Urinalysis-Urogen Disease

Glomerulus - tubuli
170,000 mL filtered plasma absob.

& excretion in tubuli 1200 mL
excreted (600-2000 mL)
Urinalysis Composition
95% water & 5% solutes
Organic subst: Urea (>50%),
Creatinine, Uric acid, Hippuric acid,
Examination of uirine 1
R.Pakasi _ PPD Unpatti 4/24/17
Inorganic subs: Cl, Na and K
Hormones
Vitamins
Urinalysis Medications
Elements: cells, casts,
crystals,mucus & bactera
Examination of urine 2
Determined by body state of
hidration
Output: 600-2000 mL,
us.1200-1500 mL
Oligoria: decreased output
< 1 mL/kg/hr in infants
< 0.5 mL/kg/hy in children
< 400 mL/day in adults
Polyuira: increased output,>
2.5 mL/day
Urinalysis 3
Biohazardous Standard precautions
Containers
Clean, dry and leak-proof
Clear material
Disposable with variet of sizes &
shapes
Wide mouth, wide flat bottom
Sterile for microbiologic exams
Recommended vol.50ml:
12 ml for microscopic analysis
Rest: reat analysis, room to mix
specimen
Specimen Collection 4
Labelling
Patient id (name, sex, age, address)
Lab.Number
Physcians name
Requisition form
Accompany specimen delivered to
lab.
Information on the form must
match info on the label
Additional
Type of specimen, interferring
medications, clinical info
Specimen Collection 5
Promptly delivery to lab
Tested within 2 hours,otherwise
preservate
Preservation
Refrigerated 2-8 C
Chemical preservative added
Return to room temperature
before chemical testing
Specimen Handling 6
Changes in Unpreserved Urine
Analyte Change Cause
Oxydation or reduction
Color Modified/ darkened
of metabolics
Bacterial growth and
Clarity Decresed precipitationof
amorphous material
Bacterial multiplication
Odor Increased or urea breakdown to
ammonia
Breakdown of uram to
ammonia by urease-
pH Increased producing bacteria/ loss
of CO2
Specimen Handling 7
Changes in Unpreserved Urine
Analyte Change Cause
Glycolysis and bacterial
Glucose Decreased
use
Volatilization and bacterial
Ketones Decreased
metabolism
Exposue tolight/photo
Bilirubin Decreased
oxidation to biliverdin
Urobilinogen Decreased Oxidation to urobilin
Multiplication of nitrite-
Nitrite Decreased
reducing bacteria
Disintegartion i dilute
Red, Whute cells & Casts Decreased
Specimen Handling
alkaline urine
Bacteria Increased Multiplication 8
Voids before going to bed
and immediately on rising
from sleep
Ideal
1st Morning for nitrites, protein
Specimen Cytology
Formed elements (RBC,WBC
& Casts) more stable &
enhanced
Specimen Types 9
Diurnal/circadian variation in
excretion & functions
(Hormones, Protein, GFR ) and
Exercise, hidration & body
metabolisme
Timed Collection Usually 12 hr or 24 hr:
Specimen Prefetermined length of time: 2
hrs, 12 hrs, 24 hrs
During specific time: 2-4 p.m

Specimen Types 10
Collecte at any time, us. during
daytime hrs, without prior patient
preparation
Routine screening
Random Urine
Specimen Excessive fluid intake &
exercisenot accurately reflects
patient condition
Specimen Types 11
Collection
Techniques
1.Routine void 1.No patient preparation
For routne urnalysis
2.Midstream 2.Respresets elementlsfrom

cleancatch bladder-ureter-kidney
3.Catheterized 3.For bacterial ecam.
specimen
4.Suprapubic
Aspiration 4.For infants
Specimen Types 12
Timed ( Date Hours Vol Action
24 hrs) Collection
Measure the 1 Jan 17:55 400mL discard
exact amount of 1 Jan 20:06 200 mL collect

chemical
1 Jan 23:01 150 mL collect
Begin and end the
period with an 2 jan 03::15 250 mL collect
empty bladder 2 Jan 06:30 100 mL cpllect
2 Jan 17:55 200mL collect
24 hours 1350 mL
Specimen Types 13
Timed (24 hrs) On arrival in Lab
Collection Mix throughly
Midstream specimen
Record volume
Cathetrized specimen
Suprapubic 2 containerscombine
Aspiration Refrgirrate/ on ice during
collection
Specimen Types
14
1.COLOR Colorless
Normal Recent fluid consumption
Commonly observed with random specimens
Polyuria or diabetes insipidusIncreased 24-

hour volume
Pale yellow Diabetes mellitus Elevated specific gravity
and positive glucose test result
Dilute random specimen recent fluid
consumption
Concentrated specimen May be normal after

Dark yellow strenuous execise or in 1st morning specimen
Physical Examination
15
Bilirubin
1.COLOR Yellow foam when shaken and positive chemical test
Orange result for bilirubin
Acriflavin Negative bile test result and possible

green fluorescence
Phenazopyridine (pyridium)Drug commonly used

for UTI. May have orange foam and thick strong
orange pigment that can be obscure or interfere with
reagent strip redings
Nitrofurantoin Antibiotics, administered for UTI

