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L’analyse d’urine et les glomerulon é phrites

L’analyse d’urine et les glomerulon é phrites. Dr Tim Meagher Exam O ne Canada AQTV, Qu é bec, 2008. L’analyse d’urine. Apparence gravit é spécifique Cellules: leucocytes, globules rouges h é moglobine Prot é ines bact éries Cylindres, rouges, blancs, hyaline. Gravit é sp é cifique.

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L’analyse d’urine et les glomerulon é phrites

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  1. L’analyse d’urine et les glomerulonéphrites Dr Tim Meagher ExamOne Canada AQTV, Québec, 2008

  2. L’analyse d’urine • Apparence • gravité spécifique • Cellules: leucocytes, globules rouges • hémoglobine • Protéines • bactéries • Cylindres, rouges, blancs, hyaline

  3. Gravité spécifique • Une mesure de concentration • Plus l’urine est concentré plus la GS est elevé • Plus l’urine est dilué plus la GS est bas • La GS dépend des tubules

  4. Hématurie • Globules rouges ou hémoglobine • Gloubules rouges proviennent du rein uretère, véssie ou prostate • > 5 méritent une investigation

  5. Leucocytes • Pyurie • proviennent du rein, uretère, véssie, prostate, ou urèthre • Cystite • Peuvent etre assures sans investigation

  6. Bactéries • Dénotent inflammation • Infection (cystite, pyelonéphrite) • Néphrite interstitielle • Medicaments, réaction allergique • Asymptomatique ou symptomatique • Accompagnées de globules blancs

  7. Cylindres (casts) • Sont des ‘empreintes’ des tubules • Proviennent des reins • D’importance variée • Bénins: hyalines, granulaires en petite quantité • Pathologies importantes: granulaires en grande quantité, RBC casts

  8. Protein comes in many sizes • Size is described in ‘molecular weight’ • Low molecular weight (small) • Light chains • Medium molecular weight (medium) • Need an example • High molecular weight (large) • albumin

  9. How does kidney handle protein? • Filters • Reabsorbs • Minimally excretes

  10. Urinary protein • Some protein is normal! • 150 mgs in 24 hours • 10-15 mgs is albumin • Small sized plasma proteins • Pieces of renal cells • ‘Proteinuria’ is an abnormal amount of protein in urine, • ie > 150 mgs in 24hrs.

  11. Detecting protein in urine • Dipstick (used in physician offices) • Trace, 1+, 2+, 3+ • False positive situations exist • High specific gravity (very concentrated urine) • Very alkaline urine • False negative situations exist • Very low specific gravity (very dilute urine) • Rule of thumb • Protein level (mgs %) should not exceed SG (last 2 digits) • Eg if SG is 1.022, protein should be < 22 mgs% • If SG 1.30 protein should be < 30 mgs%

  12. (IV) MEASURING PROTEINURIA Quantitative 10 - 30 mg/dL 31 - 50 mg/dL 51 - 125 mg/dL 126 - 300 mg/dL 301 mg/dL & up Semiqualitative (Dipstix) Trace 1+ 2+ 3+ 4+

  13. Detecting protein in urine (2) • Quantitative • Spot measurement- usually recorded in mgs% or mmol/L • 24 hour urine collection • Measure protein and creatinine • Cumbersome, inconsistent and unreliable • < 1G creatinine excreted: likely an incomplete collection

  14. PROTEINURIA (INSURANCE POPULATION) viz. 60% of cases of increased protein in urine in insurance population = due to increased albumin

  15. Detecting protein in urine (3) • protein/ creatinine ratio • Independent of specific gravity or urinary volumes • > 0.2mgs/ G creatinine is abnormal • 0.2-1.5 suggests tubular disease • > 1.5 suggests glomerular disease

  16. Detecting protein in urine (4) • Albumin/creatinine ratio • Proteinuria may be due to non-renal sources • Prostate, vaginal. RBC’s WBC’s • albuminuria is specific for renal disease • < 30mgs / 24 hours is N (< 3 mgs%) • ‘Microalbuminuria’ is 30-300 mg/24h. (3-30mgs%) • ‘Macroalbuminuria’ is > 300 mg/24h. (> 30mgs%) • Albumin/ creatinine ratio > 0.3 is abnormal

  17. Measuring urinary albumin

  18. Why measure albumin in urine? • Better index of glomerular disease • As glomerular disease progresses albuminuria appears first. This is called ‘microalbuminuria’ • As amount of albumin increases we use the term ‘macroalbuminuria’ or ‘proteinuria’ (as dipstick for protein is now positive)

  19. Benign proteinurias • Intermittent proteinuria • Postural or ‘orthostatic’ • N supine; elevated when upright • Exercise-induced • Febrile illnesses • Contaminants: seminal, prostatic, vaginal fluids

  20. Pathologic proteinurias • Constant proteinurias • > 1/3 specimens (insurance) • > 3 months duration (clinical) • Albuminuria • Microalbuminuria • Macroalbuminuria • Bence-Jones proteinuria

  21. Don’t jump to conclusions! • Albumin levels vary • posture, exercise, fever, other • Creatinine levels vary • Handling delays reduce urine creatinine • creatinine production decreases with • Increasing age • Older women in particular • 50% of abnormal results will be normal with re-testing!

  22. Significant proteinuias • Glomerular • Glomerulus is ‘leaky’ • Too many proteins are making way into tubule • Tubular • Tubules are not reabsorbing • overflow • Capacity of tubules to reabsorb is overwhelmed • Tubules are working normally

  23. structure of glomerulus arteriole collecting duct to bladder

  24. normal glomerulus

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