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文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。思考题思考题1.尿检的主要临床应用尿检的主要临床应用2.何为多尿、少尿、无尿、蛋白尿何为多尿、少尿、无尿、蛋白尿3.选择性蛋白尿、非选择性蛋白尿选择性蛋白尿、非选择性蛋白尿4.管型形成条件及临床意义管型形成条件及临床意义5.内生肌酐清除率(内生肌酐清除率(Ccr)及临床意义及临床意义6.粪便的检测的临床应用粪便的检测的临床应用7 BUN、Cr的临床意义的临床意义思考题1.尿检的主要临床应用1 1文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿液尿液是血液经肾小球是血液经肾小球滤过、肾小管和集合滤过、肾小管和集合管排泌和重吸收后形管排泌和重吸收后形成的终末产物成的终末产物 排泄代谢废物、异物排泄代谢废物、异物 维维持持体体内内水水、盐盐代代谢谢和和酸酸碱碱平平衡衡,维维持持内内环境稳定环境稳定 同同时时还还有有内内分分泌泌功功能能,调调节节血血压压,钙钙磷磷代代谢谢,红细胞生成红细胞生成尿液是血液经肾小球滤过、肾小管和集合管排泌和重吸收后形成的终2 2文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿检的主要临床应用尿检的主要临床应用(The main clinical application of urinalyisisThe main clinical application of urinalyisis)泌尿系统疾病的诊断和疗效判断:泌尿系统疾病的诊断和疗效判断:泌尿系统疾病的诊断和疗效判断:泌尿系统疾病的诊断和疗效判断:(Urinary(Urinary tract tract disease disease diagnosis diagnosis and and efficacy efficacy judgment)judgment)全身其它系统疾病的诊断:全身其它系统疾病的诊断:全身其它系统疾病的诊断:全身其它系统疾病的诊断:(other system disease diagnosis)(other system disease diagnosis)应用肾损伤药物的监控:应用肾损伤药物的监控:应用肾损伤药物的监控:应用肾损伤药物的监控:(The(The application application of of kidney kidney damage damage drugs drugs surveillance)surveillance)尿检的主要临床应用(The main clinical a3 3文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿液检测的基本内容尿液检测的基本内容(The basic content of urinalysis)物理性状检查物理性状检查物理性状检查物理性状检查:量,颜色,气味:量,颜色,气味:量,颜色,气味:量,颜色,气味,比重等比重等比重等比重等 (Physical properties:urine volume,color,smell,specific gravity,etc.)(Physical properties:urine volume,color,smell,specific gravity,etc.)化学成分分析化学成分分析化学成分分析化学成分分析:蛋白,糖,胆红素,酮体:蛋白,糖,胆红素,酮体:蛋白,糖,胆红素,酮体:蛋白,糖,胆红素,酮体(Chemical composition analysis:Protein,glucose,bilirubin,ketone body)(Chemical composition analysis:Protein,glucose,bilirubin,ketone body)观察有形成分观察有形成分:细胞,管型,结晶等:细胞,管型,结晶等(Observation urinary sediment:cells,casts,urates)(Observation urinary sediment:cells,casts,urates)病原微生物检查病原微生物检查及其它及其它特殊检查特殊检查(Pathogenic microorganism inspection and other special inspection)(Pathogenic microorganism inspection and other special inspection)尿液检测的基本内容(The basic content o4 4文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件5 5文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿液分析的自动化尿液分析的自动化(Urine analysis of automation)(Urine analysis of automation)酸碱度(酸碱度(酸碱度(酸碱度(PHPH )蛋白(蛋白(蛋白(蛋白(ProteinProtein)葡萄糖(葡萄糖(葡萄糖(葡萄糖(GlucoseGlucose)酮体(酮体(酮体(酮体(KetonsKetons)胆红素(胆红素(胆红素(胆红素(BilirubinBilirubin )尿胆原(尿胆原(尿胆原(尿胆原(UrobilinogenUrobilinogen)比重(比重(比重(比重(Specific gravitySpecific gravity)隐血(隐血(隐血(隐血(BloodBlood)白细胞(白细胞(白细胞(白细胞(LeukocytesLeukocytes)亚硝酸盐(亚硝酸盐(亚硝酸盐(亚硝酸盐(NitriteNitrite)自动化尿液分析仪组合项目报告模式自动化尿液分析仪组合项目报告模式自动化尿液分析仪组合项目报告模式自动化尿液分析仪组合项目报告模式尿液分析的自动化(Urine