Examination Of Urine Sediment Research Articles

Overview of Urine Cylinders in Patients With Pulmonary Tuberculosis Undergoing Advanced First-Line Treatment at the RSUD Ciamis

Background & Objective: Pulmonary tuberculosis is a contagious disease caused by Mycobacterium tuberculosis bacteria that can attack various organs, especially the lungs. Tuberculosis patients are treated with anti-tuberculosis drugs such as rifampicin and streptomycin, which can potentially cause kidney function impairment. To detect any abnormalities in the kidneys, a urine sediment examination is conducted, which can identify an increase in urine cylinders if any damage to the kidneys is present. This study aims to provide insights into urine cylinders in patients with pulmonary tuberculosis based on the duration of their treatment. Method: This is a descriptive study that utilised a purposive sampling technique. The study involved 38 Tuberculosis patients as respondents. Sampling was carried out at the DOTS clinic of RSUD Ciamis and the research was conducted between October 2021 and May 2022. Result: Out of 38 samples, 6 people tested positive for cylinders at a value of +1 (which means very little). These cylinders included hyaline, wax, granule, fat, and epithelial cell cylinders. The percentage of people who tested positive for cylinders was 15.8%. On the other hand, 32 people tested negative for cylinders, which accounts for 84.2% of the total sample. Conclusion: It can be concluded that cylinders were found in tuberculosis patients. Future researchers are advised to examine urine cylinders in pulmonary tuberculosis patients undergoing the sixth month of treatment in patients at a young age.

Renal B-lymphoblastic lymphoma with hematuria as the first symptom diagnosed in urine cytology: A case report and literature review.

Cytological examination of urine sediment is a helpful diagnostic tool for identifying renal involvement by hematological malignancies. We present the case of a 47-year-old man who was diagnosed with extranodal B-lymphoblastic lymphomas after presenting with gross hematuria as his first symptom. The presence of lymphoma cells in the urine led to a diagnosis confirmed through an immunophenotypic study using cell block sections of urine centrifuge sediment and core needle biopsy histology of the right renal pelvis mass. This case highlights the usefulness of a urine cytological study in diagnosing lymphoma involvement in the genitourinary tract. Furthermore, this paper reviews relevant literature on diagnosing lymphoma involvement from urine sediment.

Importance of Examination of Rasūb (Sediments) in Uroscopy

Uroscopy is the macroscopic examination of urine, and it is an important diagnostic tool in Unani medicine. The findings of uroscopy are linked with the humoral theory of medicine. Human Urine is the first fluid that was examined for medical purposes. There are seven parameters in uroscopy, each parameter is studied in detail and then the conclusion is drawn based on the findings of all. Examination of urinary sediments is one of the parameters in uroscopy. In urine, sediment is a denser and differentiable component from the watery constituent. The features of urinary sediment vary a lot in different physiological and pathological conditions of the body that are of medical importance. It is an evident fact that sediment makes up the solute component of urine, which is the waste product of hepatic digestion. One of these seven indicators that uroscopy analyses, is the inspection of urine sediment. The amount, color, homogeneity, position, and rate of sedimentation of the sediments are taken into account to ascertain the state of the body from them, and careful correlation is made with the results of other parameters. Keywords: Urine, Urine sediment, Uroscopy, Unani medicine, Urinalysis

DESCRIPTION OF URINE SEDIMENT IN DIABETES MELITUS PATIENTS AT BUNDA THAMRIN HOSPITAL MEDAN IN 2023

Diabetes Mellitus (DM) is a group of chronic diseases caused by the pancreas being unable to produce the hormone insulin to meet the body's needs. This disease is characterized by an increase in blood glucose levels or hyperglycemia. Patients with diabetes mellitus are at risk of developing urinary tract infections due to immune factors, namely in the form of leukocyte disorders. High concentrations of sugar in the urine (glucoseuria) can inhibit leukocyte activity, in connection with that we need to look at the description of urine sediment in DM patients. The purpose of this study was to find out the results of examining the appearance of urine sediment in diabetes mellitus patients at Bunda Thamrin Hospital Medan in 2023. This type of research is descriptive analytic. The sample used is morning urine as much as 20 samples. Urine Sediment Examination Results in Patients with Diabetes Mellitus at Bunda Thamrin Hospital Medan in 2023 found that Erythrocytes increased entirely in 20 samples and Leukocytes obtained normal results in 12 samples (60%) and results increased by 7 samples (35%), then in epithelium found 12 samples (60%) normal and 8 samples (40%) increased, and in oxalate crystals found in 15 samples (75%) and 5 samples (25%) increased. It can be concluded that people with diabetes mellitus must maintain a healthy diet and exercise diligently, and always control blood sugar levels.

