phosphaturia

リン酸塩尿症、リン酸塩尿

関

familial hypophosphatemia、hyperphosphaturia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/31 14:42:23」(JST)

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Urinalysis
Intervention
White blood cells seen under a microscope from a urine sample.
MeSH	D016482
Other codes:	LOINC Codes for Urinalysis panels
MedlinePlus	003579

A urinalysis (UA), also known as routine and microscopy (R&M), is an array of tests performed on urine, and one of the most common methods of medical diagnosis. The word is a portmanteau of the words urine and analysis.

The target parameters that can be measured or quantified in urinalysis include many substances and cells, as well as other properties, such as specific gravity.

A part of a urinalysis can be performed by using urine test strips, in which the test results can be read as color changes. Another method is light microscopy of urine samples.

Target parameters

In addition to the substances mentioned in tables below, other tests include a description of color and appearance.

Ions and trace metals

Target	Lower limit	Upper limit	Unit	Comments	LOINC Codes
Nitrite	n/a	0 / negative		The presence of nitrites in urine, termed nitrituria, indicates the presence of coliform bacteria. Further information: Nitrite test	5802-4
Sodium (Na) – per day	150	300	mmol / 24 h	A urinalysis is frequently ordered during the workup of acute renal failure. Full kidney function can be detected through the simple dipstick method.	2956-1
Potassium (K) – per day	40	90	mmol / 24 h	Urine K may be ordered in the workup of hypokalemia. In case of gastrointestinal loss of K, the urine K will be low. In case of renal loss of K, the urine K levels will be high. Decreased levels of urine K are also seen in hypoaldosteronism and adrenal insufficiency.	2829-0
Urinary calcium (Ca) – per day	15	20	mmol / 24 h	An abnormally high level is called hypercalciuria and an abnormally low rate is called hypocalciuria. Further information: Urinary calcium	14637-3
	100	250	mg / 24 hours		6874-2
Phosphate (P) – per day	n/a	38	mmol / 24 h	Phosphaturia is the hyperexcretion of phosphate in the urine. This condition is divided into primary and secondary types. Primary hypophosphatemia is characterized by direct excess excretion of phosphate by the kidneys, as from primary renal dysfunction, and also the direct action of many classes of diuretics on the kidneys. Additionally, secondary causes, including both types of hyperparathyroidism, cause hyperexcretion of phosphate in the urine.	14881-7

A sodium-related parameter is fractional sodium excretion, which is the percentage of the sodium filtered by the kidney which is excreted in the urine. It is a useful parameter in acute renal failure and oliguria, with a value below 1% indicating a prerenal disease and a value above 3% indicating acute tubular necrosis or other kidney damage.

Proteins and enzymes

Target	Lower limit	Upper limit	Unit	Comments
Protein	0	trace amounts / 20	mg/dl	Proteins may be measured with the Albustix test. Since proteins are very large molecules (macromolecules), they are not normally present in measurable amounts in the glomerular filtrate or in the urine. The detection of protein in urine, called proteinuria, may indicate the permeability of the glomerulus is abnormally increased. This may be caused by renal infections or by other diseases that have secondarily affected the kidneys, such as hypertension, diabetes mellitus, jaundice, or hyperthyroidism. Further information: Proteinuria
Human chorionic gonadotropin |hCG	–	50	U/l	This hormone appears in the urine of pregnant women. Home pregnancy tests commonly detect this substance.

