1. åêôßìçóç ÑÙÌÁ :
íåöñéê ò óçìåßá íåöñéê ò íüóïõ
äõóëåéôïõñãßáò óçìåßá ëïé ò íüóïõ ËÅÕÊÏ : pyuria, phosphate
áöï äéá éóôùèåß ìüíï áèïëïãéê êñåáôéíßíç /êáé crystals, chyluria or propofol
äéÜãíùóç íüóïò ãåíéê ï ñùí
õ ïêåéì íçò
íüóïõ ÑÁÓÉÍÏ : methylene blue ,
propofol or amitriptyline
éóôïñéêü
öõóéê åî ôáóç
GFR gfr = äåí ñïóäéïñßæåé ÌÁÕÑÏ : hemoglobinuria or
urinalysis ôï áßôéï ochronosis, most often due to
urinalysis åíéïôå +
alkaptonuria
á åéêïíßóåéò + âéïøßá
á áéôï íôáé ÑÏÆ : bacteriuria in patients
with urinary catheters
íåöñï áè ò
urinalysis :
ï÷é Üíôïôå óõó÷ ôéóç ìå ôçí åêôáóç ôçò
íüóïõ
ë.÷ óå á ïäñïì ó åéñáìáôïíåöñßôéäáò, False positive heme reactions :
ê.ö ôéì ò óôç ãåíéê ï ñùí = ë óç ôçò
ïîåßáò öëåãìïí ò if semen is present in the urine,
if the urine is alkaline (pH >9), or
Ç ÅÊÔÁÓÇ / ÔÕ ÏÓ ÔÇÓ ÂËÁÂÇÓ contaminated with oxidizing
ÑÏÓÄÉÏÑÉÆÏÍÔÁÉ ÌÏÍÏ ÌÅ ÂÉÏØÉÁ agents used to clean the perineum
Causes of
heme-negative red
urine :
Metabolities :
Medications
Doxorubicin Bile pigments
Chloroquine Homogentisic
Deferoxamine acid Food dyes :
Ibuprofen Melanin
Iron sorbitol Methemoglobin Beets (in selected
Nitrofurantoin Porphyrin patients)
Phenazopyridine Tyrosinosis Blackberries
Phenolphthalein Urates Food coloring
Rifampin
Sulfosalicylic acid test ïóïôéê áîéïëüãçóç
ÑÙÔÅÚÍÇ : ñùôåßíçò ï ñùí
íäåéîç = ÏÍÁ +
dipstick = ïõñá 24ùñïõ
áíé÷íå åé ìüíï áëâïõìßíç > 300 to 500 mg/day acute renal failure,
äåí ôåêìçíñéÿíåé ôçìí ìéêñïëåõêùìáôéíïõñßá benign urinalysis, total protein-to-creatinine
äåí áíé÷íå åé åëáöñ ò áë óóïõò negative or trace
dipstick or
ç áíé÷íå óéìç áëâïõìéíïõñßá á ïôåëåß áäñ
åêôßìçóç êáé å çñåÜæåôáé á ï ôï âáèìü óõí èùò immunoglobulin albumin-to-creatinine ratio
óõì êíùóçò ôùí ï ñùí light chains (mg/mg)
_________________________________________
ÄÉÅÑÅÕÍÇÓÇ on a urine sample [16-18] .
øåõäÿò èåôéêü á ïô ëåóìá ìåôÜ á ü ÷ñ óç ÌÕÅËÙÌÁÔÏÓ
iodinated radiocontrast agents :
dipstick
Sulfosalicylic acid test
áíáìïí 24ùñïõ ñéí ôç ãåíéê ï ñùí

2. dipstick ê ôôáñá :
pH
åñõèñÜ, ëåõêÜ, å éèçëéáêÜ
4.5 - 8 ñïóäéïñßæåé ôçí áßìç
> 7 éèáíÿò ìç óôåßñï, ïõñåÜóç ë óç åñõèñÿí
áéìïóöáéñßíç ó áíßùò :
o tumor cells , ë.÷ Ca
óå ÌÏ áíáì íåôáé <5.3 <5 ïõñïå éèçëéáêü
åáí ìåãáë ôåñï äéåñå íçóç RTA åóôåñÜóç = áñïõóßá ëåõêÿí
o infiltration of the renal
íéôñéêÜ = áñïõóßá parenchyma with malignant cells
åíôåñïâáêôçñéïåéäÿí (eg, lymphoma).
