Oh, urine is normal. General urine analysis (OAM). Specific Gravity or Relative Density

Urinalysis, urinalysis, leukocytes in urine, erythrocytes in urine, salts in urine, urine bacteria, mucus in urine. A general urine test should be performed in all patients, regardless of the nature of their disease. For a general analysis, 100 - 200 ml of the first morning urine is needed. This is a laboratory study of urine, carried out for the needs of medical practice, as a rule, for a diagnostic purpose. Includes organoleptic, physicochemical and biochemical studies. The general clinical analysis of urine includes the study of physical, chemical properties urine and sediment microscopy. Clinical urinalysis (general urinalysis) - a study of the physicochemical properties of urine and sediment microscopy. Deciphering its indicators gives a general picture of the state of the body as a whole. A general urine test is deciphered by determining 3 main indicators: acidity, water content, and the presence of sugar.

GENERAL URINE ANALYSIS

A general urinalysis is included in the list of mandatory studies that should be carried out by all initially applied patients, regardless of the alleged diagnosis.

It must be remembered that deviations in the general analysis of urine can be observed not only in diseases of the kidneys, but also in the pathology of other organs. Even Hippocrates (430-377 BC) in his "Aphorisms" noted: "The doctor must observe whether the urine of the patient is the same as that of a healthy one, and the less similarity, the more severe the disease."

The norms of the general analysis of urine (standards for decoding the general analysis of urine)

Indicators: Result

The amount of urine delivered for analysis: Has no diagnostic value

Urine color: Various shades yellow color

Urine transparency: Clear

Urine odor: Unsharp, non-specific

Urine reaction or pH: Acidic, pH less than 7

Specific gravity(relative density) of urine: 1.018 or more in the morning portion

Protein in urine: None

Glucose in urine: None

Ketone bodies in urine: None

Bilirubin in urine: Absent

Urobilinogen in urine: 5-10 mg/l

Hemoglobin in urine: None

Erythrocytes in urine (microscopy): 0-3 per field of view for women

0-1 in sight for men

Leukocytes in urine (microscopy): 0–6 per field of view for women

0–3 in sight for men

Epithelial cells in urine (microscopy): 0-10 per field of view

Casts in urine (microscopy): None

Salts in urine (microscopy): None

Bacteria in urine: None

Fungi in urine: None

Sample collection and preparation for urinalysis

For a general analysis, the entire portion of morning urine is collected after a thorough toilet of the genital organs.

Urine collection utensils for analysis should be clean and dry. In poorly washed dishes, urine quickly becomes cloudy and acquires an alkaline reaction.

You can store urine before conducting a general analysis for no more than 1.5 hours. A later urine test will be unreliable because its cellular composition changes. Deciphering the analysis of urine in pregnant women helps to detect in time possible problems during pregnancy

Urinalysis according to Nechiporenko

Urinalysis according to Nechiporenko is a laboratory study of urine, with the help of which a doctor can assess the condition, function of the kidneys and urinary tract.

Why is a Nechiparenko urinalysis performed?

Urinalysis of Nechiporenko is usually prescribed after a general urinalysis, if deviations from the norm of indicators were detected in the clinical analysis. Urine analysis according to Nichiporenko will allow you to study these disorders in more detail for a correct diagnosis.

You may have to take a urine test according to Nicheporenko several times, since using this diagnostic method, the doctor can monitor the effectiveness of the treatment.

How is Nichiporenko's urine test performed?

To analyze Nicheporenko's urine, doctors use 1 milliliter of the patient's portion of urine and count the number of urine components (per 1 milliliter): erythrocytes, leukocytes and cylinders using a special counting chamber.

The norms of urine analysis Nechiporenko:

Erythrocytes - no more than 1000 per 1 ml of urine.

Leukocytes - no more than 2000 per 1 ml of urine.

Cylinders - no more than 20 per 1 ml of urine.

An increase in certain shaped elements of urine can confirm or refute the results of a general urinalysis. The conducted studies provide the maximum accuracy of the diagnosis.

How to take a urine test according to Nechiporenko?

