Tests for Abnormal Constituents in Urine
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Biochemical Profiling of Renal Diseases
INTRODUCTION TO LABORATORY PROFILING Alan H. Rebar, DVM, Ph.D., Diplomate ACVP Purdue University, Discovery Park 610 Purdue Mall, West Lafayette, IN 47907-2040 Biochemical profiling may be defined as the use of multiple blood chemistry determinations to assess the health status of various organ systems simultaneously. Biochemical profiling rapidly has become a major diagnostic aid for the practicing veterinarian for several reasons. First, a more educated clientele has come to expect increased diagnostic sophistication. Secondly, the advent of high-volume clinical pathology laboratories has resulted in low prices that make profiling in veterinary practice feasible and convenient. In addition, improved technology has resulted in the development of procedures that can be used to obtain accurate analyses on microsamples of serum. Such procedures offer obvious advantages to veterinarians, who in the past were hindered by requirements for large sample size. Although biochemical profiling offers exciting potential, it is not a panacea. Since standard chemical screens provide 12 to 30 test results, interpretation of data may be extremely complex. Interpretation is often clouded by the fact that perfectly normal animals may have, indeed, are expected to have, an occasional abnormal test result. It is estimated that in a panel of 12 chemistry tests, approximately 46% of all normal subjects will have at least one abnormal test result. Such abnormalities do not reflect inaccuracies in laboratory test procedures but rather the way in which reference (or normal) values are determined. In order to establish the "normal range" for a given test, the procedure is performed on samples from a large population of clinically normal individuals. -
Guidelines for Approach to a Child with Metabolic Acidosis (Including RTA)
Guidelines for approach to a child with Metabolic acidosis (including RTA) Children’s Kidney Centre University Hospital of Wales Cardiff CF14 4XW DISCLAIMER: These guidelines were produced in good faith by the authors reviewing available evidence/opinion. They were designed for use by paediatric nephrologists at the University Hospital of Wales, Cardiff for children under their care. They are neither policies nor protocols but are intended to serve only as guidelines. They are not intended to replace clinical judgment or dictate care of individual patients. Responsibility and decision-making (including checking drug doses) for a specific patient lie with the physician and staff caring for that particular patient. Version 1, S. Hegde/Sept 2007 Metabolic acidosis ormal acid base balance Maintaining normal PH is essential for cellular enzymatic and other metabolic functions and normal growth and development. Although it is the intracellular PH that matter for cell function, we measure extra cellular PH as 1. It is easier to measure 2. It parallels changes in intracellular PH 3. Subject to more variation because of lesser number of buffers extra cellularly. Normal PH is maintained by intra and extra cellular buffers, lungs and kidneys. Buffers attenuate changes in PH when acid or alkali is added to the body and they act by either accepting or donating Hydrogen ions. Buffers function as base when acid is added or as acid when base is added to body. Main buffers include either bicarbonate or non-bicarbonate (proteins, phosphates and bone). Source of acid load: 1. CO2- Weak acid produced from normal metabolism, dealt with by lungs pretty rapidly(within hours) 2. -
Obesity, Albuminuria, and Urinalysis Findings in US Young Adults from the Add Health Wave III Study
