多彩多姿之尿液檢查

奇美醫學中心 腎臟科

王憲奕醫師

MAY 17, 2016

1

C.C: nocturia, 4-5 times/nightP.H: gout

1st morning voided urine

Appearance: yellow, clear

Glucose: -

Protein: -

Blood: -

Specific gravity: 1.005

pH: 7.0

RBC: 1-4/HPF

WBC: 1-4/HPF

Question

4

32

1

Brain CT VisualField Test

UrineOsmolality

DDAVPnasal spray

尿液檢查(1)

• 清晨第一次尿液可以提供最多的資訊

• 顏色: 淡黃色, 清澈

• 比重: 評估腎臟濃縮尿液的能力

• 酸鹼值: 評估腎臟排出酸的能力

• 蛋白質: 評估腎絲球受傷的程度

• 尿糖: 評估是否血糖值過高

• 血液：評估是否有血尿

C.C: AC sugar 80 mg/dLAm I Diabetic Patient ?F.H: Parents (DM)

Appearance: yellow, clear

Glucose: 2+

Protein: -

Blood: -

Specific gravity: 1.020

pH: 7.5

RBC: 1-4/HPF

WBC: 1-4/HPF

Question

4

32

1

Check HbA1c

Check ABG

Check 24hrsUrineP/Uric

Acid/AminoAcid

Drugs (SGLT2i)

尿液檢查(1)

• 酸鹼值: 評估腎臟排出酸的能力

• 蛋白質: 評估腎絲球受傷的程度

• 尿糖: 評估是否血糖值過高

• 血液：評估是否有血尿

尿液檢查(2)

•紅血球: 評估是否有血尿

•白血球: 評估是否有泌尿道感染

•細菌: 評估是否有泌尿道感染

•結晶: 不同結晶代表可能不同的結石

•細胞: 分辨發炎或惡性腫瘤細胞

尿液檢查（3）

KETONE: DETECT ACETOACETATE ONLY

UROBILINOGEN: DECREASED IN OBSTRUCTIVE JAUNDICE

BILIRUBIN: POSITIVE IN OBSTRUCTIVE JAUNDICE

NITRITE: MOST GNB CONVERT NITRATE TO NITRITE, NOT

ENTEROCOCCI.

LEUKOCYTE ESTERASE: DEPEND ON LEUKOCYTE ESTERASE

Colors of Urine

Which color of urine ?

• Medications, e.g amitriptyline , doxorubicin (cancer

chemotherapeutic drug), or indomethacin (Indocin)

• Foods, such as asparagus

• Food coloring (食用色素)

• Cystitis (bladder infection)

• Prostatitis (prostate infection)

• Pyelonephritis (kidney infection)

Question

Question

TEA-COLOR URINE

• 烏龍茶

• 文山包種茶

• 紅茶

• 綠茶

• 普洱茶

• 鐵觀音

• .

• ??????

Which kind of tea ?

Which color of urine?

•GENITOURINARY TRACT

TUBERCULOSIS OR CANCERS

• FILARIASIS (血絲蟲)

• TRAUMA

Question

3

Chyluria乳糜尿

Trauma

TuberculosisCancer

Filariasis

Which color of urine ?

• Infrequent condition, mainly seen in elderly patients with Foleytube, when in a plastic collection system.

•The ? Color is to a chemical reaction involving urine, plastic and

enzymes(indoxyl phosphastase/sulfatase) from some bacteria.

•Harmless, and no additional investigation is needed.

Question

PURPLE URINE BAG SYNDROME (PUBS)

• INFREQUENT, MAINLY SEEN IN

ELDERLY PATIENTS, CHARACTERISED BY PURPLE COLORING OF URINE, ONLY

WHEN IN A PLASTICCOLLECTION SYSTEM.

•THE PURPLE COLOR IS DUE TO

A CHEMICAL REACTION INVOLVING URINE, PLASTIC AND ENZYMES(INDOXYLPHOSPHASTASE/SULFATASE) FROM SOME BACTERIA.

•PUB SYNDROME IS HARMLESS, AND NO ADDITIONAL INVESTIGATION IS NEEDED.

Which color of urine ?

ANTI-TUBERCULOSIS REGIMEN

Question

3

Orange color

Rifampin

Which color of urine ?

• THE CAUSE OF DEATH IN CASE OF “洪仲丘”

• SEVERE THIGH PAIN AFTER RUNNING FULLCOURSE OF MARATHON

• URINALYSIS: BLOOD 4+, RBC 2-5/HPF