By Nagaraya P. Rao ChM., FRCS, Shalom J. Srirangam MD, MRCS, Glenn M. Preminger MD (auth.)
This concise pocket advisor to urological investigative approaches studies the indicators and pitfalls of checks ahead of they're asked and indicates which assessments might be played in person urological conditions.
Part I describes the foundations, technique, merits and drawbacks of every of the investigations and covers all urological investigations/tests. half II provides recommendation at the number of investigations for person urological stipulations. for every research partially I and urological partly II, very important bullet issues are highlighted in a ‘box’ – necessary in the course of a hectic ward around, out-patient sanatorium, or for last-minute session earlier a viva examination.
This accomplished but effortless instruction manual could be necessary for clinical scholars and citizens in urology, in addition to a superb assessment for already-practicing urologists.
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Analysis of 24-hour urine specimen will help identify the cause of proteinuria • Diagnosis of nephrotic syndrome (triad of edema, hypoalbuminemia, and proteinuria of >3 g/24 h) • To assess prognosis of progressive disease—proteinuria is one of the most potent risk markers for renal function deterioration • Aid diagnosis of multiple myeloma (immunoassay for Bence Jones protein) 1. URINE TESTS 29 Specimen collection and analysis • No dietary restriction is required • Discard ﬁrst urine specimen; then save all urine for 24 hours in a refrigerated urine-collection bottle • Send for analysis within 24 hours Interpretation Severity of proteinuria is best measured by quantifying absolute protein excretion (in 24 hours) rather than urinary protein concentration (inﬂuenced by dilution).
A minor decrease in GFR will cause the cystatin levels to rise above normal while the serum creatinine is still within the normal range • Serum creatinine—though it can provide a rough index of the level of GFR, it tends to overestimate GFR, particularly at low GFR. Because of the reciprocal relationship between clearance and serum creatinine, serum creatinine does not rise out of the normal range until there has been a substantial (50–70%) decrease in the GFR. However, in an individualized patient, a progressive increase in serum creatinine over time, even within the normal range, implies declining GFR.
PSA velocity The assumption that a consistent upward trend in the serum PSA level is more likely to be secondary to a malignant process rather than BPH is the basis for the clinical usefulness of PSA velocity (PSAV). 75 ng/mL per year has been shown correctly to distinguish patients with CAP from BPH with a sensitivity and speciﬁcity of 72% and 90%, respectively • Some authors recommended at least three annual PSA estimations (by the same laboratory) in order to determine a representative PSAV Overall, PSAV has been shown to be of limited value for a number of reasons.
Urological Tests in Clinical Practice by Nagaraya P. Rao ChM., FRCS, Shalom J. Srirangam MD, MRCS, Glenn M. Preminger MD (auth.)