investigations of urinary system dr. s chakradhar 1
TRANSCRIPT
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
DR. S ChakradharDR. S Chakradhar 22
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
DR. S ChakradharDR. S Chakradhar 33
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
DR. S ChakradharDR. S Chakradhar 44
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
DR. S ChakradharDR. S Chakradhar 55
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
DR. S ChakradharDR. S Chakradhar 66
DR. S ChakradharDR. S Chakradhar 77
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.
DR. S ChakradharDR. S Chakradhar 88
Imaging Imaging Plain X-Ray abdomenPlain X-Ray abdomen
DR. S ChakradharDR. S Chakradhar 99
Excretion urography(IVP/IVU)Excretion urography(IVP/IVU) AntegradeAntegrade RetrogradeRetrograde
DR. S ChakradharDR. S Chakradhar 1010
Excretion urography(IVP/IVU)Excretion urography(IVP/IVU) AntegradeAntegrade RetrogradeRetrograde
DR. S ChakradharDR. S Chakradhar 1111
Micturating cystourographyMicturating cystourography
DR. S ChakradharDR. S Chakradhar 1212
UltrasoundUltrasound
DR. S ChakradharDR. S Chakradhar 1313
Renal angiogramRenal angiogram
DR. S ChakradharDR. S Chakradhar 1414
Computed tomogram (CT)Computed tomogram (CT)
DR. S ChakradharDR. S Chakradhar 1515
Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)
DR. S ChakradharDR. S Chakradhar 1616
T1-weighted axial image without & with contrast medium
Radionuclide studies (DMSA and DTPA)Radionuclide studies (DMSA and DTPA)
DR. S ChakradharDR. S Chakradhar 1717
Renal biopsyRenal biopsy
DR. S ChakradharDR. S Chakradhar 1818