Urolithiasis Problems in Finishing Pigs.

This paper describes cases of urolithiasis in fattening pigs on two farms (A and B). Bladder rupture due to urethral obstruction with calculi was the principal finding during the necropsy of the pigs. An in-depth diagnostic examination was performed to elucidate possible pathophysiological mechanisms, namely Fourier-transform infrared spectrophotometry (FT-IR) analysis of the uroliths, blood analysis (farm A: 5 samples, farm B: 10 samples) for assessing concentrations of minerals, the bone resorption marker cross-linked C-telopeptide of type 1 collagen (CTX), parathyroid hormone (PTH), and vitamin D components, biochemical urinalysis (farm A: 5 samples, farm B: 7 samples), microscopic examination of urinary sediment (Farms A and B: 7 samples each), mineral composition of the feed, and analysis of the drinking water. Calcium carbonate was the main component found in stones from both farms, and calcium carbonate and struvite were the main components found in crystals from farms A and B, respectively. On farm A, urinary calcium excretion and urinary pH were high; on farm B, urinary phosphorus was high and urinary calcium was low with a normal urinary pH. The mineral compositions of the feed and drinking water were similar on both farms and could therefore not explain the difference between the two farms. Disturbances in calcium and phosphorus absorption and homeostasis might have been involved in these problems. Further research should focus on the calcium, phosphorus, and vitamin D levels in the feed and take into account other factors, such as the absorption and excretion of minerals due to gut and urinary microbiota.

Entrectinib-induced tubulointerstitial nephritis: a case report

Introduction and importance: Entrectinib has been approved and increasingly administered for the treatment of non-small cell lung cancer, especially with intracranial metastasis. Although previous clinical studies have confirmed its safety, disproportionality analysis showed unusually high potential adverse renal effects. Case presentation: We present a case of a 71-year-old woman with pulmonary adenocarcinoma who developed severe renal function impairment during the treatment with entrectinib. Urinary sediment examination revealed leukocyte casts, while urinary culture was negative, suggesting the presence of possible tubulointerstitial nephritis (TIN). A kidney biopsy was performed, and the diagnosis of TIN was confirmed. The administration of oral methylprednisolone improved renal function. Clinical discussion: Protein kinase inhibitors might lead to renal function impairment in several different ways. It is of utmost importance to differentiate between the underlying pathomechanism, which is often challenging. TIN is a potentially reversible condition when treated appropriately. Conclusion: In the case of renal function impairment during entrectinib therapy, the possibility of TIN should be considered, and a kidney biopsy should be performed since corticosteroid therapy might improve renal function.

Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report

BackgroundA colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.Case presentationA 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient’s physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.ConclusionsA covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.

Association Between Urine Sediment Examination and Adverse Outcomes in Hospitalized Patients with AKI and Severe COVID-19

Association Between Urine Sediment Examination and Adverse Outcomes in Hospitalized Patients with AKI and Severe COVID-19

B-029 Validation of an Automated Analyzer for Urine Microscopic Examination

Abstract Background Microscopic examination of urine sediment can be time-consuming and labor intensive. Automated analyzers can help to standardize resulting and reduce manual work. Urinalysis has traditionally utilized semi-quantitative grading scales, eg. “0–3/high power field”. The Sysmex UF 5000 (Symex, Kobe, JP) uses flow cytometry to enumerate microscopic particles including white and red blood cells (WBC, RBC), bacteria, casts, and epithelial cells (EC). We sought to validate the counting of these microscopic particles against our reference manual method, and also determine if the research parameters from the analyzer could be used to accurately measure other particles in urine (eg. crystals). Methods Residual urine samples were analyzed for microscopic particles both by the UF 5000 and manually using KOVA tubes (KOVA International, Garden Grove, CA). Particles were enumerated using the laboratory’s current semi-quantitative grading system. Exact agreement and agreement +/- one level were calculated. Results Conclusion The analyzer results were comparable to manual resulting; in discrepant cases, the UF result was typically higher than manual, which may reflect the increased sensitivity of this method. Additional studies are ongoing to determine if the UF 5000 research parameters are accurate for semi-quantitative reporting of pathologic casts, crystals, and yeast.

