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Diagnostic Work-Ups URINALYSIS Transparency Result Day 1 Turbid Result Day 2 Turbid Normal Values Clear ABNORMAL Possible Significance urine commonly becomes turbid on standing because of precipitation of phosphates. hematuria makes urine slightly cloudy when RBCs not quite sufficient to produce visible color change in chyluria, urine milky and laden with fat and leukocytes; implies a fistula between lymphatic system and the bladder (most common cause is filariasis) Nitrofurantoin can also cause yellow colored urine Increased markedly by proteinuria and glycosuria value of >1.030 in the absence of proteinuria, glycosuria is usually due to radiocontrast agent Volume depletion SG usually >1.020 Fixed SG 1.010 (isosthenuria) characteristic of chronic renal impairment. Fixed SG 1.000-1.005 in DI may rise to 7 on vegetarian diet 5.0 in uric acid stones 7-8 in infection stones Present in DM Specific loss of proteins into the urine such as in nephrotic syndrome occurs on a molecular weight basis, with smaller proteins being lost more rapidly than larger ones. The presence of increased numbers of erythrocytes in the urine may indicate a variety of urinary tract and systemic conditions. These include: (1) renal disease glomerulonephritis, lupus nephritis, interstitial nephritis associated with drug reactions, calculus, tumor, acute infection, tuberculosis, infarction, renal vein thrombosis, trauma (including renal biopsy), hydronephrosis, polycystic kidney, and occasionally acute tubular necrosis and malignant nephrosclerosis; (2) lower urinary tract disease acute and chronic infection, calculus, tumor, stricture, and hemorrhagic cystitis following cyclophosphamide therapy; (3) extrarenal disease acute appendicitis, salpingitis, diverticulitis, acute febrile episodes, malaria, subacute bacterial endocarditis, polyarteritis nodosa, malignant hypertension, blood dyscrasias, scurvy, and tumors of the colon, rectum, and pelvis; (4) toxic reactions due to drugs, such as sulfonamides, salicylates, methenamine, and anticoagulant therapy; and (5) physiologic causes, including exercise. Increased numbers of leukocytes (principally neutrophils) in the urine is termed pyuria, and indicates the presence of infection or inflammation in the urinary tract. When accompanied by leukocyte casts or mixed leukocyteepithelial cell casts, increased urinary leukocytes are considered to be renal in origin. Infection, either bacterial or nonbacterial, may be centered in the renal parenchyma (pyelonephritis), or may be localized as cystitis, prostatitis, urethritis, or balanitis.
Yellow 1.025
Yellow 1.030
Yellow 1.002-1.030
NORMAL NORMAL
pH
5.0
7.0
4.5-8
NORMAL
Glucose Albumin
Negative +2
Negative +4
Negative Negative
NORMAL ABNORMAL
RBC
>50/hpf
TNTC
0-2/hpf
ABNORMAL
WBC
1-3/hpf
10-15/hpf
0-2/hpf
ABNORMAL
Epithelial cells
occasional
rare
Occasional
NORMAL
a. Squamous Epithelial Cells. These cells are the most frequent epithelial cell seen in normal urine, and likewise the least
Amorphic Urates
occasional
rare
Occasional
NORMAL
Bacteria
few
few
NORMAL
Possible Significance There are two possible reasons for this. The first is prerenal where renal plasma flow is reduced, from such lesions as renal artery stenosis, renal vein thrombosis and the like. This causes a reduction in the GFR. The second cause of elevated BUN is true renal disease. Low serum creatinine values are rare; they almost always reflect low muscle mass. Theoretically, low values may also reflect increased glomerular filtration rates (GFRs). Serum creatinine increases with decreases in GFR (acute kidney injury or chronic kidney disease) Increased in acute bacterial infection, cancer, infectious disease, numerous inflammatory states Decreased in polycythemia vera and sickle cell anemia Increased in Liver disease with biliary obstruction, nephrotic stage of glomerulonephritis and DM. Decreased in pernicious anemia, hemolytic anemia, malnutrition, extensive liver disease and hyperthyroidism Increased plasma triglyceride levels are indicative of a metabolic abnormality and, along with elevated cholesterol, are considered a risk factor for atherosclerotic disease. Hyperlipidemia may be inherited or be associated with biliary obstruction, diabetes mellitus, nephrotic syndrome, renal failure, or
Creatinine
64.28
88-133 mmol/L
NORMAL
ESR
42mm/hr
M F C
ABNORMAL
Total Cholesterol
4.39 mmol/L
Desirable <200mg/dL (<5.2 mmol/L) Borderline Risk 200-239mg/dL (5.2-6.21mmol/L) High Risk Level 240mg/dL( 6.24mmol/L) 60-150mg/dL (0.70-1.7 mmol/L)
NORMAL
Triglycerides
0.70 mmol/L
NORMAL
Serum K
3.71
3.5-5.0 mmol/L
NORMAL
C3 Determination
Increased in increased intake, either orally or parentally Decreased in Addisons, sodium-losing nephropathy, vomiting, diarrhea, fistulas, tube drainage burns, renal insufficiency with acidosis, starvation with acidosis, paracentesis, ascites Increased in DKA, renal failure, Addisons Decreased in Thiazide diuretics, Cushings syndrome, cirrhosis with ascites, hyperaldosteronism, steroid therapy, malignan HPN, poor dietary habits, chronic diarrhea, diaphoresis, renal tubular necrosis malabsorption syndrome,vomiting Increased complement activity may be seen in:
Bacterial infections (especially Neisseria) Cirrhosis Glomerulonephritis Hepatitis Hereditary angioedema Kidney transplant rejection Lupus nephritis Malnutrition Systemic lupus erythematosus
Chest X-ray
Pneumonia, Bilateral McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright 2006 W. B. Saunders Company
Twenty-First Edition