Urinalisis

Eva Sian Li

Tests
Color Protein Sulfosalicylic acid test Hydrogen ion concentration Osmolality and specific gravity Glucose Urine sediment: crystal, bacteria, cells, cast

Proteinuria
Normal, urin mengandung sejumlah kecil protein (berat molekul rendah dan Tamm-Horsfall), <150 mg/ hari pd orang dewasa. Olah raga berat, demam, dan posisi berdiri lama akan meningkatkan proteinuria.

Abnormal: 1. Glomerular proteinuria: protein BM besar, bbrp gram sehari. Etiologi: glomerulonefritis primer atau sekunder spt: DM, SLE, amiloidosis 2. Tubular proteinuria: protein BM kecil, <1 g/ hari.

Measuring ProteinuriaGet into the right spot!

When you get to this point, Dont continue to get microalbumin!

Defining Proteinuria
Degree of Proteinuria Normal Microalbuminuria Macroalbuminuria Nephrotic Range 24 Hour Urine <30 mg albumin /day 30 300 mg/day 300 3500 mg/day >3.5 g /day Urine Dipstick None None >15 mg/dl (trace) >300 mg/dl (3+)

Office Urine Dipstick

Trace 1+ 2+ 3+ 4+ 15 mg/dl 30 mg/dl 100 mg/dl 300 mg/dl 2000 mg/dl

Microalbuminuria
Timed Urine (24 hour urine) (30 300mg/day or 20-200 ug/min)
(>30 ug/mg creatinine) (detects >2 ug/ml)

Urine albumin/creatinine ratio Spot microalbumin tests

Hematuria
DEF: may be grossly visible (macroscopic hematuria) or detectable only on urine examination (microscopic hematuria).

Approach to the patient with red or brown urine

Causes of heme-negative red urine

Major causes of hematuria by age and duration

Distinguishing extraglomerular from glomerular hematuria

Color (if macroscopic) Extraglomerular Red or pink Glomerular Red, smoky brown, or "Coca-Cola"

Clots

May be present

Absent

Proteinuria RBC morphology RBC casts

<500 mg/day Normal Absent

May be >500 mg/day Dysmorphic May be present

Correlation between urinary patterns and renal disease (1)

Urinary pattern Hematuria with red cell casts, dysmorphic red cells, heavy proteinuria, or lipiduria Multiple granular and epithelial cell casts with free epithelial cells Renal disease Virtually diagnostic of glomerular disease or vasculitis

Strongly suggestive of acute tubular necrosis in a patient with acute renal failure Pyuria with white cell and granular Suggestive of tubular or interstitial or waxy casts and no or mild disease or urinary tract obstruction proteinuria Hematuria and pyuria with no or variable casts (excluding red cell casts) May be observed in acute interstitial nephritis, glomerular disease, vasculitis, obstruction, and renal infarction

Correlation between urinary patterns and renal disease (2)

Urinary pattern Hematuria alone Pyuria alone Renal disease Varies with the clinical setting Usually infection; sterile pyuria suggests urinary tract tuberculosis or tubulointerstitial disease

Few cells with little or no casts or proteinuria (normal or near-normal)

In acute renal failure, prerenal disease, urinary tract obstruction, hypercalcemia, myeloma kidney, some cases of acute tubular necrosis, or a vascular disease with glomerular ischemia but not infarction (scleroderma, atheroemboli); in chronic renal failure, nephrosclerosis, urinary tract obstruction, and tubulointerstitial disease

Proteinuria
24-Hour Albumina/ Dipstick Albumina Creatinine Proteinuri (mg/24 h) Ratio a (mg/G) Normal 810 <30 30300 24-Hour Urine Proteinb (mg/24 h) <150

Microalbumin 30-300 uria

/Trace/1+

Proteinuria

>300

>300

Trace3+

>150