Teaching Tip: Designing Three-Dimensional (3-D) Printed Struvite and Calcium Oxalate Crystals for Microscopic Examination

Accredited colleges of veterinary medicine are required by the American Veterinary Medical Association (AVMA) Council on Education (COE) to provide learners with hands-on diagnostic method training, including urinalysis. Although teaching hospitals and affiliated clinical partners offer opportunities to test and interpret urine, caseload is unpredictable. Textbook images and published case reports offer substitutes for experiential learning. However, these read-only modalities lack experiences for learners to evaluate slides microscopically for crystalluria. This teaching tip describes the development of three-dimensional (3-D) printed struvite and calcium oxalate models for skills training. Micro-precision 3-D printed models were designed using computer-aided design (CAD) software. Geometric representations in the Standard for the Exchange of Product Data (STEP) file format were exported for 3-D printing on 2 μm resolution platforms. Prints were manufactured from high temperature laminating (HTL) resin and affixed to glass slides. Although these 3-D prints are macroscopic rather than microscopic, their orientation on a fixed template side by side allows learners to differentiate between shapes, a skill that is key to urine sediment examination. These proof-of-concept prototypes will be integrated into the author's pre-clinical curriculum so that learners can gain experience identifying and differentiating between printed struvite, calcium oxalate monohydrate, and calcium oxalate dihydrate models as they would during routine inspection of urine. Formal feedback on the efficacy of these printed models will be solicited from learners and the instructional team. Future iterations will miniaturize the printed models to reflect their real-to-life microscopic dimensions more accurately.

Comparison of the clinical performance of the Atyp.C parameter of the UF-5000 fully automated urine particle analyzer with that of microscopic urine sediment analysis

a) ObjectivesUrinalysis is one of the most common laboratory screening tests to detect problems in the renal and urinary system; however, they cannot detect atypical cells (Atyp.Cs). The Sysmex UF-5000, a fully automated urine particle analyzer, can detect Atyp.Cs via its Atyp.C parameter. This study aimed to compare the clinical value of the Atyp.C parameter with that of urine sediment microscopy. b) MethodA total of 471 leftover urine samples were submitted to the Department of Clinical Laboratory at the University of Tokyo Hospital for urinalysis by manual sediment microscopy examination and UF-5000 Atyp.C analysis. c) ResultOf 471 submitted samples, 117 were positive for Atyp.Cs by urine sediment and 354 samples were negative. The histological subtypes of the Atyp.Cs included 105 cases of suspected urothelial carcinoma cells, 10 suspected squamous carcinoma cells, and 2 of suspected adenocarcinoma cells. The Atyp.C values for the Atyp.C-positive and -negative groups were 2.64 ± 0.69 and 0.38 ± 0.16, respectively. The optimal Atyp.C cutoff value determined by the receiver operating characteristic curve analysis was 0.4/μL. The area under the curve was 0.856, with a sensitivity of 79.5% and specificity of 85.1%. Atyp.C values of the UF-5000 showed high predictive performance for Atyp.C-positive specimens identified by urine sediment microscopy. d) ConclusionsThis study shows that a combination of UF-5000 analysis and microscopic examination of urine sediment improves Atyp.C detection in urine sediment analysis. These results suggest that Atyp.C measured by UF-5000 could be a useful screening parameter in routine testing of urine samples.