After a thorough toilet of the genital organs, an average portion of urine is collected: for this, the first amount of excreted urine (15-20 milliliters) is passed, and the average portion of morning urine is placed in a prepared clean dish.

Material for research: the average portion of morning urine.

The term for the analysis of urine according to Nechiporenko: 1.5 hours.

An increase in leukocytes in the analysis of urine according to Nechiporenko occurs in the following diseases:

1. Pyelonephritis is an inflammatory disease of the kidneys, in which the level of leukocytes in the urine is increased. Pyelonephritis is an infectious inflammation of the pelvis and other parts of the kidneys. The presence of infection provokes the accumulation of leukocytes in this area, which leads to an increase in the number of leukocytes in the urine - leukocyturia. The main symptoms of pyelonephritis: dull pain in the lumbar region (on one or both sides), fever, weakness, headaches, loss of appetite, etc. In the analysis of urine according to Nechiporenko with pyelonephritis, there is not only an increase in leukocytes, but also hematuria (an increase in the number red blood cells in the urine), pyuria (the presence of pus in the urine), bacteriuria (the presence of bacteria in the urine), proteinuria (the excretion of protein in the urine).

2. Kidney stones (renal stones, nephrolithiasis) is a disease characterized by the formation of stones in the kidneys of various sizes, shapes and composition. In the presence of kidney stones, the main symptoms are: sharp pain in the lumbar region, especially after shaking in transport, pain radiates to the external genitalia, fever, general malaise. There is blood in the urine (hematuria). The presence of leukocytes in the urine indicates the attachment of an infection.

An increase in red blood cells in the analysis of urine according to Nechiporenko occurs in the following diseases:

1. Acute glomerulonephritis is a disease of the glomeruli of the kidneys (the main parts responsible for filtering and purifying the blood). As a rule, in acute glomerulonephritis, gross hematuria is noted (urine of the color of "meat slops"). The main symptoms of acute glomerulonephritis are as follows: the appearance of blood in the urine, increased blood pressure, pronounced edema, a decrease in the amount of urine separated (oliguria). In the analysis of urine, there is hematuria (the presence of red blood cells in the urine), proteinuria (the presence of protein in the urine), cylindruria (the presence in the urine of cylinders “covered” with red blood cells - red blood cell cylinders).

2. Chronic glomerulonephritis can also be accompanied by hematuria, but the presence of red blood cells in the urine is not constant. The main symptom of chronic glomerulonephritis is proteinuria - an increase in protein excretion in the urine, cylindruria - the presence of cylinders in the urine. Symptoms of chronic glomerulonephritis are as follows: increased blood pressure, edema, blood in the urine.

3. Kidney stones (renal stones, nephrolithiasis) damage the walls of the urinary tract, which leads to ruptures of the smallest vessels and the entry of red blood cells into the blood. Symptoms of kidney stones are described above.

4. Tumors of the kidneys and urinary tract are the cause of hematuria. Tumors can be benign (papilloma, fibroma, hemangioma) and malignant. Hematuria in kidney tumors differs from hematuria in other diseases in that, as a rule, the appearance of blood in the urine against the background of a tumor is not preceded by any other symptoms of the disease. Hematuria starts suddenly and goes away just as suddenly. Other symptoms of a kidney tumor are: a prolonged slight increase in body temperature, general weakness, loss of appetite, weight loss, dull aching pain in the kidney area, etc. The main symptoms of a bladder tumor: the appearance of blood in the urine (macrohematuria - blood can be released throughout urination or only at the end when the bladder contracts), frequent urination, false urge to urinate, pain during urination, etc.

Cylinders in the urine when analyzed according to Nechiporenko

Cylinders are protein casts formed by the tubules of the kidneys. Depending on the composition, there are several types of cylinders that occur in various diseases. Normally, urine should not contain protein. With the appearance of protein and an acidic reaction in the urine, the proteins stick together, forming cylinders. Cells (erythrocytes, cells lining the renal tubules - epithelium, etc.) can be deposited on protein cylinders. The main diseases in which cylindruria is observed (cylinders in the urine):

1. Glomerulonephritis is a kidney disease characterized by hematuria (the presence of red blood cells in the urine), cylindruria and some other symptoms. As a rule, cylinders with glomerulonephritis are “stuck around” with erythrocytes, and are called erythrocyte cylinders. Symptoms of glomerulonephritis are described above.

