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Surface layer cells 67 b.

Views: Transcription 1 Vol. 標本の観察 1 無染色での鏡検無染色での鏡検が原則である 2 染色後の鏡検尿沈渣成分の確認および同定に際し, 必要な場合は, 染色法を用いる ただし, 染色液によっては溶血作用の強いものもあり, 使用にあたって注意する 3 注意事項 1 沈渣に尿酸塩, リン酸塩, 炭酸塩などの析出が多いときは成分の鏡検が著しく妨げられるので, 尿酸塩ならば尿を加温し 50 くらいで撹拌しながらリン酸塩, 炭酸塩ならば酢酸を加え, 溶解した後に再度遠心して尿沈渣を作製するとよい 2 細胞や円柱のような形の大きなものは, カバーガラスの周辺部に集まりやすいので注意して観察する axom shockwave player id 尿蛋白検査, 尿潜血反応および尿白血球検査などの定性 半定量法所見と尿沈渣の出現とは必ずしも並行するものではない 多項目試験紙法で陰性のときでも尿沈渣を検査することは腎 尿路系疾患はもとより, 全身性疾患の鑑別上にも有用な場合がある 科 の違いにより記載法および異常とする個数は異なるので, 担当医と協議のもとで決める必要がある 1.

It is desirable that the tube is composed of transparent polyacrylic styrene. The duration of storage affects urine properties differently between specimens. J-STAGE-1 尿沈渣特集 23 Appendix: Criteria for the Axom shockwave player id Typing of Urinary Red Blood Cells In the appendix, the criteria for the morphological typing of urinary red blood cells published by the Japanese Committee for Clinical Laboratory Standards JCCLS are outlined.

Therefore, only malignant cells and those suspected to be malignant should be reported as atypical cells in routine microscopic examinations of urine sediments with accompanying comments on such cell information.

Moreover, red blood cell morphology information should be documented in consultation with clinical staff. This should be followed in principle because essential urine formed elements would be diluted if the sediment volume exceeds 0.

J-STAGE 尿沈渣特集 第一部日本臨床検査標準協議会尿沈渣検査法指針提案の目指すもの I 採尿法 II 尿沈渣標本の作製 III 尿沈渣標本の鏡検 low power field; LPF high power field; HPF IV 尿沈渣成分の分類 4 V 尿沈渣成績の記載 VI 自動分析装置による検査 5 付記尿中赤血球形態の判定基準について 5 Part 1 Aims of the Axom shockwave player id on Urinary Sediment Examination Procedures Proposed by the Japanese Committee for Clinical Laboratory Standards JCCLS I Urine Collection 9 1.

Precautions during urine collection 9 3. Classification of red blood cells in urine To clearly describe the morphological features of red blood cells in urine, non-glomerular-type and glomerulartype red blood cells are divided into four and three major subclasses, respectively.

Cells axom shockwave player id fat granules shall be classified as cells of their origin if identifiable and otherwise classified as unclassifiable cells.

Lymphocytes 59 c. IGAKU KENSA 一般社団法人日本臨床衛生検査技師会 Japanese Association of Medical Technologists 2 目次 CONTENTS Vol. For example, a hyaline cast containing two red blood cells should be described as a hyaline cast. II Specimen Preparation It is important to first observe and record the appearance of urine when preparing specimens for urinary sediment examination.

Reporting microorganisms Results from the HPF 40 microscopic examination should be described in a qualitative manner according to the continue reading described in Table 1.

遠心沈殿法 1 遠心管 ml および 0. Eosinophils 59 d. 塩類 結晶類の記載法 強拡大 40,HPF での鏡検結果を Table 1. It is advised to compare a cast of interest with other elements e. The sediment should be mixed axom shockwave player id using a pipette or another device to achieve uniformity while avoiding damage to urine formed elements.

採尿のための器具 1 採尿コップは清潔な紙, ポリスチレン樹脂, プラスチックおよびガラス製などで, コップ内壁に何も塗布されていないものを用いる 2 尿検体の一部を試験管に採って提出する場合, 採取尿全体をよく混和した後に移し替える 必ず蓋をする 3 採尿バッグ使用例 特に新生児, 乳児例 では, バッグを適切に取り付け, 尿が漏れ出さないように注意する rpm:1 分間の回転数 R: 半径, 中心から遠心管管底までの距離 cm 2 遠心時間は 5 分間とする 5 沈渣量 : アスピレータ, ピペットまたはデカンテーションによって沈渣量を 0.

Reporting parasites Results from the HPF 40 microscopic examination should be described in a qualitative manner according to the criteria described in Table 1. Reporting casts Results from the LPF 10 microscopic examination should be axom shockwave player id on the basis of approximate counts in the whole field WF or individual fields LPFor in a qualitative manner according to the criteria described in Table 1.

