,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,尿液、肾功能、粪便实验室检测,思考题,1.尿检的主要临床应用,2.何为多尿、少尿、无尿、蛋白尿,3.选择性蛋白尿、非选择性蛋白尿,4.管型形成条件及临床意义,5.内生肌酐去除率Ccr及临床意义,6.粪便的检测的临床应用,7 BUN 、Cr的临床意义,尿液,是血液经肾小球滤过、肾小管和集合管排泌和重吸收后形成的终末产物,排泄代谢废物、异物,维持体内水、盐代谢和酸碱平衡，维持内环境稳定,同时还有内分泌功能，调节血压，钙磷代谢，红细胞生成,尿检的主要临床应用(,The main clinical application of urinalyisis,),泌尿系统疾病的诊断和疗效判断：,(Urinary tract disease diagnosis and efficacy judgment),全身其它系统疾病的诊断：,( other system disease diagnosis),应用肾损伤药物的监控：,(The application of kidney damage drugs surveillance),尿液检测的根本内容(The basic content of urinalysis),物理性状检查,：量，颜色，气味，比重等,(Physical properties :urine volume,color,smell,specific gravity,etc.),化学成分分析,：蛋白，糖，胆红素，酮体,(Chemical composition analysis:Protein, glucose, bilirubin, ketone body),观察有形成分,：细胞，管型，结晶等,(Observation urinary sediment:cells,casts,urates),病原微生物检查,及其它,特殊检查,(Pathogenic microorganism inspection and other special inspection),尿液分析的自动化,(Urine analysis of automation),酸碱度 PH ,蛋白Protein,葡萄糖Glucose,酮体Ketons,胆红素 Bilirubin ,尿胆原Urobilinogen,比重Specific gravity,隐血Blood,白细胞Leukocytes,亚硝酸盐Nitrite,自动化尿液分析仪组合工程报告模式,尿标本的种类及本卷须知(Urine specimen types and matters needing attention),首次晨尿,: 经过浓缩、酸化，适合蛋白和有形成分,(The first morning urine: after concentrated and acidified, suitable for protein, and,urinary sediment,test),随机尿,: 门诊和急诊患者临时检测,(Random urine :outpatient and emergency patients temporary detection),24小时尿,检测溶质总量，如蛋白，糖，激素等,(24-hour urine :Total solute detection, such as protein, glucose, hormone, etc),清洁中段尿,:用于病原微生物的检测,(clean midstream urine:Used for testing the pathogenic microorganisms),物理性状检查,(Physical properties),一. 尿量(,urine volume ),参考值：1000-2000ml/24h,(Normal Range of,urine volume: 1000-2000ml/24h),少尿,:,400ml/24h或少于17ml/h,(Oliguria:,less than 400ml/24h or less than 17ml/h),无尿,:,2500 ml/24h,(Polyuria:more than 2500ml/24h),临床意义(Clinical significance),多尿(Polyuria)：,1.内分泌疾病 ： 糖尿病、尿崩症、甲旁亢等。 Endocrine diseases: Diabetes、insipidus、 hyperparathyroidism, etc,2.肾脏疾病 慢性肾炎，肾间质炎症,Kidney disease：Chronic nephritis，Renal interstitial inflammation,少尿和无尿： (Oliguria and Anuria),1.肾前性：心衰、脱水等有效循环血量减少。,(Prerenal： heart failure、 dehydration，etc),2.肾性：各类肾小球疾病的急性肾炎综合症。,(Renal:Acute nephritis syndrome),3.肾后性：因尿路狭窄、结石、肿瘤引起的梗阻或排尿功能障碍。 (After kidney: Obstruction 、Micturition dysfunction),二.尿液外观(COLOR),常见的异常变化有(Abnomal-Colored Urine)：,1.血尿 肉眼血尿血液1ml/L尿液，镜下血尿,(Hematuria:Gross hematuria, Microscopic hematuria),(3RBC/Hp)。见于泌尿系统炎症、结石、结核、,肿瘤、外伤，或血友病，紫癜肾等。(In urological system inflammation, stones, tuberculosis, cancer, trauma, or hemophilia, purpura kidney, etc),2.血红蛋白尿或肌红蛋白尿 :Hemoglobinuria or myoglobinuria,可使尿液呈红葡萄酒色、浓茶色或酱油色，尿中无红细胞但尿隐血试验阳性。见于严重的血管内溶血如血型不合输血反响、某些溶血性贫血等。 (Like red wine color, Strong brown,there is no red cells in urine. Concealed blood test positive . In severe hemolytic such as blood vessels are within the transfusion reactions, some hemolytic anemia, etc),3.,胆红素尿(,Bilirubinuria,) 尿中含有大量结合胆红素时，呈深黄色，常见于阻塞性黄疸和肝细胞性黄疸。