analysis of au6 6文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿标本的种类及注意事项尿标本的种类及注意事项(Urine specimen types and matters needing attention)(Urine specimen types and matters needing attention)首次晨尿首次晨尿首次晨尿首次晨尿 :经过浓缩、酸化,适合蛋白和有形成分经过浓缩、酸化,适合蛋白和有形成分经过浓缩、酸化,适合蛋白和有形成分经过浓缩、酸化,适合蛋白和有形成分(The(The first first morning morning urine:urine:after after concentrated concentrated and and acidified,acidified,suitable suitable for for protein,and protein,and urinary sediment urinary sediment test)test)随机尿随机尿随机尿随机尿 :门诊和急诊患者临时检测门诊和急诊患者临时检测门诊和急诊患者临时检测门诊和急诊患者临时检测(Random urine:outpatient and emergency patients temporary detection)(Random urine:outpatient and emergency patients temporary detection)2424小时尿小时尿小时尿小时尿 检测溶质总量,如蛋白,糖,激素等检测溶质总量,如蛋白,糖,激素等检测溶质总量,如蛋白,糖,激素等检测溶质总量,如蛋白,糖,激素等(24-hour(24-hour urine urine:Total:Total solute solute detection,detection,such such as as protein,protein,glucose,glucose,hormone,hormone,etc)etc)清洁中段尿清洁中段尿清洁中段尿清洁中段尿 :用于病原微生物的检测用于病原微生物的检测用于病原微生物的检测用于病原微生物的检测(clean midstream urine:Used for testing the pathogenic microorganisms)(clean midstream urine:Used for testing the pathogenic microorganisms)尿标本的种类及注意事项(Urine specimen ty7 7文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。物理性状检查物理性状检查(Physical properties)(Physical properties)一一.尿量尿量(urine volume)urine volume)参考值:参考值:1000-2000ml/24h(Normal Range of(Normal Range of urine volume:urine volume:1000-2000 1000-2000ml/24h)ml/24h)少尿少尿:400ml/24h或少于或少于17ml/h(Oliguria:(Oliguria:less than less than 400400ml/24h or less than ml/24h or less than 1717ml/h)ml/h)无尿无尿:2500 ml/24h(Polyuria:more than 2500ml/24h)(Polyuria:more than 2500ml/24h)物理性状检查(Physical properties)一.8 8文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。临床意义临床意义临床意义临床意义(Clinical significance)(Clinical significance)多尿多尿多尿多尿(Polyuria)(Polyuria):1.1.内分泌疾病内分泌疾病内分泌疾病内分泌疾病 :糖尿病、尿崩症、甲旁亢等糖尿病、尿崩症、甲旁亢等糖尿病、尿崩症、甲旁亢等糖尿病、尿崩症、甲旁亢等。(Endocrine diseases:DiabetesEndocrine diseases:Diabetes、insipidusinsipidus、hyperparathyroidism,etc hyperparathyroidism,etc)2.2.肾脏疾病肾脏疾病肾脏疾病肾脏疾病 慢性肾炎,肾间质炎症慢性肾炎,肾间质炎症慢性肾炎,肾间质炎症慢性肾炎,肾间质炎症(Kidney diseaseKidney disease:Chronic nephritisChronic nephritis,Renal interstitial inflammationRenal interstitial inflammation)少尿和无尿:少尿和无尿:少尿和无尿:少尿和无尿:(Oliguria and Anuria)(Oliguria and Anuria)1.1.肾前性:心衰、脱水等有效循环血量减少。肾前性:心衰、脱水等有效循环血量减少。肾前性:心衰、脱水等有效循环血量减少。肾前性:心衰、脱水等有效循环血量减少。(Prerenal (Prerenal:heart failureheart failure、dehydration dehydration,etc)etc)2.2.肾性:各类肾小球疾病的急性肾炎综合症。肾性:各类肾小球疾病的急性肾炎综合症。肾性:各类肾小球疾病的急性肾炎综合症。肾性:各类肾小球疾病的急性肾炎综合症。