Blood cells

Target	Lower limit	Upper limit	Unit	Comments
Red blood cells (RBCs) / erythrocytes	0	2 – 3	per High Power Field (HPF)	May be present as intact RBCs, which indicate bleeding. Even trace amount of blood is enough to give the entire urine sample a red/pink hue, and it is difficult to judge the amount of bleeding from a gross examination. Hematuria may be due to a generalized bleeding diathesis or a urinary tract-specific problem (trauma, stone, infection, malignancy, etc.) or artefact of catheterization in case the sample is taken from a collection bag, in which case a fresh urine sample should be sent for a repeat test. If the RBCs are of renal or glomerular origin (due to glomerulonephritis), the RBCs incur mechanical damage during the glomerular passage, and then osmotic damage along the tubules, so get dysmorphic features. The dysmorphic RBCs in urine which are most characteristic of glomerular origin are called "G1 cells", which are doughnut-shaped rings with protruding round blebs sometimes looking like Mickey Mouse (with ears). Painless hematuria of nonglomerular origin may be a sign of urinary tract malignancy, which may warrant a more thorough cytological investigation. Further information: Hematuria
RBC casts	n/a	0 / negative
White blood cells (WBCs) / leukocytes / (pus cells)	0	2 / negative		Further information: Pyuria
	–	10	per µl or mm3	"Significant pyuria" at greater than or equal to 10 leucocytes per microlitre (µl) or cubic millimeter (mm3)
"Blood" / (actually hemoglobin)	n/a	0 / negative	dip-stick qualitative scale of 0 to 4+	Hemoglobinuria is suggestive of in vivo hemolysis, but must be distinguished from hematuria. In case of hemoglobinuria, a urine dipstick shows presence of blood, but no RBCs are seen on microscopic examination. If hematuria is followed by artefactual ex vivo or in vitro hemolysis in the collected urine, then the dipstick test also will be positive for hemoglobin and will be difficult to interpret. The urine color may also be red due to excretion of reddish pigments or drugs.

Other molecules

Target	Lower limit	Upper limit	Unit	Comments
Glucose	n/a	0 / negative		Glucose can be measured with Benedict's test. Although glucose is easily filtered in the glomerulus, it is not present in the urine because all of the glucose filtered is normally reabsorbed from the renal tubules back into the blood. Presence of glucose in the urine is called glucosuria. Further information: Glucosuria
Ketone bodies	n/a	0 / negative		With carbohydrate deprivation, such as starvation or high-protein diets, the body relies increasingly on the metabolism of fats for energy. This pattern is also seen in people with diabetes mellitus, when a lack of the hormone insulin prevents the body cells from using the large amounts of glucose available in the blood. This happens because insulin is necessary for the transport of glucose from the blood into the body cells. The metabolism of fat proceeds in a series of steps. First, triglycerides are hydrolyzed to fatty acids and glycerol. Second, the fatty acids are hydrolyzed into smaller intermediate compounds (acetoacetic acid, betahydroxybutyric acid, and acetone). Thirdly, the intermediate products are used in aerobic cellular respiration. When the production of the intermediate products of fatty acid metabolism (collectively known as ketone bodies) exceeds the ability of the body to metabolize these compounds, they accumulate in the blood and some end up in the urine (ketonuria). Further information: Ketonuria
Bilirubin	n/a	0 / negative		The fixed phagocytic cells of the spleen and bone marrow destroy old red blood cells and convert the heme groups of hemoglobin to the pigment bilirubin. The bilirubin is secreted into the blood and carried to the liver, where it is bonded to (conjugated with) glucuronic acid, a derivative of glucose. Some of the conjugated bilirubin is secreted into the blood and the rest is excreted in the bile as bile pigment that passes into the small intestine. The blood normally contains a small amount of free and conjugated bilirubin. An abnormally high level of blood bilirubin may result from an increased rate of red blood cell destruction, liver damage (as in hepatitis and cirrhosis), and obstruction of the common bile duct as with gallstones. An increase in blood bilirubin results in jaundice, a condition characterized by a brownish-yellow pigmentation of the skin and of the sclera of the eyes. Further information: Bilirubinuria
Urobilinogen	0.2	1.0	Ehrlich units or mg/dL
Creatinine – per day	4.8	19	mmol / 24 h
Free catecholamines, dopamine – per day	90	420	μg / 24 hours
Free cortisol	28 or 30	280 or 490	nmol/24 h	Values below threshold indicate Addison's disease, while values above indicate Cushing's syndrome. A value smaller than 200 nmol/24 h (72 µg/24 h) strongly indicates absence of Cushing's syndrome.
	10 or 11	100 or 176	µg/24 h
Phenylalanine		30.0	mg/L	In neonatal screening, a value above the upper limit defines phenylketonuria.