Differences In Urine With Sediment Results Preserving Formalin And Toluena

Urine sediment examination is done to see the organic and inorganic elements in the urine. Urine examination no later than 2 hours from the time urine is collected, postponement urine for 2 hours without being stored at 2-80C and without the addition of preservatives can reduce the quality of examination results. Giving preservatives in the urine causing the development of bacteria can be suppressed. The purpose of this study is to determine differences in urine sediment yield with formalin and toluene preservatives. This type of research is analytic with an experimental approach. The sample used was 15 female students who were menstruating. The results of data analysis with the One-way anova and Kruskal Wallis tests showed the results of p value of erythrocytes, leukocytes, epithelial cells, crystals and bacteria respectively of 0.137; 0.699; .342; 0.665; 0,600 where p value> 0,005 which means there is no difference in urine sediment yield with preservative formalin and toluene. But each element has morphological changes after preserving it with formalin and toluene preservatives. In formalin, morphological changes are slightly smaller and enlarged, whereas in toluene, morphological changes occur in a smaller and irregular manner. It is hoped that urine sediment examination is checked immediately with fresh urine to get accurate results and can support the diagnosis of a disease. Keywords: urine sediment, formalin, toluene

C1 COMPLETE HEART BLOCK AS A RARE MANIFESTATION OF GRANULOMATOSIS WITH POLYANGITIS: A CASE REPORT

Abstract A 42–year–old male with prior smoking habit presented at our emergency department after atraumatic syncope preceded by severe pain in the left lower limb. One month prior to presentation, due to persistence of nonproductive cough he underwent a chest computed tomography (CT), which showed 2 pulmonary nodules with hypercaptation at PET performed later (figure 1). The 12–lead electrocardiogram showed sinus rhythm with complete atrioventricular block and ventricular escape rhythm at 40 bpm (figura 1). Ecofast revealed a mildly impaired left ventricular systolic function (left ventricular ejection fraction [LVEF] 45%) with basal septal hypokinesis. Laboratory assessment showed leukocytosis (marked neutrophilia and eosinophilia), thrombocytosis anemia, elevated C–reactive protein (193 mg/dl), troponin I (18483 ng/L), NTproBNP (14627 ng/l) and creatinine (2.27 mg/dL) levels. The patient was transported to the catheterization laboratory for temporary pacemaker insertion and coronary angiography, which depicted distal occlusion of the first septal branch (Figure 2A), the first diagonal branch (Figure 2B) and the obtuse marginal branch (Figure 2C). After the procedure due to persistent ischemia of the left lower limb, several unsuccessful procedures to restore limb vascularization by means of locoregional thrombolysis and percutaneous angioplasty were attempted, but a leg amputation above the knee was eventually performed after few days. Neoplastic markers, blood cultures and urine cultures resulted negative, urine sediment examination showed cylinders, leucocytes and microhematuria. A brain/facial bones CT scan was performed, showing left maxillary sinusitis (figure 1). A rheumatologic screening was also performed, showing high titer of cANCA(125 UI/ml) hinting at a systemic vasculitis. The histopathological results of the amputated limb depicted marked necrotizing vasculitis with extensive involvement of small–medium caliber and larger caliber arterial vessels (figure 2). Based on these clinical and laboratory findings, a diagnosis of granulomatosis with polyangiitis (GPA) was made. The patients was treated with ev methylprednisolone and rituximab. After the induction therapy, chest CT scan showed a marked reduction of the size of the pulmonary nodule (Figure 3); renal function progressively improved and physiological atrioventricular conduction being restored

Automated Urine Cell Image Classification Model Using Chaotic Mixer Deep Feature Extraction.

