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Clinical investigation of renal disease 

Clinical investigation of renal disease

Chapter:
Clinical investigation of renal disease
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.
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date: 23 August 2017

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 (<5.3 in an early-morning specimen makes a renal acidification defect unlikely), glycosuria, specific gravity (should be >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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