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PEMERIKSAAN LABORATORIUM KELAINAN UROGENITAL

PEMERIKSAAN LABORATORIUM KELAINAN UROGENITAL. Efrida, dr., SpPK., MKes. Staf Pengajar Patologi Klinik FK UNAND SMF Patologi Klinik RS. Dr. M. Djamil Padang 7 Maret 2013.

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PEMERIKSAAN LABORATORIUM KELAINAN UROGENITAL

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  1. PEMERIKSAAN LABORATORIUM KELAINAN UROGENITAL Efrida, dr., SpPK., MKes Staf Pengajar Patologi Klinik FK UNAND SMF Patologi Klinik RS. Dr. M. Djamil Padang 7 Maret 2013

  2. Urinalisis

  3. Urinary System

  4. Urinalisis/Analisis Urin Memberi informasi: • Keadaan Ginjal dan saluran kemih • Faal hati • Saluran empedu • Pankreas • Korteks adrenal • Dll

  5. Komponen Urin Normal • Air (95%) • Produk sisa terlarut: ureum, kreatinin, as. Urat • Elektrolit: Na, K, Cl, Ca, Fosfat • Hormon: setelah menjalankan fungsi • Komposisi lain: tergantung makanan/cairan/obat yang dikonsumsi

  6. Tujuan Urinalisis • Menunjang diagnosis gangguan ginjal, traktus urinarius, dan penyakit sistemik yang mempengaruhi fungsi ginjal • Memantau perjalanan penyakit (misal: DM) • Memantau efektivitas pengobatan/komplikasi • Skrining dan pemantauan penyakit asimptomatik kongenital/herediter • Skrining drug abuse • General check up

  7. Indikasi Permintaan Urinalisis • Gejala/riwayat penyakit ginjal/sal. Kemih • Gangguan endokrin • Ikterik • Terapi yg mempengaruhi fungsi ginjal • Kehamilan • Toksikologi/over dosis obat/narkoba • Abnormalitas genetik(gangguan metabolisme AA)

  8. Tahap pemeriksaan: • Praanalitik a. persiapan pasien b. persiapan sampel teknik sampling yg baik wadah penampung bersih, kering, bermulut lebar. tes biakan urin wadah dan metode sampling harus steril

  9. Pedoman NCCLS • Identifikasi sampel: nama, MR, alamat/ruang rawat, penggunaan pengawet • Specimen acceptability Urinalisis dilakukan dalam waktu < 2 jam setelah dikemihkan. Jika ditundarefrigerator Sampel tanpa label/identitastolak Hindari kontaminasi • Kontrol kualitas

  10. c. Cara pengumpulan sampel - sering pengumpulan urin ketika berkemih suatu saat (urine sewaktu) - kateterisasirisiko infeksi - punksi suprapubik - clean catch/clean voided midstream

  11. Urine sewaktu /random • Urine pagi • Urine postprandial / 2 jam pp • Urine 24 jam • Jenis sampel urine • Urine sewaktu Yang dikeluarkan pada satu waktu yg tidak ditentukan dengan khusus (u/ pem rutin, skrining, tanpa saran khusus) • Urine pagi Yang dikeluarkan kedua kali pada pagi hari setelah bangun tidur sebelum makan dan sebelum gerak badan( urine lebih pekat). (u/ pem sedimen, BJ, protein, kehamilan)

  12. Urine 2 jam PP Yang dikeluarkan pertama kali 2 jam Setelah makan. (u/ pem glukosa) • Urine 24 jam u/ penetapan kuantitatif sesuatu zat dalam urine Perlu pengawet PATIENT GETS UP URINATES (AT 06.00) DISCARDED AT 06.00 THE OTHER DAY URINE PASSED DURING THE REST OF THE DAY

  13. Pemeriksaan rutin • Urine baru • Jika terpaksa + pengawet urine • Jenis pengawet urine • Toluena • Thymol • Formaldehida • Asam sulfat pekat • Natriumkarbonat • Wadah urine • Besih dan kering • Bermulut lebar • Tutup rapat

