Clinical investigation of renal disease - Oxford Medicine [PDF]

Midstream urine (MSU) sample—this standard investigation requires consideration of: (1) macroscopic appearance—this

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Oxford Medicine Online

Oxford Textbook of Medicine Edited by David A. Warrell, Timothy M. Cox, and John D. Firth Online access to the Oxford Textbook of Medicine in low and middle income countries is available through the World Health Organization-led HINARI Access to Research in Health programme.

Latest update The May 2017 update includes substantial amendments to several chapters on disorders of the kidney and urinary tract.

Featured content This title features a number of videos to further illustrate concepts and procedures.

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Clinical investigation of renal disease Publisher: Oxford University Press Print ISBN-13: 9780199204854

Chapter: Clinical investigation of renal disease DOI: 10.1093/med/9780199204854.001.1

Print Publication Date: May 2010 Published online: Jul 2015

Author(s): A. Davenport

DOI: 10.1093/med/9780199204854.003.2104_update_006 Update: Estimation of glomerular filtration rate – equations combining use of serum creatinine and serum cystatin C measurements. Updated on 30 Jul 2015. The previous version of this content can be found here.

An accurate history and careful examination will determine the sequence and spectrum of clinical investigations required to make a diagnosis or decide on prognosis or treatment. Midstream urine (MSU) sample—this standard investigation requires consideration of: (1) macroscopic appearance—this may be suggestive of a diagnosis, e.g. frothy urine suggests heavy proteinuria; (2) stick testing—including for pH (1.024 in an early-morning or concentrated sample), nitrite (>90% of common urinary pathogens produce nitrite) and leucocyte esterase; and (3) microscopy—for cellular elements (in particular red cells, with the presence of dysmorphic red cells detected by experienced observers indicative of glomerular bleeding), casts (cellular casts indicate renal inflammation), and crystals....

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