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Praktikum Urin

Praktikum Urin. Dr. Donny Kostradi, M.Kes. Sp.PK. Pemeriksaan Urin Rutin. 1. Jumlah Urin 2. Makroskopis: warna dan jernihnya urin 3. Berat Jenis 4. Protein 5. Glukosa 6. Pemeriksaan Sedimen. ………….Pemeriksaan Urin Rutin. Ad.1. Jumlah Urin  menentukan adanya ggn . Faal ginjal ,

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Praktikum Urin

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  1. SDU-DK-1107 PraktikumUrin Dr. Donny Kostradi, M.Kes. Sp.PK

  2. Pemeriksaan Urin Rutin • 1. Jumlah Urin • 2. Makroskopis: warna dan jernihnya urin • 3. Berat Jenis • 4. Protein • 5. Glukosa • 6. Pemeriksaan Sedimen SDU-DK-1107

  3. ………….Pemeriksaan Urin Rutin • Ad.1. JumlahUrin  menentukanadanyaggn. Faalginjal,  kel. keseimbangancairanbadandan  menafsirkanhasilpmx. kuantitatifdankualitatif urin. • Cara m’ukurjuml. Urin: 1. Urin 24 jam → prod. dewasa 800-1300 ml 2. Urinsiang 12 jam & urinmalam 12 jam→ prod. U. siang 2 sp 4 x lebihbanyakdr u. malam 3. Timed specimen pd sesuatupercob. ttu → detil u/ juml. absolut 4. Urinsewaktu → u/ protein dan GDS SDU-DK-1107

  4. ………….Pemeriksaan Urin Rutin • Ad.2. Warna Urin  tidak berwarna  kuning muda  kuning  kuning tua  kuning bercampur merah  merah bercampur kuning  merah  coklat kuning bercampur hijau  putih spt susu SDU-DK-1107

  5. ………….Pemeriksaan Urin Rutin • Warna urin tergantung besarnya diuresis, mkn bsr diuresis → mkn muda warna urin • Normal: kuning muda sp kuning tua → urochrom & urobilin • Kuning - Normal: Urochrom dan urobilin - Abnormal: bilirubin, obat2an & diagnostika (santonin, PSP, riboflavin (dg resensi hijau)), permen dan kembang gula. SDU-DK-1107

  6. ………….Pemeriksaan Urin Rutin • Hijau - Normal: Indikan - Abnormal: obat2 dan diagnostika (methylen blue, Evan’s blue), serta kuman2 (Ps. aeruginosa. B. pyocyaneus) • Merah - Normal: Uroerythrin - Abnormal: hemoglobin, porfirin, porfobilin, obat2 dan diagnostika (Santonin, PSP, Amidopyrin, Congored, BSP) serta kuman2 (B. prodigiosus) SDU-DK-1107

  7. ………….Pemeriksaan Urin Rutin • Coklat - Normal: Urobilin - Abnormal: Bilirubin, hematin dan porfobilin • Coklat tua atau hitam - Normal: Indikan - Abnormal: darah tua, alkapton, melamin, dan obat2 (derivat fenol dan argyrol) • Seperti susu - Normal: Fosfat, urat - Abnormal: pus, getah prostat, chylus, zat2 lemak, bakteri2 dan protein yg membeku SDU-DK-1107

  8. ………….Pemeriksaan Urin Rutin • Ad.3. Kejernihan 1. Jernih 2. Agak keruh 3. Keruh/sangat keruh - Normal: jika urin dibiarkan/didinginkan, lendir, sel2 epitel dan lekosit yg lambat laun mengendap. Urin keruh dari awal: - Fosfat amorf dan karbonat (>>>): makan >> → kekeruhan hilang setelah diberi as. asetat encer Pengaruh di u. sedimen → kristal fosfat/karbonat >> SDU-DK-1107

