urinalysis report on patient with nephrolithiasis

When a patient presents with signs and symptoms of nephrolithiasis, a urinalysis that includes detection of blood should be performed. The presence of hematuria can support the diagnosis of a kidney stone in the appropriate setting.

Full Answer

Is there a 24-hour urine test for nephrolithiasis prophylaxis?

There may be no other body of chemistry tests in any branch of medical practice that is potentially as useful and so often indicated, yet so infrequently utilized, as the 24-hour urine test for nephrolithiasis prophylaxis.

What is the role of urine in the work-up of nephrolithiasis?

Urine analysis also forms part of the work-up of a stone-forming patient for the identification of diseases predisposing to or associated with nephrolithiasis. These conditions include primary hyperparathyroidism, primary hyperoxaluria, enteric hyperoxaluria, cystinuria, and distal renal tubular acidosis.

Which physical findings are characteristic of nephrolithiasis?

A diagnosis of nephrolithiasis may be suspected based on the clinical history, physical exam findings, and laboratory test results, and is confirmed with imaging studies. Obstructed renal and ureteric stones can cause renal colic: severe, acute flank pain that may radiate to the ipsilateral groin, commonly associated with nausea and vomiting.

How are kidney stones diagnosed in nephrolithiasis?

Nephrolithiasis - Kidney Stone. Imaging is used to confirm presence of a stone and to determine whether intervention might be required for removal. A stone analysis and a 24-hour urine evaluation can help identify the cause of stone formation, although these are not often performed in adults experiencing a first stone.

What urinalysis results indicate kidney stones?

Acidity (pH) is a measure of the amount of acid in the urine. A pH that is above normal may be a sign of kidney stones, urinary infections, kidney problems, or other disorders.

What labs would be elevated with kidney stones?

If your doctor suspects that you have a kidney stone, you may have diagnostic tests and procedures, such as: Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.

What is used to diagnose nephrolithiasis?

Computed tomography (CT) scans are the most commonly used imaging test for detecting kidney stones. CT scans of your abdomen and pelvis combine multiple x-ray images to provide a 3D picture of your urinary tract. This is generally considered to be the most accurate and useful imaging test for visualizing kidney stones.

What does calcium oxalate crystals in urine indicate?

Calcium oxalate crystals are heavily associated with kidney stones, which can form when too much oxalate (found in such foods as spinach) is in the system. Kidney stone symptoms include severe groin or abdominal pain, nausea, fever, and difficulty passing urine.

How do you read urinalysis results?

Normal values are as follows:Color – Yellow (light/pale to dark/deep amber)Clarity/turbidity – Clear or cloudy.pH – 4.5-8.Specific gravity – 1.005-1.025.Glucose - ≤130 mg/d.Ketones – None.Nitrites – Negative.Leukocyte esterase – Negative.More items...•

How do you rule out nephrolithiasis?

When a person has blood in the urine (hematuria) or sudden abdominal or side pain, tests like an ultrasound or a CT scan may diagnose a stone. These imaging tests tell the health care provider how big the stone is and where it is located. A CT scan is often used in the ER when a stone is suspected.

What does a urine test show?

Overview. A urinalysis is a test of your urine. It's used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the appearance, concentration and content of urine.

Does urine dipstick show kidney stones?

Things the dipstick test can check for include: Acidity, or pH. If the acid is abnormal, you could have kidney stones, a urinary tract infection (UTI), or another condition.

Do kidney stones cause elevated WBC?

Kidney stones, a tumor in the pelvis, or some other type of blockage in the urinary tract may also cause more leukocytes to appear.

What causes high oxalate levels in urine?

But too much oxalate in your urine can cause serious problems. Hyperoxaluria can be caused by inherited (genetic) disorders, an intestinal disease or eating too many oxalate-rich foods. The long-term health of your kidneys depends on early diagnosis and prompt treatment of hyperoxaluria.

What is the pH of urine when calcium oxalate and uric acid crystals are seen?

<5.5Urine of pH <5.5 shows an increased capacity to develop uric acid crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals. In contrast, urine of pH >6.0 has an increased capacity to develop calcium phosphate crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals.

What tests are used to diagnose nephrolithiasis?