(Renal:Acute nephritis syndrome)(Renal:Acute nephritis syndrome)3.3.肾后性:因尿路狭窄、结石、肿瘤引起的梗阻或肾后性:因尿路狭窄、结石、肿瘤引起的梗阻或肾后性:因尿路狭窄、结石、肿瘤引起的梗阻或肾后性:因尿路狭窄、结石、肿瘤引起的梗阻或排尿功能障碍。排尿功能障碍。排尿功能障碍。排尿功能障碍。(After kidney:Obstruction After kidney:Obstruction、Micturition Micturition dysfunction)dysfunction)临床意义(Clinical significance)9 9文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。二二.尿液外观尿液外观(COLOR)(COLOR)常见的异常变化有常见的异常变化有常见的异常变化有常见的异常变化有(Abnomal-Colored Urine)(Abnomal-Colored Urine):1.1.血尿血尿血尿血尿 肉眼血尿(血液肉眼血尿(血液肉眼血尿(血液肉眼血尿(血液1ml/L1ml/L尿液)尿液)尿液)尿液),镜下血尿镜下血尿镜下血尿镜下血尿 (Hematuria:Gross hematuria,Microscopic hematuria)(Hematuria:Gross hematuria,Microscopic hematuria)(3RBC/Hp)(3RBC/Hp)。见于泌尿系统炎症、结石、结核、。见于泌尿系统炎症、结石、结核、。见于泌尿系统炎症、结石、结核、。见于泌尿系统炎症、结石、结核、肿瘤、外伤,或血友病,紫癜肾等。肿瘤、外伤,或血友病,紫癜肾等。肿瘤、外伤,或血友病,紫癜肾等。肿瘤、外伤,或血友病,紫癜肾等。(In urological system(In urological system inflammation,stones,tuberculosis,cancer,trauma,or hemophilia,purpura inflammation,stones,tuberculosis,cancer,trauma,or hemophilia,purpura kidney,etc)kidney,etc)2.2.血红蛋白尿或肌红蛋白尿血红蛋白尿或肌红蛋白尿血红蛋白尿或肌红蛋白尿血红蛋白尿或肌红蛋白尿 :(Hemoglobinuria or Hemoglobinuria or myoglobinuriamyoglobinuria)可使尿液呈红葡萄酒色、浓茶色或酱油色,尿中无红可使尿液呈红葡萄酒色、浓茶色或酱油色,尿中无红可使尿液呈红葡萄酒色、浓茶色或酱油色,尿中无红可使尿液呈红葡萄酒色、浓茶色或酱油色,尿中无红细胞但尿隐血试验阳性。见于严重的血管内溶血如血细胞但尿隐血试验阳性。见于严重的血管内溶血如血细胞但尿隐血试验阳性。见于严重的血管内溶血如血细胞但尿隐血试验阳性。见于严重的血管内溶血如血型不合输血反应、某些溶血性贫血等。型不合输血反应、某些溶血性贫血等。型不合输血反应、某些溶血性贫血等。型不合输血反应、某些溶血性贫血等。(Like red wine(Like red wine color,Strong brown,there is no red cells in urine.Concealed blood test color,Strong brown,there is no red cells in urine.Concealed blood test positive.In severe hemolytic such as blood vessels are within the positive.In severe hemolytic such as blood vessels are within the transfusion reactions,some hemolytic anemia,etc)transfusion reactions,some hemolytic anemia,etc)二.尿液外观(COLOR)常见的异常变化有(Abnomal-1010文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。3.3.胆红素尿胆红素尿胆红素尿胆红素尿(BilirubinuriaBilirubinuria )尿中含有大量结合胆红素时,尿中含有大量结合胆红素时,尿中含有大量结合胆红素时,尿中含有大量结合胆红素时,呈深黄色,常见于阻塞性黄疸和肝细胞性黄疸。呈深黄色,常见于阻塞性黄疸和肝细胞性黄疸。呈深黄色,常见于阻塞性黄疸和肝细胞性黄疸。呈深黄色,常见于阻塞性黄疸和肝细胞性黄疸。(Contains a large number of Conjugated bilirubin in the urine,(Contains a large number of Conjugated bilirubin in the urine,Common symptoms of obstructive jaundice and liver cell jaundice)Common symptoms of obstructive jaundice and liver cell jaundice)4.4.结晶尿结晶尿结晶尿结晶尿 (Urinary crystalsUrinary crystals )出现浑浊,或砖红色沉淀,出现浑浊,或砖红色沉淀,出现浑浊,或砖红色沉淀,出现浑浊,或砖红色沉淀,尿酸盐结晶和磷酸盐结晶最多见尿酸盐结晶和磷酸盐结晶最多见尿酸盐结晶和磷酸盐结晶最多见尿酸盐结晶和磷酸盐结晶最多见(Appear turbid,or brick(Appear turbid,or brick red precipitate,urate crystals and phosphate crystallization,)red precipitate,urate crystals and phosphate crystallization,)5.5.