  9. ………….Pemeriksaan Urin Rutin •  Bakteri2 >>: berkembangbiaknya bakteri/ kuman, tp jg o/ bertambah unsur sedimen (sel epitel, lekosit, dsb) •  Unsur2 sedimen dlm juml besar: - Urin keruh dan berwarna merah spt air daging eritrosit >> - Urin keruh → lekosit >> → sedimen (+) → tes Donne → sedimen urin + lart. NaOH pekat → massa yg amat kental •  Chylus & lemak: urin menyerupai susu encer - adanya butir2 lemak (lipuria) sec. mikroskopis SDU-DK-1107

  10. ………….Pemeriksaan Urin Rutin •  Benda2 koloid: urin tdk dapat dijernihkan dg filtrasi/ sentrifugasi • Urin keruh setelah dibiarkan: - Nubecula - Urat2 amorf dlm urin asam & dingin → keruh → dipanasi akan hilang - Fosfat amorf & karbonat → m’endap pd urin lindi/basa - Bakteri2 dari luar tubuh → unsur2 sedimen tdk berubah/ bertambah SDU-DK-1107

  11. ………….Pemeriksaan Urin Rutin • Ad.4. Berat Jenis (BJ) - Cara pmx BJ: 1. tuangkan urin secukupnya ke dlm tab. Urino- meter 2. masukkan urinometer ke tab. dan putar dg ibu jari & telunjuk lalu baca pd tangkai urinometer setinggi meniskus bawah - Normal:  1,016 – 1,022 (lazim: 1016-1022) pd urin 24 jam  1003 – 1030 pd urin sewaktu SDU-DK-1107

  12. ………….Pemeriksaan Urin Rutin - Abnormal: * >> 1030, kemungkinanglukosuria, dlmpmx diagnostikrontgen u/ ginjal - Bljumlurinsedikit, tp hrs cek BJ makaharus ditambahaquadestilatadan 2 angkaterakhirdr pembacaanharusdikali 2. • Ad.5. BauUrin Bauurindariawal: 1. Makanan: petai, jengkol, durian 2. Obat2an: terpentin, menthol SDU-DK-1107

  13. ………….Pemeriksaan Urin Rutin 3. Bau amoniak: akibat perombakan bakteriil dr ureum di dlm kantong kencing → pd urin yg dibiarkan tanpa pengawet. 4. Bau keton: mirip bau buah2an/ bunga ½ layu 5. Bau busuk: akibat perombakan zat2 protein, misal pd carcinoma sal. kencing • Bau urin setelah dibiarkan: 1. Bau amoniak: urin yg dibiarkan tanpa pengawet. 2. Bau busuk: akibat pembusukan urin yg mengandung banyak protein diluar tubuh. SDU-DK-1107

  14. ………….Pemeriksaan Urin Rutin • Ad.6. DerajatKeasaman (pH) - Normal: 4,5 – 7,5 - pH asamec: bakteri E. coli - pH basaec: bakteri Proteus - Cara manual: 1. dg pakaikertaslakmus  kertaslakmusbirumenjadimerah: Asam  kertaslakmusmerahmenjadibiru: Basa/ Lindi 2. dg pakaikertasnitrazin  teteskanurindikertasnitrazin→tunggu 1’ SDU-DK-1107

  15. ………….Pemeriksaan Urin Rutin  bandingkan warna kertas itu dg skala warna yg tersedia  warna kuning pH 4,5  warna biru akan berubah dg bertambahnya pH yg lebih tinggi SDU-DK-1107

  16. Pemeriksaan Protein Urin 1. Masukkanurinjernihkedlmtabungreaksi sp 2/3 penuh 2. layangkantabungygberisi lap atasurindiatasnyalaapi sp mendidihslm 30’’ 3. perhatikankekeruhanygterjadidilapisanatasurin, danbandingkanjernihnya dg bag. bawahygtdkdipanasi 4. Jikakeruhmungkindisebabkan o/ protein, kalsiumfosfat/ kalsiumkarbonat 5. Teteskan 3-5 teteslart. As. Asetat 6% (boleh 3-6%) kedlmurinygmasihpanas, jikatetapkeruh → (+) positifprotein. * Kecualitesinitidakbisadilakukanbila BJ rendahatau BJ >> 1003 dan 1006 tambahkan dg lartNaCljenuhsebanyak 1/5 dr vol. urin SDU-DK-1107