  14. Wadah urine yg memenuhi syarat

  15. URINE BARU ADUK ~ HOMOGEN • MAKROSKOPIK • WARNA • BAU • KEKERUHAN • KEASAMAN • BERAT JENIS • VOLUME SEDIMEN SUPERNATAN • KIMIA • ALBUMIN • GLUCOSE • UROBILIN • BILIRUBIN • KETOBODY • BENZIDIN • MIKROSKOPIK • ERITROSIT • LEUKOSIT • EPITEL • KRISTAL • CAST

  16. 1. MAKROSKOPIK URINE WARNA • KUNING MUDA NORMALUROKROM • KUNING TUA BILIRUBIN (?) • FOAM TEST (+) KUNING (JELAS) HAWKINSON/HARISON (-) / MERAGUKAN FOUCHET KOCOK (KUAT-KUAT) FOAM • MERAH (DARAH?) • SEDIMEN ERITROSIT : (+) = HEMATURI • (-) BENZIDIN TEST

  17. KEKERUHAN (NORMAL : JERNIH) • KEMERAHAN DARAH SEDIMEN ? • (ERITROSIT) • BERKABUT BAKTERI (GRAM) • KERUH (ALKALIS / URINE NETRAL) - PUS - FOSFAT / KRISTAL KARBONAT • BERKURANG / HILANG • (FOSFAT/KRISTAL KARBONAT) • SPERMATOZOA + ASAM ASETAT (6%)

  18. Color and clarity • Color : normally , pale to dark yellow (urochrome) Abnormal color : some drugs cause color changes 1. red urine: causes: hematuria hemoglobinuria myoglobinuria 2. yellow-brown or green-brown urine: bilirubin cause : obstructive jaundice

  19. Microscopic Hematuria Urinary tract source Urethra or bladder Prostate Ureter or kidney Non-Urinary tract source Vagina Anus or rectum Pseudohematuria (non-hematuria related red urine) Myoglobinuria Hemoglobinuria PhenolphthaleinLaxatives Phenothiazines Porphyria Rifampin Pyridium Bilirubinuria Phenytoin Pyridium Red diaper syndrome Foods (Beets, Blackberries, Rhubarb) Red Urine

  20. Red Urine • Causes of Asymptomatic Gross Hematuria by Incidence • Acute Cystitis (23%) • Bladder Cancer (17%) • Benign Prostatic Hyperplasia (12%) • Nephrolithiasis (10%) • Benign essential hematuria (10%) • Prostatitis (9%) • Renal cancer (6%) • Pyelonephritis (4%) • Prostate Cancer (3%) • Urethral stricture (2%)

  21. Examples of Urine Color

  22. Clarity: normally, clear Abnormal color: cloudy urine Causes: 1. crystals or nonpathologic salts phosphate, carbonate in alkaline urine (dissolve---add acetic acid) uric acid in acid urine (dissolve---warming to 60℃) 2. various cellular elements: leukocytes, RBCs, epithelial cells

  23. Examples of Urine Clarity

  24. Urine volume • The average adult : 1000ml to 2000ml/24h • Increase polyuria---more than 2000ml of urine in 24 hours 1. physiological states: water intake, some drugs, intravenous solutions 2. pathologic states: diabetes mellitus, diabetes insipidus

  25. Urine volume • Decrease Oliguria---less than 400ml of urine in 24 hours Anuria---less than 100ml of urine in 24 hours 1. prerenal: hemorrhage, dehydration, congestive heart failure 2. postrenal: obstruction of the urinary tract (may be stones, carcinoma) 3. renal parenchymal disease: acute tubular necrosis, chronic renal failure

