Urinalisa 2014
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Transcript of Urinalisa 2014
DJOKO HADIWIDODODJOKO HADIWIDODOBAGIAN PATOLOGI KLINIKBAGIAN PATOLOGI KLINIK
FAKULTAS KEDOKTERAN UNS FAKULTAS KEDOKTERAN UNS SURAKARTASURAKARTA
Urine AnalysisUrine Analysis
Surakarta, 19 Maret 2014Surakarta, 19 Maret 2014
TUJUAN PEMERIKSAAN URINETUJUAN PEMERIKSAAN URINE
UMUM :
1. Membantu / menegakkan diagnosis2. Follow up & prognosis3. Fungsi organ
KHUSUS :
1. Kelainan Traktus Urinarius / Urogenital2. Penyakit ginjal3. Penyakit diluar ginjal
Specimen Specimen CollectionCollection
– Pertama - pagi
– Tampung
– Type of specimen
– Analisis dalam 2 jam
– Bebas dari debris vaginal
Specimen CollectionSpecimen CollectionMengapa urine pagiMengapa urine pagiurine urine rutin ?rutin ?
o Asam pengawet
o Kandungan tinggi
o Nilai Rujukan
o Perlakuan minimal
MacroscopicChemical Analysis (Urine Dipstick)
Microscopic
CultureCulture
CytologicalCytological
Types of Types of AnalysisAnalysis
MacroscopicMacroscopicBau :− Ammonia-like: (Urea-splitting bacteria)− Foul, offensive: Old specimen, pus or inflammation− Sweet: Glucose− Fruity: Ketones− Maple syrup-like: Maple Syrup Urine Disease
Warna :− Colorless Diluted urine− Deep Yellow Concentrated Urine, Riboflavin− Yellow-Green Bilirubin / Biliverdin− Red Blood / Hemoglobin− Brownish-red Acidified Blood (Actute GN)− Brownish-black Homogentisic acid (Melanin)
ChemicalChemical AnalysisAnalysisUrine Dipstick
GlucoseGlucose
BilirubinBilirubin
KetonesKetones
Specific GravitySpecific Gravity
BloodBlood
pHpH
ProteinProtein
UrobilinogenUrobilinogen
NitriteNitrite
Leukocyte EsteraseLeukocyte Esterase
SpecificSpecific GravityGravity
Significance- Diabetes insipidus
Limitations- Interference: alkaline urine
pHpH
Significance- Acidic (> 4.5):
high-protein diet- Alkaline (> 8.0)
Limitations- Interference: bacterial
overgrowth (alkaline or acidic),
Other- Acidic sepanjang hari batu
asam urat- Alkaline sepanjang hari infeksi
GlucoseGlucose
SignificanceDiabetes mellitus.Renal glycosuria.Glukosuria fisiologis
LimitationsInterference: reducing
agents vit. C , buah2an, antibiotik
KetonesKetones
Significance- Diabetic ketoacidosis- Prolonged fasting
- Demam
Functional Renal- Severe muscular exertion - Glomerulonephritis- Pregnancy - Nephrotic syndrome- Orthostatic proteinuria - Renal tumor or infection
Pre-Renal Post-Renal- Fever - Cystitis- Renal hypoxia - Urethritis or prostatitis- Hypertension - Contamination with vaginal secretions
Causes of Causes of ProteinuriaProteinuria
Protein % of TotalDaily Maximum
Albumin 40%60 mg
Tamm-Horsfall 40%60 mg
Immunoglobulins 12%24 mg
Secretory IgA 3%6 mg
Other 5%10 mg
TOTAL 100%150 mg
Proteins in “Normal” UrineProteins in “Normal” Urine
NitriteNitrite
Significance Limitations- Gram negative bacteriuria - Interference: bacterial
overgrowth - Vitamin C negativ
palsuLeukocyte EsteraseLeukocyte EsteraseSignificance
- UTI- Infeksi sekitar Saluran kemih- Sumbatan saluran kemih bagian bawah
Limitations- Interference: menstrual contamination
BilirubinBilirubin
Significance- Increased direct bilirubin (correlates with urobilinogen and
serum bilirubin)
Limitations- Positif palsu : Obat2-an yang berwarna merah- Negatif palsu : vit. C
Significance- High: increased hepatic processing of bilirubin- Low: bile obstruction
Limitations- Positf palsu : Obat2-an yang berwarna merah
UrobilinogeUrobilinogenn
BloodBlood
Significance- Hematuria (nephritis, trauma, etc)- Hemoglobinuria (hemolysis, etc)- Myoglobinuria (rhabdomyolysis, etc)
- UTI, urolithiasis, hipertensi, terapi antikoagulan.
