URINE  ANALYSIS

                                                                                                พ.ท.ชาติวุฒิ ค้ำชู

·         สามารถแบ่งได้เป็น 2 system

Rare < 2/ field	Trace < 1/4 field
Occasional = 3-5 / field	1+ = 1/4 field
Frequent = 5-9 / field	2+=1/2 field
Many = large number/ field	3+= 3/4 field
TNTC = too numerous to count	4+= field is full

Normal value

1. Appearance : yellow,clear,straw color
2. Specific gravity : with normal fluid intake 
3. pH: 4.6-8.0
4. negative for : bilirubin,blood,acetone,glucose,protein,nitrate
5. RBC : male 0-3 / hpf , female 0-5 / hpf
6. WBC : 0-4 / hpf
7. Epithelial & hyaline cells : occasional
8. Bacteria : none
9. Crystal : acid urine=oxalate( small square crystals with a central cross )            uric acid ( square crystal ),           alkaline urine = calcium carbonate,triple phosphate

DDx for routine U/A

Apearance :

Colorless= diabetic insipedus,diuretic,excess fluid intake

Dark= acute intermittent porphyria,malignant melanoma

Cloudy = pyuia,blood,mucus,bilirubin

Pink/red = blood,Hb,myoglobin

Orange/yellow = rifampin,bile pigment

Blown/black = myoglobin,bile pigment,melanin,iron,alkaptonuria

Green = bile pigment,bethylene blue

Foamy= proteinuria,bile salt

pH :

acid = high-protein diet,ammonium chloride,acidosis(stavation,ketoacidosis)

base = UTI,RTA,NaHCO3            therapy,vomiting,metabolic alkalosis

specific gravity :

increase = volume depletion,CHF,adrenal insufficiency,DM,SIADH, if > 1.050 suspect artifact or excretion of radiographic contrast media

decrease = DI,pyelonephritis,glomerulonephritis

 

 

blood ( dipstick test )

positive = stones,trauma,tumor,urethral stricture,coagulopathy,infection,menses(contamination),polycystic kidneys,interstitial nephritis,hemolytic anemia,transfusion reaction,instrumentation

ketone :

positive = starvation,high-fat diet,DKA,vomiting,diarrhea,hyperthyroidism,pregnancy

nitrate :

bacteria หลายชนิดสามารถเปลี่ยน nitrate > nitrite , negative ไม่ rule out

protein :

positive= pyelonephritis,GN,nephrotic syndrome,malingnant HT,CHF,myeloma,pre-eclampsia

urine sediment

1. RBC : trauma,pyelonephritis,cystitis,prostatitis,stones,tumors,coagulopathy
2. WBC : infection,tumor,acute GN,interstitial nephritis
3. Epithelial cells : ATN,necrotizing papillitis
4. Abnormal crystal : cystine,sulfonamide,leucine,tyrosine,cholesterol  
5. Hyaline cast : benign hypertension,nephrotic syndrome,after exercise
6. RBC cast : acute GN,SBE,Goodpasture’s disease , vasculitis,malignant HT
7. WBC cast : pyelonephritis
8. Epithelial cast : tubular damage,nephrotoxin,virus
9. Granular cast : ATN
10. Waxy cast : end stage of granular cast,amyloidosis,severe chronic renal disease
11. Fatty cast : NS,DM,
12. Broad cast : chronic renal disease