Background
- Morning urine conc. - best anaylysis
- ? diabetes, do 2hr post prandial
- SG not reliable after radiol. contrast
- UTI may give false Pos blood
- Lab: casts, crystals, cells, & bugs
- Tyrosine crystals = ? liver
- Ambumin Pos in renal disease
- Renal tubular cells seen in ATN, poisoning, pyelonephtitis and viraemia
- Eosinophiles ATN, nephritis and UTI
- Dilute (low SG) in Diabetes I
Normal values
- pH – 4.5-8
- SG – 1.005-1.025
- Glucose - ≤7
- Ketones – 0
- Nitrates - 0
- Leukocyte esterase – 0
- Bilirubin – Negative
- Urobilirubin – Small
- RBC - ≤3/hpf
- Protein - ≤8mmol
- WBCs - ≤5 WBCs/hpf
- Squamous epithelial cells - ≤20/hpf
- Casts – 0-5 hyaline/lpf
- Crystals – Occasionally
- Bacteria/Yeast – None
FRCEM exam hints
- Red - Propofol, chlorpromazine
- Red - Rhabdo, UTI, porphyria
- Orange - Vit C, carrots, rifampicin
- Green - Asparagus, Vits B, propofol
- Blue - Methylene blue, indomethacin, amitriptyline, cimethidine, tryptophan
- Purple - UTI (catheterised patient)
- Brown - Biliary dis., levodopa, metronidazole, nitrofurantoin
- Black - Malig melanoma, Gilberts
- White - Propofol, chyluria, pyuria, phosphate crystals++
pH
N. mildly acidic (H+ excretion).
Acidosis ↓pH
- ↓pH - Cranberries/high-protein diet
- Uric acid & cystine stones
Alkaline ↑pH
- ↑pH - Fruit, low carb diet
- Calcium oxalate/phosphate, struvite, staghorn stones
- UTI with urea splitting proteus/klebsiella