investigations of urinary system dr. s chakradhar 1

INVESTIGATIONS OF INVESTIGATIONS OF URINARY SYSTEMURINARY SYSTEM

DR. S ChakradharDR. S Chakradhar 11

In BloodIn Blood Serum Urea:Serum Urea:

Normal level 2.5-6.6 mmol/l (15-40mg/dl)Normal level 2.5-6.6 mmol/l (15-40mg/dl) High level can occur in high protein diet, GI bleeding, High level can occur in high protein diet, GI bleeding,

trauma, hypovolemia, burn.trauma, hypovolemia, burn. Low level can occur in low intake, liver failure, over Low level can occur in low intake, liver failure, over

hydration.hydration. Serum Creatinine:Serum Creatinine:

Normal level 55-120mmol/l (0.62-1.36 mg/dl)Normal level 55-120mmol/l (0.62-1.36 mg/dl) High level can occur in large muscle mass, rhabdomyolysis, High level can occur in large muscle mass, rhabdomyolysis,

drugs like trimethoprim, cimetidinedrugs like trimethoprim, cimetidine Low level can occur in small muscle mass. Low level can occur in small muscle mass.

Serum potassium: (Serum potassium: (Serum sodium)Serum sodium) Normal level 3.7-5.2 mmol/lNormal level 3.7-5.2 mmol/l False high levels can occur in hemolysed sampleFalse high levels can occur in hemolysed sample

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Urine examinationUrine examinationBroadly divided into Broadly divided into Routine Routine Special Special Routine Routine Physical Examination Physical Examination Chemical examination Chemical examination Microscopic examination Microscopic examination

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Physical examinations includes Physical examinations includes Amount (Volume) – 800 – 2500 ml / day Amount (Volume) – 800 – 2500 ml / day Odour - Pungent Odour - Pungent Color of the urine – Straw colour Color of the urine – Straw colour Appearance – Clear & transparent Appearance – Clear & transparent Specific gravity – 1.010 – 1.030Specific gravity – 1.010 – 1.030

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Chemical examinations includesChemical examinations includesReaction – Acidic (avg 6)Reaction – Acidic (avg 6)Protein (24hrs urine) – less than 150mg/24 Protein (24hrs urine) – less than 150mg/24

hourhourGlucose (reducing substance)Glucose (reducing substance)ketonesketones

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Microscopic examinations includesMicroscopic examinations includes Cells Cells

Epithelial cells – normally found in samall number Epithelial cells – normally found in samall number WBC ( Pus cells )WBC ( Pus cells ) RBC ( normal, dysmorphic )RBC ( normal, dysmorphic ) Others Others

Casts --RBC casts, WBC casts, epithelial casts, granular Casts --RBC casts, WBC casts, epithelial casts, granular casts casts

Crystals - uric acid, calcium oxalate, triple phosphate, Crystals - uric acid, calcium oxalate, triple phosphate, calcium carbonate etc calcium carbonate etc

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Estimation of GFREstimation of GFR

Calculation of creatinine clearanceCalculation of creatinine clearance

Cockcroft and Gault: Cockcroft and Gault: {(140-age) {(140-age) X body weight X 1.22 (male) and 1.04 (female)} X body weight X 1.22 (male) and 1.04 (female)}

Divided by serum creatinine in μmol/l Divided by serum creatinine in μmol/l

More accurate method:More accurate method: {Urine creatinine×urine volume} X {Urine creatinine×urine volume} X 1000 1000

divided by serum creatininedivided by serum creatinine 14401440

Normal range:Normal range: Men 90-140 ml/minMen 90-140 ml/min Women 80-125 ml/min.Women 80-125 ml/min.

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Imaging Imaging Plain X-Ray abdomenPlain X-Ray abdomen

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Excretion urography(IVP/IVU)Excretion urography(IVP/IVU) AntegradeAntegrade RetrogradeRetrograde

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Excretion urography(IVP/IVU)Excretion urography(IVP/IVU) AntegradeAntegrade RetrogradeRetrograde

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Micturating cystourographyMicturating cystourography

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UltrasoundUltrasound

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Renal angiogramRenal angiogram

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Computed tomogram (CT)Computed tomogram (CT)

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Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)

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T1-weighted axial image without & with contrast medium

Radionuclide studies (DMSA and DTPA)Radionuclide studies (DMSA and DTPA)

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Renal biopsyRenal biopsy

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