2. Pyelonephritis is an inflammatory disease of the kidneys. With pyelonephritis in the analysis of urine according to Nechiporenko, as a rule, leukocyturia (an increase in leukocytes in the urine), bacteriuria (the presence of bacteria in the urine) and cylindruria is observed. With pyelonephritis, the most common are simple (or hyaline) cylinders, as well as epithelial cylinders (cylinders on which there are epithelial cells of the tubules of the kidneys).

3. Poisoning by nephrotoxic (poisonous to the kidneys) substances also cause casts in the urine. With toxic kidney damage, so-called waxy cylinders are observed in the urine. The waxy casts are made up of cells from the destroyed tubules of the kidneys.

What determines the Zimnitsky test?

Urinalysis according to Zimnitsky allows the doctor to determine the ability of the kidneys to concentrate urine. The concentration ability of the kidneys is a natural regulatory mechanism that allows the body to maintain a constant fluid environment. So, for example, with an increase in the amount of fluid in the body (plentiful drink, liquid food), the kidneys excrete a larger amount of dilute urine.

On the contrary, if the human body receives little water, the kidneys begin to produce very concentrated urine and thus conserve fluid.

One of the most informative fragments of a general urine test is sediment microscopy, in which the number of different elements in one field of view is counted.

Urinalysis according to Zimnitsky determines the density of urine - this is an indicator that expresses the amount of metabolic products dissolved in urine (salts, proteins, ammonia, etc.). The density of urine depends on the amount of liquid consumed, as well as on the concentration ability of the kidneys. Normal urine density ranges from 1.003 to 1.035. During the day, a person consumes an unequal amount of liquid, so the density of urine in different time day changes: during the day, urine is less dense due to fluid intake, morning urine, on the contrary, has the highest density.

Using the Zimnitsky test, daily diuresis is also determined - the total amount of urine excreted during the day. Normally, about 1.5-2 liters of urine is excreted during the day. With the help of the Zimnitsky test, it is determined how much urine was released during the day and how much at night. Daily fluctuations in diuresis ( different amount urine excreted during the day and during the night) reveal some abnormalities in the functioning of the kidneys or heart.

How is urine collected for the Zimnitsky test?

Collection of urine for the Zimnitsky test, it is carried out within one day. During the collection of urine, the subject should eat as usual and take the usual amount of fluid for himself (preferably no more than 1.5-2 liters of fluid per day). In parallel with the collection of urine, it is necessary to calculate the amount of fluid taken (including liquid food), as this is important in calculating the results of the analysis.

The subject is given 8 jars, in each of which, after a day, urine should be collected. At 6 am on the first day, the subject empties the bladder into the toilet. Then, exactly every 3 hours, you should collect all the urine in the appropriate jar. Thus, urine is collected at 9, 12, 15, 18, 21, 24, 3, and 6 am the next day. In total, 8 servings of urine are obtained, one serving of urine in each jar.

All jars of urine, as well as data on how much liquid was drunk during the day, are sent to the laboratory. Before sending urine samples to the laboratory, it is recommended to keep them in the refrigerator.

What are the norms of the Zimnitsky test?

Using the Zimnitsky test, several parameters of kidney function are evaluated: urine density, fluctuations in urine density during the day, the amount of fluid excreted during the day, fluctuations in the amount of fluid excreted day and night. With normal kidney function, the results of the Zimnitsky test are as follows:

The amount of urine excreted during the day (daily diuresis) - 1500 - 2000 ml

The ratio of the amount of fluid excreted by the kidneys to the amount of fluid drunk during the day is 65 - 80%.

The amount of urine excreted during the day significantly exceeds the amount of urine excreted at night (2/3 of the total urine during the day, 1/3 at night)

The density of urine in one or more portions is not less than 1.020

Significant fluctuations in the amount and density of urine in different portions during the day. For example, during the day one serving is 300 ml, and at night a serving is 50 ml. Or, in one portion of urine, the density is 1.008, and in the other portion it is 1.022.