Phenindione anticoagulant, orange in alkaline
urine, colorless in acid urine
16
1.COLOR
Yellow-green Bilirubin oxidized to biliverdin color foam
Yellow-brown in acidic urine and false-negative chemical
test results for bilirubin
Green
Psudomonas infection Positive urine culture
Amitryptlin anti-depressant
Blue-green
Methocarbamol muscle relaxant, may be
green-brown
Indican Bacterial infection
Methylene blue Fistulas
Phenol when oxized 17
1.COLOR RBCs Cloudy urine with positive chemical
test result for blood & RBCs
Pink Red
Hb Clear urine with chemical test results
for blood; intavascular hemolysis
Myoglobin Clear urine with chemical test
results for blood
Porphyrins Negative chemical test result
for blood
Beets Alkaline urine of genetically
susceptible persons
Rifampin tuberlulosis medication
Menstrual contanination Cloudy specimen
with RBC, mucus and clots
18
1.COLOR RBCs oxidized to methemoglobin seen in
acidic urine after standing; positive chemical test
Brown Black result forblood
Methemoglobin Denaturated Hb
Homogentisic acid (alkaptonuria) seen in
alkaline urine after standing; specific test are
available
Melanin or melanogen Urine darkens on
standing and reacts with nitroprusside and ferric
chloride
Phenolderivatives Interfere with copper
reduction tests
Methyldopa or levodopa antihypertensive
Metronidazole (Flagyl) darkens on standing
19
2.CLARITY
Normal Clarity Refer to transparecy or turbidity of

specimen
Nonpathologic Common report: Clear, Hazy, Cloudy,
Turbidity Turbid, Milky.
20
Refer to transparecy or turbidity of
specimen
Common report: Clear, Hazy, Cloudy,
Turbid, Milky.
Clear. Precipitaion of
2.CLARITY amorphousphosphates & carbonates may
Normal Clarity cause a white coudiness
URINE CLARITY
Clear No visible particulate, transparent
Hazy Few particles, print easily seen through
urine
Cloudy Many particlulates, print blurred through
urine
Physical
Milky
Examination
Turbid Print cannor be seen through urine
May precipitate or be clotted
21
2.CLARITY
Nonpathologic Squameous epithelial cells &mucus
Turbidity (esp.women): hazy urine
Semen, spermatozoa
Fecal contamination
Vaginal cream
Radiographic contrast media
Talcum power
22
RBCs
WBCs
2.CLARITY
Bacteria
Pathologic cause Yeast
of Turbidity Nonsquameous epithelia;cells
Abnormal crystals
Lymph fluid
Lipids
23
3.SPECIFIC The density of a solution compared with the
GRAVITY (SG) density of similar volume of distilled water at a
similar temperature
Ability of the kidney to selectively reabsorbed
essential chemicals
Urine = water that contains dissolved
chemicalsthe SG urine is a measure of the
density of the dissolved chemicals
Methods of Influence by Number & size of partcles present
measurement Direct: Urinometer (hydrometer),
densitometer
Indirect: Rfractometer, Chemial ragent strip
24
4. Odor Faint aromatic odor
Unusual odor; Unpleasent (bacterial
infection, and sweet/fruity (diabetic
ketones
ODOR CAUSE
Aromatik Normal
Foul,ammoni-like Bacterial decomposition,UTI
Fruity, sweet Ketones (DM, starvation,
vomiting)
Maplesyrup Maple syrup urine disease
Mousy Phenylketonuria
Rancid Tyrosinemia
Physical
Bleach
Examination
Sweety feet
contamination
Isovaleric acidemia
25
Disposable Test Strips
1.Glucose,
2.Bilirubin
3.Ketone,
4.Specific Gravity (BJ)
5.Blood
6.pH
7.Protein
8.Urobilinogen
9.Nitrate
10.Leucocyte Esterase
Chemical Examination
26
Fresh urine
Remove excess
urine
Read:
autoatically
(reader)
VisuallyColo
r Chart
27
1.Glucose
Double enzyme rx
Glucose oxidase
Peroxidase
Interpretation GlucoseGluconic
Filtered load of acid + H2O2
glucoe exceed the
max tubular reab
sorptive capacity H2O2+NaJ
chromogen colors
28
2.Bilirubin
Coupling of bilirubin with diatzotized
dichloroNline in a strongly acid
Interpretation
Presence of liver disease or billiary onstruction
Very low amounts can be detected
29
3.Ketone
Acetoacetic acid reacts with nitroprusside
Acetonee or -hydroxybuteric acid are not detected
Interpretation
Large amounts present in Ketoacidosis (insulin deficiency or
starvation
30
4.Specific Gravity (SG)
Change of polyelectrictrolytes inrelation to ionic
concentration
Bromthymol Blue change colors to blue-
greengreenyello-green
Interpretation
< 1.10 : concetrating defect
> 1.025: normal renl concetration & makes chronic renal insufficiency
Presence of protein, glucose large MW
31
5.Blood
Catalyzes of the rs of diisopropylbenzene duhydroperoxide
& ttramethylbenzidine by proxidase-like activity of Hb
Interpretation
Presene of large number of RBCsHematuira
More strongly Hemoglobinuria or myoglobiuria
32
6.pH
concentration
Bromthymol Blue change colors to blue-
greengreenyello-green
Interpretation:
Seldom of diagnostic value
Phosphate precipitate in alkaline urine, uric acid precipitate in acidicurin
33
7.Protein
Protein+tetrabromphenolchanges color yellow
yellow-green green-blue
More sensitive to albumin
Interpretation
Heavy proteinuriaabnormality in glomerular filtration
34
8.Urobilinogen
Para-diethylaminobnzaldehyde reacts with urobilinogen
in a strongly medium to produce pimk-red color
Interpretation
Any cause of increased production or retention of bilirubin
increase urobilinogen
35
9.Nitrite
Conversion of nitrate to nitrite by Gram-negative
Interpretation
Bacteriuria (Gram-negative) give positive test
36
10.Leockocy
tes
Esterase catalyzes
Interpretation
the hyrdolysis Positive test provide indirect
ofpyrole amino acid evidence for bacteriuria
to liberate 3-
hydroxy-5-phenyl
pyrolereacy with
diazonium
saltpurple
product
37
*Microscopic Examination
1.Hyalin Casts
Hyalin casts are formed in the
abscence of cells
Smooth texture
Refractive index very clos to
surrounding fluid
Interpretation
Lower numbers (0-
1/LPF)not indicative of
significat disease
Greater numbers
glomerular disease or
myeloma
R.Pakasi _ PPD Unpatti 38 4/24/17
Microscopic Examination
2.Cellular cells
Commonly caused by ishemia,
infarction or nephrotoxicity
degenration and necrosis of
tubular cells
common scenario
Renal perfusion
Dehydrationoliguria
39
3.Granular casts
Fine to coars texture
A stage in the
degeneration of cellular
castssimilat
interpretation for
cellular casts
40
4.Fatty casts
Identified by the presence of
refracile fat dropplets
Backgroun matrix: hyaline or
granular
Often seen in urine
caontaining free lipid
dropplets
Seldom of clinical significans
41
5.Waxy casts
Found espeially in chronic
renal diseases, associated with
chronic renal failure
Occur in diabetic
nephropathy,malignant
hypertension &
glomerulonephritis
42
6.Oval Fat Bodies
Similar in composition and
significance to fatty casts
In Glomerulonephritis
Desmorphic RBCs
(heterogenous siza,
hypochromia, distorted
irregular outlies, small
extruded blobs
43
7.White Boold Cells
Unstained:
Round, granular cells
1.5-2 x RBC
Most commonly
Meutrophil
May lyse very dilute or
highly alkaline urine
Interpretation
~5/HP: normal
Greater number (Pyuria)
indicate
inflammation/infection 44
8.Fresh RBClls
Fresh: tend to have a
red or yellow color
Prolonged exposure:
pa;e or colorless
(losing HB)
SG >1.025: shrink
small, crenated cells
More dilute urine:
swell
>>>1.025 or < 1.008
RBC lysis very
faint ghost cells 45
9.Squameoua cells
Thin, flat cells
with angularor
irregular outline
Small round nucleus
Present singly or
variably-sized cluster
Lower number
generally represnt
contamination from
the genital tract
46
10.Parabasalsquameo
us epithelial cells
Immature
squameous epthelial
cells
Commonly seen in
specimen from
postmenopausel
women
Atrophic vaginitis
caused by estrogen
47
11.Transitional epithelial cells