,(Contains a large number of Conjugated bilirubin in the urine, Common symptoms of obstructive jaundice and liver cell jaundice),4.,结晶尿,(,Urinary crystals ),出现浑浊，或砖红色沉淀，尿酸盐结晶和磷酸盐结晶最多见,(Appear turbid, or brick red precipitate, urate crystals and phosphate crystallization,),5.,脓尿和菌尿,(Pyuria and bacteriuria),尿液出现白色或云雾状浑浊，多伴有尿路刺激征，见于泌尿系统感染(,White or turbidity, with urinary irritation, for urinary tract infection ),。,6.,乳糜尿和脂肪尿,(chyluria and lipiduria),尿液呈乳白色，多见于丝虫病和肾周围淋巴管梗阻，脂肪尿见于脂肪挤压伤、肾病综合症。(,Urine has milk-white, see more at filariasis and kidneys obstruction of the surrounding lymph ,lipiduria,may occur with nephrotic syndrome.),三.气味(smell),典型病理性气味,1.氨味：慢性膀胱炎、慢性尿潴留,Ammonia smell: Chronic cystitis Chronic urinary retention,2.发酵苹果味：糖尿病酮症酸中毒,(Rotten apples taste：diabetic ketoacidosis),3.蒜臭味：有机磷中毒,(Garlic smell:organophosphorouspoisoning),四.酸碱反响(ACIDITY),肾小管上皮细胞分泌的H,+,与滤液中的NH,3,和HPO,4,2,结合，形成NH,4,+,或可滴定酸H,2,PO,4,随尿排出。,参考值：4.58.0,(Normal Range of pH):,4.58.0,临床意义：,1.尿PH降低：酸中毒、高热、痛风、糖尿病等。,(Decreased,Urine pH: Acidosis, high fever, gout and diabetes),2.尿PH增高：碱中毒、尿潴留、膀胱炎、肾小管,酸中毒。,(,Increased Urine pH: Alkali poisoning, urinary retention, cystitis, renal tubular acidosis),五.尿比重测定,(,SPECIFIC GRAVITY),是指4条件下尿液与同体积纯水的重量之比。受尿中可溶性物质的量及尿量影响。可大致反映肾小管的浓缩功能。 (the specific gravity measures the kidneys to ability concentrate urine),参考值：成人1.0151.025,(Normal Urine Specific Gravity Range:1.0151.025),临床意义：,1.增高：禁食、脱水，糖尿病，急性肾小球肾炎等,Fasting and dehydration,glycosuria, Acute glomerulonephritis 。,2.降低：大量饮水，急、慢间质性肾炎，尿崩症。 (Compulsive water drinking, acute/chronic Interstitial nephritis ,diabetes insipidus),化学成分分析,一.尿蛋白测定(Urinary protein determination),正常情况下肾小球毛细血管滤过膜具有孔径屏障和电荷屏障，血浆中高分子量蛋白质7万如白蛋白、球蛋白不能通过滤膜，低分子量的蛋白质2万如2-M、1-M滤过后95在近曲小管重吸收，因此正常情况下尿液中蛋白含量很低，定性试验阴性，定量检测150mg/24h。(Normally,only the smallest protein molecules can pass the filtration barrier of the glomerulus,and most of these are reabsorbed by the tubules, Therefore normally urine protein content is low, the qualitative test negative, Quantitative detection 150mg 3个称镜下血尿。(,Hematuria:Normal:0-3 red blood cells(RBCs)/hpf),临床意义：1.,肾小球源性血尿,红细胞通过滤过膜受到机械性损伤，肾小管中受到不同PH和渗透压变化的影响，呈多形性改变，常见于急慢性肾小球肾炎、紫癜肾、狼疮肾炎等,。 (Glomerular haematuria :,Erythrocytes,polymorphism ,like,glomerulonephritis, Purpura nephritis,sle nephritis),2.,非肾小球性血尿,损伤在肾间质或输尿管以下部位，常见于肾结石、泌尿系肿瘤、肾盂肾炎、急性膀胱炎、尿道炎等。,Non-Glomerular haematuria: In the renal stroma damage or below the ureteral, stones, urinary tract tumors, pyelonephritis, acute cystitis, urethritis, etc,二.白细胞和脓细胞(Leukocytes and purulent cells),白细胞外形完整，分散存在，以中性粒细胞多见。脓细胞是指在炎症过程中破坏或死亡的中性粒细胞，外形不规那么，常成堆聚集存在。 Leucocyte appearance, complete, scattered by neutrophils. Pus cell refers to the process of inflammation of the destruction or death, irregular shape neutrophils, often gathered there heaps,参考值：正常平均0-5个/高倍视野,Normal:0-5 white blood cells(WBSs)/hpf.,临床意义：假设 有较多白细胞或脓细胞，多为泌尿系感染如肾盂肾炎、膀胱炎、尿道炎。