  26. Specific gravity (SG) • Reflect the density of the urine • Range of 1.001 to 1.040 • Increase: Dehydration、Fever、VomitingDiarrheaDiabetes Mellitus and other causes of Glycosuria、Congestive Heart Failure、Syndrome Inappropriate ADH Secretion (SIADH) 、Adrenal Insufficiency failure (urine volume↓ and SG↑) • Decrease: diabetes insipidus (urine volume↑ and SG ↓)

  27. BERAT JENIS • REFRACTOMETER • KEUNTUNGAN : • BAHAN SEDIKIT • MUDAH • KERUGIAN : • < AKURAT • HARUS DIKALIBRASI : • SUHU • GLUKOSA • PROTEIN - URINOMETER 1,000 KEUNTUNGAN : -> AKURAT KERUGIAN : -BAHAN BANYAK 1,020 KOREKSI 1,040 - CARIK CELUP

  28. 1.002-1.030 ; BJ URINE 24 JAM : 1.015-1,025

  29. Urine PH • Normal PH The average is about 6 Range from 5~9 (depends on diet)/4,7-7,5 • Higher PH---alkaline urine 1.drugs: sodium bicarbonate 2.classic renal tubular acidosis 3.alkalosis (metabolic or respiratory) • Lower PH---acid urine 1.drugs: ammonium chloride 2. acidosis (metabolic or respiratory)

  30. KEASAMAN (pH) (N. 4,7 – 7,5) RATA-RATA : 6,0 • KERTAS LAKMUS • BIRUMERAH= ASAM • BIRU = NORMAL MERAH = NORMAL • RED BIRU = BASA/ALKALIS METODE LAIN: CARIK CELUP

  31. B A U • NORMAL BAU URINE (Bau ureum) KARENA ADANYA UREUM DLM URINE • ABNORMAL c/ BAU JENGKOL • INTOKSIKASI JENGKOL • + ALBUMINURIA • HEMATURIA • KRISTALURIA • BUAH-BUAHAN KETONURIA

  32. 2. MIKROSKOPIK URINE URINE SENTRIFUS 1500 RPM / 5 MNT TUTUP DGN COVER GLASS SEDIMEN TETESKAN SLIDE MIKROSKOP OBJECTIVE 40 X DAN 10 X OCULAR 10 X CONDENSOR PEMERIKSAAN ! ! ERITROSIT/ HIGH POWER LEUKOSIT / HIGH POWER SEDIMEN ORGANIK SILINDER / LOW POWER SEL EPITEL KRISTAL ANORGANIK SEDIMEN

  33. LEUKOSIT NORMAL : 0 - 6 / LPB MORFOLOGI : • BAGIAN PINGGIRNYA TIDAK JELAS • UKURAN ; F+ 11 m • GRANULA (+) DLM SITOPLASMA E ERITROSIT NORMAL : 0 - 1 / LPB MORFOLOGI : • A.NORMAL (URINE BARU) : • - UKURAN, F + 7 m • - KEKUNINGAN • - PINGGIRNYA JELAS • CRENATED (BJ URINE TINGGI)

  34. Squamous epithelial cells

  35. Squamous epithelial cells

  36. Transitional epithelial cells

  37. Hyalin cast

  38. Red blood cell cast

  39. White blood cell and granular cast

  40. Stained white blood cell cast

  41. Fatty cast

  42. Mucus

  43. Uric acid crystals

  44. Calcium oxalate crystals

  45. Triple phosphate crystals

  46. Cystine crystals

  47. Cholesterol crystals

  48. Pemeriksaan Kimiawi BENEDICT (PEMERIKSAAN GLUKOSA) • Prinsip: Dalam suasana alkali kuat, gula-gula (reduktor) akan mereduksi Cupri menjadi Cuprohidroksida (CuOH) yang berwarna kuning atau Cuprooksida (CuO) yang berwarna merah • Metode : Benedict (manual) • Reagen : CuSO4.5H2O …………………17,3 gram Na Carbonat Anhidrous ……… 100 gram Na Citrat ……………………... 173 gram Dilarutkan dalam 1 liter akuades

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