  17. Pemeriksaan Protein Urin Interpretasi: - Negatif (-) : tidakadakekeruhan - Positif + /1 + : adakekeruhanringantanpa butir2, kadar± 0,01 – 0,05% - Positif ++/2+ : kekeruhanmudahdilihat & tampak butir2 dlmkekeruhan, kadar ± 0,05 – 0,2% - Positif +++/3+ : urinjelaskeruh & kekeruhanituber- keping-keping, kadar ± 0,2 – 0,5% - Positif ++++/4+: urinsangatkeruhdankekeruhan berkeping - keping SDU-DK-1107

  18. Pemeriksaan Sedimen Urin(Urine Sediment Analysis) • MetodaPemeriksaan: A. Natif B. Cat SternheimerMalbin • Bahan: - U. pagidansegar (diperiksadlmwaktu 3-6 jam) - BJ min: 1.015 - Bl as. Urat >>> → encerkan dg aquadest 1:1 danpanaskan 60 ºC agar uratlarut - Blfosfat/karbonat >>> →tambah as. Asetat 10% dg hati2 → spy urinjernih, tpblterlalubanyak→eritrositdan torakrusak SDU-DK-1107

  19. Pemeriksaan Sedimen Urin • MetodaNatif: - Urindicampur dg baik - Reagen: - - Cara Kerja: 1. Pusingkan 10 -15 ml urin dg kecepatan 1500 – 2000 ml (5-10 mnt) 2. Buatfiltratnya: sisakan 0,5 ml, selanjutnya kocokhati- hatitutup dg kacapenutup, jangan sp adagelembungudara 3. periksa/ baca dg mikroskop dg pembesaran lemah (LPK):100 x → lihatsedimen sec. keselu- ruhandanpembesarankuat (LPB):400 x → identifikasi unsur2 ygada SDU-DK-1107

  20. Pemeriksaan Sediment Urin • Metoda Pengecatan: - Bahan : Urin - Reagen: Cat Sternheimer Malbin yg tda: Lart A : Methyl Rosalina Chlorida (kristal violet) 3 gr Ethanol 20,0 ml Amonium oksalat 0,8 gr Aquadest ad 80,0 ml Lart B : Safranin 0,25 gr Ethanol 10,0 ml Aquadest ad 100,00 ml SDU-DK-1107

  21. Pemeriksaan Sediment Urin • Pembuatan cat: - Campur 3 bagianlart A dg 97 bagianlart B - Saringdansimpan • Cara Pengecatan: 1. Teteskan ± 3 tetes cat pd sedimen (0,5 ml) 2. ketuk2 agar cat merata, kemudiandiamkan 3 mnt 3. ambil 1 tetes →buatpreparat 4. periksadibawahmikroskop • Kelebihanpengecatan SM: - unsur2 sedimentampaklebihjelas • Kekuranganpengecatan SM: - tarafpermulaandptmengacaukaninterpretasi, misal silinderhialinygbanyakgranuladptkeliru dg silinder granula, krngranulatercat SDU-DK-1107

  22. Unsur-unsur sedimen • A. Unsur Organis (Asal jaringan) * Epithel * Eritrosit * Lekosit * Torak (silinder) • B. Unsur Anorganis (macam2 kristal) * Tidak/Kurang punya arti klinis (kristal urat, fosfat, karbonat, as. Hipurat) * Ada arti klinis patologis ( kristal cystine, leucine, kolesterol, dll) → menunjukkan katabolisme tubuh SDU-DK-1107

  23. Unsur-unsur Organis • A. Unsur-unsur organis * Epithel: 1. Skuamosa: btk polimorf, sitopl. lebar inti 1 besar asal: kandung kemih, urethra, kontaminasi vagina 2. Poligonal/ bulat: inti besar, sitopl. Sering berisi gra- nula asal: ren/ ginjal 3. Epithel berekor (transisional): inti besar bulat, sito- plasma. Seperti ekor asal: ureter, pelvis renalis dan prostat 4. Kontaminasi epithel dr vagina atau adanya sel2 tumor SDU-DK-1107