Originate from renal pelvis,
ureter, bladdr and/or urethra
Round or polygonal; less
commonly pear-shaped,
caudate or
Presence of transitional sheets:
Transitional Cell Cancer
48
12.Basal Tubular Cells
Original shape: cubic exfo
liated they adopt rounded
shape
Slightly larger than WBC
Nucleus is round, well defined,
usually centric
Cytoplasma: perinuclear halo
(when stained)
49
13.Trichomonas
vaginalis
Sexually-transmitted
urogenital parasite
Size 1-2 x WBC
Identification: rapid
erratic
jerkymovement
50
14.Calcium Oxalate crystals

Colorless square, corners are
connected by intersecting line
rresembling envelope
Occur in urine of any pH
Vary in size: quite large to
very small
51
15.Amorphous crystals
Aggregates of finely granular
material without any defining
shape
Amorphous Na, K, Mg or Ca
aggregate in acidic urin
Yellow or yellow-brown
Amorphous phosphate
aggregates in alkaline urine
Similar appearance
Lack color
52
16.Triple phosphate
[Struvite, Magnesium
Ammonium Phosphate]
Colorlesprism-like coffinlids
Favour form in Neutral to
alkaline urine
Often seen in healthy subjects
Urease-producing bacteria
(Proteus vulgaris)raise pH &
increase free
ammoniapromote sturvote
crystalluria urolithiasis 53
17.Uric acid (Biuret) crystals

