl after meal & descends slowly but not to normal value


- No impaired glucose tolerance (‫)مش هيجيلك‬

- No D.D , only say

o D.M
o Normal blood glucose

-Take rapid look on glucose tolerance curve


kidney function report

Normal kidney function Renal failue
Serum creatinine level Normal 0.4-1.4 mg/dl High
Blood urea level Normal 15-45 mg/dl High

D.D if you find

 One value is high

 The other is normal

High serum creatinine High blood urea

Pre- renal  Subject with large muscle  Decreased renal perfusion
causes(only one mass o Shock
value is  High protein intake o Haemorrhage
elevated)  Transient increase after o Burns
vigorous exercise o Severe vomiting
 Using non-specific analytical o Congestive heart failure
methods  After high protein diet
 Some drugs as  Increased protein catabolism
o Salicylates o Trauma
o Cimetedine o Major surgery
o Extreme starvation
o Haemorrhage into GIT
Renal  Impaired renal perfusion
causes(both o Reduced blood
values are o Fluid depletion
elevated) o Renal artery stenosis
 Diseases lead to loss of functioning nephrons
o Acute glomerulonephritis
o Chronic glomerulonephritis
Post renal  Urinary tract obstruction
causes(both o Enlarged prostate
values are o Stones or casts


Liver function tests

Normal total bilirubin level : 0.3-1 mg%


Haemolytic Hepatocellular Obstructive

Direct bilirubin − ↑ ↑
(up to 0.2 mg%)
Indirect bilirubib ↑ ↑ −
(up to 0.8 mg%)
Alkaline phosphatase − − ↑
(3-13 KAU)
SGPT(ALT) − ↑ −
(5-30 U/L)
SGOT(AST) − ↑ −
(8-40 U/L)
Albumin − ↓ −
(4-5 gm%)

D.D of hypoalbuminemia

(with chronic diseases only)

 Decreased intake
o Malnutrition
o Malabsorption
 Decreased synthesis
o Severe liver failure
 Increased loss
o Nephritic syndrome
o Severe burn
 Increased catabolism
o Infection
o Thyrotoxicosis
o Cushing syndrome
 Haemodilution
o Late stages of pregnancy
o During I.V therapy

Total protein
Increased Normal Decreased
With acute diseases 6-8 gm% With chronic diseases


D.D of hyperproteinemia D.D of hypoproteinemia

 Dehydration  Over hydration
 Artifactual(staisis during venepuncture)  Artifactual(drip arm)
 Paraproteinemia→ multiple myeloma  Excessive protein loss
 Chronic diseases (immunoglobulins) o Nephritic syndrome
 Liver cirrhosis o Severe burns
 Autoimmune diseases  Decreased synthesis
o Protein deficiency
o Liver disease
o malabsorption

↑direct bilirubin + ↑alkaline phosphatase = obstructive jaundice
↑direct & indirect bilirubin + ↑ALT,AST + ↓albumin = hepatocellular jaundice
only abnormality in protein
- ↑total protein →D.D of hyperprotenemia
- ↓total protein →D.D of hypoprotenemia
- ↓total albumin →D.D of hypoalbuminemia


Blood report
o Type of anemia
o D.D
o Investigations required

1- type

if Hb is decreased : anemia
microcyic normocytic macrocytic
hypochromic normochromic normochromic

normal normal

Microcytic hypochromic anemia

Microcytic hypochromic anemia
D.D Investigations
Normal reticulocytic count  Iron deficiency anemia  Serum iron
 Anemia of chronic  Total iron binding
disease capacity
 Sideroblastic anemia  Serum ferritin
 Transferring saturation
 Iron store
 Serum soluble
transferrin receptor
Reticulocytosis  Thalassemia  Serum indirecr bilirubin
 Serum LDH
 Serum haptoglobin
 Direct Coomb’s test
 Osmotic fragility


 Hb electrophoresis

Macrocytic normochromic anemia

Macrocytic normochromic anemia
D.D Investigations
With thrombocytopenia  Megaloblastic anemia Serum B12
and o ↓Vit. B12 Serum folate
leucopenia(pancytopenia) o ↓folate RBCs folate
Schilling test
Normal thrombocytic &  Macrocytic Non megaloblastic anemia due to:
leucocytic count o Haemolytic anemia & post haemorrhagic
anemia (reticulocytosis)
o Anemia due to bone marrow infiltration or
 Myelosclerosis
 2ry carcinoma of bone
 Multiple myeloma
 Malignant lymphoma
o Leukemia especially acute
o Liver disease
o scurvy
o myxoedema & hypopituitarism


Normocytic normochromic anemia

normocytic normochromic

reticulocytosi reticulocytop
reticulocytic count s enia

↑WBC pancytopenia
WBCs & platelets pancytopenia

chronic aplastic aplastic anemia

haemolytic normocytic
anemia normochromic
anemia, leucocy BM infiltration
-tosis &
enia preleukemia

hyper splenism

- Pancytopenia→ BM aspiration
- Thalassemia → mentioned before
- Normocytic normochromic anemia , leucocytosis & thrombocytopenia
 According to differencial leukocytic count