Distinction between the various types of
RTA can be made by :
óôåßñá õïõñßá :
measurement of o interstitial nephritis,
o renal tuberculosis, and
the urine pH and o nephrolithiasis
the fractional excretion of
bicarbonate
êñ óôáëëïé
at different plasma bicarbonate
concentrations ïõñéêï = üîéíï ñÇ
ïîáëéêü áóâ óôéï = äåí
å çññåÜæåôáé á ü ôï ñÇ
Osmolality öùóöïñéêü áóâ óôéï = ó÷åôéêÜ
áëêáëéêü ñÇ
áîéïëüãçóç õ ï- / õ åñ - íáôñéáéìßáò, ___________________________
ïëõïõñßáò
Magnesium ammonium
phosphate (struvite) and
The specific gravity generally varies with the calcium carbonate-apatite are
osmolality. However, the presence of large the constituents of struvite stones
molecules in the urine, such as glucose or
radiocontrast media, can produce large ñïû ïè óåéò :
changes in specific gravity with relatively little
change in osmolality áõîçì íç áñáãùã
áììùíßáò
^ñÇ ï üôå áäéÜëõôï ôï áéìáôïõñßá
öùóöïñéêü
áñïäéê å ßìïíç
Glucose Both of these requirements may
be met when urinary tract áñïäéê = óõ÷í áëëÜ ü÷é áíçóõ÷çôéê óå íåáñ ò
infection occurs with a çëéêßåò, áëëÜ > 50 Ca äéåñå íçóç
óå öõóéïëïãéêü íåöñü,
ãëõêïæïõñßá = plasma glucose> 180 mg/dl urease-producing organism,
such as Proteus or Klebsiella
ñüêåéôáé ãéá Ó ÄÉÁÂÇÔÇ áñïäéê
+ õïõñßá +âáêôçñéïõñßá +äõóïõñßá
= êõóôßôéäá, ñïóôáôßôéäá %%
íåöñéê ãëõêïæïõñßá = fanconi
= âëÜâç óôï Ü ù óùëçíÜñéï Üíôïôå äéåñå íçóç ãéá :
o kidney stones,
o hypophosphatemia, óïâáñ ò åñé ôÿóåéò o malignancy, and
o hypouricemia, o glomerular disease
o renal tubular acidosis, and
o aminoaciduria êõóôéíïõñßá
o ãëõêïæïõñßá Findings strongly suggestive of glomerular disease
are :
ÏÍÁ + ïîáëéêü áóâ óôéï o red cell casts,
= ethylene glycol ingestion o proteinuria, and
ãëõêüæç ï ñùí = äåí åíäåßêíåéôáé ãéá diabetes o dysmorphic red cells, particularly
screening acanthocytes
å çññï á ü ôïí üãêï ï ñùí
á áéôåß ñïõ Üñ÷ïõóá óçìáíôéê ÏÍÁ + ìåãÜëç óõãê íôñùóç
õ åñãëõêáéìßá êñõóôÜëëùí ïõñéêï
áíôáíáêëÜ ôç ì óç ôéì óáê÷Üñïõ êáé ü÷é ôçí
óõãê íôñùóç ãëõêüæçò ôç óôéãì ôçò = consistent with tumor lysis
ì ôñçóçò syndrome

3. õïõñßá White cell casts
äéÜìåóïò íåöñßôéäá
åíäåéêôéê ëïßìùîçò åÜí ìåìïíïì íç õåëïíåöñßôéäá
êáëëé ñãåéá ~ êáé ãéá tbc
áíåõñßóêïíôáé êáé óå ó åéñáìáôéê ~
óõí èùó óå õ åñ ëáóôéê
ëéãüôåñï áîéïëïãßóéìç åáí ++
o CELLULAR CASTS,
o ADDITIONAL CELLULAR ELEMENTS, Fatty casts
= ñï÷ùñçì íï íåöñùóéêü ìå
AND/OR PROTEINURIA óçìáíôéê ñùôåúíïõñßá
strain wright :
ëåìöïê ôôáñá, åùóéíüöéëá
Granular casts
óå ïëë ò íåöñéê ò íüóïõò
= óõóóÿñåõóç ñùôåúíçò
õ ïäçëÿíïõí áíáãåííçôéê éêáíüôçôá
óå ñï÷ùñçì íç íåöñ. áíå Üñêåéá,
óôá áèñïéóôéêÜ ó÷çìáôßæïíôáé
å éèçëéáêÜ ê ôôáñá :
Waxy casts
á ü ï ïõä ïôå
áîéïëïãï íôáé ôá íåöñéêÜ óùëçíáñéáêÜ êáé ç óå íåöñÿíåò ìå ïë áñã ñï
ë ïí áîéü éóôç íäåéîç = ñï÷ùñçì íç ÍÁ
= å éèçëéáêÜ ê ôôáñá åíôüò êõëßíäñùí ôá÷ ùò åîåëéóóüìåíç ÓÍ/Á
____________________________
óå ^^ áñéèìü äéåñå íçóç ãéá :
áéìïóöáéñßíçò
o acute tubular necrosis,
o pyelonephritis, and the
o nephrotic syndrome
ìõïóöáéñßíçò =
íåöñùóéêü
ïäïê ôôáñá óôá ï ñá äéÜìåóç íåöñßôéäá
ñáâäïìõüëõóç
= ó åéñáìáôéê íüóïò
áõîÜíïíôáé óå åíñãü íüóï
åëáôôÿíïíôáé ìå áãùã
äåí õ Üñ÷åé áêüìá êëéíéê åî ôáóç
ñïôåßíåôáé ùó ë ïí áîéü éóôç ì èïäïò
áîéïëüãçóçò ôçò ó åéñáìáôéê ò âëÜâçò á ï
ôçí ñùôåúíïõñßá
Hyaline casts
ó áíßùò = íåöñéê íüóïò
= o with small volumes of concentrated urine
= o with diuretic therapy
Red cell casts
= ó åéñáìáôïíåöñßôéäá, áêüìç êáé íáò