脓尿和菌尿脓尿和菌尿脓尿和菌尿脓尿和菌尿 (Pyuria and bacteriuria)(Pyuria and bacteriuria)尿液出现白色或云雾尿液出现白色或云雾尿液出现白色或云雾尿液出现白色或云雾状浑浊,多伴有尿路刺激征,见于泌尿系统感染状浑浊,多伴有尿路刺激征,见于泌尿系统感染状浑浊,多伴有尿路刺激征,见于泌尿系统感染状浑浊,多伴有尿路刺激征,见于泌尿系统感染(White or turbidity,with urinary irritation,for urinary tract infection)White or turbidity,with urinary irritation,for urinary tract infection)。6.6.乳糜尿和脂肪尿乳糜尿和脂肪尿乳糜尿和脂肪尿乳糜尿和脂肪尿(chyluria and lipiduria)(chyluria and lipiduria)尿液呈乳白色,尿液呈乳白色,尿液呈乳白色,尿液呈乳白色,多见于丝虫病和肾周围淋巴管梗阻,脂肪尿见于多见于丝虫病和肾周围淋巴管梗阻,脂肪尿见于多见于丝虫病和肾周围淋巴管梗阻,脂肪尿见于多见于丝虫病和肾周围淋巴管梗阻,脂肪尿见于脂肪挤压伤、肾病综合症。脂肪挤压伤、肾病综合症。脂肪挤压伤、肾病综合症。脂肪挤压伤、肾病综合症。(Urine has milk-white,see Urine has milk-white,see more at filariasis and kidneys obstruction of the surrounding lymph,more at filariasis and kidneys obstruction of the surrounding lymph,lipiduria lipiduria may occur with nephrotic syndrome.)may occur with nephrotic syndrome.)3.胆红素尿(Bilirubinuria)尿中含有大量结1111文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。三三.气味气味(smell)典型病理性气味典型病理性气味 1.氨味:慢性膀胱炎、慢性尿潴留氨味:慢性膀胱炎、慢性尿潴留(Ammonia smell:Chronic cystitis Chronic urinary retentionAmmonia smell:Chronic cystitis Chronic urinary retention)2.发酵苹果味:糖尿病酮症酸中毒发酵苹果味:糖尿病酮症酸中毒(Rotten apples taste(Rotten apples taste:diabetic ketoacidosis)diabetic ketoacidosis)3.蒜臭味:有机磷中毒蒜臭味:有机磷中毒(Garlic smell:organophosphorouspoisoning)(Garlic smell:organophosphorouspoisoning)三.气味(smell)典型病理性气味1212文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。四四.酸碱反应酸碱反应(ACIDITY)ACIDITY)肾肾肾肾小小小小管管管管上上上上皮皮皮皮细细细细胞胞胞胞分分分分泌泌泌泌的的的的H H+与与与与滤滤滤滤液液液液中中中中的的的的NHNH3 3和和和和HPOHPO4 42 2结合,形成结合,形成结合,形成结合,形成NHNH4 4+或可滴定酸或可滴定酸或可滴定酸或可滴定酸H H2 2POPO4 4随尿排出。随尿排出。随尿排出。随尿排出。参考值:参考值:参考值:参考值:4.54.58.0 8.0(Normal Range of pH):(Normal Range of pH):4.5 4.58.08.0临床意义:临床意义:临床意义:临床意义:1.1.尿尿尿尿PHPH降低:酸中毒、高热、痛风、糖尿病等。降低:酸中毒、高热、痛风、糖尿病等。降低:酸中毒、高热、痛风、糖尿病等。降低:酸中毒、高热、痛风、糖尿病等。(Decreased Urine pH:Acidosis,high fever,gout and diabetes)(Decreased Urine pH:Acidosis,high fever,gout and diabetes)2.2.尿尿尿尿PHPH增高:碱中毒、尿潴留、膀胱炎、肾小管增高:碱中毒、尿潴留、膀胱炎、肾小管增高:碱中毒、尿潴留、膀胱炎、肾小管增高:碱中毒、尿潴留、膀胱炎、肾小管 酸酸酸酸中中中中毒毒毒毒。(Increased Increased Urine Urine pH:pH:Alkali Alkali poisoning,poisoning,urinary urinary retention,retention,cystitis,renal tubular acidosis)cystitis,renal tubular acidosis)四.酸碱反应(ACIDITY)肾小管上皮细胞分泌的H+与滤液1313文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。五五.尿比重测定尿比重测定(SPECIFIC GRAVITY)SPECIFIC GRAVITY)是是是是指指指指4 4条条条条件件件件下下下下尿尿尿尿液液液液与与与与同同同同体体体体积积积积纯纯纯纯水水水水的的的的重重重重量量量量之之之之比比比比。受受受受尿尿尿尿中中中中可可可可溶溶溶溶性性性性物物物物质质质质的的的的量量量量及及及及尿尿尿尿量量量量影影影影响响响响。可可可可大大大大致致致致反反反反映映映映肾肾肾肾小小小小管管管管的的的的浓浓浓浓缩缩缩缩功功功功能能能能。