  24. Unsur-unsur Organis • * Eritrosit:bentukbulat, bikonkaf, kdgtampakcekung tengahnya, tidakberintiataubergranula, refraktilthp cahaya - dlmurinhipotonik/encer: eritr. membengkakdan besar - dlmurin alkalis/hipertonik/pekat: eritr. mengkerut, dindingagak rata (Crenasi) • Harga normal: 1-3 sel LPB atau s/d 2500 eritrosit/ ml urin ** U/ hindarikontaminan, pakeurinkateter ** Sumberkesalahan: - yeast cell/jamur: ukurantdksama - kristalamoniumurat - tetesanlemak (dripped fat) → larut dg diberi as. Asetat 3% ( lewattepikacapenutup) SDU-DK-1107

  25. Unsur-unsur Organis • ** Sumber kesalahan: - masif hematuri : karena kesalahan teknik kateterisasi ** Positif Palsu: - erithrosit hemolisis - tertutup unsur-unsur lain yg jumlahnya besar • * Lekosit: - bentuk bulat, lebih besar dr eritrosit, mengandung inti (1 atau lebih, akan tambah jelas dg penambahan as. asetat 3% (urin asam), sitopl. bergranula. → Bila urin tidak segera diperiksa → lekosit rusak bentuk amorf detritus. • Harga normal: - ♀: << 15 sel / LPB - ♂: << 5 sel/LPB atau s/d 3000 lekosit/ ml sedimen urin SDU-DK-1107

  26. SDU-DK-1107

  27. Kristal dilaporkan SDU-DK-1107

  28. (Urine Sediment Analysis) Pemeriksaan Sediment Urin • Struvite crystals are the most common type in urine from dogs and cats. They are often seen in urine from clinically normal individuals. Though they can be found in urine of any pH, their formation is favored in neutral to alkaline urine. Urinary tract infection with urease-positive bacteria can promote struvite crystalluria (and urolithiasis) by raising urine pH and increasing free ammonia. SDU-DK-1107

  29. (Urine Sediment Analysis) • Cylindrical bilirubin crystals have formed in association with droplets of fat, resulting in a "flashlight" appearance. This form is less commonly seen. Bilirubin crystals are seen most commonly in canine urine, especially in highly concentrated specimens. They are less common in urine of other species. In dogs, they often are of no significance (healthy dogs can have low, but detectable, bilirubin levels in urine). SDU-DK-1107

  30. Bilirubin crystals (or positive chemical reaction on the urine dipstick) in feline, equine, or bovine urine should be investigated since an underlying Bilirubin crystals (Urine Sediment Analysis) cholestatic process is likely. SDU-DK-1107

  31. (Urine Sediment Analysis) Calcium Carbonate SDU-DK-1107

  32. Amorph crystals (Urine Sediment Analysis) Calcium oxalate dihydrate crystals sometimes also can present as "amorphous" when the individual crystals are very small. Examination at higher magnification will reveal the typical "envelope" appearance. Xanthine crystals are usually in the form of "amorphous" crystals. These crystals occur in Dalmations on allopurinol therapy for urate urolithiasis. Generally, no specific clinical interpretation can be made based on the finding of amorphous crystals. Small amorphous crystals can be confused with bacterial cocci in some cases, but can be distinguished by Gram-staining. SDU-DK-1107

  33. (Urine Sediment Analysis) Calcium oxalate dihydrate crystals • Typically are seen as colorless squares whose corners are connected by intersecting lines (resembling an envelope). They can occur in urine of any pH. The crystals vary in size from quite large to very small. In some cases, large numbers of tiny oxalates may appear as amorphous unless examined at high magnification. These crystals often are seen in normal urine from horses and cattle. They are less common in normal canine and feline urines. Urolithiasis due to calcium oxalate has been reported in both dogs and cats. In some cases, they occur secondary to abnortmal calcium (increased) excretion due to disorders of calcium metabolism (e.g. hyperparathyroidism). Miniature Schnauzers are predisposed to calcium oxalate urolithiasis, despite no abnormalities in urinary calcium excretion. Calcium oxalate dihydrate crystals can also be seen in cases of ethylene glycol intoxication. If seen in large numbers in the urine of a dog or cat with acute renal failure, consideration should be given to this diagnosis. SDU-DK-1107