Sphere with irregular thorn-
apple or ox-horn
projections
Radially striated
Yellow-brown
Form favourly in Meutral to
Alkaline urine
54
18.Cystine crystals
Flat colorless hexagonal plates
Often aggregate in layers
favouely formed in acidic
urine
Cystinuria is an error of metabo
lism: defective renal tubulat
reabsorptionof amino acids
(cystine)
55
19.Leucine crystals
Yellow spheres with concentric
and radial strias
Polarized lightleucine
transmit a matese cross
interference pattern
Very rarely seen,found in some
hereditary disease: Tyrosinosis,
Maple Syrup Desease.
Found concurentlynin
severe/terminal hepatic disease
56
20.Tyrosine crystals
Fine brownish needles, either
isolated or as rosettes
Assosiated with severa liver
disease
57
22.Cholesterol crystals
Thin rectangular plates with 1
(sometimes 2) of the corners
square-nocthed
Cause:??
Seen in degenerative renal
disease
Usually be accompanied by
proteinuria, but rarely seen
58
23.Sulfadiazine crystals
Common finding is
administration of
Trimethoprim-sulfadiazine
Seen asshocks of wheat or
radially-striated spherules
59
24.Sulfonamide crystals
Seen asshocks of wheat or
radially-striated spherules
60
Reference Ranges
TESTS REF.RANGE
Color Straw Dark yellow
Spec.Gravity 1.003 1.029
pH 4.5 7.8
Protein s Negatiev
Glucose Negatiev
Ketones Negatiev
Bilirubin
Occult blood Negatiev
Leukocyte Esyerae Negatiev 61

Reference Ranges
TESTS REF.RANGE
Nitrite Negatiev
Urobilinogen 0.1 1.0 EU/dL
WBCs 0 -4 /HPF
RBCs 0-3/HPF
0-5/ HPF
Casts 0 4/ HPF
Bacteriuria Negatiev
62
63 4/24/17
Intermezzo
R.Pakasi _ PPD Unpatti
Laboratory Study in
Urogenital Disorders &
Diseases
64
4/24/17 R.Pakasi _ PPD Unpatti

ARF = AKI
An abrupt or rapid decline in renal
Lab.Studies diltration function
CBC, blood smear & Rouleaux formationsuggest
serology MMimmunoelectrophoresis of serum or
urine
Myoglobin (free Hb) (+), serum uric acid
and other related findings help to
further define etiology of AKI
Urine Electrolyte Calculate the fractional excretion of
Sodium (FENa)
FENa = (UNa/PNa)(Uc.Pc) x100
Prerenal azotemia: FENa < 1%
ATN: FENa >1%; exceptions: Acute GN,,
radiocontrast nephropathy, severe burns,
rhabdomyolysis.
Acute Ranal Failure (ARF) 65

ARF = AKI
An abrupt or rapid decline in
renal diltration function
In liver diseases FENa can be < 1%

in the presence of ATN; diuretic
may cause FENa to be greater
* Acute Ranal Failure than 1%
(ARF) Receiving diureticobtain a
fractional excretion of urea
(FEUrea). Diuretic does not affect
Lab.Studies urea tranport
Urine Electrolyte FEUrea = (Uurea/Purea)/(Uc/Pc) x 100
FEUrea < 35% is suggestive of
prerenal state

Chronic Kidney disease (CKD)
asociate with inceased risk factor
of cardiovascular disease and CRF
CBC: normochrominc normocytic

anemia
* Chronic Renal Urinalysis with calculaton of
renal function
Failure (CRF) Basic metabolic panel
Serum phosphate, vit D &
PTH:evidence of renal bone
Lab. Studies diasese
Approaching Albumin: hypoalbuminemia due

to urine loss
Considerations Lipid profile: cardiovascular
risks

Chronic Kidney disease (CKD)
asociate with inceased risk factor
of cardiovascular disease and
CRF
Serum and urine elctrophoriss:

* Chronic Renal mono clonal protein (possibly
MM)
Failure (CRF) ANA, DS-DNA: screen for SLE
Complements :may be depressed
Lab. Studies Hepatiti B & C, HIV, VDRL
serology: associated with some
In certain cases, for glomerulonephritis
evaluation aptients with c-ANCA & p-ANCA: helpful if
CKD postive in positive in diagnosing
polyareritis nodosa

Denotes the causal relationship
Lab.Studies
PRA (Plasma Renin Activity)
in 50-80% patients
Renal vein renin ,easurements
Compare renin release from each kdney
Ischemic kidney increase renin when compared to th
contralateral
Renal vein renin difference od 1.5 foldpositive test
*Renal Hypertension
Laboratory Tests
Initial blood tests
CBC Hctdemonstrate diutional anemia
Pleocytosis : infectious etiology
ESR Usually
Complements Low level suggest systemic disease

Cryoglobulinemia
* Acute Glomerulonephritis
SLE
Bacteral endocarditis
MPGN & PSGN

Laboratory Tests
Complements Normal level suggest
Visceral abscess
Polyarteritis nodosa
Goofpasture syndrome
Henoch-Schnlein syndrome
Urinalysis Dark, SG> 1. 020

RBC & WBC cats present

Laboratory Tests
Urinalysis Urinalysis
Proteinuria
HMW & LMW may help predict
the clinical outcome
HWM: FEIgG; LWM: -1-
microglobulin.
24-hrs Urine Protein & creatinine clearance
todocument the degree of renal
dysfunction