They can be here into those derived from renal tubular epithelial cells and those derived from macrophages, but they are collectively referred to as the oval fat bodies.

The order of microscopic examination The whole field WF of the preparation is examined under a low power field LPFand selected fields are then examined under a high power field HPF. When using lenses with different conditions, a correction should be made according to the applicable information obtained from the manufacturers.

Monocytes 59 2 Macrophages 60 3 Others 61 Endometrial stromal cells 61 Mesothelial cells 61 2 Epithelial cells 61 1 Basic axom shockwave player id cells 64 Renal tubular epithelial cells 64 Urothelial cells 65 a. Mixing Mix the urine well to achieve uniformity. In particular, in case of https://5elements-2014.ru/bonus/6-2.html female, guidance on urine collection, including the use of a cleaning procedure, axom shockwave player id be given to prevent the https://5elements-2014.ru/bonus/-23.html from being contaminated by components from the vulva e.

J-STAGE-1 尿沈渣特集 7 Squamous epithelial cells 67 a. Non-glomerular-type red blood cell [Discocyte] Typical discocyte Swollen discocyte Some swollen discocytes have a thick margin and exhibit a doughnut-like shape.

Urine testing can accurately detect five abnormalities of urine, i. The guidelines provide terms and classification criteria for different shapes of red blood cells. The number of fields examined must be at least Specimen observation 1 Microscopic examination without staining In principle, urine sediments should be examined without staining. Urine collection containers 1 Collection containers should be made of resinprecoated clean paper, polystyrene resin, plastic, or glass. Where possible, the report should be tailored to the individual needs in consultation with attending physicians. Types of urine specimens 9 2. 採尿時の留意事項正確な尿沈渣検査の結果を報告するために, 以下の点に留意し実施することが望ましい 1 尿沈渣検査には早朝尿かつ中間尿が適しているため患者への指導が必要である 2 尿の種類および採尿方法 自然採尿, カテーテ ル採尿など を明記する 3 採尿前に尿道口を清拭することが望ましい 特に女性の場合, 外陰部からの成分 赤血球, 白血球, 扁平上皮細胞, 細菌など 混入を避けるため, 清拭することを含めた採尿指導が必要である 4 特別に保存が必要な場合は, 防腐剤としてホルマリンを尿 ml に対して 1 ml の割合で添加する また, 沈渣の固定を目的とする場合は, グルタルアルデヒド液が望ましい 5 採尿時間を原則として記載する 6 尿検体は, 遅くとも採尿後 4 時間以内に速やか Table 1. For urinary sediment examination procedures in Japan, the Japanese Committee for Clinical Laboratory Standards JCCLS proposed guidelines on urinary sediment examination procedures, namely GP1-P3 urinary sediment examination procedures , in , and the revised version, named GP1-P4 urinary sediment examination procedures , was released in In this part, we outline the urinary sediment examination procedures according to GP1-P4 with some modifications. Middle layer deep layer cells 66 Columnar epithelial cells 66 医学検査 Vol. J-STAGE-1 尿沈渣特集 5 Bence Jones , VI 尿沈渣検査の自動化 尿中有形成分測定装置運用の考え方 医学検査 Vol. However, staining solutions should be carefully chosen because some have potent hemolytic activity. Types of urine specimens Urine specimens are classified by time or type of collection Table 1. The use of a short sample should be recorded. Surface layer cells 65 b. IV Identification of Urine Formed Elements Urine formed elements are divided into components as shown in Table 1. Precautions during urine collection It is desirable to note the following points in order to report accurate results of urinary sediment examination. Centrifugation 1 Centrifugation tube: Use a sharp, pointed spitz-type centrifugation tube accurately graduated at 10 and 0. The