实验诊断学之尿液、肾功能检验

1、1(Normal Range of (Prerenal： heart failure、 dehydration，etc)Abnomal-Colored UrineACIDITY)(Normal Range of pH):Urine pH: Acidosis, high fever, gout and diabetes) Increased Urine pH: Alkali poisoning, urinary retention, cystitis, renal tubular acidosis)SPECIFIC GRAVITY) (the specific gravity measures

2、the kidneys to ability concentrate urine)(Normal Urine Specific Gravity Range:（Fasting and dehydration,glycosuria, Acute glomerulonephritis ） (Compulsive water drinking, acute/Interstitial nephritis ,diabetes insipidus)Urinary protein determination)Normally,only the smallest protein molecules can pa

3、ss the filtration barrier of the glomerulus,and most of these are reabsorbed by the tubules, Therefore normally urine protein content is low, the qualitative test negative, Quantitative detection 150mg 24h .) increased albumin in the urine,no large protein molecules appear,most foralbumin ,such as I

4、mmunoglobulin, The complement also appear in urine, In the most acute glomerulonephritis)Tubular injury limits reabsorption of filtered proteins.)the smallest protein molecules in plasma increased above the capacity for tubular reabsorption and protein appear in the urine，like hemoglobin,myoglogin.

5、Immunoglobulin light chain，ect)filtration of the glomerulus increase when body in injuryproduces measurable proteinuria, Glomerulonephritis or Pyelonephritis ,Glucosuria) (Glucose is normally filtered in the glomerulus and completely reabsorbed,mostly in the proximal tubule.Glucose in randomly colle

6、ctable fresh urine specimens is normally undetectable) (When the serum glucose rises above 8.88mmol/L,the filtered load will exceed the capacity for tubule reabsorption and glucose will appear in the urine. Dipsticks,impregnated with glucose oxidase and an indicator color)glucose glucosuria ) Hyperg

7、lycemia in diabetes mellitus) Glucosuria by stress: Craniocerebral trauma, Hemorrhage, Acute myocardial infarction)glucose glucosuria : proximal tubular dysfunction,and hereditary renal glycosuriaKetones are the products of fatty acid metabolism.Increased ketones in the urine indicate that cellular

8、metabolism is dependent upon fattyacid rather than glucose for energy. Progressively diminished glucose utilization in uncontrolled diabetes mellitus leads to lipolysis with increasing plasma and urinary concentration of acetoacetic acid,beta-hydroxybutyric acid,and ketones.Ketonuris uncontrolled di

9、abetes mellitus leads to lipolysis with increasing plasma and urinary concentration of acetoacetic acid,beta-hydroxybutyric acid,and ketones.Ketonuris :high fever, Severe vomiting, Diarrhea. Fast, Cirrhosis)： URINARY SEDIMENT)(Centrifuge 10ml of urine in a conical tube for 5 minutes,decant the super

10、natant,flick the tube to disperse formed elements in the remaining drop,and place it on a slide under a cover slipe to be examined with the high-power objective of a microscope(hpf).Abnormal numbers of cells and casts or any bacteria reveal the presence of disease.)Erythrocytes)Hematuria:Normal:0-3

11、red blood cells(RBCs)/hpf)Erythrocytes glomerulonephritis, Purpura nephritis,sle nephritis) Leukocytes and purulent cells) Normal:0-5 white blood cells(WBSs)/hpf.肾小管上皮细胞尾形、小圆、大圆上皮细胞扁平上皮细胞Casts (The tubular has ability to fully concentrated and acidify the urine )(hyaline casts: (Red cell casts: Acut

12、e glomerulonephritis)Leukocyte cast: Pyelonephritis (granular casts)granular castscell casts,indicate (Broad casts :occur in chronic renal failure. Indicate the poor prognosis)透明管型蜡样管型宽幅管型phosphate may occur in Alkaline urine may occur in 尿酸盐结晶草酸钙结晶 a site of injury in the urinary tract or kidney sh

13、ould be sought.)尿淀粉酶测定尿淀粉酶测定(Urine amylase determination)参考值：参考值：1000U/L (Reference: 40mmol/LKidneys 2.肾前性少尿肾前性少尿 重吸收正常或增强，一次性尿钠重吸收正常或增强，一次性尿钠20mmol/L (before Kidneys RENAL FUNCTIONcreatinine ,CREATININE CLEARANCE,Ccr) Urea nitrogen,an end product of protein metabolism,is excreted by the kidney.BUN

14、is directly related to protein intake and nitrogen metabolismcreatinine（近端小管）（近端小管）2-微球蛋白测定微球蛋白测定 ( beta 2 - micro globulin determination)参考值：成人血清参考值：成人血清12mg/L, 尿液尿液0.3mg/L临床意义：临床意义： 1.灵敏的肾小球滤过功能受损指标灵敏的肾小球滤过功能受损指标 Ccr80ml/min即可出现血即可出现血2-微球蛋白的升高。微球蛋白的升高。2.当血当血2-微球蛋白微球蛋白5mg/L,尿尿2-微球蛋白升高为近微球蛋白升高为近端肾小管损害。如血尿中端肾小管损害。如血尿中2-微球蛋白均升高，为微球蛋白均升高，为肾小球和肾小管均受损。肾小球和肾小管均受损。3. 应用肾损害药物的及肾移植排斥反应监测应用肾损害药物的及肾移植排斥反应监测（近端小管）（近端小管）1-微