Laboratory Tests
Urinalysis Presence of dysmorphic RBCs,
albumin or RBC casts suggest GN
as the cause of renal failure
Waxt or broad casts observed
SG indicates loss of tubular
concentrating ability, early finding
of CKD
excretion
*
Chronic Glomerulonephritis
Urinary protein Estimated by calculating protein/
creatinine ratio on a spot morning
urine

Estimated by calculating protein/
Laboratory Tests creatinine ratio on a spot morning
Urinary protein urine
excretion e.g. Urine protein 300 mg/dL, urine
creatinine 150 mg/dLratio= 300/150
= 2; the 24 hrs urne protein excretion
is 2 g.
To estimate and monitor GFR
Cockroft-Gautl formula: cr clearance
Chronic
Estimated creatinine
MDRD: GFR
clearance rate
Glomerulonephritis 74
Laboratory Tests
CBC Anemia is significant finding in
GFR decline; impairment of
erthropoietin production
Serum chemistry Creatinine urea-nitrogen
Impaired axcretion of
Khyperkalemia
Impaired axcretion of water
*Chronic Glomerulonephritis
hyponatremia
Impaired axcretion of acid low
bicarbonate

Laboratory Tests
Urinalysis Proteinuria (24 hrs: >3.5 g/1.73
m3/24 hrs)
Presence of hematuria,
cellularcasts & pyuria is suggestive
of NS
Urine sediment exam
Oval fat bodies (tubular epithelial
Blood chemistries cells with cholesterol)
*Nephrotic Syndrome
Serum albumin
Totalproein
Cholesterol,glucose < 3 g/dL
BUN, creatinine Decreased
Serologic studies Elevated
(azotemia)
Laboratory Tests
Serologic studies Screen hepatitis B & C and HIV
Additional tests
ANA, serum & urin immuno electro
phoresis
C3, C4, CH50
LDH, AP
*Nephrotic Syndrome
Lab.Studies
Urinalysis WBC > 10 WBC/mL
WBC casts may be observed
Proteinuria: usually low grade; > 2g pot/24 hrs
suggests glomerular disease
Dipstick testing Include glucose,prtein, blood, nitrite and

leukocyte esterase
Urine Cuulture Standard of Dx

*Urinary Tract Infection (UTI)

* potentially organ-life Laboratory Studies
threatening infection oNitrite positive: bacteriuria
* Causes scarringkidney False-negative: diuretic
damage, abscess formation, use,low dietary nitrate,
kidnet failure, nonproducing reductase
sepsis,multiorgan system failure bacteria
Laboratory Studies oProteinuria
* Urinalysis oSediment: WBC cast:
oGross hematuria suggestive for pyelonephritis
oPyuria: 5-10 WBC/hpf * Urine culture
o Leucoesterase positive (>10
WBC/hpf
* Blood culture
*Acute Pyelonephritis
* Renal injury induced Laboratory Studies
by *Urinalysis
*Pyuria
recurrent/persistent *Culture: Gram negative
renal infection *Proteinuria ; negative prognostic
*BUN
*Blood studies
*Craetinine
BUN + Craetinine = Azotemia
*Chronic
Pyelonephritis
Calculi in the kidney and/or ureter
Laboratory studies
Urine sediment/dipstick:
blood cells. Nitrite & urine culture
Crystala: ca.oxalate, uric acid or cystine
Serum creatinie: to assess renal function
CBC: indicated if patient with fever
Seum/plasma Na & K: patient with vomiting
pH: provide insight into the type of stone
pH > 7:suggest the presence of urea-splitting bacteria & struvite stones
pH < 5: suggest uric acid stones
Urolithiasis
(nephrolithiasis) 81
* Use dipstick method and/or centrifuged
sedimentassess the presence of blood.
WBC, bacteria, Protein or Glucose
* Benign Prostatic
Hypertrophy
* Performed when initial urinalysis indicate an
Lab.Studes abnormality

* ToUrinalysis
exclude infectious causes of irritative
voiding
Urine culture
* Men at risk for BPH are also at risk for
prostate cancerScreening

*&Useful
Electrolytes, BUN
PSA
Creatiine
for screening chronic renal
insufficiency in patients with high postvoid
recidual

Should include:
CBC
* Prostate Cancer Chemistry profile
Ceatinine
LFT
Lab.Studies Acid and alkaline phosphatase
Blood studies
Any abnormal result warrant additionalstudies
* concurrently with staging (DRE + biopsy)
* < 10 ng/mLmay proceed to surgery
* > 10 ng/mL probably undergo imaging studies
PSA (Prostate-specific antigen)

* in 80-85% cases.
* Not suffiiently sensitive or specific but
* Testicular Cancer
vital in evaluation & management
establish Dx, staging & prognosis and for
Lab Studies
AFP and/or hCG following response Rx
* In combination with AFP & hCG

* Independent prognostic significance
* Not useful for posttreatment suveillance
LDH

* Bladder
Cancer * To detect hematuria & infection. Hematuria
Lab.Studies may be intermittentrepeat negatve result
Urinalysis: does not exclude the Dx
microscopic & cultures
* Often used for Dx suggestive findings
encourage biopsy
Voided urine cytology
cytoscopy

