??????? prostaglandin

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?????????????????????????????

• ??.????? ????????
• ??????????????????

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?????????????
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??????????????????????????????????
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(No Transcript)
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?????????????????????????????????????
??????? prostaglandin ?????????????????????? ???
???????????????
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Urinary System Anatomy

• 2 kidneys
• Nephron
• Blood vessels
• Formation of urine
• Glomerular filtration (dependent on BP
  perfusion)
• Tubular reabsorption
• Tubular secretion
• 2 ureters
• Urinary bladder
• Urethra

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Urinary System Function

• Removal of toxic waste products
• Regulation of blood volume
• Regulation of electrolyte balance
• Regulation of acid-base balance
• Regulation of fluids/electrolytes in tissue fluid
• Production of erythropoietin

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?????????????????????????????????????????????

• 1. ??????????????????? (Urinalysis)
• 2. ???????????????????????????????? (Glomerular
  filtration rate)
• 3. ??????? Tubular function

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??????????????????????? (Urinalysis)

• ???????????????????????
• 1. ??????????????????????????????????????????
• (Clean vioded midstream specimen)
• 2. ?????????????????????????????????????
• (Catheterized specimen)
• 3. ?????????????????????????????????????????
• (Percutanous suprapubic aspiration of bladder)

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????????????????????????

• 1. ?????????????????? (Random Specimen)
• 2. ????????????????????????????????? (First
  morning specimen)
• 3. ?????????????? 24 ??????? (Twenty four hour
  specimen)
• 4. ?????????????????????????????????? (Day night
  specimens)

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???????????????? UA

• 1. ????????????????
• ?? , ?????????????????? , ?????
• 2. ??????????????
• PH , specific gravity , ?????? , ?????? , ?????
  , ?????????????????? , ????????? , ?????????????
  , ??????? Leukocyte esterase
• 3. ????????????????????????
• RBC , WBC , Epithelial cell , Renal tubular
  cells , Transitional epithelial cells , Cast ,
  ????

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1. ?????????????????????
?????? ??????
??????? ????????????????? , ?????????? ??????
???? WBC , ???? , ?????? , ????????? , ????????? , ?????????
????????????? ??????????? ?????????? , ????????? , ?????????
????????????? bilirubin biliverdin
????? RBC , ?????????? , ??????????? , ?????????
????????? Phenolsultonphthalein , sulfobromophthalein
????????? ?????????
?????????? Methemoglobin , phenols
???????????? Methylene blue , ??????????? Pseudomonas
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• 2. ??????????????????
• - ???????????? , ??????
• - ??????????????????? , Seminal fluid , Mucous
• - ????????????????? , WBC
• - ???????????????????? (chylunia)
• 3. ?????

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??????????????

• pH
• - ??????? 6 (4.5 8.2)
• - ?????????????? - ??????????????

Acid Urine Alkaline Urine
Metabolic acidosis Starvation Diarrhea Respirotory acidosis Respirotory alkalosis Metabolic alkalosis Gastric suction or Vomiting Alkaline therapy
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• 2. ????????????????? (Specific gravity)
• - ??????? (1.003 1.035)
• - ????????????????????????????????????????????
  ???? ????????????

gt 1.035 gt 1.020 lt 1.009 Fixed 1.010
Contrast media Manitol Dehydration Fever sweeting Vomitting diarrhea CHF SIADH Excess water ingrstion Diuresis Hypothermia - Diabetes insipidos Severe renal damage
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??????

• ???? 100 - 150 ??????????????? ???? 10
  ????????????????????
• trace 5 20 mg/dl
• 1 30 mg/dl
• 2 100 mg/dl
• 3 300 mg/dl
• 4 gt 1,000 mg/dl

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??????

• ???????????????????????????????????? 160 - 180
  mg/dl
• ??????????????????????????
• 1. ????????????????????????? ?????????????????????
  ??????
• - ????????????? (Glycosuria of pregnercy)
• - ??????????????????????????????????????????????
  (renal glycosuria)
• 2. ????????????????????????? ?????????????????????
  ????????
• - ???????
• - ??????????? (Alimentary glycosuria)
• - Cushing syndrome

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????? (Acetone , diacetic acid)

• ???????? Diacetic Ketoacidosis , stravation ,
  alcoholism , severe dehydration

??????????????????