Microscopic examination of urinary sediments is a common laboratory procedure. Automated image-based classification of urinary sediments can reduce analysis time and costs. Inspired by cryptographic mixing protocols and computer vision, we developed an image classification model that combines a novel Arnold Cat Map (ACM)- and fixed-size patch-based mixer algorithm with transfer learning for deep feature extraction. Our study dataset comprised 6,687 urinary sediment images belonging to seven classes: Cast, Crystal, Epithelia, Epithelial nuclei, Erythrocyte, Leukocyte, and Mycete. The developed model consists of four layers: (1) an ACM-based mixer to generate mixed images from resized 224 ×224 input images using fixed-size 16 ×16 patches; (2) DenseNet201 pre-trained on ImageNet1K to extract 1,920 features from each raw input image, and its six corresponding mixed images were concatenated to form a final feature vector of length 13,440; (3) iterative neighborhood component analysis to select the most discriminative feature vector of optimal length 342, determined using a k-nearest neighbor (kNN)-based loss function calculator; and (4) shallow kNN-based classification with ten-fold cross-validation. Our model achieved 98.52% overall accuracy for seven-class classification, outperforming published models for urinary cell and sediment analysis. We demonstrated the feasibility and accuracy of deep feature engineering using an ACM-based mixer algorithm for image preprocessing combined with pre-trained DenseNet201 for feature extraction. The classification model was both demonstrably accurate and computationally lightweight, making it ready for implementation in real-world image-based urine sediment analysis applications.

Automatic Classification of Particles in the Urine Sediment Test with the Developed Artificial Intelligence-Based Hybrid Model.

Urine sediment examination is one of the main tests used in the diagnosis of many diseases. Thanks to this test, many diseases can be detected in advance. Examining the results of this test is an intensive and time-consuming process. Therefore, it is very important to automatically interpret the urine sediment test results using computer-aided systems. In this study, a data set consisting of eight classes was used. The data set used in the study consists of 8509 particle images obtained by examining the particles in the urine sediment. A hybrid model based on textural and Convolutional Neural Networks (CNN) was developed to classify the images in the related data set. The features obtained using textural-based methods and the features obtained from CNN-based architectures were combined after optimizing using the Minimum Redundancy Maximum Relevance (mRMR) method. In this way, we aimed to extract different features of the same image. This increased the performance of the proposed model. The CNN-based ResNet50 architecture and textural-based Local Binary Pattern (LBP) method were used for feature extraction. Finally, the optimized and combined feature map was classified at different machine learning classifiers. In order to compare the performance of the model proposed in the study, results were also obtained from different CNN architectures. A high accuracy value of 96.0% was obtained in the proposed model.

Urine Sediment Examination: Comparison Between Laboratory-Performed Versus Nephrologist-Performed Microscopy and Accuracy in Predicting Pathologic Diagnosis in Patients with Acute Kidney Injury.

Automated urine technology is becoming standard for urinalysis microscopy. We sought to compare the urine sediment analysis performed by nephrologist to the analysis performed by the laboratory. When available, we also compared the suggested diagnosis per nephrologists' sediment analysis to the biopsy diagnosis. We identified patients with AKI that had urine microscopy with sediment analysis performed by the laboratory (Laboratory-UrSA) and by a nephrologist (Nephrologist-UrSA) within 72 hours of each other. We collected data to determine the following: number of RBCs and WBCs per HPF, presence and type of casts per LPF, and presence of dysmorphic RBCs. We evaluated agreement between the Laboratory-UrSA and the Nephrologist-UrSA using cross tabulation and Kappa statistic. When available, we categorized the nephrologist sediment findings into four categories: (1) bland, (2) suggestive of acute tubular injury (ATI), (3) suggestive of glomerulonephritis (GN), and (4) suggestive of acute interstitial nephritis (AIN). In a group of patients with kidney biopsy within thirty days of the Nephrologist-UrSA, we assessed agreement between the nephrologist diagnosis and the biopsy diagnosis. We included 387 patients with both Laboratory-UrSA and Nephrologist-UrSA. The agreement was moderate for presence of RBCs (Kappa 0.46, 95% CI: 0.37, 0.55), fair for WBCs (Kappa 0.36, 95% CI: 0.27, 0.45). There was no agreement for casts (Kappa 0.026, 95% CI: -0.04, 0.07). Eighteen dysmorphic RBCs were detected on Nephrologist-UrSA compared to zero on Laboratory-UrSA. Among the 33 patients with kidney biopsy, 100% ATI and 100% GN suggested per Nephrologist-UrSA were confirmed on the biopsy. Of the 5 patients with bland sediment on the Nephrologist-UrSA, 40% showed ATI pathologically while the other 60% demonstrated GN. A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic RBCs. Correct identification of these casts carries important diagnostic and prognostic value when evaluating kidney disease.

