2 1 2 10 mgd L 150 mgday

2. 요화학 선별검사 (요시험지봉 검사) 1) 요단백 - 정상 : 요량에 따라서 2 -10 mg/d. L, ～ 150 mg/day 요단백 >1/3 Tamm-Horsfall glycoprotein (요원주의 주성분) - 검사원리 : Tetrabromphenol blue…. - Detection limit : 10 -15 mg/d. L - More sensitive to albumin than globulin - Physiologic NL excretion in concentrated urine - 위양성 : 심한 알칼리성뇨(약제, 세균오염) quaternary ammonium compound (세척제, 세정제), chlorohexidine amido amine (fabric softners)제, 혈액, 농, 질분비물 - 위음성 혹은 위감소 : Bence Jones protein, globulin, mucoprotein - 임상적 의의 - 미세알부민뇨증

2. 요화학 선별검사 (요시험지봉 검사) 2) 요당 - 검사원리 : glucose oxidase, H 2 O 2, potassium iodide(KI), peroxidase. . - detection limit : 50 -100 mg/d. L - 위음성 : sodium fluoride (보존제), high SG, 과량의 비타민 C - 위양성 : strong oxidizing cleaning agents in container - 임상적 의의 : 혈당 농도가 신세뇨관의 재흡수능을 초과 혈당 > 180 -200 mg/d. L , 이하의 혈당에서도 glycosuria 가능 * DM * Glycosuria with hyperglycemia : 내분비질환(Acromegaly, Cushing’s syn. , Hthyroidism, pheochromocytoma…) : Pancreatic dis. (carcinoma, pancreatitis. . ) : 기타 - CNS disorders (tumor, Hrr, . . ) Disturbance of metabolism (burn, infection, Fx, MI, uremia, liver dis. , . . ) * Glycosuria without hyperglycemia : renal tubular dysfunction * Pregnancy : Increase of GFR, 지속 혹은 trace를 넘는 경우 W/U

2. 요화학 선별검사 (요시험지봉 검사) 3) 요케톤체 - 검사원리 : acetoacetate & acetone + sodium nitroprusside 참고) ketone : 지방 대사의 부산물 - acetoacetate, acetone, β-hydroxybutyrate (main 소변 ketone, 소변 측정X) - 위양성 : 요의 심한 착색, levodopa 대사물 - 임상적 의의 : diabetic ketonuria - diabetic ketoacidosis : non-diabetic ketonuria - 영아나 어린이 (acute febrile dis. , 심한 설사 구토) - hyperemesis of pregnancy - cachexia - 심한 운동, 기아 - low carbohydrate diet

Hemolysis H Transport deficit (Gilbert) Conjugation deficit (CN) Non-conjugated bilirubin (indirect, water insoluble) Conjugated bilirubin (direct, water soluble) Excretion deficit (D-J, Rotor) H Biliary obstruction Liver disease (hepatitis) : both

Urine & Fecal findings in jaundice Finding Normal Biliary obstruction Urinary Bilirubin Absent ↑ Dark urine Urinary urobilinogen Present Neoplasm : Low or – Gallstone : variable Fecal color Dark Pale GS in CBD : intermittent Neoplasm in duct or pancreas : persistent Hemolytic anemia Liver damage, 간염, cholestasis Absent Early ↑ ↑ Early ↓ Late ↑ Dark Hepatitis : Early pale Late dark Cholestasis : pale 용혈성 황달 or 신생아 황달 : 요빌리루빈 - / 요우로빌리노겐 + 간세포성 황달 : 요빌리루빈 + / 요우로빌리노겐 + Biliary obstruction : 요빌리루빈 + / 요우로빌리노겐 -

2. 요화학 선별검사 (요시험지봉 검사) 6) 요잠혈 - 검사원리 : Hb or Mb의 heme compound H 2 O 2 + chromogen heme peroxidase oxidized chromogen + H 2 O (color change) - detection limit : Hb 0. 05 -0. 3 mg/d. L (Hb 0. 3 mg/d. L = 10 lysed RBC/u. L) - 위감소(위음성) : high SG, 단백, 비타민 C, formalin - 위양성 : oxidizing contaminants (hypochlorites, iodine) microbial peroxidse (UTI infec. ) - 적색뇨의 감별 : Hematuria, Hemoglobinuria, Myoglobinuria

3. 요침사 검사 (Urine sediment) * 요침사자동분석기 참고치 RBC < 20/u. L WBC < 25/u. L Bacteria < 2000/u. L

3. 요침사 검사 (Urine sediment) 3) 임상적 의의 - 정상 요침사의 구성 - 병적 Cystine RBC cast Tyrosine WBC cast Leucin Epi. cell cast Cholesterol Waxy cast Fatty cast

Hematuria, Hemoglobinuria, & Myoglobinuria : common uncommon rare : dark red to brown urine, reagent strip 요잠혈 +, 요침사 some RBC 1) Hematuria - ab. NL number of RBC in urine - asymptomatic microscopic hematuria - When? neoplastic & nonneoplastic dis. & trauma (including calculi) in kidney & urinary tract bleeding disorder & anticoagulant uses use of drug such as cyclophosphamide 심한 운동을 한 정상인(마라톤선수) - tendency of RBC to undergo lysis in urine (esp, alkaline p. H or SG < 1. 010) : reagent strip - useful adjunct to microscopic exam. more sensitive than microscopic exam. but, interfering substance (commonly, ascorbic acid) hematuria 발견위해 routine microscopic exam. 필요 - NL urinary sediment / reagent strip + Fresh urine exam

Hematuria, Hemoglobinuria, & Myoglobinuria 2) Hemoglobinuria - Hemolysis -> Hb : binding to plasma haptoglobin -> saturated -> free Hb : pass through glomerulus (MW 32 k. Da) -> reabsorption by proximal tubular cells (Hb -> ferritin & hemosiderin) excretion of remaining Hb (hemoglobinuria) - Pink plasma (at 50 mg/d. L level) - acquired hemolytic anemia > hereditary hemolytic anemia 참고) hemosiderinuria : chronic hemolytic state

Hematuria, Hemoglobinuria, & Myoglobinuria 3) Myoglobinuria - destruction of muscle fiber -> Mb release -> rapid clearance from blood (MW 17 k. Da) -> urine excretion (red-brown pigment) - rhabdomyolysis, trauma, strenuous exercise dermatomyositis… - Dx of Rhabdomyolysis & Myoglobinuria muscle tenderness or cramp red-brown urine within a day or two after exertion reagent strip 잠혈반응 : strong positive 요침사검사 : a few RBC clear serum markedly elevated CK, elevated aldolase Normal haptoglobin 회복양상 – 소변 2 -3일 내에 clearing, CK 감소

Differentiation of Hematuria, Hemoglobinuria, & Myoglobinuria Condition Plasma Urine Hematuria Color : Normal Color : NL, smoky, pink, red, brown RBC : Many Renal : RBC casts, Protein ↑↑↑ Lower UT : No casts, Protein + or - Hemoglobinuria Color : Pink (early) Haptoglobin : Low Color : pink, red, brown RBC : occasional Pigment casts : occasional Protein : + or Hemosiderin : Late Myoglobinuria Color : Normal Haptoglobin : Normal CK : Marked increase Aldolase : Increase Color : red, brown RBC : occasional Dense brown casts : occasional Protein : + or -