CJASN ePress. Published on October 17, 2007 as doi: 10.2215/CJN.00540107 Obesity, Albuminuria, and Urinalysis Findings in US Young Adults from the Add Health Wave III Study Maria Ferris,* Susan L. Hogan,* Hyunsook Chin,* David A. Shoham,† Debbie S. Gipson,* Keisha Gibson,* Sema Yilmaz,‡ Ronald J. Falk,* and J. Charles Jennette§ *University of North Carolina Kidney Center and Division of Nephrology and Hypertension and §Department of Pathology and Laboratory Animal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; †Department of Preventive Medicine and Epidemiology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; and ‡Department of Pediatrics, Hospital of Dumlupinar University, Kutahya, Turkey Background and objectives: Obesity has been associated with kidney disease in adults. This study was designed to evaluate the association of obesity with an early marker of kidney disease, albuminuria, among young adults. and body mass ,(4463 ؍ albumin-to-creatinine ratio (n ,(9371 ؍ Design, setting, participants, & measurements: Urinalysis (n index (kg/m2) were measured in the Add Health Wave III cohort (2001 to 2002), a multiethnic sample of young adults followed for approximately 6 yr. Multivariate logistic regression modeled the association of sex-specific albuminuria with body mass index, adjusted for sample weights, sex, race, ethnicity, and glycosuria. Results: Urinalysis revealed that 0.8% had proteinuria, 4.6% had hematuria, 0.2% had combined hematuria and proteinuria, and 1.5% had glycosuria. Albuminuria prevalence was 4.4%. Mean body mass index was higher among those with albuminuria compared with those without. There were no associations between body mass index categories of 25 to <30 or 30 to <35 kg/m2 with albuminuria compared with the lowest body mass index (<25 kg/m2); however, the highest category (>35 kg/m2) was %95 ;4.0 ؍ CI: 1.02 to 3.04). -
The Investigation of Symptomless Glycosuria with the Galactose and Cortisone Modified Glucose Tolerance Tests by R
J Clin Pathol: first published as 10.1136/jcp.11.5.428 on 1 September 1958. Downloaded from J. clin. Path. (1958), 11, 428. THE INVESTIGATION OF SYMPTOMLESS GLYCOSURIA WITH THE GALACTOSE AND CORTISONE MODIFIED GLUCOSE TOLERANCE TESTS BY R. B. GOUDIE, W. P. STAMM, AND S. DISCHE From the Royal Air Force Institute of Pathology and Tropical Medicine (RECEIVED FOR PUBLICATION OCTOBER 21, 1957) Glycosuria is sought in routine clinical exami- Joslin and Lawrence are two leading authorities nations in order to detect patients with early or who are representative of the two main schools of mild diabetes mellitus. There is good evidence thought. Joslin, Root, White, and Marble (1952) that early treatment may avert deterioration and gave the following criteria for the diagnosis of lead to a lower and later incidence of the vascular, diabetes mellitus with the 100 g. glucose tolerance renal, and ophthalmic complications (Dunlop, test (" true glucose " technique, capillary blood): 1954; Ricketts, 1947). a fasting blood glucose over 100 mg./100 ml., Certain occupations are unsuitable for the dia- or a peak glucose value over 170 mg./100 ml. He betic, and early diagnosis is of particular im- considered that the two-hour level was " of greatcopyright. portance in the Royal Air Force because a value " but that " one cannot disregard the height diagnosis of diabetes is a ban on aircrew duties. to which the curve goes. In borderline cases it is Since other conditions may give rise to glycos- well to be conservative and to repeat the test on uria, its discovery must be followed by a careful a later occasion." investigation in every case to determine the cause. -
Hyperglycaemia, Glycosuria and Ketonuria May Not Be Diabetes J Gray, a Bhatti, J M O'donohoe
The Ulster Medical Journal, Volume 72, No. 1, pp. 48-49, May 2003. Case Report Hyperglycaemia, glycosuria and ketonuria may not be diabetes J Gray, A Bhatti, J M O'Donohoe Accepted 20 November 2002 Diabetic ketoacidosis is a well recognised, tenderness, maximal in the lower abdomen now important, but rare differential diagnosis ofacute with associated guarding and rebound. abdominal pain in children. We report a case A presumptive diagnosis of acute appendicitis highlighting the need for complete assessment of was made and an exploratory laparotomy any child presenting with new-onset glycosuria, undertaken through a lower mid line incision. A ketonuria and hyperglycaemia. Causes other than perforated appendix was found along with pus in diabetes may rarely produce these findings. the peritoneal cavity. Appendicectomy and CASE REPORT A girl aged three years and ten peritoneal lavage were performed. months with a six-hour history ofabdominal pain Postoperative recovery was uneventful, and she and vomiting was referred to the surgical team by was discharged home on the third postoperative a general practitioner. Past medical history day. Subsequent random blood glucose was included a diagnosis of non-specific abdominal normal at 4.6mmol/L. Her HbAlc was normal pain at three years old. There was no significant while islet cell antibodies were negative. At review family history nor recent illness in the family she was well, with no complaints orcomplications. circle. DISCUSSION On examination she was restless and thirsty, but apyrexic. There was no foetor or rash. She had Rarely diabetic ketoacidosis may present with grunting respiration with tachypnoea, but the acute abdominal pain.' As this is an important lungs were clear on auscultation. -