(the(the specific specific gravity gravity measures measures the the kidneys kidneys to to ability ability concentrate urine)concentrate urine)参考值:成人参考值:成人参考值:成人参考值:成人1.0151.0151.0251.025(Normal Urine Specific Gravity Range:(Normal Urine Specific Gravity Range:1.0151.0151.0251.025)临床意义:临床意义:临床意义:临床意义:1.1.增高:禁食、脱水,糖尿病,急性肾小球肾炎等增高:禁食、脱水,糖尿病,急性肾小球肾炎等增高:禁食、脱水,糖尿病,急性肾小球肾炎等增高:禁食、脱水,糖尿病,急性肾小球肾炎等(Fasting and dehydration,glycosuria,Acute glomerulonephritis Fasting and dehydration,glycosuria,Acute glomerulonephritis)。2.2.降降降降低低低低:大大大大量量量量饮饮饮饮水水水水,急急急急、慢慢慢慢间间间间质质质质性性性性肾肾肾肾炎炎炎炎,尿尿尿尿崩崩崩崩症症症症。(Compulsive(Compulsive water water drinking,drinking,acute/acute/chronic chronic Interstitial Interstitial nephritis nephritis,diabetes,diabetes insipidus)insipidus)五.尿比重测定(SPECIFIC GRAVITY)是指4条1414文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。化学成分分析化学成分分析一一.尿蛋白测定尿蛋白测定(Urinary protein determination)正正常常情情况况下下肾肾小小球球毛毛细细血血管管滤滤过过膜膜具具有有孔孔径径屏屏障障和和电电荷荷屏屏障障,血血浆浆中中高高分分子子量量蛋蛋白白质质(7万万)如如白白蛋蛋白白、球球蛋蛋白白不不能能通通过过滤滤膜膜,低低分分子子量量的的蛋蛋白白质质(2万万)如如2-M、1-M滤滤过过后后95在在近近曲曲小小管管重重吸吸收收,因因此此正正常常情情况况下下尿尿液液中中蛋蛋白白含含量量很很低低,定定性性试试验验 阴阴 性性,定定 量量 检检 测测 150mg/24h。(Normally,only Normally,only the the smallest smallest protein protein molecules molecules can can pass pass the the filtration filtration barrier barrier of of the the glomerulus,and glomerulus,and most most of of these these are are reabsorbed reabsorbed by by the the tubules,tubules,Therefore Therefore normally normally urine urine protein protein content content is is low,low,the the qualitative qualitative test test negative,negative,Quantitative detection 150mg 24h.)Quantitative detection 150mg 33个个个个称称称称镜镜镜镜下下下下血血血血尿。尿。尿。尿。(Hematuria:Normal:0-3 red blood cells(RBCs)/hpf)Hematuria:Normal:0-3 red blood cells(RBCs)/hpf)临临临临床床床床意意意意义义义义:1.1.肾肾肾肾小小小小球球球球源源源源性性性性血血血血尿尿尿尿 红红红红细细细细胞胞胞胞通通通通过过过过滤滤滤滤过过过过膜膜膜膜受受受受到到到到机机机机械械械械性性性性损损损损伤伤伤伤,肾肾肾肾小小小小管管管管中中中中受受受受到到到到不不不不同同同同PHPH和和和和渗渗渗渗透透透透压压压压变变变变化化化化的的的的影影影影响响响响,呈呈呈呈多多多多形形形形性性性性改改改改变变变变,常常常常见见见见于于于于急急急急慢慢慢慢性性性性肾肾肾肾小小小小球球球球肾肾肾肾炎炎炎炎、紫紫紫紫癜癜癜癜肾肾肾肾、狼狼狼狼疮疮疮疮肾肾肾肾炎炎炎炎等等等等。(Glomerular(Glomerular haematuria haematuria:Erythrocytes Erythrocytes polymorphism polymorphism,like,like glomerulonephritis,glomerulonephritis,Purpura Purpura nephritis,sle nephritis,sle nephritis)nephritis)2.2.非非非非肾肾肾肾小小小小球球球球性性性性血血血血尿尿尿尿 损损损损伤伤伤伤在在在在肾肾肾肾间间间间质质质质或或或或输输输输尿尿尿尿管管管管以以以以下下下下部部部部位位位位,常常常常见见见见于于于于肾肾肾肾结结结结石石石石、泌泌泌泌尿尿尿尿系系系系肿肿肿肿瘤瘤瘤瘤、肾肾肾肾盂盂盂盂肾肾肾肾 炎炎炎炎、急急急急 性性性性 膀膀膀膀 胱胱胱胱 炎炎炎炎、尿尿尿尿 道道道道 炎炎炎炎 等等等等。