1 In Blood Serum Urea Normal level 2566 mmol l 1540mgdl High level can occur in high protein diet GI bleeding trauma hypovolemia burn Low level can occur in low intake liver failure over hydration ID: 935971
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INVESTIGATIONS OF URINARY SYSTEM
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Slide2In Blood
Serum Urea:Normal level 2.5-6.6 mmol/l (15-40mg/dl)High level can occur in high protein diet, GI bleeding, trauma, hypovolemia, burn.Low level can occur in low intake, liver failure, over hydration.Serum Creatinine:Normal level 55-120mmol/l (0.62-1.36 mg/dl)High level can occur in large muscle mass, rhabdomyolysis, drugs like trimethoprim, cimetidineLow level can occur in small muscle mass. Serum potassium: (Serum sodium)Normal level 3.7-5.2 mmol/lFalse high levels can occur in hemolysed sample
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Slide3Urine examination
Broadly divided into
Routine Special Routine Physical Examination Chemical examination Microscopic examination 3
Slide4Physical examinations includes
Amount (Volume) – 800 – 2500 ml / day
Odour - Pungent Color of the urine – Straw colour Appearance – Clear & transparent Specific gravity – 1.010 – 1.0304
Slide5Chemical examinations includes
Reaction – Acidic (
avg 6)Protein (24hrs urine) – less than 150mg/24 hourGlucose (reducing substance)ketones5
Slide6Microscopic examinations includes
Cells
Epithelial cells – normally found in small number WBC ( Pus cells )RBC ( normal, dysmorphic )Others Casts --RBC casts, WBC casts, epithelial casts, granular casts Crystals - uric acid, calcium oxalate, triple phosphate, calcium carbonate etc 6
Slide7Estimation of GFR
Calculation of
creatinine clearanceCockcroft and Gault: {(140-age) X body weight X 1.22 (male) and 1.04 (female)} Divided by serum creatinine in μmol/lMore accurate method: {Urine creatinine×urine volume} X 1000divided by serum creatinine 1440
Normal range:
Men 90-140 ml/min
Women 80-125 ml/min.
DR. S Chakradhar
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Slide8Imaging
Plain X-Ray abdomen
DR. S Chakradhar8
Slide9Excretion urography(IVP/IVU)
Antegrade
RetrogradeDR. S Chakradhar9
Slide10Excretion urography(IVP/IVU)
Antegrade
Retrograde10
Slide11Micturating cystourography
DR. S Chakradhar
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Slide12Ultrasound
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Slide13Renal angiogram
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Slide14Computed tomogram (CT)
DR. S Chakradhar
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Slide15Magnetic resonance imaging (MRI)
DR. S Chakradhar
15T1-weighted axial image without & with contrast medium
Slide16Radionuclide studies (DMSA and DTPA)
DR. S Chakradhar
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Slide17Renal biopsy
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