* Bladder* Anemia or WBC further explanation
* Liver function tests. BCG vaccine in used in
Cancer treating CIS. Absroption can produce
Lab.Studies hepatitis.Perform baseline liver function
CBC test
Chemical Panel
* Evaluate kidney funnction before the
initiaton of Rx. Marginal or abnormal renal
Creatinine function may have an obstruction
worsen intravesical Rx
Urine Tumor Markers

REPRODUCTIVE
DISORDERS AND DISEASES
LABORATORY STUDIES
4/24/17
87
HYPEREMESIS
BeginsGRAVIDARUM
by 9-10 wks, peaks at 11-13 wks
1-10% pregnancies: symptom continue
Characteristics
Persistent nause & vomiting
Volume depletion
Electrolytes & acid-base imbalance
4/24/17
88
HYPEREMESIS GRAVIDARUM (HEG)
Lab Studies
Uinalysis: Keton & Keton may be harmful to fetal
SG deelopment
SG: volume depletion
Serum electrolye & To evaluate for low K or low Na,
Ketones hyperchloremic metabolic alkalosis or
acidosis, evaluate renal function &
volume status
Liver enzymes Trasnaminase in 50% cases a sign
of another underlying dis.: viral, ischemic
or autoimmune hepatitis
Amylase/alipase Amylase in 10% patients
Amylase + lipase : pancreatits as an
etiology
4/24/17
89
HYPEREMESIS GRAVIDARUM (HEG)
Lab Studies HEG associated with transient hyper

TSH, free thyroxin thyroidism & suppressed TSH (50-60%);
elevated free thyroxine may suggest
overt hyperthyroiismfurther workup
UTI Is commmon in pregnancycan be
Urine culture associated with HEG
Hypercalcemia associated with HEG
resulting form hyperparathyroidim
Calcium (rare)
Hct because of volume contraction
Hematocrit If indicated, hepaitis A,B,or C may be
confused with HEG
Hepatitis panel
4/24/17
90
HYPERTENSION IN
PREGNANCY
Classification for 18 yrs
Systolic Diastolic
(mmHg) (mmHg)
Normal < 120 < 80
Prehypertensi
on 120-129 90-99
Stage 1 140-159 90-99

Stage 2
4/24/17
91
HYPERTENSION IN PREGNANCY
CBC, serum electrolyte, creatinine,

glucose, uric acid & urinalysys
Lipid Profile: Total Chol, LDL, HDL &
Lab.Studies Trigliseride
1.For routine Electrolites, BUN, creatinine: to
studies (2ndary cause evaluate renal impairment
for hyperten sion not CBC + Smear: to exclude micro
suspected) angipathic anemia
Dipstick urinalysis: to detect
2.For hypertensive proteinuria or hematuria, RBC or
Emergencies RBCs casts
4/24/17
92
Microalbuminuria: early
indication of diabetic
Aldosteron/PRA ratio
Ratio > 20-30: Primary
Hyperaldosteronism
Urine 24 hrs
Na > 100 mmol/L + K < 30 mmol/L
Lab.Studies hyperaldosteronism
3.For assessment K > 30mmol/L measure PRA
PRA : Estrogen R/, renovascular
of Suspected 2ndary hypertension, malignant hypertension
Causes PRA: licorice/mineralocorticoid ingestion
4/24/17
93
TSHs: exclude hypo- or hyper

thyroidism as a cause of
hypertension
Suspecious pheochromocytoma:
test catelcholamine &
fractionated metanephrin
Lab.Studies
3.For assessment
of Suspected
2ndary Causes
4/24/17
94
ANEMIA IN IN
PREGNANCY
Normal pregnant: blood volume hemodiluton
RBC & plasma volume more relative anemia
Hb < 10.5g/dL
Iron Deficiency Anemia
MCV <80 mg/dL, hypochromia micrcytic
Clinical consequencies
Preterm deliveries, Perinatal mortality, Postpartum depression
Low bitrh weight, poor mental & psychomotoric performance
Lab.Study
CBC: MCH , hypochromia micrcytic.
Serum iron hypochromia micrcytic.
TIBC, ferritin levels, Hb electrophoresis
4/24/17
95
ANEMIA IN IN
PREGNANCY
Folate & vitamin B12 deficiency anemia
MCV
Clinical risk: Neural tube
Lab.Studies
Vit.B12 & Folate
Intrinsic factor to exclude pernicious anemia
Schilling test not recommended in pregnancies
Infectious causes of anemia (rare)
Parvovirus B-19 Babesiosis
CMV Bartonellosis
HIV, hepatitis virus Clostridium toxain
EBV Malaria
4/24/17
96
TORCH INFECTION
TOXOPLASMOSIS, RUBELLA, CYTOMEGALI VIRUS, HERPES
SIMPLEX VIRUS
Detect T gondii (Tox) inblood, body fluis &

