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7/25/2019 patologi klinik kelainan ginjal
1/21
Laboratory Examination
for Renal Disease
Dr. E. Henny Herningtyas, MSi.PhD
Clinical Pathology Dept.Faculty of Medicine, UGM Yogyakarta
7/25/2019 patologi klinik kelainan ginjal
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Learning Objectives
Students understand the physiology andpathophysiology of kidney function anddisfunction
Students understand the laboratory tests toscreen, diagnose, evaluate kidney disease
Students will be able to interpret urinalysisresults to screen kidney dysfunction
Students will be able to make clinicalinterpretation of laboratory results in renaldisease
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Kidney Physiology
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Mechanism of Urin Formation
Filtration Reabsorption
Secretion
Collection(concentration)
Ureum
Creatinine
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Laboratory tests for Renal (1)
Urine:
urine chemistry (reagent strips)
Wet urinalysis (routine)
Urine microbiology
Urine cytology (conventional)
Cytodiagnostic urinalysis
Image cytometry and DNA analysis
Flow cytometry
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Kidney:
Glomerular function: BUN/ureum, creatinine,
creatinine clearance (GFR)BUN/creatinine ratio,
Tubular function: water, electrolyte (Na, K, Cl)
acid-base (bicarbonate, phosphate and hydrogen)
Endocrine function: renin, 1--hydroxylase,
eritropoetin
Laboratory tests for Renal (2)
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Causes of Renal Failure
Medical DoctorCompetence ???
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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, di-
calsium phosphate, ammo-
nium urate, calsium carbonat
Hematuria (>4/LMF) Leucocyturia (>5/LMF)
Bacteriuria
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Urinalysis Interpretation
Dry chemistry (dip stick)
pH acid
pH alkaline
Blood (+)
Leucocyte esterase (+)
Nitrit (+)
Wet urinalysis
Crystal: uric acid, calsiumoxalate, di-calsiumphosphate
Crystal:triple phosphate, di-calsium phosphate, ammo-nium urate, calsium carbonat
Hematuria (>4/LMF)
Leucocyturia (>5/LMF),pyuria
Bacteriuria
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Urine sediment (cell)
Red blood cell White blood cell Squamous
epithelial cell
Transisionalepithelial cell
Tumor cell
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Urine sediment (cast)
Hyaline cast Cellular cast
Granular cast Fatty cast Waxy cast
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Urin Sediment (crystal)
Di-Oxalate crystal
Struvite
Uric acid
Mono
oxalate
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Urine Sediment (crystal)
Carbonat Amorph
Cystine
Biurate Tyrosine
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Urine sediment (other)
Candida Bacteria Fungi
Microfilaria
Parasite
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Sediment Interpretation
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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.
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Interpretation (2)
Lab parameters Prerenal Renal Post renal
BUN
Creatinine N/mild
BUN/creatinine ratio >20:1 10-20:1 10-20:1
GFR
Uosm/Posm Glomerular: >1.2, Tubular:
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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.
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Case 1
Laboratory results
Na 136 Ca 9.3
K 3.5 Protein 7.5
Cl 95 Albumin 3.8
CO2 31 Mg++ 1.8BUN 28 Phos 2.5
Creat 2.1
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?
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Case 2
Laboratory results
Na 134 Ca 8.9
K 4.2 Protein 7.2
Cl 97 Albumin 3.2
CO2 19 Mg++ 2BUN 13 Phos 4
Creat 1.1
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?
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Thank you
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