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Biochemical Tests of Renal Function

Biochemical Tests of Renal Function

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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