same applies to casts containing white blood cells, renal tubular epithelial cells, or fat granules. Even if the available urine volume is lower than recommended, perform the test whenever possible. However, if this is not possible, then perform a microscopic examination such that the mean value for the WF can be obtained. Glutaraldehyde is a preferred choice for sediment fixation. Specific points including color, turbidity, hematuria, and foreign matters e. After prolonged storage, red blood cells, white blood cells, epithelial cells, and casts tend to decrease in number, whereas the number of bacteria and yeast tend to increase. 円柱類の記載法弱拡大 10,LPF での鏡検結果を Table 1. In such cases, dissolve the precipitate by heating the urine at approximately 50 C with stirring if it contains urates or by adding acetic acid if it contains phosphates and carbonates and then centrifuge the resulting sample to prepare a urinary sediment specimen. V Reporting Format The reporting format described below is for reference. J-STAGE-1 尿沈渣特集 10 第一部 日本臨床検査標準協議会尿沈渣検査法指針提案の目指すもの 油野友二 1 1 北陸大学医療保健学部 石川県金沢市太陽が丘 要旨臨床検査の世界で尿検査の歴史は特に古いが, 今日でも腎尿路系疾患および全身疾患のスクリ-ニング検査として重要な位置づけにある その臨床的意義は 5 つの尿異常,1 膿尿,2 細菌尿,3 血尿,4 蛋白尿,5 代謝異常尿 結晶尿, 糖尿その他 を見逃しなく検出することである 尿沈渣検査は形態学的検査として位置づけられ, 尿中の有形成分である上皮細胞類, 血球類, 円柱類, 塩類 結晶類, 細菌類についてそれぞれ正確に分類と概数計測することで, 尿定性検査所見と組み合わせて尿異常を示す病態の推定情報を提供する目的がある 本邦における尿沈渣検査法は日本臨床検査標準協議会 Japanese Committee for Clinical Laboratory Standards; JCCLS より 年に尿沈渣検査法指針提案 GP1-P3 尿沈渣検査法 が発表され, 年に GP1-P4 尿沈渣検査法 として改訂された 本稿では,GP1-P4 に準拠 一部改変 して尿沈渣検査法の概要を解説する キーワード 尿沈渣検査, 採尿法, 標本作成, 鏡検 I 採尿法 1. Neutrophils 59 b. Classification by type of collection 1 Natural urine: urine voided naturally 1 Total urine: urine completely collected in one natural voiding 2 Partial urine: part of a single natural urine voiding: i first urine: the first part of voided urine ii midstream voided urine: collected during voiding but excluding the first and last parts 2 Catheter urine: urine collected with a urethral catheter 3 Bladder puncture urine: urine collected by aspirating urine from a distended bladder through the anterior abdominal wall 4 Double voided urine: urine from a single voiding but dividing the specimen in accordance with the testing purposes 5 Others: urine sampled after urinary diversion surgery, e. The centrifuge must be allowed to stop naturally before attempting to remove any centrifugation tubes. Epithelial cells 1 Basic epithelial cells 1 Renal tubular epithelial cells 2 Urothelial cells 3 Columnar epithelial cells e. However, non-glomerular-type and glomerular-type red blood cells do not have to be divided into subclasses in routine examinations. Class should be identified using the following standards: 1 A hyaline cast containing three or more red blood cells, white blood cells, epithelial cells, and fat granules in the substrate should be classified as an RBC cast, WBC cast, epithelial cast, and fatty cast, respectively. A different type of macrophage-derived, fat granule-containing cells found in cystitis, prostatitis, and other urologic diseases should be classified as macrophages rather than oval fat bodies. Reference 1 Japanese Association of Medical Technologists: Examination of Urinary Sediment , Tokyo, Editorial Committee of Japanese Clinical Practice Guidelines for Hematuria Diagnosis: Japanese Clinical Practice Guidelines for Hematuria Diagnosis , Life Science Publishing, Tokyo, [Abstract: Horie S et al. 尿の種類尿の種類は採取時間による分類と採取方法による分類がある Table 1. 