tissue
Lab.Studies
Isolation Tox from amniotic fluid diag nostic
1.Toxoplasmosis of congenital infection (mouse inoculation)
Lymphocytes transformation to Tox antigen
indicate previous infection (in adults)
ELISA: detect Tox antigen acute infection
Sabin-Feldman dye test: detect IgG.(Reference
test); IgG titer indicate acute toxoplasmosis
PCR (Polymerase Chain Reaction)
IgM antibody : recent infection acquired after

birth (IgM do not cross the placenta)
2.Rubella
4/24/17
97
TORCH INFECTION
SIMPLEX VIRUS
Serology
IgM or IgG 4x
False-positive CMV IgM: EBV, RF
Reactivation: IgM (+) & IgG (+) not uncommon
Antigen assay
Antigen testing: CMV pp65 antigen in leukocytes
Qualitative/ Quantitative PCR
Cytopathology
Lab.Studies Intracellular inclusins surrounded by a clear halo
3.Cytomegalovirus Stains: Giemsa, Papaniculao, Wright, HE,

(CMV) Owls eye
4/24/17
98
TORCH INFECTION
SIMPLEX VIRUS
Tissue culture
Tzank preparation
PCR: DNA
Direct fluorescent antigen (DFA)
Scrapping
Stain with direct antibody
Differetiate HSV1 & HSV2
Lab.Studies
4.Herpes simpelx virus
(HSV)
4/24/17
99
DYSTOCIA
Defined as difficult of labor or abnormally

slowprogress of labor.
Other terms
Cephalopelvic disproportion (CPD)
Dysfunctional labor
Failure to porogress ( lack of progressive cervical dilatation of
lack of descent)
Lab.Studies: none specific to assess abnormal
labor
100
4/24/17
POSTPARTUM
INFECTIONS
Comprise a wide range of entitiesoccuring after
vaginal and cesarean delivery or during
breastfeeding
Trauma sustained during birth process or cesarean &
Physiologic changescontribute to the development of
postpartum infections
Postpartum fever
Temperature >38 C
Any of 2 of the first 10 days following delivery exclusive of the
first 24 hours
101
4/24/17
POSTPARTUM
INFECTIONS
Lab.Studies
Directed at elucidating the severity ofillness and etiology
Mildmastitis usually do not require lab investigation
Wound infections & infection of genital tractsmore difficult to
ascertain the extent of involvement
Includes:
CBC, Electrolytes
Blood cultures: if sepsis suspected
Urinalysis: with culrures and sensitivity tests
Cervical or uterie cultures
Wound culture: if appropriate
Lactate: if sepsis suspected\Coagulation studies: if pelvic thrombosis,
deep vein thrombosis, pulmonary embolism, surgical procedura is
being considered
102
4/24/17
ENDOMETRIOSIS
The presence of normal
endometrium mucosa abnormally
implanted in locations other than
the uterine cavity.
Lab.Studies
To diffeentate from pelvic
CBC & Differential
infection, assess the degree of
bloodloss
Urinalysis &
cultures If UTI is in consideration
Cervical Gram STD can also cause pelvic pain &

stain & cultures infectivity
103
4/24/17
UTERINE CANCER
Any invasive neoplasm of the uterus corpus
Lab.Studies
No lab tests aid in the diagnosis
CA-125
Used in surveillance of advanced endometrial cancer
Pretreatment value : prove useful in posttreatment
surveillance
Preoperative : useful in predicting
104
4/24/17
OVARIAN
DYSGERMINOMA
3 types: epithelial(mostly),sex cord, and germ cell (rarely)
Impotantly: affect women of reproductive age (< 30 yrs)
Lab.Studies
Urine pregnancy test: mandatory in any women of a reproductive and sexually active age
presents with abdominopelvic symptoms
Standard workup:
LDH
AFP
-HCG
Useful tumor markers:
-HCG
AFP
LDH
105
4/24/17
Ca-125
HYDATIDIFORM MOLE
Gestational trophoblastic disease: partial mole, placental

site trophoblastic tumors, choriocarcinomas & ivasive
moles
Lab.Studies:
Quantitative -hCG
>100.000 U/mL indicate trophoblastic growth and raise suspicion
for molar pregnancy
CBC & platelets
Anemia could be present
Coagulopathy could occur
Clotting function
To exclude the developmnt of coagulopathy or to treat one if
discovered
106
4/24/17
HYDATIDIFORM MOLE
Lab.Studies:
Liver function tests
BUN & creatinine
Thyroxine: usually increased above ref.range
107
4/24/17
GYNECOLOGIC
TUMORMARKERS
Important Gynecologic Tumor Potential Gynecologic Tumor
Markers Markers
Cancer Antigen 125 (CA-125) Lysophosphatidic acid
-human chorionic gonadotropin MB1-determined tumor growth
(-hCG) fraction
Urinary gonadotropin fragment Li (CAM)
Alfa-feto protein (AFP) Mesothelin
Inhibin Human epididymis protein 4 (HE4)
Estradiol Osteopontin
108
4/24/17
GYNECOLOGIC
TUMORMARKERS
Important Gynecologic Tumor Potential Gynecologic Tumor
Markers Markers
Carcinoembrionic antigen (CEA) Vascular endothelial growth
factor (VEGF)
Squameous cell carcinoma (SCC) Interleukin 8 (IL-8)Macrophage
antigen colony-stimulating factor (M-CSF)
Mllerian inhibiting substances Insulinlike growth factor-binding
(MIS) protein
Topoisomerase II Tumor-associated trypain inhibito
Carbohydrate antigen 19-9 (CA Cyclin E
19-9)
Cancr antigen 27-29
109
4/24/17
Gonorrhea
most common and oldest Gonococcal infection causes
urethritis, cervicitis, epididymitis,
known sexually pharyngitis, proctitis, & pelvic
transmitted diseases inflammatory disease (PID) can
(STDs). spread throughout the body to
cause both localized and
purulent infection of disseminated disease.
mucous membrane Complications :ectopic
surfaces caused by pregnancy and increased
susceptibility to human
Neisseria gonorrhoeae immunodeficiency virus (HIV)
infection
DEMATOLOGICAL AND GENITAL DISORDERS AND

