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Diagnostics

Lee, Lucero, Macalintal , Magallanes , Maningas , Ombao , Pacifico. Diagnostics. Initial Laboratory Tests. CBC leukocytosis Low Hgb , low Hct – bleeding (obstructive uropathy ) ESR CRP. Urinalysis. Pyuria With bacteriuria (≥10 5 /ml): highly sensitive indicator of UTI

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Diagnostics

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  1. Lee, Lucero, Macalintal, Magallanes, Maningas, Ombao, Pacifico Diagnostics

  2. Initial Laboratory Tests • CBC • leukocytosis • Low Hgb, low Hct – bleeding (obstructive uropathy) • ESR • CRP

  3. Urinalysis • Pyuria • With bacteriuria (≥105/ml): highly sensitive indicator of UTI • Sterile pyuria • Atypical organisms: C. Trachomatis, U. Urealyticum, M. Tuberculosis • Non-infectious urologic conditions: calculi, anatomic abnormality, nephrocalcinosis, VUR, interstitial nephritis, polycystic disease • Gram-stained uncentrifuged urine (for empiric choice of antibiotic) • Leukocyte casts which form casts – characteristic of acute pyelonephritis • Hematuria – urolithiasis

  4. Serum BUN and Creatinine • determine (reversible) renal damage

  5. Two 24-h urine collections • calcium, sodium, phosphorus, magnesium, oxalate, uric acid, citrate, sulfate, creatinine, pH, and total volume

  6. Comprehensive Metabolic Panel • serum calcium, uric acid, and phosphorus; parathyroid hormone level

  7. Urine culture and sensitivity • No longer requested for uncomplicated acute cystitis • criterion standard for evaluation of a urinary tract infection (UTI) during pregnancy • results are often unavailable at the time of treatment

  8. Blood culture • Severely ill patients

  9. Imaging • The total dosage of ionizing radiation should not exceed 3-5 rads during the course of pregnancy

  10. UTZ • cheap; no exposure to radiation or dyes • stones may not be identified due to hydronephrosis in pregnancy • typical acoustic shadowing

  11. X-ray • one-shot pyelogram (ie KUB) • to identify stones obscured in renal ultrasound • can deliver 0.4-1 rad

  12. Helical CT scan • gold standard for urolithiasis in non-pregnant patients

  13. Other Procedures • evaluation of fetal status: FHT

  14. Thank you!

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