尿検体の攪拌検体は必ず均等になるよう十分に混和する 2. J-STAGE-1 尿沈渣特集 13 Table 1. Key words urinary sediment examination, urine collection method, specimen preparation, microscopic examination I Urine Collection 1. Different patient groups have differing requirements for urine sediment reports. J-STAGE-1 尿沈渣特集 6 2 49 VII 尿沈渣検査の精度管理 49 Part 2 Urinary Sediment Examination I What is Desirable in a Urinary Sediment Examination? 付記尿中赤血球形態の判定基準について 日本臨床検査標準協議会により発表された尿中赤血球形態の判定基準 の概要を付記する [ 引用 : 血尿診断ガイドライン ライフサイエンス出版 ] 日本臨床検査標準協議会 JCCLS 尿沈渣検査法指針提案 GP1-P4 赤血球形態情報は, 血尿の由来を考えるためのひとつの情報である 本指針では, 赤血球形態の用語と判定基準を示す 報告にあたっては個々の形態だけではなく尿沈渣全体のパターンを把握することが大切であり, すべての血尿について分類できるとは限らないことを認識する必要がある また, 赤血球形態情報は臨床側との協議に応じて記載する 尿中赤血球形態の表現 尿中赤血球形態の表現は, 非糸球体型赤血球 均一赤血球 と糸球体型赤血球 変形赤血球 とする 尿中赤血球の分類 尿中赤血球の形態の特徴を明確に把握するために, 非糸球体型赤血球を 4 分類, 糸球体型赤血球を 3 分類に大別する しかし, 日常検査では非糸球体型赤血球, 糸球体型赤血球の各小分類に分ける必要はない 医学検査 Vol. The inside of the containers should not be coated. The lid must be placed on the container. Urinary sediment examination is a morphological examination that accurately identifies and roughly counts urine formed elements, i. Abnormal crystals should be noted if any were found in the WF. 医学検査 Vol. In cases of absolute necessity, the specimens should be labeled as such. J-STAGE-1 尿沈渣特集 21 Table 1. Otherwise, the cast should be referred to as a hyaline cast. 寄生虫類の記載法強拡大 40,HPF での鏡検結果を Table 1. J-STAGE-1 尿沈渣特集 19 2 Clearly document the type of specimen and collection method e. J-STAGE-1 尿沈渣特集 15 非糸球体型赤血球 [ 円盤状赤血球 ] 典型 円盤状赤血球 膨化 円盤状赤血球 膨化 円盤状赤血球のなかには辺縁が厚くドーナツ状を示すものも認められる しかし, 糸球体型赤血球のドーナツ状不均一赤血球と異なり, ドーナツ状の辺縁は均一である 萎縮 円盤状赤血球 ここでいう萎縮とは, 小型になった形状の意味ではない したがって, 低浸透圧下で円盤状に大きく広がった赤血球が, その後, 高浸透圧下で萎縮することにより辺縁がギザギザした形状である 従来, 金平糖状といわれている辺縁がギザギザした赤血球の形態も萎縮とする [ 球状赤血球 ] 球状赤血球 萎縮 球状赤血球 コブ 球状赤血球 コブ 球状赤血球が検出された場合は, 背景にコブ部分の分離した赤血球の断片が同時に出現していることが一般的である これら赤血球の断片は赤血球としてカウントしない [ 円盤 球状移行型赤血球 ] [ 膜部顆粒成分凝集状脱ヘモグロビン赤血球 ] 前立腺生検実施後の尿や多発性嚢 のう 胞腎の尿では, 前立腺液や嚢胞液の影響を受けて通常の脱ヘモグロビン状の赤血球形態とは異なり, 脱ヘモグロビン状した赤血球の膜部に凝集状の顆粒成分が認められる 6 第一部日本臨床検査標準協議会尿沈渣検査法指針提案の目指すもの 16 糸球体型赤血球 [ ドーナツ状不均一赤血球 ] ドーナツ状不均一赤血球 標的 ドーナツ状不均一赤血球 コブ ドーナツ状不均一赤血球 コブ ドーナツ状不均一赤血球が検出された場合は, コブ 球状赤血球と同様, 背景にコブ部分の分離した赤血球の断片が同時に出現していることがある これら赤血球の断片は赤血球としてカウントしない [ 有棘状不均一赤血球 ] [ ドーナツ 有棘状不均一混合型赤血球 ] 注意事項 1 分類に用いている膨化や萎縮の用語は大きさを表しているのでなく, 最終的な赤血球の状態を意味するものであり, 膨化は広がった状態, 萎縮はしぼんだ状態である 2 糸球体型赤血球が小球状を示す要因は, 糸球体 尿細管通過の際に生じる赤血球の断片化が第一に考えられる 医学検査 Vol. For reporting, it is important to capture both individual shapes and the overall pattern of urinary sediments, and one should recognize that classification may not be possible for all cases of hematuria. Table 1. J-STAGE-1 尿沈渣特集 4 V 尿沈渣成分の見方 a. This is being done to establish its position as a screening test in the future. J-STAGE-1 尿沈渣特集 11 に検査する 尿性状の保存時間による影響は検体によって一様でない 赤血球, 白血球, 上皮細胞および円柱は減少し, 細菌と真菌は増加する傾向がある 7 女性が生理中の場合には, 検査は適切でない やむを得ない場合には, その旨を明記する 3. Even when the sample tested negative using multi-item test strips, urinary sediment examination can be useful for the differential diagnosis of kidney and urinary tract diseases as well as systemic diseases. Human polyomavirus-infected cells 72 b. Urine collection containers 10 医学検査 Vol. Slide preparation for microscopy 1 Loading urine on slide: Use mm glass slides. 微生物類の記載法強拡大 40,HPF での鏡検結果を Table 1. Terms for red blood cell morphology Non-glomerular-type red blood cell isomorphic RBC and glomerular-type red blood cell dysmorphic RBC are terms to describe red blood cell morphology. Cells difficult to classify should be reported as unclassifiable cells with a note on morphological information.