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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
Reabsorption
Ureum
Creatinine
Secretion
Collection
(concentration)
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
Squamous
epithelial cell
Transisional
epithelial cell
Tumor cell
Hyaline cast
Granular cast
Cellular cast
Fatty cast
Waxy cast
Uric acid
Struvite
Di-Oxalate crystal
Carbonat
Amorph
Cystine
Biurate
Tyrosine
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
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