ôï ó íçèåò åßíáé íá åñé ÷åé ëßãá åñõèñÜ êáé
íá âñßóêåôáé ì óá óå êïêêÿäç õáëßíçò
ê ëéíäñï

4. WITH CHRONIC RENAL DISEASE, DISORDERS THAT SHOULD BE CONSIDERED
INCLUDE:
o prerenal disease (as with congestive heart failure),
o urinary tract obstruction,
o benign nephrosclerosis, and
o tubular or interstitial diseases
Normal or near-normal (few cells with little or no casts or proteinuria;
hyaline casts are not an abnormal finding)
óå ÏÍÁ : [ Prerenal Disease, Urinary Tract Obstruction, Hypercalcemia,
Myeloma Kidney (Although The SSA Test Should Be Markedly Positive)
Some Cases Of Acute Tubular Necrosis,
A Vascular Disease With Glomerular Ischemia But Not Infarction (Scleroderma,
Atheroemboli [Which Are Irregularly Shaped And Do Not Completely Occlude
Vessels]
And Rare Cases Of Polyarteritis Nodosa Affecting The Renal Arteries But Not The
Glomeruli).
Pyuria alone =
Assuming no contamination with vaginal secretions (which is unlikely if there are no
large vaginal epithelial cells in the sediment)
pyuria alone is usually indicative of urinary tract infection (including
tuberculosis).
Sterile pyuria suggests some form of tubulointerstitial disease, such as analgesic
nephropathy.
Hematuria alone =
varies with the clinical setting.
It is suggestive of vasculitis or obstruction In the patient with acute
renal failure, and
of urolithiasis in the patient with flank pain.
It can also be found with mild glomerular disease (particularly
postinfectious glomerulonephritis, IgA nephropathy, thin basement
membrane disease, and hereditary nephritis), polycystic kidney
disease, and with extrarenal disorders such as tumors, and prostatic
disease.
Hematuria and pyuria with no or variable casts (excluding red cell casts)
-
acute interstitial nephritis, glomerular disease, vasculitis, obstruction, and renal
infarction.
Eosinophiluria may also be seen with acute interstitial nephritis, but the absence
of this finding does not exclude the diagnosis.
Pyuria with white cell and granular or waxy casts and no or mild
proteinuria -
suggestive of tubular or interstitial disease or urinary tract obstruction
White cells and white cell casts can also be seen in acute glomerulonephritis,
particularly postinfectious glomerulonephritis; in this setting, however, there are
also other signs of glomerular disease, such as hematuria, red cell casts, and
proteinuria.
HEMATURIA WITH RED CELL CASTS, DYSMORPHIC RED CELLS, PROTEINURIA,
AND/OR LIPIDURIA -
This constellation of findings is virtually diagnostic of glomerular disease or
vasculitis
However, the absence of these pathognomonic changes in patients with
hematuria does not exclude these disorders.
Multiple granular and epithelial cell casts with free epithelial cells -
These findings are strongly suggestive of acute tubular necrosis in a patient with
acute renal failure, although their absence does not exclude this diagnosis
In this setting, ischemic or toxic injury to the tubular epithelial cells can lead to
cell sloughing into the tubular lumen due either to cell death or to defective
cell-to-cell or cell-to-basement membrane adhesion [29] .
In addition to acute tubular necrosis, similar urinary abnormalities can also be
induced by marked hyperbilirubinemia alone (plasma bilirubin concentration
usually above 8 to 10 mg/dL or 136 to 170 µmol/L); how this occurs is not clear
[30] .