• ??????????????????? Hemoglobinuria ???
  Myoglobinuria
• Homaturia (RBC gt 3 ??? / HP)

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????????? (Bilirubin)

• - ???? Liver disease (obstructive civer disease)
• - ??????? 0.02 mg/dl

????????????? (Urobilinogen)
- ??????? 0.1 1.0 Ehrlich unit/dl -
???????? Hemolysis , Infections hepatitis
Cirrhosis)
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???????????????????????????????????? ???
?????????
?????? Hemolysis ?????? ??????????????
????????????? ????????? ???? ????? ????????? ????? ????????? ??????????? ???????????? ??
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??????? (Nitrite)
- ???????????????? ?????????????????????????????
????? 10 ???????????????
Leukocyte esterase
- ?????????? WBC ????????? - ?? trace ??
WBC 5 15 cell / HF
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????????????????????????
- Red blood cells (Hematuria) -
?????????????? 3 5 Cell/HF ????????????????????
?????????????????????????????????????????????????
????????????????
Extraglomeruler Glomeruler
Color Clots Proteinuria RBC morphology RBC Cast Red or pink May be present lt 500 mg/??? Normal Absent Red,smoky brown or coca cola Absent May be gt 500 mg/??? Dysmorphic , Acanthocyst May be present
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White blood cell (Leukocyuria , Pyuria)
- ???????????? WBC gt 5 cell / HF -
??????????? Inflamnation at any level Urinary
trat - Neutrophile Infection or
Noninfaction inflammation - Eosinophils
Allergic interstitial nephrith - Epithelial
cells - ???? lt 3 5 cell / HF - Renal
tubulor cells (?????????????????) -
???????????????????????? Acute tubular necrosis ,
nephrotoxin injury
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White blood cell (Leukocyuria , Pyuria)
- ???????????? WBC gt 5 cell / HF -
??????????? Inflamnation at any level Urinary
trat - Neutrophile Infection or
Noninfaction inflammation - Eosinophils
Allergic interstitial nephrith - Epithelial
cells - ???? lt 3 5 cell / HF - Renal
tubulor cells (?????????????????) -
???????????????????????? Acute tubular necrosis ,
nephrotoxin injury
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• - Transitional epithelial cells
• ????????????????????? , ???????????????,transition
  al cell carcinoma
• Squamous epithelial cells
• ????????????????????????

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????? (Casts)

• ?????????? Tamm Horsfall protein
  ???????????????????????? ?
• Granular cast
• Waxy casts
• RBC casts
• WBC casts
• Oval fatbody cast

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???? (crystal)

• ??????????? ????????,????????????????
• ???????????? triple phosphate , ammoniun
  biurate

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??????????????????????????????????????????? ?

• Glomerular disease
• Glomerulopathy pvoteinuna
• Acute qlomerulonephritis RBC cast,proteinuria
• Tubulointerstitial Disease
• pyelonephitis pyuria ,leukocyte cast , Positive
  Urine culture
• Interstitial nephritis pyuria , Leukocyte cast,
  sterile urine culture

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• Allergicinterstitialnephritis
  eosinophiluria,pyuria,leukocyte cast
• Acute tubular necrosis Epithelial cell,Muddy
  brown cast
• Vascular disease
• Renal artery stenosis Leukocyte cast
• Vasculitis RBC casts,protienuria

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???????????????????????????????(Glomerular
Filtration rate (GFR)

• ??????????????????????????????????????????????????
  ?????
• 1. ???????????????????????
• 2. ????????????????????????????????,??????????????
  ???????????????????,???????????????
• 3. ???????????????? ??????????????????????????
• 4. ??????????????????????????????????????????

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• GFR ??????????????? , ??? , ??????????????
• ??? 130 8 ????????????????
• ???? 120 14 ????????????????
• ???????? 40 ?? GFR ???? 1 ?????????????????????

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??????? GFR

• Serum Creatinine
• ??????? ??? 0.8 1.3 ????????????????????
• ???? 0.6 1.0 ????????????????????
• Blood Urea nitrogen (BUN)
• ???? 10 20 mg/dl

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??????????????? GFR ??? Pcr
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????????????????? BUN , Creatinin ???????
?????????????????????????????

• Increased BUN
• - Catabolic states
• - Increase protein intake
• - Gastrointestinal bleeding
• - Corticosteroid
• Increase serum creatinine
• - Rhabdomyolysis
• - Drugs Cimetidine , Trimethoprim
• - Ketone
• - Cephalosporins

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?????????????????????? (Creatinine Clearance
CCr)

• CCr (140 - ????) x ???????(??.) / Pcr x 72
• ?????????????????????????????? 0.85
• ??????? ??????? 95 20 ml/min
• ?????? 120 25 ml/min