Saturday, August 4, 2012

The diagnostic significance of urinary sediment microscopic examination of kidney disease


Urine sediment microscopic examination of the abnormal results are often seen with the renal biopsy consistent with structural changes, in particular, abnormal results of urine protein analysis, the diagnosis of kidney disease have a greater practical value. Its contents, including red blood cells, white blood cells and pus cells, epithelial cells, tubular, salt crystallization, addition to the tube, its contents are as follows.


(1) red blood cell (RBC) in normal urine, usually red blood cells, or only individual red blood cells. After centrifugation, the urine, such as the microscope for each high power field, the average visible 1 to 2 red blood cells is abnormal; such as each high power field, erythrocyte, urine appearance pale skin, called microscopic hematuria in more than three; such as urinary appearance was to wash the meat in water samples or red ocher, compared with gross hematuria. Hematuria is common in acute nephritis, chronic nephritis, renal tuberculosis, kidney stones, kidney tumors.


(2) white blood cell (WBC) and pus cells in the normal urine can be a small amount of white blood cells, white blood cells per high-power field (HP) generally centrifuged urine for 1 to 2, it is still normal. Such as per high power field of more than 5 white blood cells, called microscopic pyuria. Microscope the pyuria prompt urinary tract suppurative inflammation, such as pyelonephritis, bladder, or urethritis, renal tuberculosis; glomerulonephritis, urine white blood cells can also be slightly increased.


(3) the epithelial cells of normal urine, showing that a small number of epithelial cells, centrifuged urine per high power field shows the epithelial cells remain normal. Epithelial cells have a flat, transitional, small round epithelial cells. Flat epithelial cells, generally little clinical significance. Transitional epithelial cells from different sources, surface, middle, and the underlying transitional epithelial cells, in which the middle transitional epithelial cells increased common in pyelonephritis. Small round epithelial cells from kidney, normal urine in rare, large numbers of tubular lesions, the diagnosis of renal parenchymal disease. When chronic renal congestion, renal infarction and hemoglobin calm, showing that the cytoplasm of round cells contain brown granules (hemosiderin).


(4) precipitation of salts Results goods urine salt crystals, mainly due to the influence of urine pH. Alkaline urine, a common trivalent phosphate crystals, the crystallization of urinary ammonium, non-product form of phosphate, calcium phosphate, calcium carbonate, calcium phosphate is more common in chronic pyelonephritis, the rest of little clinical significance. Acidic urine, common uric acid crystals, calcium oxalate Results goods, non-crystalline urate associated with hematuria appear, suggesting the possibility of uric acid stones. Cystine crystallization in normal urine is rare, the large number of cystinosis and the formation of stones. Normal urine, cholesterol is rare, but seen in renal amyloidosis or steatosis, pyelonephritis, cystitis, pyuria.


(5) other tangible components of lipid droplets appear separately in the urine is common in the nephrotic syndrome. Mucus filaments appeared in large numbers in the urine, can be found in the urinary tract irritation or mucosal inflammation. Microorganisms, such as urine, bacteria found in the fresh centrifuged urine, can be the initial diagnosis of urinary tract infection.


(6) two kinds of urinary sediment and quantitative examination 3h urinary cell excretion rate, normal male, red blood cells <3 x 104 / h, the white blood cells <7 × 104 / h; normal female, red blood cells <4 × 104 / h, white blood cells < 14 × 104 / h.

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