– a) Esame macroscopico

Diagnostica del paziente nefropatico
•
Esame delle urine (1)
–
a) Esame macroscopico
1. Volume
VN = 1000 - 1500 ml/die
< 100 = Anuria
< 500 = oliguria
> 1500 - 2000 = poliuria
2. Colore - Aspetto
- Giallo paglierino
- Rosso - Marrone
- Blu - Verde
- Torbido
- Lattescente
- Scuro - Nero
- Schiumoso
Urocromo
Emoglobina
Mioglobina
Farmaci
Blu di metilene
Urati, fosfati
Pus
Porfirine, melanina
Proteine, acidi biliari
3. Peso specifico
(misura indiretta della capacità renale di
concentrazione)
VN = 1020 - 1030
False elevazioni :
Mezzi di contrasto
Glucosio
Proteinuria
Esame delle urine (3)
–
b) Esame chimico
1.pH (VN = 4.5 - 8.5)
Urine acide:
(Dieta iperproteica, riposo notturno, digiuno, chetosi diabetica, TBC renale, acidosi
respiratoria, iperuricemia)
Urine alcaline:
(Dieta ricca di vegetali e/o latte, alcalosi respiratoria, acidosi tubulare, infezioni
delle vie urinarie, alcalosi metabolica)
2. Proteine (VN = 50 -150 mg/die)
3. Osmolarità (VN = 600 - 1200 mOsm/l)
4. Na urinario
5. Corpi chetonici
(Digiuno, alcolismo, chetosi diabetica)
6. Glicosuria
(Difetto tubulare prossimale, diabete)
c) Esame microscopico
Sedimento urinario
Cellule
Emazie
Leucociti
Epiteliali
Batteri
Valori normali
0 - 3 p.c.m.
0 - 5 p.c.m.
0 - 2 p.c.m.
Cilindri
Ialini
Leucocitari
Ematici
Granulosi
Cerei
Broad casts
Significato
Proteinuria
Nefrite interstiziale
Proliferazione
Degen. epit. tub.
Necrosi tub.
Atrofia tubulare
Cristalli
Urati (urine acide)
Fosfati (urine alcaline)
Ossalati (urine acide)
Three urine samples are shown. The one at the left
shows a red, cloudy appearance. The one in the
center is red but clear. The one on the right is
yellow, but cloudy.
These are oxalate crystals, which
look like little envelopes (or
tetrahedrons, depending upon your
point of view). Oxalate crystals are
common.
These "triple phosphate" crystals
look like rectangles, or coffin lids if
you are feeling depressed.
These cystine crystals are shaped like
stop signs. Cystine crystals are quite
rare.
Red blood cells in urine appear as
refractile disks. With hypertonicity of
the urine, the RBC's begin to have a
crenated appearance
Note the irregular outlines of many
of these RBC's, compared to two
relatively normal RBC's at the center
left of the right panel. These
abnormal RBC's are dysmorphic
RBC's.
These white blood cells in urine have
lobed nuclei and refractile
cytoplasmic granules.
Oval fat bodies consist of
degenerated tubular cells containing
abundant lipid, which appears
refractile.
Under polarized light, oval fat bodies
demonstrate the "Maltese cross"
appearance.
Large polygonal squamous epithelial cells
with small nuclei are seen here.
Hyaline casts, which appear very
pale and slightly refractile, are
common findings in urine.
Hyaline casts, which appear very
pale and slightly refractile, are
common findings in urine.
This section of renal cortex reveals
tubules containing hyaline casts that
are bile stained in a patient with
hyperbilirubinemia
This histologic section at medium
power with trichrome stain highlights
red blood cells grouping together in
tubules to form casts. The tubular
epithelium is also damaged, with a
foamy appearance, and is the basis
for the appearance of oval fat bodies
in urine in this case.
The presence of this red blood cell
cast in on urine microscopic analysis
suggests a glomerular or renal tubular
injury
This white blood cell cast suggests an
acute pyelonephritis.
This renal tubular cell cast suggests
injury to the tubular epithelium.
These are granular casts, with a
roughly rectangular shape
Casts which persist may break down,
so that the cells forming it are
degenerated into granular debris, as
has occurred in this granular cast.
This is a broad, waxy cast. Note that
the edges are sharp and there are
"cracks" in this cast.