Analysis:
Routine urine examination items, reference values and clinical significance
Urine pH value of 5.0~7.0 is less than 5.0, which is called acidic urine, and greater than 7.0 is called alkaline urine.
The maximum range of urine specific gravity is about1.002 ~1.030+0.015 ~1.025 morning urine 1.020. Increased specific gravity of urine: prerenal oliguria caused by high fever dehydration; Gru curia; Proteinuria and radioactive contrast agent can increase the specific gravity of urine. 2. Decreased urine specific gravity: reflecting hypotonic urine, visible renal tubular and interstitial damage; When diabetes insipidus occurs, it is characterized by severe low specific gravity urine.
Urine sediment examination
Leukocyte < 5 /HP indicates urinary system infection.
Erythrocyte 0~ occasionally /HP can be seen in urinary calculi, inflammation, glomerular diseases, etc. It can also be seen in systemic hemorrhagic diseases such as thrombocytopenic purpura and hemophilia.
children
Epithelial cells 0~ a small amount /HP renal parenchyma damage can be seen renal tubular epithelial cells; A large number of transitional epithelial cells are wary of transitional epithelial cell carcinoma; A large number of stratified squamous epithelial cells suggest urethritis.
Cast 0~ occasionally transparent cast /HP renal epithelial cell cast can be seen in acute tubular necrosis, renal amyloidosis, acute glomerulonephritis, chronic nephritis, nephrotic syndrome, rejection after renal transplantation, metal and other chemical poisoning; Erythrocyte cast is common in glomerular diseases; Leukocyte casts usually indicate active infection of renal parenchyma; Granular cast often suggests the late stage of chronic nephritis or acute glomerulonephritis; Transparent cast can be seen in physiological or nephrotic syndrome, chronic nephritis, heart failure and so on. Wax casts often suggest that renal tubular lesions are serious; Plaster of renal failure usually indicates poor prognosis.
Urine sediment 12h count (Addis count)
Erythrocyte < 500,000/65,438+0.2h, the number of cells and casts in urine of patients with various nephritis can be increased from mild to significant. White blood cells increased significantly in pyelonephritis, urinary tract infection and prostatitis.
White blood cells < 1 10,000/12h
Tube type < 5000 pieces/12h
Urine sediment 3h count
Leukopyelonephritis increased by 400,000 white blood cells/hour and acute glomerulonephritis increased by 200,000 red blood cells/hour. ..
Male < 70,000 pieces/hour
Female <140,000 pieces/hour
erythrocyte
Male < 30,000 pieces/hour
Female < 40,000 pieces/hour
0 tubes/hour
Urine multinomial determination test paper
The semi-quantitative determination of urine protein (PRO) is negative or micro-suggests (1) that the typical selective glomerular proteinuria sexually transmitted disease is nephrotic syndrome; Non-selective glomerular proteinuria can be seen in all kinds of primary glomerulonephritis and also in all kinds of secondary glomerulonephritis, suggesting a poor prognosis. Tubular proteinuria can be seen in various tubulointerstitial diseases; Mixed proteinuria can be seen in renal diseases involving glomeruli and renal tubules; Overflow proteinuria can be seen in plasma cell diseases such as multiple myeloma, acute intravascular hemolysis such as paroxysmal nocturnal hemoglobinuria, and acute muscle injury such as crush syndrome. Normal people can see functional proteinuria during strenuous exercise, and normal teenagers can see upright proteinuria.
Glucose determination (Glu) negative (1) can be seen in diabetes, chronic nephritis, renal tubular injury, stress factors, abnormal liver function or pseudodiabetes caused by oral isoniazid and aspirin.
Negative occult blood test (BLD) (1) False positive will appear when the concentration of vitamin C in various glomerular diseases increases.
Ketone body test (KET) negative (1) can be seen in diabetic ketosis, stress factors, hunger and so on.
BIL is negative (1), which can be seen in acute icteric hepatitis and obstructive jaundice. Drug-induced inflammation, fibrosis and cholestasis around portal vein.
Nitrite (NIT) negative (1) can be seen in urinary tract infection, and eating foods rich in vitamin C or nitrate will lead to false positive.