Blast cells ↑Basophils ↑lymphocytes

↑Segmented cells
D.D Acute lymphoblastic Chronic myeloid Chronic lymphocytic
leukemia(ALL) leukemia(CML) leukemia


Acute myeloblastic Lymphoma

Investigations B.M aspiration B.M aspiration B.M aspiration
Cytochemistry NAP score L.N biopsy
Immunephenotyping Philadelphia
Cytogenetics chromosome

Urine report
1- volume
normally: 600-2400 cc/day
increased → polyurea due to
o drugs
 caffeine
 alcohol
 thiazide diuretics
o pathologic
 D.M
 Diabetes incipidus
 Chronic renal failure
Decreased →oligurea due to
o Dehydration (severe diarrhea or vomiting)
o Renal ischemia (heart failure, shock)
o Oligurea stage of chronic nephritis
o Acute tubular necrosis
o Acute glomerulonephritis
o Obstruction of urinary tract : may lead to anurea

2- Aspect
Normally: clear and yellow or transparent

Turbid urine due to

o Phosphate precipitation
o Urate precipitation
o Presence of pus cells
o Bacterial growth
o Mucus


o Red cells
o Chylurea

3- Colour
Normally: amber yellow (urobilin & uroerythrin, small amount)
Abnormal may be:
o Watery
o Diabetes incipidus
o Diuretics
o Excess fluid intake
o Red urine
o After eating beets
o Haemoglobinurea
o Haematurea
o Porphrinurea
o Yellow brown or green brown
o Bile pigment (as obestructivejaundice)
o Orange red
o Excess urobilin →oxidized →urobilinogen
o Dark brown or black urine
o Alkaptonurea
o Melanurea
o Drugs
o Milk urine
o Presence of lymph and chylmicrons(due to rupture of lymphatics into urinary
o Foamy (frothy) urine
o Proteinurea
o Bile salts
o Concentrated urine
o haematurea

Drugs that change the color of urine

Drugs causing dark brown urine

o 2m methyldopa , metronidazole
o 2n nitrate , nitrofurantoin
o F ferrous salts
o S sulphonamides
o C chloroquine


o Q quinine

Drugs causing blue- blue green urine

o 2m methylene blue , methocarbamol

o Amitryptylene
o Triametrine

Drugs causing red – pink urine

o 3p phenothiazine , Phenylbutazone , Phenytoin

o Salicylates
o Rifampicin
o Heparin

4- Sugar
Normally very small amount of glucose

Sugar in urine
Indicates :
o Presence of glucose in urine
o Its serum level is > 180 mg/dl (renal threshold)
If fructose , pentose , galactose & lactose are present
o D.M
o certain poisons: CO , morphine
o increased ingestion of sugar or carbohydrates (aliemientary glucosurea)
renal glucosurea
o glucose in urine
o normal bl. Glucose level
o due to incomplete reabsorption of glucose by renal tubules

5- protein
normally < 150 mg/day


orthostatic (postural)

o increased by upright position


o recumbency (urine of early morning)

functional (transient)

o fevers
o severe exercise
o heat stroke
o severe cold atmosphere
o congestive heart failure

disease of the kidney

o acute & chronic glomerulonephritis

o nephritic syndrome
o pyelonephritis
o miscellaneous
o renal TB
o tumours

diseases of urinary tract

o calculi
o infection

6- specific gravity
normally : 1015 -1025
increased in
o D.M
o Nephritic syndrome
Decreased in
o 1010→ renal failure
o Other→ diabetes incipidis

7- RBCs
o In male→ 0-3/hpf
o In female→ 1-5/hpf
Increased in:
o Trauma
o Pyelonephritis

8- Pus cells (WBCs)

Normally : 0-4/hpf


Increased in
o Urinary Tract infection
o TB
o Renal tumours
o Acute glomerulonephritis
o Interstitial nephritis
o Analgesic abuse
o Steril pyorea
o TB
o Analgesic nephropathy
o Interstitial nephritis
o Nonspecific inflammation of the bladder

9- Casts
Hyaline casts
o Benign hypertension
o Nephritic syndrome
o After exercise
Red cell casts
o Acute glomerulonephritis
o Lupus nephritis
o Subacute bacterial endocarditis
o Good pasture’s disease (immune disease of the kidney)
o After streptococcal infection
o Malignant hypertension
WBCs casts
o Pyelonephritis
Epithelial casts
o Tubular damage
o Nephrotoxins
o Viraemia
Granular casts
o Acute tubular necrosis
Waxy casts
o Severe chronic disease
o Amyloidosis
Fatty casts
o Nephritic syndrome
o D.M