,( more white cells, or septic for urinary tract infection such as pyelonephritis, cystitis, urethritis),三.上皮细胞(Epithelial cells),1.肾小管上皮细胞：来自近曲小管和远曲小管，较多出现提示肾小管病变。慢性炎症时肾小管上皮细胞发生脂肪变性，称脂肪颗粒细胞。,Renal tubular epithelial cells: From the proximal convoluted tubules and far convoluted tubules, prompting renal tubular lesions.,2.移行上皮细胞：有尾形、小圆、大圆，来自肾盂、输尿管、膀胱，有炎症时在尿中出现增多,.transitional epithelium cells :With tail shape, small circle, big circle, from the pelvis, ureter, bladder, when these parts inflammation,transitional epithelium cells,appeared in the urine,3.复层扁平上皮细胞：来源于尿道前段，女性排除阴道分泌物污染后，且伴有尿白细胞增多，见于尿道炎。,Stratified squamous epithelial cells: urethritis,肾小管上皮细胞,尾形、小圆、大圆上皮细胞,扁平上皮细胞,四.管型Casts,是滤出液中的蛋白质、细胞或其它物质在肾小管、集合管中凝固而成的类圆柱形蛋白聚体。其形成条件：(The proteins ,cell, or other substances in renal tubular collection, frozen tube of cylindrical protein together. ),1.尿中有少量的清蛋白和由肾小管上皮细胞产生的T-H糖蛋白是构成管型的基质(A small amount of albumin and T - H glycoproteins),2.肾小管有使尿液浓缩和酸化能力浓缩可提高蛋白质含量、盐类浓度，尿液酸化后使蛋白质沉淀,(The tubular has ability to fully concentrated and acidify the urine ),3.有交替使用的肾单位，处于休息状态的肾单位，尿液在肾小管内有一定的滞留时间，使蛋白质浓缩和凝结，当该肾单位活动时，已形成的管型随尿排出(Have the alternate use of renal units),尿液中的管型和临床意义：,1.,透明管型,：由T-H糖蛋白和白蛋白构成，某些人在剧烈运动、发热、麻醉后等无肾脏器质性病变时有轻度增多，在慢性肾炎，肾病综合症，高血压肾损伤的增多。,(,hyaline casts:,component by T - H glycoprotein and albumin,occur Chronic nephritis, Nephrotic syndrome, Hypertensive renal damage),2.,红细胞管型,：基质中含有红细胞，最多见于急性肾小球肾炎。,(,Red cell casts: Acute glomerulonephritis),3.,白细胞管型,：含有白细胞，见于肾盂肾炎。,Leukocyte cast: Pyelonephritis,4.,颗粒管型,：,(granular casts),基质中含有较多粗大颗粒，多见于急慢性肾小球肾炎初期，肾盂肾炎累及肾小球。细颗粒多为粗颗粒转化而来，见于急慢性肾小球肾炎后期。,5.,蜡样管型,：由颗粒管型、红细胞管型在肾小管中长期滞留变性形成，提示较严重的肾小管损伤，预后不良。(,Waxy cast: By,granular casts, and red,cell casts,for long-term retention in tubular,indicate,more serious injury of the renal tubular d and bad prognosis.),6.,宽幅管型,：由基质和坏死的集合管上皮构成，外形宽大，又称肾衰管型。在急性肾衰多尿早期可大量出现，随着肾功能改善而渐少消失，在慢性肾衰时出现，提示预后不良。,(,Broad casts :occur in chronic renal failure.,Indicate t,he poor prognosis),透明管型,蜡样管型,宽幅管型,五.结晶体(crystals),尿液经沉淀后，有些会出现形态各异的结晶体。,1.碱性尿中易出现磷酸盐结晶，,phosphate may occur in Alkaline urine,2.酸性尿中易出现尿酸盐结晶。,Urate,may occur in,acidic urine,与饮食和个人体质代谢有关，一般无致病意义，较多出现并伴有红细胞者提示泌尿系统结石可能。,尿酸盐结晶,草酸钙结晶,尿液的其它检验,尿蛋白电泳,(,Urinary protein electrophoresis),一般用聚丙烯酰胺凝胶电泳来区分不同分子量和电荷的蛋白质。,(General use polyacrylamide gel electrophoresis to distinguish different molecular weight and charge of protein.),可分辨不同分子量的蛋白质。区分肾小球和肾小管性蛋白尿。,(Can distinguish different molecular weight of protein. Distinguish glomerular and tubular proteinuria),临床意义 推断损害部位,。,(Clinical significance:,a site of injury in the urinary tract or kidney should be sought.),尿淀粉酶测定(Urine amylase determination),参考值：1000U/L,(Reference: 40mmol/L,Kidneys,oliguria: reabsorption decreased, urinary sodium 40mmol/L,2.