Non-Glomerular Non-Glomerular haematuria:haematuria:In In the the renal renal stroma stroma damage damage or or below below the the ureteral,ureteral,stones,stones,urinary tract tumors,pyelonephritis,acute cystitis,urethritis,etcurinary tract tumors,pyelonephritis,acute cystitis,urethritis,etc尿液中主要的有形成分一.红细胞(Erythrocytes)2929文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件3030文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件3131文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。二二二二.白细胞和脓细胞白细胞和脓细胞白细胞和脓细胞白细胞和脓细胞(Leukocytes and purulent cells)(Leukocytes and purulent cells)白细胞外形完整,分散存在,以中性粒细胞多见。白细胞外形完整,分散存在,以中性粒细胞多见。白细胞外形完整,分散存在,以中性粒细胞多见。白细胞外形完整,分散存在,以中性粒细胞多见。脓细胞是指在炎症过程中破坏或死亡的中性粒细脓细胞是指在炎症过程中破坏或死亡的中性粒细脓细胞是指在炎症过程中破坏或死亡的中性粒细脓细胞是指在炎症过程中破坏或死亡的中性粒细胞,外形不规则,常成堆聚集存在。胞,外形不规则,常成堆聚集存在。胞,外形不规则,常成堆聚集存在。胞,外形不规则,常成堆聚集存在。Leucocyte Leucocyte appearance,complete,scattered by neutrophils.Pus cell refers to the appearance,complete,scattered by neutrophils.Pus cell refers to the process of inflammation of the destruction or death,irregular shape process of inflammation of the destruction or death,irregular shape neutrophils,often gathered there heapsneutrophils,often gathered there heaps 参考值:正常平均参考值:正常平均参考值:正常平均参考值:正常平均0-50-5个个个个/高倍视野高倍视野高倍视野高倍视野 Normal:0-5 white blood cells(WBSs)/hpf.Normal:0-5 white blood cells(WBSs)/hpf.临床意义:若临床意义:若临床意义:若临床意义:若 有较多白细胞或脓细胞,多为泌尿有较多白细胞或脓细胞,多为泌尿有较多白细胞或脓细胞,多为泌尿有较多白细胞或脓细胞,多为泌尿系感染如肾盂肾炎、膀胱炎、尿道炎。系感染如肾盂肾炎、膀胱炎、尿道炎。系感染如肾盂肾炎、膀胱炎、尿道炎。系感染如肾盂肾炎、膀胱炎、尿道炎。(more white cells,or septic for urinary tract infection such as more white cells,or septic for urinary tract infection such as pyelonephritis,cystitis,urethritis)pyelonephritis,cystitis,urethritis)二.白细胞和脓细胞(Leukocytes and puru3232文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件3333文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件3434文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。三三三三.上皮细胞上皮细胞上皮细胞上皮细胞(Epithelial cells)(Epithelial cells)1.1.肾肾肾肾小小小小管管管管上上上上皮皮皮皮细细细细胞胞胞胞:来来来来自自自自近近近近曲曲曲曲小小小小管管管管和和和和远远远远曲曲曲曲小小小小管管管管,较较较较多多多多出出出出现现现现提提提提示示示示肾肾肾肾小小小小管管管管病病病病变变变变。慢慢慢慢性性性性炎炎炎炎症症症症时时时时肾肾肾肾小小小小管管管管上上上上皮皮皮皮细细细细胞胞胞胞发发发发生生生生脂脂脂脂肪肪肪肪变变变变性性性性,称称称称脂脂脂脂肪肪肪肪颗颗颗颗粒粒粒粒细细细细胞胞胞胞。Renal Renal tubular tubular epithelial epithelial cells:cells:From From the the proximal proximal convoluted convoluted tubules tubules and and far far convoluted tubules,prompting renal tubular lesions.convoluted tubules,prompting renal tubular lesions.2.2.