Other urine parameters

Test		Lower limit	Upper limit	Unit	Comments
Urine specific gravity		1.003	1.030	no unit	This test detects the ion concentration of urine. Small amounts of protein or ketoacidosis tend to elevate the urine's specific gravity (SG). This value is measured using a urinometer and indicates hydration or dehydration. If the SG is under 1.010, the patient is hydrated; an SG value above 1.020 indicates dehydration.
Osmolality		400	n/a	mOsm/kg
pH		5	7	(unitless)
Bacterial cultures	by urination	–	100,000	colony forming units per millilitre (CFU/mL)	Bacteriuria can be confirmed if a single bacterial species is isolated in a concentration greater than 100,000 CFU/ml of urine in clean-catch midstream urine specimens (one for men, two consecutive specimens with the same bacterium for women). Further information: Bacteriuria
	by bladder catheterisation	–	100		For urine collected via bladder catheterisation, the threshold is 100 CFU/ml of a single species. Further information: Bacteriuria

Methods

When doctors order a urinalysis, they will request either a routine urinalysis or a routine and microscopy (R&M) urinalysis, with the difference being a routine urinalysis does not include microscopy or culture.

Urine test strip

A urine test strip can quantify:

• Leukocytes – with presence in urine known as leukocyturia
• Nitrite – with presence in urine known as nitrituria
• Protein – with presence in urine known as proteinuria, albuminuria, or microalbuminuria
• Blood – with presence in urine known as hematuria]]
• specific gravity

Microscopic examination

A urine sample is about to be examined under a phase-contrast microscope using a Neubauer counting chamber. The urine is under the cover slide, in the upper segment formed by the H-shaped grooves.

The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and may suggest a specific diagnosis.

• Hematuria – associated with kidney stones, infections, tumors and other conditions
• Pyuria – associated with urinary infections
• Eosinophiluria – associated with allergic interstitial nephritis, atheroembolic disease
• Red blood cell casts – associated with glomerulonephritis, vasculitis, or malignant hypertension
• White blood cell casts – associated with acute interstitial nephritis, exudative glomerulonephritis, or severe pyelonephritis
• (Heme) granular casts – associated with acute tubular necrosis
• Crystalluria – associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN)
• Calcium oxalatin – associated with ethylene glycol

Other methods of urinalysis

• Urine culture – a microbiological culture of urine samples, detecting bacteriuria, is indicated when a urinary tract infection is suspected.
• Ictotest – this test is used to detect the destruction of old red blood cells in the urine.
• Hemoglobin test – this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urinary system, which cause hemoglobin to appear in the urine.

See also

• Uroscopy, the ancient form of this analysis
• Medical technologist
• Urinary casts
• Proteinuria
• Urine test strip
• Urine collection device
• Drug test
• Pregnancy test, measures hCG levels in urine

References

External links

• Lab Tests Online: Urinalysis
• Different Types of Urinalysis

UpToDate Contents

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• 1. 腎疾患の診断における尿検査 urinalysis in the diagnosis of kidney disease
• 2. 高リン血症の原因および治療の概要 overview of the causes and treatment of hyperphosphatemia
• 3. 尿細管性アシドーシスの概要 overview of renal tubular acidosis
• 4. 幼児および小児における尿細管性アシドーシスの病因および臨床症状 etiology and clinical manifestations of renal tubular acidosis in infants and children
• 5. デント病（X連鎖劣性腎結石症） dents disease x linked recessive nephrolithiasis

English Journal

• PCSK9 in diabetic kidney disease.

