HEMATURIA AND EXAMINATION OF THE URINE

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HEMATURIA AND EXAMINATION OF THE URINE



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Hematuria
Proteinuria
Appearance of urine
Volume of urine
Specific gravity and osmolality
PH (potential of hydrogen)
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Hematuria

• Type
• microscopic hematuria
• defined as 4 erythrocytes per high-powered
  field on a spun urine specimen
• gross hematuria
• bloody urine ,indicates sufficient red blood
  cells to discolor the urine

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• Clinical occurrence 
• 1.systemic disease
• blood disease, congenital hemophilia, sickle 
  cell disease,
•   leukaemia, thrombocytopenia,
  bleeding disorders, including anticoagulant drugs
  scurvy. vitamin K deficiency
• 2.Infective disease epidemic hemorrhagic fever
  ,  ichorrhemia, epidemic meningitis 
• 3.Cardiovascular disease infective endocarditis,
  Malignant hypertension, congestive heart failure 
  

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• 4.Urinary system disease
• diastrophic erythrocyturia glomerular hematuria
  
• glomerular disease acute glomerulonephritis,
  nephrotic syndrome,
• orthomorphic erythrocyturia non-glomerular
  hematuria
• non-renal source infarct/papillary necrosis, trau
  ma , pyelitis,
• stones, renal tumours/ infection/tuberculosis,
  kidney injury of drugs
• (e.g.,sulfonsmides, nonsteroidal, antiinflammatory
   drug or  mannitol),
• renal infarction.
• post renal Ureteric/bladder stone ureteric
  /bladder/ prostate cancers
• bladder tuberculosis, infectious urethritis,
   prostatitis, interstitial/bacterial cystitis
  urethral stricture , Urethral  neoplasma

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• 5 others Radiation nephritis or cystitis, 
  metabolic/toxic hemorrhagic cystitis(
  e.g. cyclophosphamide or ifosfamide) ,analgesic 
  Nephropathy, anticoagulants
• 6 functional
• heavy exercise, fever,  post surgical.

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• Clinical feature
• 1Change of color
• Microscopic hematuria normal
• Gross hematuria color change according to the
  amount of bleeding.
• Renal bleeding---dark red
• Bladder/prostate bleeding---Bright red
• Red color urine is not all hematuria
  haemoglobinuria or myoglobinuria

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Normal chyluria hematuria
haemoglobinuria
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• 2.Source of blood
• initial hematuria urethra
• terminal hematuria the trigone region of the
  bladder or prostate
• total hematuria the kidney or ureter.
• erythrocyte casts proves a renal source

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• 3.Microscopic hematuria
• found only on chemical testing,
• judge renal source or not renal source
• diastrophic erythrocyturia ----glomerular
  hematuria
• Red cells size differ, shape multiplicity
• orthomorphic erythrocyturia---- non- glomerular
  hematuria
• renal pelvis calices, Ureteric, bladder ,
  prostate
• Red cells shape unity

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• 4.symptomatic hematuria
• renal region dull pain or colicky pain renal
  disease
• frequent micturition, urgent micturition,
  Dysuriabladder, urethra
• 5.asymptomatic hematuria
• the early stage of some disease
• tuberculosis of kidney, renal carcinoma or
  bladder carcinoma,
• hiding nephritis

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• Test
• Stix test followed by microscopy
• fresh urine, exception of menstruating
• confirm the presence of red cells ,
• exclude haemoglobinuria or myoglobinuria.
• . detect red-cell casts, which are diagnostic of
  glomerulonephritis.
• In the absence of red-cell casts, further
  investigations, such as urine cytology, renal
  imaging and cystoscopy, are required to define
  the site of bleeding.
• Renal biopsy may be required

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Proteinuria

• Proteinuria is one of the most common signs of
  renal disease. Detection is primarily by Stix
  testing.
• Most reagent strips can detect protein if
  albuminuria exceeds 300 mg/d.
• Most reagent strips react primarily with albumin
  and are relatively insensitive to globulin and
  Bence Jones proteins.
• Excretion in 24 hour urine collections should be
  measured.

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• Healthy adults excrete up to 30 mg daily of
  albumin.
• fever, exercise and adoption of the upright
  posture (postural proteinuria) all increase
  urinary protein output but are benign.

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Appearance

• Little value except diagnosis of hematuria
• Very concentrated urine appear dark .
• Discoloration of urine
• cholestatic jaundice, haemoglobinuria, drugs
  such as rifampicin, use of fluorescein or
  methylene blue, and ingestion of beetroot.
• after standing for some time occurs in
  porphyria,
• ingesting the drug L-dopa.

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Volume

• Determined by diet and fluid intake. Normal
  10002000 ml/d
• The minimum amount 650ml/d to stay in fluid
  balance.
• oliguria lt400ml /d
• anuria lt100ml/d
• polyuriagt2500ml /d
• Chronic kidney disease or diabetes, insipidus,
  impairment of concentrating ability requires
  increased volumes of urine to be passed, given
  the same daily solute output. An increased solute
  output, such as in glycosuria or increased
  protein catabolism following surgery, also
  demands increased urine volumes.

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Specific gravity and osmolality

• Urine specific gravity is a measure of the weight
  of dissolved particles in urine, whereas urine
  osmolality reflects the number of such
  particles.
• Measurement of is required only in the
  differential diagnosis of oliguric renal failure
  or the investigation of polyuria or inappropriate
  ADH secretion.
• Specific gravity1.015-1.025 ,
• Specific gravity is usually fixed at 1.010 in CKD
  or acute tubular necrosis as compared to prerenal
  acute kidney injury and inappropriate ADH
  secretion where specific gravity is very high
  close to 1.025.

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Urine PH

• Measurement of urinary pH is nnecessary except in
  the investigation and treatment of renal tubular
  acidosis.
• 6.5

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Glomerular disease
Dysmorphic Rbc
hematuria
Calculus,tumor, TB,infection
Hemogeneous Rbc
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• proteinuriagt150mg/24hr

Proteinuria analysis
glomerular tubular overflow
secretory or gt1.5g/24hr lt1.5g/24hr
immunoglobulin histic
Bence Jones protein
?2-micro globulin Infection toxicity
Selective (albumin)
Non Selective (mixture)
myeloma
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• 10cm in length
• 5cm in width
• 4cm in thickness
• 134 148g in weight

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Renal Cortex

• renal cortex
• 8090 of glomerulus
• Glomerular capsule
• renal medulla
• renal tubule