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ur feme


Macleod's Clinical Examination 11E, 2005
Urinary specific gravity
o is an index of the concentration of solute (e.g. sodium, chloride, urea, glucose)
o range of value in health: 1.002 1.035
o High values kidney is actively reabsorbing water
e.g. fluid depletion
o low values failure of the renal tubules to concentrate urine (high urine volumes)
Urinary pH
o range of value in health: 4.5 8.0
o Use fresh urine for protein testing.
o Reading greater than 'trace' indicates significant proteinuria.
o Causes of transient proteinuria
Cold exposure
Vigorous exercise
Febrile illness
Orthostatic (postural) proteinuria
Abdominal surgery
Congestive cardiac failure
o Orthostatic (postural) proteinuria: occasional finding in healthy young subjects in whom
protein is not detected in the first urine passed after sleeping recumbent overnight, but
will be present during the day
o Proteinuria > 2 g per day suggests glomerular disease.
Urine dipstick test changes on the reagent area at 60 seconds:
o Intact erythrocytes green spots
o Free haemoglobin green colour
Note: The test does not differentiate between haemoglobin and myoglobin.
Bilirubin and urobilinogen
o Bilirubin: normally absent from urine
o Urobilinogen: may be present - up to 33 mol/l in health
o Abnormalities of either
haemolysis or hepato-biliary disease

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Aetiology With Respect To Frequency
Note: It is important to know what are the clinical and other urinary features associated with
this haematuria before you can make a diagnosis of the cause.
Commonest cause:

urinary tract infection

also common:

renal tract stones

Less common causes:

renal trauma and infarction

benign prostatic hypertrophy
benign microscopic haematuria
malignant hypertension
bleeding diathesis (anticoagulant treatment)
ulcer at the urethral meatus

Uncommon causes:

polycystic disease
transitional cell carcinoma
renal adenocarcinoma or Wilm's tumour

Rare causes:

polyarteritis nodosa, SLE, vasculitis, infective endocarditis

atrial fibrillation - microemboli settling in the kidneys

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Journal of Renal Nutrition
Volume 18, Issue 1, Pages 158-164 (January 2008)
Renal Alterations During Exercise
Guido Bellinghieri, MD, Vincenzo Savica, MD, Domenico Santoro, MD
Proteinuria and hematuria are common during exercise. Proteinuria is usually due to
glomerular or tubular changes or to an excessive production of protein as in myeloma. Certain
clinical conditions can, however, result in a functional or temporary proteinuria, especially
during pregnancy, fever, orthostasis, or following physical activity. Sport-related proteinuria
following marching, exercise, and stress, was first observed in soldiers after long marching.
Prevalence of proteinuria during exercise ranges from 18% up to 100% depending on type of
exercise and its intensity. A higher incidence of proteinuria has been observed in some sports
requiring great exercise intensity and it is certainly related to muscular work intensity and would
decrease after prolonged training. Indeed, exercise-induced proteinuria is strictly related to
exercise intensity rather than to exercise duration. Exercise aggravates the proteinuria of various
nephropathies and that of renal transplant recipients. The prevalence of hematuria is higher in the
athletic than the general population and the main difference is that sport-related hematuria
resolves spontaneously after physical exercise while hematuria found in nonathletic population
can be chronic. Sport-induced hematuria is influenced by exercise duration and intensity. Among
the mechanisms underlying the exercise induced hematuria are increased body temperature,
hemolysis, increased production of free radicals, and excessive release of catecholamines. Lactic
acidosis, generated during anaerobic conditions, causes the passage of erythrocytes into the
urine, through increased glomerular permeability.

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