INVESTIGATIONS OF URINARY SYSTEM DR. S Chakradhar

Normal level 2.5-6.6 mmol/l (15-40mg/dl) In Blood Serum Urea: Normal level 2.5-6.6 mmol/l (15-40mg/dl) High level can occur in high protein diet, GI bleeding, trauma, hypovolemia, burn. Low level can occur in low intake, liver failure, over hydration. Serum Creatinine: Normal level 55-120mmol/l (0.62-1.36 mg/dl) High level can occur in large muscle mass, rhabdomyolysis, drugs like trimethoprim, cimetidine Low level can occur in small muscle mass. Serum potassium: (Serum sodium) Normal level 3.7-5.2 mmol/l False high levels can occur in hemolysed sample DR. S Chakradhar

Microscopic examination Urine examination Broadly divided into Routine Special Physical Examination Chemical examination Microscopic examination DR. S Chakradhar

Physical examinations includes Amount (Volume) – 800 – 2500 ml / day Odour - Pungent Color of the urine – Straw colour Appearance – Clear & transparent Specific gravity – 1.010 – 1.030 DR. S Chakradhar

Chemical examinations includes Reaction – Acidic (avg 6) Protein (24hrs urine) – less than 150mg/24 hour Glucose (reducing substance) ketones DR. S Chakradhar

Microscopic examinations includes Cells Epithelial cells – normally found in samall number WBC ( Pus cells ) RBC ( normal, dysmorphic ) Others Casts --RBC casts, WBC casts, epithelial casts, granular casts Crystals - uric acid, calcium oxalate, triple phosphate, calcium carbonate etc DR. S Chakradhar

DR. S Chakradhar

Calculation of creatinine clearance Cockcroft and Gault: Estimation of GFR Calculation of creatinine clearance Cockcroft and Gault: {(140-age) X body weight X 1.22 (male) and 1.04 (female)} Divided by serum creatinine in μmol/l More accurate method: {Urine creatinine×urine volume} X 1000 divided by serum creatinine 1440 Normal range: Men 90-140 ml/min Women 80-125 ml/min. DR. S Chakradhar

Imaging Plain X-Ray abdomen DR. S Chakradhar

Excretion urography(IVP/IVU) Antegrade Retrograde DR. S Chakradhar

Excretion urography(IVP/IVU) Antegrade Retrograde DR. S Chakradhar

Micturating cystourography DR. S Chakradhar

Ultrasound DR. S Chakradhar

Renal angiogram DR. S Chakradhar

Computed tomogram (CT) DR. S Chakradhar

T1-weighted axial image without & with contrast medium Magnetic resonance imaging (MRI) DR. S Chakradhar T1-weighted axial image without & with contrast medium

Radionuclide studies (DMSA and DTPA) DR. S Chakradhar

Renal biopsy DR. S Chakradhar