尿液检验讲义.ppt

Decreased urination is usually related to one of three problems insufficient blood reaching the kidneys, so they cannot make urine kidney damage, which makes the kidney unable to filter blockage in the tubes that carry urine from the kidneys to the outside of the body Blood loss dehydration from vomiting, diarrhea, excessive sweating, or inability to take in fluids. Medicines, such as a diuretic congestive heart failure low blood pressure from shock or a serious infection. Kidney damage acute tubular necrosis autoimmune disorders cancer chronic renal failure glomerulonephritis Blockage in the tubes cancer or a tumor in the bladder or prostate kidney stones that affect both kidneys, which is rare prostate enlargement, also called benign prostatic hyperplasia, a common condition in men older than 40 Diabetes mellitus Diuretic therapy Chronic renal failure Alcohol High calcium Marked thirst? Yes No No No Yes Abnormalities on urinalysis? Yes No Possible No No Abdominal pain and vomiting? Possible No No No Yes Episodic? No Possible No Yes No Anorexia/weight loss? Yes No Possible No Possible 蛋白尿形成的机理和临床意义 肾小球性蛋白尿(glomerular proteinuria) 双重屏障的损害 见于各种原发和继发型肾小球疾病 肾小管性蛋白尿(tubular proteinuria） 重吸收功能的损害 见于各种肾小管-间质性疾病、肾小球疾病的后期 混合型蛋白尿 肾小球和肾小管同时受损 见于糖尿病、SLE 蛋白尿形成的机理和临床意义 溢出性蛋白尿(overflow protinuria) 血中低分子蛋白质大量滤过超过肾小管重吸收能力，见于肌红蛋白尿，血红蛋白尿，Bence-Jones蛋白尿 组织性蛋白尿(tissue protinuria) 尿路和肾小管的炎症，肿瘤 血流动力型蛋白尿(hemodynamic protinuria) 肾小球毛细血管内压力过高和血流量增多，见于剧烈运动，长时间站立，环境温度升高和受寒时，肾外疾病如发热，充血性心力衰竭和癫痫发作时 尿系列微量蛋白 尿免疫球蛋白、补体(complement C3 ) 分子量：IgG16万d IgA17万d IgM90万d C318.5万d 参考值：正常尿中为阴性 意义：高分子蛋白尿，非选择性，滤过膜机械屏障的损害 尿白蛋白 4万d~ 9万d 参考值：排泄量 5~30mg/24h，排泄率 20~200ug/min 尿白蛋白/肌酐 0.03~0.3mg/mg 意义：中分子蛋白尿，选择性好，滤过膜电荷屏障的损害 是糖尿病肾病、高血压肾病早期诊断的指标 是大多数肾小球肾炎的诊断指标 如微小病变、膜性肾病、系膜增生性肾炎等原发、继发性肾炎 尿系列微量蛋白 尿β2微球蛋白(β2 microglobin, β2M) 分子量：11800d 参考值：0.2mg/L, 375ug/24h 意义：反映肾小管重吸收功能、协助诊断恶性疾病 尿α1微球蛋白(α2 microglobin,α1M)