The Effect Of Centrifugation Speed On The Results Of Urine Sediment Examination

The process of centrifugation in urine examination is very important because it can be used in the manufacture of urine sediment. The purpose of this study was to determine the effect of centrifugation speed on the results of urine sediment examination. Centrifugation speeds used were 3000 rpm, 3500 rpm, 4000 rpm, and 4500 rpm using pathological urine samples. The samples used were 32. The research method used was an experimental laboratory at the Pusura Yos Sudarso clinical laboratory in Surabaya. The results of the study with a speed of 3000 rpm obtained an average of erythrocytes = 6.63/LPB, leukocytes = 13.63/LPB, and epithelial = 10.50/LPB. At a speed of 3500 rpm the average value of erythrocytes = 7.63/LPB, leukocytes = 15.13/LPB, and epithelium 11.63/PLB. At a speed of 4000 rpm the average value of erythrocytes = 8.63/LPB, leukocytes = 17.75/LPB and epithelial = 13.50/LPB. At a speed of 4500 rpm the average value of erythrocytes = 9.63/LPB, leukocytes = 20.50/LPB, and epithelial = 15.38/LPB. The results of the statistical test One Way Anova obtained p-value results of 0.001 < (0.05) in erythrocyte cells, p-value results for leukocytes 0.025 < (0.05), and p-value results for epithelial cells 0.002 < (0.05) means that there is an effect on the centrifugation speed on the results of urine sediment examination.

Profil mikroskopis sedimen urin pada kondisi glukosuria di Laboratorium Klinik Prodia, Banda Aceh

Background: Laboratory examination of urine (urinalysis) is crucial in establishing various diagnoses. Urine examination can be done through macroscopic examination, including color, clarity, and microscopic examination of urine sediment (U-sed) and urine chemical examination such as glucose. Urine sediment is insoluble elements such as erythrocytes, leukocytes, epithelial cells, thorax, bacteria, crystals, fungi, and parasites originating from the blood, kidneys, and urinary tract. Glucosuria is a condition where glucose is found in the urine, and when excessive >180 mg/dL can experience hyperglycemia, the impact is to damage the capillary blood vessels in the kidneys. U-sed is used to identify sediment elements that can be used to detect kidney and urinary tract abnormalities.Objectives: This study aims to determine the U-sed profile in glucosuria at Prodia Clinical Laboratory, Banda Aceh.Methods: Descriptive research using an experimental design and analyzing secondary data from patients with glucosuria and referred for U-sed examination at Prodia Clinical Laboratory, Banda Aceh Branch. The study was conducted in Mai 2022, with a total sample size of 24 respondents. Microscopic examination U-sed data was processed in stages starting from editing, coding, entry, and cleaning data. Data were only analyzed descriptively using frequency distribution.Results: The results of the study of the U-sed profile in patients with glucosuria conditions were abnormal flat epithelial cells (50,0%), the occurrence of leukocyturia (67,7%), the occurrence of hematuria (70,8%), and other sediments that were above normal only 25,0% of patients. Thus, the U-sed profile in patients with glucosuria conditions may be pathological such as infection, inflammation, and stones in the urinary tract.Conclusion: Some of the MSU profile data in patients who performed laboratory examinations at Prodia Banda Aceh showed above-normal threshold values, such as the data of flat epithelial cells, leukocytes, erythrocytes, and some other sentiments that were above normal had a low frequency. Patients who perform urine tests are at risk of infection and inflammation of the urinary tract and even the risk of kidney stones.

Perbandingan Hasil Pemeriksaan Leukosit Pada Sedimen Urin Yang Disentrifugasi Lima Menit Dengan Variasi Waktu Tiga Menit, Tujuh Menit Dan Sepuluh Menit

