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Biochemical Tests of Renal Function

Biochemical Tests of Renal Function. D. Urinalysis Appearance Specific gravity and osmolality pH Glucose Protein Urinary sediments Measurement of GFR Plasma creatinine Clearance tests Tubular function tests. 2. Preanalytical phase of the urinary sediment. 2 nd morning void

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Biochemical Tests of Renal Function

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  1. Biochemical Tests of Renal Function D • Urinalysis • Appearance • Specific gravity and osmolality • pH • Glucose • Protein • Urinary sediments • Measurement of GFR • Plasma creatinine • Clearance tests • Tubular function tests 2

  2. Preanalytical phase of the urinary sediment • 2nd morning void • concentrated • acidic (pH>7 à lysis of WBC and casts) • without lysis of the elements (overnight) • Avoid physical exercise • Avoid excessive diuresis • No menstrual cycle • No catheterization 3

  3. Stability of sample forthe urinary sediment • Collect in appropriate disposable containers • Analysis ideally within 1 hour (acceptable within 2 hour) to avoid bacterial overgrowth and lysis of cells and casts • Refrigeration and preservative agents are definitely inferior to prompt examination. 4

  4. Preparation of theurinary sediment • Centrifugation • Supernatant removal • Resuspension • Preparation of slide • Evaluate immediately 5

  5. Findings of the urinary sediment • Erythrocytes (morphology) • Leukocytes • tubular • Epithelial cells transitional • squamous • Casts • Crystals • Bacteria and yeasts 6

  6. Urinalysis • Appearance: • Blood • Colour (haemoglobin, myoglobin) • Turbidity (infection, nephrotic syndrome) • Specific gravity • pH: • Physiological = acidic, except after meal 7

  7. Urinalysis • At high density (>1025) RBC and WBC shrink • At low density (<1010) RBC and WBC swell and undergo lysis • At high pH (>7) WBC survival is shortened, casts diminishes and phosphates precipitate • At low pH (<5.5) urates precipitate 8

  8. Microematuria • Microematuria: sangue nell’urina, in quantità ridotta, non visibile macroscopicamente • Rilievo: osservazione microscopica del sedimento e/o reazione positiva per l’emoglobina • Può essere presente per numerose cause fisiologiche (attività fisica!), ma deve essere sempre considerata con estrema attenzione • Alcuni dettagli morfologici delle emazie (emazie dismorfiche) possono consentire di identificare la sede di provenienza (d.d. glomerulo/basse vie urinarie) 9

  9. Microematuria 10

  10. Microematuria 11

  11. Microematuria 12

  12. Leukocytes (Neutrophils) • Urinary Tract Infections • Non-infectious renal diseases • glomerulonephritis • interstitial nephritis • polycystic kidney • tumours of urinary tract • urolithiasis • Contamination by genital secretions (women, + large amount of squamous cells) 13

  13. Leukocytes (Neutrophils) 14

  14. Epithelial cells 15

  15. Tubular cells 16

  16. Tubular cells • Acute tubular necrosis • Acute interstitial nephritis • Acute rejection of renal allograft • Active proliferative glomerulonephritis • Nephrotic syndrome • Nephrotoxic drugs 17

  17. Transitional cells - deep 18

  18. Transitional cells - deep 19

  19. Transitional cells (of the deep layers) • Bladder carcinoma • Urolithiasis • Hydronephrosis • Uretheric stent • Bladder catheters 20

  20. Tubular damage • Tubular cells • Casts (epithelial casts) • Dysmorphic erytrocytes • Lipids 21

  21. Urothelium damage • Transitional cells of the deep • layers (ovoid and club-like) • Isomorphic erytrocytes • Leukocytes 22

  22. Transitional cells - superficial 23

  23. Transitional cells (of the superficial layers) • Lower urinary tract infections 24

  24. Squamous cells 25

  25. Squamous cells • Small number of SC are almost invariably present in the sediment of females, shed from the urethra and vagina • Large numbers of SC are seen in vaginitis often associated to bacteria and/or Candida. 26

  26. Casts - I 27

  27. Casts - II 28

  28. Hyaline Casts 29

  29. Granular Casts 30

  30. Epithelial & Leukocyte Casts 31

  31. Erytrocyte Casts 32

  32. Crystals – main types 33

  33. Crystals – uncommon types 34

  34. Crystals – Uric acid 35

  35. Crystals – Ca oxalate 36

  36. Crystals – Ca phosphate 37

  37. Crystals – Ca phosphate 38

  38. Crystals – MgNH4 triplephosphate 39

  39. Bacteria 40

  40. Candidiasis 41

  41. Trichomonas vaginalis 42

  42. Urinalysis 3 • Urine sediments: • Microscopic examination of sediment from freshly passed urine: • Looking for cells, casts (Tamm-Horsfall protein), fat droplets • Red Cell casts - haematuria = glomerular disease • White Cell casts + polymorphs + bacteriuria = pyelonephrites • Lower UTI polymorphs no casts • Acute glomerulonephritis =haematuria, cells, casts • Chronic glomerulonephritis = less sediment 43

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