• Elewa U1,2,3, Fernández-Fernández B1,2,3, Mahillo-Fernández I1, Martin-Cleary C1,2,3, Sanz AB1,2,3, Sanchez-Niño MD1,2,3, Ortiz A1,2,3.
• European journal of clinical investigation.Eur J Clin Invest.2016 Sep;46(9):779-86. doi: 10.1111/eci.12661. Epub 2016 Aug 9.
• BACKGROUND: Chronic Kidney Disease (CKD) and, specifically, diabetic kidney disease (DKD)+, is among the fastest increasing causes of death worldwide. A better understanding of the factors contributing to the high mortality may help design novel monitoring and therapeutic approaches, since protectio
• PMID 27438893

• Klotho/fibroblast growth factor 23- and PTH-independent estrogen receptor-α-mediated direct downregulation of NaPi-IIa by estrogen in the mouse kidney.

• Webster R1, Sheriff S2, Faroqui R1, Siddiqui F1, Hawse JR3, Amlal H4.
• American journal of physiology. Renal physiology.Am J Physiol Renal Physiol.2016 Aug 1;311(2):F249-59. doi: 10.1152/ajprenal.00542.2015. Epub 2016 May 18.
• Estrogen treatment causes renal phosphate (Pi) wasting and hypophosphatemia in rats and humans; however, the signaling mechanisms mediating this effect are still poorly understood. To determine the specific roles of estrogen receptor isoforms (ERα and ERβ) and the Klotho pathway in mediating these
• PMID 27194721

• [Klotho and vascular calcification].

• Matsui M1, Saito Y1.
• Clinical calcium.Clin Calcium.2016 Aug;26(8):1157-64. doi: CliCa160811571164.
• The link between chronic kidney disease(CKD)and cardiovascular diseases has recently been attracting attention as cardiorenal connection. Vascular calcification due to down-regulation of klotho is partly involved in the pathogenesis of cardiorenal connection. Klotho protein which is mainly expressed
• PMID 27461499

Japanese Journal

• Treatment of Hypophosphatemic Rickets with Phosphate and Active Vitamin D in Japan : A Questionnaire-based Survey

• FUJIWARA Makoto,NAMBA Noriyuki,OZONO Keiichi,ARISAKA Osamu,YOKOYA Susumu
• Clinical pediatric endocrinology 22(1), 9-14, 2013-01-01
• NAID 10031199647

• Treatment of Hypophosphatemic Rickets with Phosphate and Active Vitamin D in Japan: A Questionnaire-based Survey

• , , , ,
• Clinical Pediatric Endocrinology 22(1), 9-14, 2013
• Hereditary hypophosphatemic rickets represented by X-linked hypophosphatemic rickets (XLH) is a rare disorder characterized by hypophosphatemia, elevated alkaline phosphatase (ALP) and undermineraliza …
• NAID 130004853591

• カドミウム曝露によるリン代謝異常 : FGF23産生亢進機序の検討

• 木戸 慎介,藤原 真理奈,野村 憲吾 [他],佐々木 祥平,塩崎 雄治,瀬川 博子,辰巳 佐和子,宮本 賢一
• 日本衞生學雜誌 67(4), 464-471, 2012-09-15
• … Phosphaturia has been documented following cadmium (Cd) exposure in both humans and experimental animals. …
• NAID 10031120520

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★リンクテーブル★

リンク元	「リン酸塩尿症」「familial hypophosphatemia」「リン酸塩尿」
拡張検索	「hyperphosphaturia」

「リン酸塩尿症」

　　[★]

英

phosphaturia

関

高リン酸尿症、リン酸塩尿、家族性低リン酸血症

「familial hypophosphatemia」

　　[★] 家族性低リン酸血症

関

hyperphosphaturia、phosphaturia

「リン酸塩尿」

　　[★]

英

phosphaturia

関

リン酸塩尿症

「hyperphosphaturia」

　　[★]

高リン酸尿症

関

familial hypophosphatemia、phosphaturia