Initial laboratory tests in all patients with suspected nephrolithiasis are urinalysis, CBC, and serum chemistry to include electrolytes, BUN/creatinine (to assess renal function), calcium, phosphorus, and uric acid. Urinalysis is helpful in confirming a diagnosis of renal stones as microscopic hematuria is present in the majority of patients. However, the absence of hematuria does not exclude nephrolithiasis. [30]#N#Mefford JM, Tungate RM, Amini L, et al. A comparison of urolithiasis in the presence and absence of microscopic hematuria in the emergency department. West J Emerg Med. 2017 Jun;18 (4):775-9. https://www.doi.org/10.5811/westjem.2017.4.33018 http://www.ncbi.nlm.nih.gov/pubmed/28611901?tool=bestpractice.com#N#Presence of more than 5 to 10 WBCs per high-powered field in urine or pyuria could indicate presence of urinary tract infection or be secondary to inflammation. Urinary crystals of calcium oxalate, uric acid, or cystine may indicate the nature of the calculus, although only cystine crystals are pathognomonic for the underlying type of stones. A urine pH greater than 7 suggests presence of urea-splitting organisms, such as Proteus, Pseudomonas, or Klebsiella species, and struvite stones. A urine pH less than 5.5 suggests uric acid stones.

What are the signs of sepsis?

In patients with renal colic, costovertebral angle and ipsilateral flank tenderness may be pronounced. Signs of sepsis, including fever, tachycardia, and hypotension, might indicate an obstructing stone with infection, warranting urgent urology referral.

Why is IVP less commonly used?

However, IVP is now less commonly used due to the improved sensitivity of CT scans. Disadvantages include the need for intravenous contrast material, which may provoke an allergic response or renal failure, and the need for multiple delayed films in certain cases and concerns for radiation exposure.

Can you get a CT scan with a low BMI?

However, low-dose CT is not recommended for those with a BMI >30 kg/m², owing to lower sensitivity and specificity in these patients. Patients with indinavir and ritonavir stones from anti-HIV medication may have radiolucent stones on CT scan. However, this makes up only a tiny fraction of patients.

Is hypercalcemia a underlying etiology?

Hypercalcemia may suggest hyperpara thyroidism as an underlying etiology; hyperuricemia may indicate gout. In women of childbearing age, a pregnancy test should be done prior to imaging with ionizing radiation and to rule out ectopic pregnancy as a cause of symptoms.

Can a urinary tract stone cause urinary urgency?

As stones pass and get lodged in the distal ureter or intramural tunnel, this can lead to bladder irritation manifested as urinary frequency or urgency. Ipsilateral testicular and groin pain may occur rarely in men with obstructive stones. However, in the absence of obstruction, calculi may be asymptomatic.

Does magnesium inhibit calcium phosphate?

Magnesium, which can also exert a certain capacity to inhibit the formation of calcium salts, plays its most important role in the formation of a soluble species with the oxalate ion, which leads to a decrease in the level of supersaturation of urine with respect to calcium oxalate and calcium phosphate [68].

What is consensus on Q8?

Consensus on Q8. The Group agreed that more research is needed into the action of inhibitors and promoters of crystallization in urine, and how their concentrations can be clinically managed, before measurement of any of these becomes a regular part of the screening and treatment of stone formers. Q9.

Can urine data be used to assess diet?

Despite these strengths, there are weaknesses in using 24-h urine data alone to assess diet. This method will yield data only for a single day’s diet and will not provide a measure of fat or carbohydrate intake. Moreover, the urine data alone will not allow an assessment of calcium or oxalate intake.

Is urea a marker of protein?

Urine urea can be used as a marker of total protein intake [42], while sulphate is as a marker of animal protein intake, as sulphur amino acids are oxidized to sulfuric acids, which is excreted as sulphate [42, 44]. These two markers are highly correlated, and either can be used to monitor protein intake.

Can you use urine to diagnose kidney stones?

The use of urine analysis as a guide to the diagnosis and treatment of kidney stones is recommended for at least some stone formers in all of the published international guidelines [1–4] (see Supplemental Table 1), but data suggest it is not generally utilized as widely as has been recommended .

What is PTH testing?

Serum – uric acid, ionized calcium, and parathyroid hormone (PTH)-related peptide (PTHrP) PTH testing may be reserved for recurrent disease unless primary hypoparathyroidism is a concern. Amino acids analysis – evaluate when cystinuria is a concern or in those with cystine stones. Stone collection and analysis.

What does blood indicate in a urine culture?

Blood indicates injury due to crystal passage. Crystals indicate the possibility of a stone. Urine culture – consider to evaluate for concomitant urinary tract infection. CBC – especially if symptoms of concomitant infection are present. Serum electrolytes – evaluate for electrolyte abnormalities.

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Can you do electrolyte analysis with first stone?

Not usually performed with first stone, except in children (refer to Pediatrics) Usually includes electrolyte analysis (eg, sodium) and metabolic analysis (eg, oxalate and calcium) Collection of two different urine specimens is recommended.

Can a 24-hour urine test detect a kidney stone?

A stone analysis and a 24-hour urine evaluation can help identify the cause of stone formation , although these are not often performed in adults experiencing a first stone. The first kidney stone in a child prompts a more complete workup.