Education healthcare

1. Management of patient with
urinary syndrome
Dr. Neverovskyi Artem

2. Urinary syndrome
• most constant sign of renal and urinary tract disorders.
• urinary syndrome includes proteinuria, urinary sediment
abnormalities, hematuria, leukocyturia and abnormal amount and/or
type of urinary casts

3. Proteinuria
• In healthy individuals, less than 150 mg of protein is excreted in the
urine each day.
• Transient proteinuria can occur after vigorous exercise, during fever, in
heart failure, orthostatic proteinuria
• Microalbuminuria refers to the urinary excretion of small amounts of
albumin.

4. Organic proteinuria is of three types
1) Pre-renal proteinuria – when the kidneys are affected secondary to
some other disease.
2) Renal proteinuria – when the cause is the kidney disease (glomerular
and tubular)
3) Post-renal proteinuria – when the protein is added to the urine after
it has left the renal tubules.

5. • Total 24-hour protein >3 g/day
– sign of nephrotic syndrome

6. Hematuria
• Healthy individuals may have
occasional red blood cells in the
urine (up to 12500 cells/mL)
• dipstick testing (15 000–20 000
cells/mL or more)
• Microscopy (the presence of 5
or more red blood cells)

8. Leucocyturia
• presence of 10 or more white blood cells per cubic millimeter in a
urine specimen
• 10 or more white cells per high-power field of unspun urine
• urinary dipstick test that is positive for leukocyte esterase
• Sterile and non-sterile

9. UTI

12. Pyelonephritis

17. Tubulointerstitial nephritis
• TIN is characterized by an immune-mediated infiltration of the kidney
interstitium by inflammatory cells
• TIN has multiple etiologies, including drug-related, infectious, systemic,
autoimmune, genetic, and idiopathic.
• The most common cause of TIN is related to a medication or drug exposure
• Possible additional symtoms: rash, arthralgia and fever
• Blood studies: Renal Failure, Anemia, Eosinophilia
• Urine studies: Sterile Pyuria, Proteinuria, Eosinophiluria, White Blood Cell
Casts, Micro/Macroscopic Hematuria (rare)
• Treatment is based on etiology; aside from removal of offending agents, the
mainstay of therapy is corticosteroids, and less often mycophenolate mofetil

18. Indicator Result Р Reference standards
Volume 150 ml
Color Straw-yellow Straw-yellow
Transparence Transparent Transparent
Reaction (pH) 6 5-7
Specific gravity 1021 1015-1025
Protein - < 0,015 g/l
Glucose - Negative
Ketones - Negative
Bile pigments - Negative
Microscopic examination
Epitelial cell:
Flat None-few/lpf None-few/lpf
Transitional - None-few/lpf
Renal - None-few/lpf
Leucocytes 2/lpf in male- up to 3/lpf
in female- up to 5/lpf
Casts:
Hyaline - None-few/lpf
Granular - -
Red blood cells - 0-1 /lpf
Mucus - None-few/lpf
Crystals - -