DISEASES IN REPRODUCTIVE AND UROGENITAL SYSTEMS
110
Gonorrhea
most common and oldest Gonococcal infection causes
urethritis, cervicitis, epididymitis,
known sexually pharyngitis, proctitis, & pelvic
transmitted diseases inflammatory disease (PID) can
(STDs). spread throughout the body to
cause both localized and
purulent infection of disseminated disease.
mucous membrane Complications :ectopic
surfaces caused by pregnancy and increased
susceptibility to human
Neisseria gonorrhoeae immunodeficiency virus (HIV)
infection

111
Gonorrhea
Laboratory exam. 1. Culture
Gram stainingPerform a
culture or nonculture detection
test for N gonorrhoeae on
endocervical, urethral,
pharyngeal, or rectal
discharge. Because organisms
are intracellular, attempt to
obtain specimens in a manner
that will contain mucosal cells
and not merely discharge

112
Gonorrhea
Laboratory exam. 2. Culture
A Gram stain of urethral or
cervical discharge may
show gram-negative
intracellular diplococci
(diagnostic in the male) &
polymorphonuclear cells

113
THANK
YOU
114

Urinalysis-Urogen Disease

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Glomerulus - tubuli

170,000 mL filtered plasma absob.

2.Midstream 2.Respresets elementlsfrom

exact amount of 1 Jan 20:06 200 mL collect

2 Jan 17:55 200mL collect

Polyuria or diabetes insipidusIncreased 24-

Concentrated specimen May be normal after

Acriflavin Negative bile test result and possible

Phenazopyridine (pyridium)Drug commonly used

Nitrofurantoin Antibiotics, administered for UTI

Normal Clarity Refer to transparecy or turbidity of

11.Transitional epithelial cells

14.Calcium Oxalate crystals

17.Uric acid (Biuret) crystals

Color Straw Dark yellow

Spec.Gravity 1.003 1.029

Occult blood Negatiev

Leukocyte Esyerae Negatiev 61

Urobilinogen 0.1 1.0 EU/dL

4/24/17 R.Pakasi _ PPD Unpatti

Acute Ranal Failure (ARF) 65

In liver diseases FENa can be < 1%

R.Pakasi _ PPD Unpatti 66 4/24/17

CBC: normochrominc normocytic

Approaching Albumin: hypoalbuminemia due

R.Pakasi _ PPD Unpatti 67 4/24/17

Serum and urine elctrophoriss:

R.Pakasi _ PPD Unpatti 68 4/24/17

Complements Low level suggest systemic disease

R.Pakasi _ PPD Unpatti 70 4/24/17

Urinalysis Dark, SG> 1. 020

R.Pakasi _ PPD Unpatti 71 4/24/17

R.Pakasi _ PPD Unpatti 72 4/24/17

R.Pakasi _ PPD Unpatti 73 4/24/17

R.Pakasi _ PPD Unpatti 75 4/24/17

Dipstick testing Include glucose,prtein, blood, nitrite and

Urine Cuulture Standard of Dx

R.Pakasi _ PPD Unpatti 78 4/24/17

R.Pakasi _ PPD Unpatti 82 4/24/17

R.Pakasi _ PPD Unpatti 83 4/24/17

* In combination with AFP & hCG

R.Pakasi _ PPD Unpatti 84 4/24/17

R.Pakasi _ PPD Unpatti 85 4/24/17

R.Pakasi _ PPD Unpatti 86 4/24/17

Lab Studies HEG associated with transient hyper

Stage 1 140-159 90-99

CBC, serum electrolyte, creatinine,

TSHs: exclude hypo- or hyper

Detect T gondii (Tox) inblood, body fluis &

IgM antibody : recent infection acquired after

Qualitative/ Quantitative PCR

3.Cytomegalovirus Stains: Giemsa, Papaniculao, Wright, HE,

Defined as difficult of labor or abnormally

Cervical Gram STD can also cause pelvic pain &

Gestational trophoblastic disease: partial mole, placental

DEMATOLOGICAL AND GENITAL DISORDERS AND

DEMATOLOGICAL AND GENITAL DISORDERS AND

DEMATOLOGICAL AND GENITAL DISORDERS AND

DEMATOLOGICAL AND GENITAL DISORDERS AND

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