Clinical Significance of Biochemical Detection in Urine the Importance Of
Clinical significance of biochemical detection in urine The Importance of Urinalysis for Veterinary use In addition to the external excretion of metabolic products, sick pet urine also contains other pathogens as well as physical particles and cellular components. The physical ， biochemical and cellular analysis of pet urine allows a comprehensive pathological assessment for pet various diseases. Due to their special body structure, pets such as cats, dogs etc. are prone to suffer from diseases of the urinary tract, which can endanger the health of pets. Urinalysis testing allows a profound diagnosis of pet diseases such as: • Kidney disease • Liver diseases • Diabetes mellitus • Anemia • Inflammation of urinary tract In addition, periodic physical examination is an important measure to maintain the health of pets, and early regular urine examinations also provides a wide range of comprehensive health information for pets. Ⅰ. Uric acid base reaction Clinical significance: The clinical significance of urine acid-base changes. The change of urine pH will affect the type of crystal formation in urine is as follows: 1. Pathological acid urine is found in animals, such as carnivores, suckling animals, and starved animals. Pathological acid urine is found in fever, acidosis (diabetes, uremia, etc.). Oral acid salts, such as phosphate, ammonium chloride, and sodium chloride, can cause artificial acid urine. 2. Alkaline urine is present in herbivores. Pathologically alkaline urine is present in cystitis, urinary retention (bacterial breakdown of urea into ammonia), and alkalosis. Artificially alkaline urine can be produced by alkaline salts, such as sodium bicarbonate, sodium citrate, and sodium lactate. Ⅱ.Urine protein Clinical meaning: The protein content in the urine increases, the physiology and pathology should be considered when increased protein is seen. -
Idiopathic Rhabdomyolysis D
Arch Dis Child: first published as 10.1136/adc.46.249.594 on 1 October 1971. Downloaded from Archives of Disease in Childhood, 1971, 46, 594. Idiopathic Rhabdomyolysis D. C. L. SAVAGE, MEHROO FORBES*, and G. W. PEARCE From the Department of Child Health, Dundee University; and the Department of Pathology, Newcastle General Hospital, Newcastle upon Tyne Savage, D. C. L., Forbes, M., and Pearce, G. W. (1971). Archives of Disease in Childhood, 46, 594. Idiopathic rhabdomyolysis. The clinical, biochemical, and pathological findings in 2 children with idiopathic rhabdomyolysis are reported. Hypocalcaemic tetany, a previously unrecognized complication of severe muscle damage, was seen in one child and was associated with hyperphosphataemia and hyperphosphaturia consequent on the rhabdomyolysis. Respiratory distress and an acute tubular necrosis contributed to her eventual death. The second child recovered; an intracellular granular material of unknown nature was seen in his muscle biopsy on electron microscopy. The literature of idiopathic recurrent rhabdomyolysis occurring in childhood is reviewed. Idiopathic rhabdomyolysis, which may be re- with glucose 72 mg/100 ml. Urine contained a trace current, is a rare and potentially lethal disorder of of sugar and ketones. skeletal muscle, not previously recorded in the The child died shortly after admission to hospital, and copyright. British paediatric literature. Two forms of the death was recorded as being due to diabetic ketosis. At necropsy no abnormality was found; muscle tissue disease have been described: Type I usually pre- was not examined. In retrospect the CSF glucose ceded by physical exertion, and Type II often level makes this diagnosis untenable and it is probable associated with mild infections. -