肾前性少尿 重吸收正常或增强，一次性尿钠20mmol/L (,before Kidneys,oliguria: reabsorption increased, urinary sodium 20mmol/L肾衰期。,Chronic renal failure stages: 9 mmol/L decompensated 20mmol/L renal failure.,3.肾前性少尿：当严重脱水，大量腹水，心功能衰竭等血容量缺乏，肾血流灌注缺乏导致滤过率下降而少尿，BUN升高，但升高幅度较小，经扩容后尿量增加可自行下降。At before Renal oliguria: when severe dehydration, a lot of ascites, heart failure ,kidney blood perfusion shortages filtration rate decreases oliguria, BUN rise, but smaller, after the expansion may decline.,4.组织蛋白分解增强：当高热，大面积烧伤，严重创伤，大手术后，甲亢，上消化道出血等。Renal tissue protein decomposing enhancement: when high fever, burned, serious injuries, hyperthyroidism, upper gastrointestinal bleeding, etc.,血清肌酐测定,原理：,外源性：肉类食物中摄取,External: meat food intake,内源性：肌酸和磷酸肌酸经非酶促反响生成,当肾小球滤过功能下降到一定程度低于50以下时，血肌酐浓度会上升，通过观察该指标来判断肾小球滤过功能的损伤状况。敏感性较BUN好，也非早期诊断指标。When the glomerular filtration function decline to a certain degree (below 50%), serum creatinine levels rise, through the observation of the index to judge glomerular filtration function.，nor early diagnosis.,(serum,creatinine,Scr,),参考值：血清：男：53106 mol/L,女：4497 mol/L,临床意义：升高见于,1.尿量明显减少伴血肌酐进行性升高，每日升高44.2mol/L ，应考虑急性肾衰。血肌酐442mol/L，急慢性肾衰透析指征之一。,Urine volume reduce rapidly and serum creatinine increased with progressive , creatinine daily increased more than 44.2 mol/L should consider the acute renal failure. Creatinine 442 mol/L may occur acute renal failure,it is indications of dialysis,2.慢性肾衰分期标准： 178mol/L失代偿期， 445mol/L肾衰期。,Chronic renal failure stages: 178 mol/L decompensated, mol/L renal failure,.,3.鉴别肾前性和肾性少尿指标之一：肾前性血尿素氮升高幅度更大BUN/Cr10；肾性血肌酐升高幅度更大 BUN/Cr10;when kideys damage, creatinine rising more ,BUN/Cr 10,.,内生肌酐去除率测定,肾小球滤过率GFR：单位时间内一般每分钟经肾小球滤出的血浆液体量，正常120-160ml/min，反映肾小球的滤过功能。,GFR : unit of time (usually per minute) by glomerular filtration liquid of plasma, normal 120-160ml/min, reflecting the glomerular filtration function,肾去除率clearance：是指肾脏在每分钟内，能将多少毫升血浆中的某物质全部去除，结果以毫升/分钟 ml/min 表示。 Refers to the kidney in every minute, how could a substance in the plasma milliliter all clear,内生肌酐去除率Ccr： 肾脏每分钟把多少毫升血浆中的肌酐全部去除出去，称内生肌酐去除率,the kidney could clear creatinine in the plasma all out per minute 。,方法和公式：,1.标准24小时留尿计算法：13天低蛋白饮食，禁食肉类，防止剧烈运动，2准确收集24小时尿液，测尿量和尿肌酐浓度并计算分钟尿量，3同时采静脉血检测血肌酐浓度。,Standard 24-hour urine calculation method: (1) 3 days low-protein diet, avoid strenuous exercise, meat; (2) collect urine for 24 hours, urine volume and urine creatinine concentration is measured,calculation urine volume per minutes, (3) by venous serum creatinine concentration detection.,2.计算公式：CUVP,U：尿肌酐浓度，V：每分钟尿量，P：血浆肌酐浓度。 formula: C = U * V/PU: urine creatinine concentration, V: every minute of urine, P,plasma creatinine concentration,参考值：成人80120ml/min,Reference: adult 80-120ml/min,临床意义：,1.由于肾脏较强的储藏功能，当GFR降低到正常值的50，血尿素氮、肌酐仍可在正常范围，而Ccr值已经表现出低至50ml/min，故Ccr是较早反映肾功能损害的敏感指标.be