移移移移行行行行上上上上皮皮皮皮细细细细胞胞胞胞:有有有有尾尾尾尾形形形形、小小小小圆圆圆圆、大大大大圆圆圆圆,来来来来自自自自肾肾肾肾盂盂盂盂、输输输输尿尿尿尿管管管管、膀膀膀膀胱胱胱胱,有有有有炎炎炎炎症症症症时时时时在在在在尿尿尿尿中中中中出出出出现现现现增增增增多多多多.transitional.transitional epithelium epithelium cells cells:With:With tail tail shape,shape,small small circle,circle,big big circle,circle,from from the the pelvis,pelvis,ureter,ureter,bladder,bladder,when when these these parts parts inflammation,inflammation,transitional transitional epithelium cells epithelium cells appeared in the urineappeared in the urine3.3.复复复复层层层层扁扁扁扁平平平平上上上上皮皮皮皮细细细细胞胞胞胞:来来来来源源源源于于于于尿尿尿尿道道道道前前前前段段段段,女女女女性性性性排排排排除除除除阴阴阴阴道道道道分分分分泌泌泌泌物物物物污污污污染染染染后后后后,且且且且伴伴伴伴有有有有尿尿尿尿白白白白细细细细胞胞胞胞增增增增多多多多,见见见见于于于于尿道炎。尿道炎。尿道炎。尿道炎。Stratified squamous epithelial cells:urethritisStratified squamous epithelial cells:urethritis三.上皮细胞(Epithelial cells)3535文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。肾小管上皮细胞尾形、小圆、大圆上皮细胞扁平上皮细胞肾小管上皮细胞尾形、小圆、大圆上皮细胞扁平上皮细胞3636文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。四四四四.管型管型管型管型CastsCasts 是是是是滤滤滤滤出出出出液液液液中中中中的的的的蛋蛋蛋蛋白白白白质质质质、细细细细胞胞胞胞或或或或其其其其它它它它物物物物质质质质在在在在肾肾肾肾小小小小管管管管、集集集集合合合合管管管管中中中中凝凝凝凝固固固固而而而而成成成成的的的的类类类类圆圆圆圆柱柱柱柱形形形形蛋蛋蛋蛋白白白白聚聚聚聚体体体体。其其其其形形形形成成成成条条条条件件件件:(The The proteins proteins,cell,cell,or or other other substances substances in in renal renal tubular tubular collection,frozen tube of cylindrical protein together.)collection,frozen tube of cylindrical protein together.)1.1.尿尿尿尿中中中中有有有有少少少少量量量量的的的的清清清清蛋蛋蛋蛋白白白白和和和和由由由由肾肾肾肾小小小小管管管管上上上上皮皮皮皮细细细细胞胞胞胞产产产产生生生生的的的的T-HT-H糖糖糖糖蛋蛋蛋蛋白白白白是是是是构构构构成成成成管管管管型型型型的的的的基基基基质质质质(A A small small amount amount of of albumin albumin and T-H glycoproteins)and T-H glycoproteins)2.2.肾肾肾肾小小小小管管管管有有有有使使使使尿尿尿尿液液液液浓浓浓浓缩缩缩缩和和和和酸酸酸酸化化化化能能能能力力力力(浓浓浓浓缩缩缩缩可可可可提提提提高高高高蛋蛋蛋蛋白质含量、盐类浓度,尿液酸化后使蛋白质沉淀)白质含量、盐类浓度,尿液酸化后使蛋白质沉淀)白质含量、盐类浓度,尿液酸化后使蛋白质沉淀)白质含量、盐类浓度,尿液酸化后使蛋白质沉淀)(The tubular has ability to fully concentrated and acidify the urine)The tubular has ability to fully concentrated and acidify the urine)3.3.有有有有交交交交替替替替使使使使用用用用的的的的肾肾肾肾单单单单位位位位,处处处处于于于于休休休休息息息息状状状状态态态态的的的的肾肾肾肾单单单单位位位位,尿尿尿尿液液液液在在在在肾肾肾肾小小小小管管管管内内内内有有有有一一一一定定定定的的的的滞滞滞滞留留留留时时时时间间间间,使使使使蛋蛋蛋蛋白白白白质质质质浓浓浓浓缩缩缩缩和和和和凝凝凝凝结结结结,当当当当该该该该肾肾肾肾单单单单位位位位活活活活动动动动时时时时,已已已已形形形形成成成成的的的的管管管管型型型型随随随随尿排出尿排出尿排出尿排出(Have the alternate use of renal units)(Have the alternate use of renal units)四.管型Casts3737文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。实验诊疗学之尿液肾功能检验培训ppt课件3838文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。尿液中的管型和临床意义:尿液中的管型和临床意义:尿液中的管型和临床意义:尿液中的管型和临床意义:1.1.透透透透明明明明管管管管型型型型:由由由由T-HT-H糖糖糖糖蛋蛋蛋蛋白白白白和和和和白白白白蛋蛋蛋蛋白白白白构构构构成成成成,某某某某些些些些人人人人在在在在剧剧剧剧烈烈烈烈运运运运动动动动、发发发发热热热热、麻麻麻麻醉醉醉醉后后后后等等等等无无无无肾肾肾肾脏脏脏脏器器器器质质质质性性性性病病病病变变变变时时时时有有有有轻轻轻轻度度度度增增增增多多多多,在在在在慢慢慢慢性性性性肾肾肾肾炎炎炎炎,肾肾肾肾病病病病综综综综合合合合症症症症,高高高高血血血血压压压压肾肾肾肾 损损损损 伤伤伤伤 的的的的 增增增增 多多多多。