Benedict's Testas Performed with the Qualitative Reagent Is Definitely
March, 1934 GLYCOSURIA IN CHILDHOOD 105 Postgrad Med J: first published as 10.1136/pgmj.10.101.105 on 1 March 1934. Downloaded from GLYCOSURIA IN CHILDHOOD.t By NOAH MORRIS, M.D. (From the Department of Pcediatrics, University of Glasgow and Biochemical Laboratory, Royal Hospital for Sick Children, Glasgow.) Glycosuria although not in itself serious is of the utmost importance as a diagnostic clue to a metabolic defect which may or may not be of grave import. In the majority of cases the onset of diabetes mellitus in childhood is heralded by the symptoms of thirst and polyuria: thus in 30 cases of diabetes at the Royal Hospital for Sick Children, Glasgow, thirst was a first manifestation in 27 and polyuria in 23. Nevertheless, there exists a certain number in whom the onset of glycosuria is silent so that in the routine examination of children it is of importance not to neglect the urinary tests which in children are so apt to be overlooked. It must, however, be emphasized that although glycosuria associated with polyuria and thirst is almost invariably due to diabetes, silent glycosuria is frequently not of the same grave significance. Hoist has followed the subsequent histories of who were refused life insurance because of he found that I50 persons glycosuria: Protected by copyright. over periods varying from 5 to I6 years only 30 exhibited the clinical picture of true diabetes mellitus. It is clear, therefore, that the correct interpretation of "silent" glycosuria presents a problem of great practical importance to the patient. The common tests for glycosuria are Fehling's and Benedict's. -
Tubular Dysfunction and Microalbuminuria in Insulin Dependent Diabetes Bulging Fontanelles in Infants Without Meningitis
Correspondence 635 4Packe GE, Innes JA. Protective effect of BCG vaccination in Walton's study, a significant correlation was found be- infant Asians: a case-control study. Arch Dis Child 1988;63: tween HbAjc values and urinary a-1-microglobulin excre- 277-81. tion as well as between 24 hour glycosuria and urinary excretion of a-1-microglobulin. In poorly controlled dia- G E PACKE and J A INNES betics with duration of disease shorter than 10 years (group Birmingham Chest Clinic, A and B) urinary a-1-microglobulin excretion returned to Birmingham normal when metabolic control improved, while it re- mained high in children with duration of diabetes longer than 10 years (group C) (table). Albumin excretion rate was less than 15 tg/minute in all diabetic children during the study. Our data confirm that glycaemic control influences Tubular dysfunction and urinary excretion of a-1-microglobulin; however, despite microalbuminuria in insulin dependent good metabolic control, children with long duration of diabetes diabetes and without microalbuminuria show an increased excretion of a-1-microglobulin. Sir, Although diabetic kidney disease is primarily a In a recent paper by Walton et al investigating tubular glomerulopathy,3 we believe that impaired tubular func- function in diabetics, urinary a-1-microglobulin excretion tion is detectable earlier than glomerular damage. was found to be significantly higher in diabetic children compared with controls.' Using an enzyme immunoassay References (Imzyne a,-M, Fujirebio Inc) we obtained similar results. Walton C, Bodansky HJ, Wales JK, Forbes MA, Cooper EH. In 62 type 1 diabetics (38 girls), aged 3 to 21 years, with Tubular dysfunction and microalbuminuria in insulin dependent duration of disease from one week to 13 years, urinary diabetes. -
Pitfalls of Using Microalbuminuria As a Screening Tool to Identify Subjects with Increased Risk for Kidney and Cardiovascular Disease
