patologi klinik kelainan ginjal

7/25/2019 patologi klinik kelainan ginjal

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Laboratory Examination

for Renal Disease

Dr. E. Henny Herningtyas, MSi.PhD

Clinical Pathology Dept.Faculty of Medicine, UGM Yogyakarta


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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


6/21

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)


7/21

Causes of Renal Failure

Medical DoctorCompetence ???


8/21

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


15/21

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.


19/21

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?


20/21

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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