AbstractVariations in centrifugation time have an affect on the results of urine sediment examination. Urine sediment checks are listed in regular or routine inspections. Sediment examination is very good using morning urine because it is more concentrated and the material has not been damaged or lysis. The purpose of this study was to determine the comparison of the results of the examination of urinary leukocyte sediments that were centrifuged five minute with time variations of three minutes, seven minutes and ten minutes. The research was conducted at the Clinical Pathology Laboratory of the Faculty of Health Sciences and Technology, Binawan University. The material used morning urine. The study sample was given a 2x 60 ml urine container consisting of 2 adolescents and 4 elderly people who were willing to be respondents for urine sediment examination. The result of leukocyte analysis data are known that the average number of leukocyte cells at a time of 5 minutes is 13.14 leukocyte cells / LPB, a centrifugation time of 3 minutes is known to average 9.06 leukocyte /LPB, a centrifugation time of 7 minutes the average leukocyte cell is increasing to 17.33 leukocyte cells / LPB. The results of the urinary sediment leukocytes of the Paired T-Test can be concluded that there are significant differences in the examination of urinary leukocyte sediments with variations in centrifugation time of 3 minutes, 7 minutes and 10 minutes compared to the control time 0f 5 minutes. Keywords: Leukocytes Sediments; Time Centrifuges.

362 COMPLETE HEART BLOCK AS A RARE MANIFESTATION OF GRANULOMATOSIS WITH POLYANGIITIS: A CASE REPORT

Abstract A 42-year-old male with prior smoking habit presented at our emergency department after atraumatic syncope preceded by severe pain in the left lower limb. He had no past relevant medical history until one month prior to presentation, when the onset and persistence of nonproductive cough deemed the performance of a chest computed tomography (CT), which showed a 28 mm pulmonary nodule. A positron emission tomography-CT scan performed thereafter showed hypercaptation of the apical pulmonary nodule (SUV 6.87), and hypercaptation of the left nasal cavities. He was not on daily medications. On presentation the patient complained of dyspnoea at rest with no chest pain. On physical examination the left foot was cold and numb with no pedidial pulses. Laboratory assessment showed leukocytosis, thrombocytosis, anemia and elevated C-reactive protein, troponin I, NTproBNP and creatinine levels. The 12-lead electrocardiogram showed sinus rhythm with complete atrioventricular block and ventricular escape rhythm at 40 bpm; the transthoracic echocardiography revealed a mildly impaired left ventricular systolic function with basal septal hypokinesis; a chest-CT scan confirmed the stability of the aforementioned pulmonary lesions. The patient was transported to the catheterization laboratory for temporary pacemaker insertion and coronary angiography, which depicted distal occlusion of the first septal branch, the first diagonal branch and the obtuse marginal branch; no percutaneous coronary intervention was performed. The patient was then transferred to our Coronary Intensive Care Unit: due to persistent ischemia of the left lower limb, and several unsuccessful procedures to restore limb vascularization, a leg amputation above the knee was performed on day 2 of hospitalization. Meanwhile, the patient also developed fever, epididymitis, digital infarcts with bilateral hand purpura, upper and lower extremities paresthesia, worsening renal failure, persistent anemia and leukocytosis with eosinophilia. Neoplastic markers, blood cultures and urine cultures resulted negative; urine sediment examination showed cylinders, leucocytes and severe dysmorphic microhematuria suggestive of glomerulonephritis; bronchoalveolar lavage showed inflammatory cells. A rheumatologic screening was also performed, showing high titer of cANCA (125 UI/ml) hinting at a systemic vasculitis. The histopathological results of the amputated limb depicting marked necrotizing vasculitis with extensive involvement of small-medium caliber and larger caliber arterial vessels. Based on these clinical and laboratory findings, a diagnosis of granulomatosis with polyangiitis (GPA) with myocardial infarction due to coronary involvement and subsequent atrioventricular block was made on day 4 of hospitalization. Daily 500 mg boluses of intravenous methylprednisolone were administered for three days since day 4 of hospitalization, followed by high dose oral glucocorticoids (prednisone 1 mg/kg/day) and subsequent remission induction therapy with rituximab 375 mg/m2 weekly. Renal function progressively improved; heart conduction abnormalities gradually recovered and there was a marked reduction of the size of the pulmonary nodule. GPA presents remains one of the most challenging diagnostic dilemmas in clinical medicine. Despite we performed a prompt diagnosis, a leg amputation had to be done due to the common rapid progression of the disease. Clinicians should be aware of the various manifestations of GPA and bear in mind the possibility of coronary vasculitis.