HEMATURIA AND
EXAMINATION OF THE URINE
汇报提纲
1
Hematuria
2
Proteinuria
3
Appearance of urine
4
Volume of urine
5
Specific gravity and osmolality
6
PH (potential of hydrogen)
Hematuria
Type
 microscopic hematuria
defined as 4 erythrocytes per high-powered field on a spun
urine specimen
 gross hematuria
bloody urine ,indicates sufficient red blood cells to discolor the
urine
Clinical occurrence
1.systemic disease
blood disease, congenital hemophilia, sickle cell disease,
leukaemia, thrombocytopenia, bleeding disorders,
including anticoagulant drugs; scurvy. vitamin K deficiency
2.Infective disease
epidemic hemorrhagic fever, ichorrhemia,
epidemic meningitis;
3.Cardiovascular disease: infective endocarditis,
Malignant hypertension, congestive heart failure;
4.Urinary system disease
diastrophic erythrocyturia: glomerular hematuria
glomerular disease: acute glomerulonephritis, nephrotic syndrome,
orthomorphic erythrocyturia: non-glomerular hematuria
non-renal source: infarct/papillary necrosis, trauma , pyelitis,
stones, renal tumours/ infection/tuberculosis, kidney injury of drugs
(e.g.,sulfonsmides, nonsteroidal, antiinflammatory drug or mannitol),
renal infarction.
post renal: Ureteric/bladder stone; ureteric /bladder/ prostate cancers;
bladder tuberculosis, infectious urethritis, prostatitis,
interstitial/bacterial cystitis ; urethral stricture , Urethral neoplasma
5 others
Radiation nephritis or cystitis, metabolic/toxic hemorrhagic cystit
is( e.g. cyclophosphamide or ifosfamide) ,analgesic Nephropathy,
anticoagulants
6 functional
heavy exercise, fever, post surgical.
Clinical feature
1Change of color:
• Microscopic hematuria: normal
• Gross hematuria: color change according to the amount of
bleeding.
• Renal bleeding---dark red
• Bladder/prostate bleeding---Bright red
• Red color urine is not all hematuria: haemoglobinuria or
myoglobinuria
Normal chyluria hematuria
haemoglobinuria
2.Source of blood:
initial hematuria: urethra
terminal hematuria : the trigone region of the bladder or prostate
total hematuria : the kidney or ureter.
erythrocyte casts :proves a renal source
3.Microscopic hematuria
found only on chemical testing,
judge renal source or not renal source
diastrophic erythrocyturia ----glomerular hematuria
Red cells size differ, shape multiplicity
orthomorphic erythrocyturia---- non- glomerular hematuria
renal pelvis calices, Ureteric, bladder , prostate
Red cells shape unity
4.symptomatic hematuria
renal region dull pain or colicky pain – renal disease
frequent micturition, urgent micturition, Dysuria—bladder, urethra
5.asymptomatic hematuria
the early stage of some disease
tuberculosis of kidney, renal carcinoma or bladder carcinoma,
hiding nephritis
Test
• Stix test followed by microscopy
fresh urine, exception of menstruating
confirm the presence of red cells ,
exclude haemoglobinuria or myoglobinuria.
. detect red-cell casts, which are diagnostic of glomerulonephritis.
• In the absence of red-cell casts, further investigations, such as
urine cytology, renal imaging and cystoscopy, are required to
define the site of bleeding.
• Renal biopsy may be required
Proteinuria
• Proteinuria is one of the most common signs of renal
disease. Detection is primarily by Stix testing.
• Most reagent strips can detect protein if albuminuria
exceeds 300 mg/d.
• Most reagent strips react primarily with albumin and are
relatively insensitive to globulin and Bence Jones proteins.
• Excretion in 24 hour urine collections should be measured.
• Healthy adults excrete up to 30 mg daily of albumin.
• fever, exercise and adoption of the upright posture
(postural proteinuria) all increase urinary protein output
but are benign.
Appearance
 Little value except diagnosis of hematuria
 Very concentrated urine appear dark .
 Discoloration of urine:
cholestatic jaundice, haemoglobinuria, drugs such as
rifampicin, use of fluorescein or methylene blue, and
ingestion of beetroot.
after standing for some time occurs in porphyria,
ingesting the drug L-dopa.
Volume
Determined by diet and fluid intake. Normal 1000–2000 ml/d
The minimum amount 650ml/d to stay in fluid balance.
oliguria <400ml /d
anuria <100ml/d
polyuria>2500ml /d
Chronic kidney disease or diabetes, insipidus, impairment of
concentrating ability requires increased volumes of urine
to be passed, given the same daily solute output. An
increased solute output, such as in glycosuria or increased
protein catabolism following surgery, also demands
increased urine volumes.
Specific gravity and osmolality
• Urine specific gravity is a measure of the weight of
dissolved particles in urine, whereas urine osmolality
reflects the number of such particles.
• Measurement of is required only in the differential
diagnosis of oliguric renal failure or the investigation of
polyuria or inappropriate ADH secretion.
• Specific gravity1.015-1.025 ,
• Specific gravity is usually fixed at 1.010 in CKD or acute
tubular necrosis as compared to prerenal acute kidney
injury and inappropriate ADH secretion where specific
gravity is very high close to 1.025.
Urine PH
• Measurement of urinary pH is nnecessary except
in the investigation and treatment of renal tubular
acidosis.
• 6.5
Dysmorphic
Rbc
Glomerular
disease
hematuria
Hemogeneous
Rbc
Calculus,tumor,
TB,infection
• proteinuria>150mg/24hr
Proteinuria analysis
glomerular
>1.5g/24hr
Selective Non
Selective
(albumin)
(mixture)
tubular
overflow
secretory or
<1.5g/24hr immunoglobulin histic
Β2-micro
globulin
Bence Jones
protein
Infection
toxicity
myeloma
• 10cm in length
• 5cm in width
• 4cm in
thickness
• 134 ~ 148g in
weight
Renal Cortex
• renal cortex
– 80~90% of
glomerulus
– Glomerular
capsule
• renal medulla
– renal tubule