(hyaline hyaline casts:casts:component component by by T T-H H glycoprotein glycoprotein and and albumin,occur albumin,occur Chronic Chronic nephritis,nephritis,Nephrotic Nephrotic syndrome,Hypertensive renal damage)syndrome,Hypertensive renal damage)2.2.红红红红细细细细胞胞胞胞管管管管型型型型:基基基基质质质质中中中中含含含含有有有有红红红红细细细细胞胞胞胞,最最最最多多多多见见见见于于于于急急急急性性性性肾小球肾炎。肾小球肾炎。肾小球肾炎。肾小球肾炎。(Red cell casts:Acute glomerulonephritis)Red cell casts:Acute glomerulonephritis)3.3.白细胞管型白细胞管型白细胞管型白细胞管型:含有白细胞,见于肾盂肾炎。:含有白细胞,见于肾盂肾炎。:含有白细胞,见于肾盂肾炎。:含有白细胞,见于肾盂肾炎。Leukocyte cast:PyelonephritisLeukocyte cast:Pyelonephritis4.4.颗颗颗颗粒粒粒粒管管管管型型型型:(granular(granular casts)casts)基基基基质质质质中中中中含含含含有有有有较较较较多多多多粗粗粗粗大大大大颗颗颗颗粒粒粒粒,多多多多见见见见于于于于急急急急慢慢慢慢性性性性肾肾肾肾小小小小球球球球肾肾肾肾炎炎炎炎初初初初期期期期,肾肾肾肾盂盂盂盂肾肾肾肾炎炎炎炎累累累累及及及及肾肾肾肾小小小小球球球球。细细细细颗颗颗颗粒粒粒粒多多多多为为为为粗粗粗粗颗颗颗颗粒粒粒粒转转转转化化化化而而而而来来来来,见见见见于于于于急急急急慢慢慢慢性性性性肾小球肾炎后期。肾小球肾炎后期。肾小球肾炎后期。肾小球肾炎后期。尿液中的管型和临床意义:3939文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。5 5.蜡蜡蜡蜡样样样样管管管管型型型型:由由由由颗颗颗颗粒粒粒粒管管管管型型型型、红红红红细细细细胞胞胞胞管管管管型型型型在在在在肾肾肾肾小小小小管管管管中中中中长长长长期期期期滞滞滞滞留留留留变变变变性性性性形形形形成成成成,提提提提示示示示较较较较严严严严重重重重的的的的肾肾肾肾小小小小管管管管损损损损伤伤伤伤,预预预预后后后后不不不不良良良良。(Waxy Waxy cast:cast:By By granular granular casts,casts,and and red red cell cell casts casts for for long-term long-term retention retention in in tubular,tubular,indicate,indicate more more serious serious injury injury of of the the renal tubular d and bad prognosis.)renal tubular d and bad prognosis.)6 6.宽宽宽宽幅幅幅幅管管管管型型型型:由由由由基基基基质质质质和和和和坏坏坏坏死死死死的的的的集集集集合合合合管管管管上上上上皮皮皮皮构构构构成成成成,外外外外形形形形宽宽宽宽大大大大,又又又又称称称称肾肾肾肾衰衰衰衰管管管管型型型型。在在在在急急急急性性性性肾肾肾肾衰衰衰衰多多多多尿尿尿尿早早早早期期期期可可可可大大大大量量量量出出出出现现现现,随随随随着着着着肾肾肾肾功功功功能能能能改改改改善善善善而而而而渐渐渐渐少少少少消消消消失失失失,在在在在慢慢慢慢性性性性肾肾肾肾衰衰衰衰时时时时出出出出现现现现,提提提提示示示示预预预预后后后后不不不不良良良良。(Broad Broad casts casts:occur:occur in in chronic renal failure.chronic renal failure.Indicate tIndicate the poor prognosis)he poor prognosis)5.蜡样管型:由颗粒管型、红细胞管型在肾小管中长期滞留变性形4040文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。透明管型蜡样管型宽幅管型透明管型蜡样管型宽幅管型4141文档仅供参考,不能作为科学依据,请勿模仿;如有不当之处,请联系网站或本人删除。五五.结晶体结晶体(crystals)尿液经沉淀后,有些会出现形态各异的结晶体。尿液经沉淀后,有些会出现形态各异的结晶体。尿液经沉淀后,有些会出现形态各异的结晶体。尿液经沉淀后,有些会出现形态各异的结晶体。1.1.碱性尿中易出现磷酸盐结晶,碱性尿中易出现磷酸盐结晶,碱性尿中易出现磷酸盐结晶,碱性尿中易出现磷酸盐结晶,phosphate may occur in Alkaline urine phosphate may occur in Alkaline urine 2.2.酸性尿中易出现尿酸盐结晶。酸性尿中易出现尿酸盐结晶。酸性尿中易出现尿酸盐结晶。酸性尿中易出现尿酸盐结晶。Urate Urate may occur in may occur in acidic urineacidic urine 与与与与饮饮饮饮食食食食和和和和个个个个人人人人体体体体质质质质代代代代谢谢谢谢有有有有关关关关,一一一一般般般般无无无无致致致致病病病病意意意意义义义义,较多出现并伴有红细胞者提示泌尿系统结石可能。较多出现并伴有红细胞者提示泌尿系统结石可能。较多出现并伴有红细胞者提示泌尿系统结石可能。较多出现并伴有红细胞者提示泌尿系统结石可能。五.结晶体(crystals)尿液经沉淀后,有
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