UniKL RCMP MITC YFN ur feme

URINE DIPSTICK TESTMacleod's Clinical Examination 11E, 2005http://www.studentconsult.com/content/default.cfm?ISBN=0443074046&ID=HC006023

Urinary specific gravityo is an index of the concentration of solute (e.g. sodium, chloride, urea, glucose) o range of value in health: 1.002 – 1.035o High values – kidney is actively reabsorbing water

e.g. fluid depletiono low values – failure of the renal tubules to concentrate urine (high urine volumes)

Urinary pHo range of value in health: 4.5 – 8.0

Proteinuriao Use fresh urine for protein testing. o Reading greater than 'trace' indicates significant proteinuria.

o Causes of transient proteinuria Cold exposure Vigorous exercise Febrile illness Orthostatic (postural) proteinuria Abdominal surgery Congestive cardiac failure

o Orthostatic (postural) proteinuria: occasional finding in healthy young subjects in whom protein is not detected in the first urine passed after sleeping recumbent overnight, but will be present during the day

o Proteinuria > 2 g per day suggests glomerular disease.

HaematuriaUrine dipstick test – changes on the reagent area at 60 seconds:

o Intact erythrocytes green spotso Free haemoglobin green colour

Note: The test does not differentiate between haemoglobin and myoglobin.

Bilirubin and urobilinogeno Bilirubin: normally absent from urineo Urobilinogen: may be present - up to 33 μmol/l in healtho Abnormalities of either

haemolysis or hepato-biliary disease

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UniKL RCMP MITC YFN ur feme

Haematuriahttp://www.gpnotebook.co.uk/simplepage.cfm?ID=-469368825&linkID=38414&cook=yes

Aetiology With Respect To Frequency

Note: It is important to know what are the clinical and other urinary features associated with this haematuria before you can make a diagnosis of the cause.

Commonest cause:

urinary tract infection

also common:

renal tract stones

Less common causes:

renal trauma and infarction benign prostatic hypertrophy benign microscopic haematuria glomerulonephritis malignant hypertension bleeding diathesis (anticoagulant treatment) ulcer at the urethral meatus

Uncommon causes:

hydronephrosis polycystic disease transitional cell carcinoma renal adenocarcinoma or Wilm's tumour

Rare causes:

polyarteritis nodosa, SLE, vasculitis, infective endocarditis atrial fibrillation - microemboli settling in the kidneys

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UniKL RCMP MITC YFN ur feme

http://www.jrnjournal.org/article/S1051-2276(07)00249-X/abstractJournal of Renal Nutrition

Volume 18, Issue 1, Pages 158-164 (January 2008)

Renal Alterations During Exercise

Guido   Bellinghieri , MD, Vincenzo   Savica , MD, Domenico   Santoro , MDProteinuria and hematuria are common during exercise. Proteinuria is usually due to glomerular or tubular changes or to an excessive production of protein as in myeloma. Certain clinical conditions can, however, result in a functional or temporary proteinuria, especially during pregnancy, fever, orthostasis, or following physical activity. Sport-related proteinuria following marching, exercise, and stress, was first observed in soldiers after long marching. Prevalence of proteinuria during exercise ranges from 18% up to 100% depending on type of exercise and its intensity. A higher incidence of proteinuria has been observed in some sports requiring great exercise intensity and it is certainly related to muscular work intensity and would decrease after prolonged training. Indeed, exercise-induced proteinuria is strictly related to exercise intensity rather than to exercise duration. Exercise aggravates the proteinuria of various nephropathies and that of renal transplant recipients. The prevalence of hematuria is higher in the athletic than the general population and the main difference is that sport-related hematuria resolves spontaneously after physical exercise while hematuria found in nonathletic population can be chronic. Sport-induced hematuria is influenced by exercise duration and intensity. Among the mechanisms underlying the exercise induced hematuria are increased body temperature, hemolysis, increased production of free radicals, and excessive release of catecholamines. Lactic acidosis, generated during anaerobic conditions, causes the passage of erythrocytes into the urine, through increased glomerular permeability.

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