Limitations- Interference:
reducing agents, microbial peroxidases
Microscopic ExaminationMicroscopic Examination
Per High Power Field (HPF) (400x)– > 5 erythrocytes
– > 12 leukocytes
– > 2 renal tubular cells
– > 10 bacteria
Per Low Power Field (LPF) (100x)– > 3 hyaline casts or > 1 granular cast
– > 10 squamous cells (indicative of contaminated specimen)
– Any other cast (RBCs, WBCs)
Presence of:– Fungal hyphae or yeast, parasite, viral inclusions
– Pathological crystals (leucine, tyrosine, cystine)
– Large number of uric acid or calcium oxalate crystals
AbnormalAbnormal
Bacterial CastsBacterial Casts
Individual LeukocytesIndividual Leukocytes
Leukocyte CastsLeukocyte Casts
Individual ErythrocytesIndividual Erythrocytes
Erythrocyte CastsErythrocyte Casts
Individual BacteriaIndividual Bacteria
Significance of Cellular CastsSignificance of Cellular Casts
Erythrocyte Casts: Glomerular diseases
Leukocyte Casts: Pyuria, glomerular disease
Degenerating Casts:- Granular casts Nonspecific (Tamm-Horsfall protein)- Hyaline casts Nonspecific (Tamm-Horsfall protein)- Waxy casts Nonspecific- Fatty casts Nephrotic syndrome (oval fat body casts)
CastsCasts
Urine microscopyUrine microscopy cast cast
Erythrocyte cast. Leukocyte cast Epithelial cast.
Hyaline – Granula cast
Acid Urine pH Neutral Urine pH
Alkaline Urine pH
Calcium Oxalate Ammonium Biurate
Triple Phosphates
Uric Acid Calcium Carbonate
Ammonium Biurate
Calcium Oxalate Calcium Carbonate
Triple Phosphate Calcium Phosphate
Amorphous urates
Amorphous Phosphates
pH pH unsur anorganik unsur anorganik
KRISTAL URINEKRISTAL URINE
1. Umum - Asam urat, Ca Oxalat, Ca Phosphat - Makanan, dehidrasi, perubahan pH & suhu - Gagal ginjal akut : - Asam urat urat akut nephropaty - Calsium oxalat keracunan ethylen
glycol
2. Patologi - Cholestrol, cystine, leucine, tyrosine
3. Obat - Overdosis, dehidrasi, pH, hypoalbuminemia
CRYSTAL PATOLOGICRYSTAL PATOLOGI
1. Cholesterol2. Leucine3. Cystein4. Tyrosine
Kristaluria yang berhubungan dengan Kristaluria yang berhubungan dengan Gagal Ginjal Akut :Gagal Ginjal Akut :
1.Uric acid2.Calsium oxalate
Cystine hexagonal
tyrosineleucine
KRISTAL PATOLOGIKRISTAL PATOLOGI
MANIFESTASI KLINIK KRISTALURIA :MANIFESTASI KLINIK KRISTALURIA :
1.Tanpa gejala2.Hematuria & / leukosituria3.Obstruksi batu4.Presipitasi intratubular gagal ginjal akut
pH alkalis RBC lisis
Urine „syndromes”Urine „syndromes”
Urinary tract infection
Glomerulo-nephritis
Nephrosis(idiopathic)
Bacterial infection of renal
parenchyma
Structural glomerular
damage
Increased permeability to
albumine
Leucocytesbacteria
Erythrocytes(dysmorphic)
-
(erythrocytes+/-) (leucocytes+/-) -
(Protein+/-) Protein ++(0.5-1-2 g/day)
Protein ++++(>3.5 g/day)
Leucocyte casts(=Pyelonephritis)
Erythrocyte casts (Hyaline/waxy casts)