Negative leukocyte (lipase) (1) indicates urinary tract infection.
Special urine examination
Urinary fibrin degradation product (FDP) 0? The increase of urine FDP in g/ml primary glomerular disease indicates the progressive development of renal disease and anticoagulation. Urine FDP can also be positive in patients with disseminated intravascular coagulation, primary fibrinolytic disease and renal tumor.
Examination of antibody-wrapped bacteria suggests upper urinary tract infection.
The normal molecule of urine protein disc electrophoresis is 1 ~ 1 10,000; Low molecular proteinuria1~ 70000; Middle molecular proteinuria is 50 ~ 654.38+ 10,000; High molecular weight proteinuria 56438+100,000 mixed proteinuria 1 ~ 1 10,000 renal tubular damage diseases, such as acute pyelonephritis, renal tubular acidosis, etc., often appear small molecular weight proteins, and the main electrophoresis bands are below albumin and albumin; In diseases with glomerular damage, such as primary and secondary glomerulonephritis, nephrotic syndrome, etc. , middle molecular and large molecular weight proteins often appear, and the main electrophoresis bands are near and above albumin; The whole nephron is damaged, such as chronic renal failure, and mixed proteinuria often occurs, and the electrophoresis band is mainly in albumin band.
Determination of urinary enzyme activity
amylase in urine
Urinary N-β-D glucosaminidase (NAG)9.24±8.4? The increase of urinary NAG in g/ml mainly reflects renal tubular injury, such as renal tubular necrosis and interstitial nephritis caused by ischemia or poisoning. Renal transplantation rejection; Chronic glomerulonephritis, nephrotic syndrome and so on.
Urine lysozyme 0. 13 0.62? G/ml suggests renal tubular lesions, and persistent failure suggests poor renal tubular function recovery; It will increase in acute monocytic leukemia.
C3 of minimal change nephritis and renal tubular lesion was 0, and C3 and IgM in urine were mostly negative. Positive often suggests non-selective proteinuria; The increase of IgM in urine indicates that the glomerular filtration membrane is seriously damaged and the curative effect and prognosis are poor.
IgM determination 0
Measured adults in urine osmotic pressure: 600~ 1000mO *** /L Average: 800 mO *** /L 1. Increased urine osmotic pressure: Prerenal oliguria and glycosuria caused by high fever and dehydration. 2. urine osmotic pressure decreased: renal tubular and interstitial damage such as acute and chronic renal failure can be seen; diabetes insipidus
Urine microalbumin < 20~200? G/min early diabetic nephropathy; Most glomerular diseases, lupus nephropathy, tubulointerstitial diseases, etc. Hypertension, obesity, hyperlipidemia, smoking and drinking can also cause microalbuminuria.
Urinary β2- microglobulin
Urine A 1- microglobulin 0 ~ 1.5 mg/L is an early diagnostic index for renal proximal convoluted tubule damage.
Urinary Tamn-Horsfall protein (THP) is 29.8 ~ 43.9 mg/24 h, and the increase of THP in urine is seen in long-term urinary tract obstruction, reflux, interstitial nephritis, nephrotic syndrome, cadmium poisoning nephropathy, etc. Acute renal tubular injury caused by rejection and nephrotoxic drugs after renal transplantation can be temporarily increased. The decrease of THP excretion can be seen in many chronic kidney diseases, and THP is hardly excreted when renal failure occurs. Judging the curative effect of extracorporeal shock wave lithotripsy, the content of lithotripsy reached its peak on the second day after success, and then gradually decreased.
Crush syndrome caused by myoglobin urine negative trauma; Ischemic myoglobinuria, such as arterial occlusion and myocardial infarction. Hereditary myoglobinuria is caused by phosphorylase deficiency; Paroxysmal myoglobinuria occurs several hours after the onset of muscle pain spasm.
Negative hemoglobinuria is found in acute intravascular hemolysis, such as paroxysmal nocturnal proteinuria, some poisonous snake bites, hemolytic transfusion reaction of blood group incompatibility, etc.
Bence-jones proteinuria negative is mainly seen in patients with monoclonal immunoglobulin, such as multiple myeloma.
Simply put, it mainly depends on whether there is kidney disease.