  34. (Urine Sediment Analysis) Infectious Agents in Urine Sediment SDU-DK-1107

  35. Candida albicans (Urine Sediment Analysis) Candida SDU-DK-1107

  36. Bacteria can be identified in unstained urine sediments when present in sufficient numbers. Rod-shaped bacteria and chains of cocci are often readily identifiable. The images at right show E.coli bacilli from a case of cystitis in a dog. However, small amorphous crystals, cellular debris, and small fat droplets can either mask or mimic cocci. If there is any doubt about the presence of bacteria, a Gram-stained smear of urine sediment (middle panel) should be examined. Urine in the bladder of normal animals is sterile. Though bacteria from the distal urethra and/or genital tract may contaminate voided specimens, they are usually too few to see if a good mid-stream collection was obtained. SDU-DK-1107

  37. (Urine Sediment Analysis) • Although phagocytized bacteria cannot be seen in unstained wet • mounts of urine sediment, they may found in stained smears of sediment. The lower panel at the right shows a neutrophil containing phagocytized bacteria. Notice that the nucleus in this cell is round; nuclei tend to become round as neutrophils age in urine. • Bacteriuria of clinical significance, e.g., bacterial cystitis, is usually accompanied by increased numbers of white cells (pyuria). The presence of a few bacteria without pyuria is very rarely significant of infection SDU-DK-1107

  38. Fungal (Urine Sediment Analysis) SDU-DK-1107

  39. Microfilaria (Urine Sediment Analysis) • Microfilaria • Microfilariae of Dirofilaria immitis may be seen in the urine sediment in cases of hematuria in microfilaremic dogs. The finding is without significance, other than as an indication of heartworm disease. SDU-DK-1107

  40. (Urine Sediment Analysis) Urinary Tract Parasites Capillaria plica is a helminth parasite of the canine urinary bladder. C. felis-cati is the feline counterpart. The ova are similar to those of Trichuris spp. in that they are oval in shape and SDU-DK-1107

  41. (Urine Sediment Analysis) SDU-DK-1107

  42. Urine Sediment Analysis) Cystine crystals are flat colorless plates and have a characteristic hexagonal shape with equal or unequal sides. They often aggregate in layers. Their formation is favored in acidic urine. Cystine SDU-DK-1107

  43. Urine Sediment Analysis) Biurates SDU-DK-1107

  44. Urine Sediment Analysis) Drug Crystals SDU-DK-1107

  45. Urine Sediment Analysis) Tyrosine Calcium Oxalate Monohydrate SDU-DK-1107

  46. Urinary Casts Urine Sediment Analysis) SDU-DK-1107

  47. Urine Sediment Analysis) General Interpretation of casts:Casts are quantified for reporting as the number seen per low power field (10x objective) and classified as to type (e.g., waxy casts, 5-10/LPF). Casts in urine from normal individuals are few or none. An absence of casts does not rule out renal disease. Casts may be absent or very few in cases of chronic, progressive, generalized nephritis. Even in cases of acute renal disease, casts can be few or absent in a single sample since they tend be shed intermittently. Furthermore, casts are unstable in urine and are prone to dissolution with time, especially in dilute and/or alkaline urine. Although the presence of numerous casts is solid evidence of generalized (usually acute) renal disease, it is not a reliable indicator of prognosis. If the underlying cause can be removed or diminished, regeneration of renal tubular epithelium can occur (provided the basement membrane remains intact). SDU-DK-1107

  48. Urine Sediment Analysis) Hyaline casts are formed in the absence of cells in the tubular lumen. They have a smooth SDU-DK-1107

  49. (Urine Sediment Analysis) Granular Casts SDU-DK-1107

  50. Urine Sediment Analysis) Fatty Casts Waxy Casts Waxy casts have a smooth consistency but are more refractile and therefore easier to see compared to hyaline casts. They commonly have squared off ends, as if brittle and easily broken. Waxy casts indicate tubular injury of a more chronic nature than granular or cellular casts and are always of pathologic significance SDU-DK-1107

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