Pitfalls of using microalbuminuria as a screening tool to identify subjects with increased risk for kidney and cardiovascular disease Results of the Unreferred Renal Insufficiency (URI) study and the Early Renal Impairment and Cardiovascular Assessment in Belgium study (ERICABEL). Arjan van der Tol Promotor: Prof. dr. Wim Van Biesen Co-promotor: Prof. dr. Raymond Vanholder Thesis submitted in fulfillment of the requirements for the degree of ‘Doctor in Health Sciences’ 2014 Contents TABLE OF CONTENTS LIST OF ABBREVIATIONS ....................................................................................................... 5 CHAPTER 1: INTRODUCTION ................................................................................................ 7 1.1 Preface ................................................................................................................................... 9 1.2. Normal renal handling of albuminuria ................................................................................. 11 1.3. Mechanisms of tubular and glomerular albuminuria ........................................................... 13 1.4. Albuminuria as a manifestation of chronic kidney disease ................................................. 18 1.5. Albuminuria as a manifestation of cardiovascular disease .................................................. 21 1.6. The prevalence of albuminuria ............................................................................................ 25 1.7. How to measure albuminuria .............................................................................................. -
Interpretation of Urine Analysis
UNDERSTANDING URINALYSIS Slides __________________________________________________________________________________________________________ Urine Analysis Interpretation of • Appearance or color • Specific gravity • pH Urine Analysis • Leukocyte esterase March 2015 • Nitrites • Urobilinogen • Bilirubin • Glucose • Ketones • Protein • Blood • Microscopic examination Denise K Link, MPAS, PA-C The University of Texas Southwestern Medical Center [email protected] Proper Specimen Collection Routine Urine Analysis Appearance Chemical tests (dipstick) • Teach every patient how to collect proper specimen • pH 1. Clean-catch midstream • Protein 2. In patients with indwelling urinary catheters, a • Glucose recently produced urine sample should be obtained • Ketones (directly from the catheter tubing) • Blood 3. Best examined when fresh. Chemical composition • Urobilinogen of urine changes with standing and formed • Bilirubin elements degenerate with time • Nitrites • Leukocyte esterase 4. Refrigerated is best when infection is suspected • Specific gravity 5. First voided morning urine is ideal when evaluating suspected glomerulonephritis Microscopic examination of spun urinary sediment Urine Analysis with Microscopy Dipstick Methodology • Paper tabs impregnated with chemical reagents • Reagents are chromogenic • Reagents are timed developed • Some rxns are highly specific • Other are sensitive to the presence of interfering substances or extremes of pH • Rapid, semiquantitative assessment of urinary characteristics © 2015 National Kidney Foundation, -
Utility of Routine Prenatal Urine Dipsticks Authors: Michele Alba, MD and Zoë Cappe, MD
Department of Family and Community Medicine Healthy Families in Healthy Communities Utility of Routine Prenatal Urine Dipsticks Authors: Michele Alba, MD and Zoë Cappe, MD Introduction Results Gestational Diabetes Table 1. Results Abrams Family Medicine Clinic performs a Urine Dipstick screen at each Urinary Tract • The results of 35 patients were analyzed, of the total, 4 had gestational Gestational DM Preeclampsia prenatal visit. This urine test is used to screen for gestational diabetes, Infection preeclampsia, and UTI. diabetes. Two people were excluded from the study due to inability to confirm GDM (1 left practice before GDM screening with standard 1hr Sensitivity 25 0 100 Journal of Family Medicine 2005 Practice Recommendations: gtt, 1 had abnormal screen without dx 3hr gtt). Specificity 100 32 46 • Screening for gestational diabetes using urine dipsticks for glycosuria • Using presence of glucose defined on a urine dipstick as >250mg/DL, is ineffective with low sensitivities. False-positive tests outnumber true PPV 100 0 3.7 the sensitivity 25% and specificity 100% for dipstick urinalysis were positives 11:1. A 50-g oral glucose challenge is a better test. Tests for NPV 91 91 100 calculated. PPV = 100%, NPV = 91%. False negative = 75%. glycosuria after this blood test are not useful (B).1 • Proteinuria determined by dipstick in pregnancy is common and a poor Preeclampsia False Positive Rates 75 67 86 predictor for preeclampsia with a positive predictive value between 2% • The results of 32 patients were analyzed, of the total, 1 had and 11%. If the blood pressure is elevated, a more sensitive test preeclampsia.