Laboratory Examination

for Renal Disease

Dr. E. Henny Herningtyas, MSi.PhD
Clinical Pathology Dept.
Faculty of Medicine, UGM Yogyakarta

Learning Objectives
Students understand the physiology and
pathophysiology of kidney function and
disfunction
Students understand the laboratory tests to
screen, diagnose, evaluate kidney disease
Students will be able to interpret urinalysis
results to screen kidney dysfunction
Students will be able to make clinical
interpretation of laboratory results in renal
disease

Kidney Physiology

Mechanism of Urin Formation

Filtration

Reabsorption

Ureum
Creatinine

Secretion

Collection
(concentration)

Laboratory tests for Renal (1)

Urine:
urine chemistry (reagent strips)
Wet urinalysis (routine)
Urine microbiology
Urine cytology (conventional)
Cytodiagnostic urinalysis
Image cytometry and DNA analysis
Flow cytometry

Laboratory tests for Renal (2)

Kidney:
Glomerular function: BUN/ureum, creatinine,
creatinine clearance (GFR)BUN/creatinine ratio,
Tubular function: water, electrolyte (Na, K, Cl)
acid-base (bicarbonate, phosphate and hydrogen)
Endocrine function: renin, 1--hydroxylase,
eritropoetin

Causes of Renal Failure

Medical Doctor
Competence ???

Urinalysis Interpretation
Dry chemistry (dip stick)
pH acid

pH alkaline

Blood (+)
Leucocyte esterase (+)
Nitrit (+)

Wet urinalysis
Crystal: uric acid, calsium
oxalate, di-calsium
phosphate
Crystal:triple phosphate, dicalsium phosphate, ammonium urate, calsium carbonat
Hematuria (>4/LMF)
Leucocyturia (>5/LMF)
Bacteriuria

Urinalysis Interpretation
Dry chemistry (dip stick)
pH acid

pH alkaline

Blood (+)
Leucocyte esterase (+)

Nitrit (+)

Wet urinalysis
Crystal: uric acid, calsium
oxalate, di-calsium
phosphate
Crystal:triple phosphate, dicalsium phosphate, ammonium urate, calsium carbonat
Hematuria (>4/LMF)
Leucocyturia (>5/LMF),
pyuria
Bacteriuria

Urine sediment (cell)

Red blood cell

White blood cell

Squamous
epithelial cell
Transisional
epithelial cell

Tumor cell

Urine sediment (cast)

Hyaline cast

Granular cast

Cellular cast

Fatty cast

Waxy cast

Urin Sediment (crystal)

Mono
oxalate

Uric acid

Struvite

Di-Oxalate crystal

Urine Sediment (crystal)

Carbonat

Amorph

Cystine

Biurate

Tyrosine

Urine sediment (other)

Microfilaria

Candida

Bacteria

Fungi
Parasite

Sediment Interpretation

Interpretation(1)
Based on the site of problem in kidney:
Prerenal cause: reduced renal plasma flow (renal
artery stenosis, renal vena thrombosis, etc.)
Renal cause: the true renal disease that affect
glomerular comparment or tubular compartment
Postrenal cause: obstructive uropathy due to renal
or ureteral stones, prostate enlargement, UTI,
bladder stasis, urothelial carcinoma etc.

Interpretation (2)
Lab parameters

Prerenal

Renal

Post renal

N/mild

>20:1

10-20:1

10-20:1

BUN
Creatinine
BUN/creatinine ratio
GFR
Uosm/Posm

GFR = Ccr = Ucr x V/Pcr

Glomerular: >1.2, Tubular: <1.2

Electrolyte Interpretation
Check the concentration level, above or below
normal range
Results: Hyper/hyponatremia,
hyper/hypokalemia, hyper/hypochloremia
Calculate the anion gap.
Anion gap formula: Na-(Cl+HCO3-).
The presence of anion gap need to be treated
soon.

Case 1
Patient 70 years old female,
presentation: routine lab visit; have
uncontrolled diabetes.

Questions:
1. What is the associated condition?
2. What is the further lab test needed?
3. What is the possible urinalysis results?

Laboratory results
Na

136 Ca

9.3

3.5 Protein

7.5

Cl

95 Albumin 3.8

CO2

31 Mg++

1.8

BUN

28 Phos

2.5

Creat

2.1

Case 2
Patient 24 years old female,
presentation: brought to ER after
drinking heavily at a party

Questions:
1. What is the associated condition?
2. What is the further lab test needed?
3. What is the possible urinalysis results?

Laboratory results
Na

134 Ca

8.9

4.2 Protein

7.2

Cl

97 Albumin 3.2

CO2

19 Mg++

BUN

13 Phos

Creat

1.1

Thank you