Interpretation (decoding) of the results of the Zimnitsky test.

When conducting a Zimnitsky test in people with impaired renal function, various deviations from the norm are observed. The main violations detected using the Zimnitsky test are as follows:

1. Low urine density is the result of the Zimnitsky test, in which in none of the portions the urine density exceeds 1.012-1.013. Low density of urine is called hypostenuria and indicates a violation of the concentration ability of the kidneys.

2. Violation of urine concentration occurs while taking diuretic drugs (furosemide, ethacrynic acid, etc.), as well as in the following diseases:

3. Late stages of chronic renal failure occur in people suffering from certain kidney diseases for a long time (glomerulonephritis, pyelonephritis, amyloidosis of the kidneys, etc.). In chronic renal failure, the following main symptoms are observed: deterioration in general condition, headaches, lethargy, loss of appetite, thirst, bad smell from mouth. In biochemical analysis

4. increase in blood levels of creatinine, urea, etc.

5. Exacerbation of bilateral pyelonephritis, or inflammation of the pelvis of both kidneys, is also the cause of a decrease in urine density. With pyelonephritis, the main symptoms are: periodic pain in the lumbar region, fever to high numbers, headaches, nausea, etc.

6. Severe heart failure in some cases leads to kidney damage and disruption of the urine concentration process. With poor heart function, blood stagnates in the kidneys and other organs, which leads to disruption of their work. With heart failure, there is marked shortness of breath, weakness, headaches, swelling in the legs, dropsy (ascites) is possible.

Low density of urine, which practically does not change depending on the time of day or the amount of fluid taken, is called hypoisostenuria. With hypoisostenuria, the density of urine in each portion of the Zimnitsky test, as a rule, does not exceed 1.009 and practically does not change throughout the day. Such a result of the Zimnitsky test suggests that the kidneys are not able to adapt to changing conditions for the intake of fluid into the body and indicates severe renal failure.

Reberg-Tareev test

The Reberg-Tareev test helps the doctor determine the excretory function of the kidneys and the ability of the renal tubules to excrete or reabsorb (reabsorb) certain substances.

The test method consists in the fact that the patient in the morning on an empty stomach in a supine position collects urine for 1 hour and in the middle of this period of time they take blood from a vein to determine the level of creatinine.

Using a simple formula, the value of glomerular filtration (characterizes the excretory function of the kidneys) and tubular reabsorption are calculated.

In healthy men and women of young and middle age, the glomerular filtration rate (CF), calculated in this way, is 130-140 ml / min.

A decrease in CF is observed in acute and chronic nephritis, kidney damage in hypertension and diabetes mellitus - glomerulosclerosis. The development of renal failure and the increase in nitrogenous wastes in the blood occurs with a decrease in CF to about 10% of the norm. In chronic pyelonephritis, the decrease in CF occurs later, and in glomerulonephritis, on the contrary, earlier than disturbances in the concentration ability of the kidneys.

Persistent drop in CF to 40 ml/min at chronic disease kidney indicates severe renal failure, and a decrease in this indicator to 15-10-5 ml / min indicates the development of the final (terminal) stage of renal failure, which usually requires the patient to be connected to an "artificial kidney" apparatus or a kidney transplant.

Tubular reabsorption normally ranges from 95 to 99% and can drop to 90% or less in people without kidney disease when drinking large amounts of fluid or taking diuretics. The most pronounced decrease in this indicator is observed in diabetes insipidus. A persistent decrease in water reabsorption below 95%, for example, is observed in primary wrinkled (against the background of chronic glomerulonephritis, pyelonephritis) or secondary wrinkled kidney (for example, observed in hypertension or diabetic nephropathy).

Survey urogram covers the area from the upper poles of the kidneys to the beginning urethra. Any radiological examination of a patient with a urological disease should begin with an overview image. Often, a diagnosis can already be established from an overview picture. When interpreting a plain radiograph, the state of the skeleton must be taken into account. Of great diagnostic value is the identification of anomalies in the development of the spine (lumbarization, sacralization, spina bifida), pathological changes in the musculoskeletal system (scoliosis, deforming spondylosis, spondylitis, tuberculosis, tumor metastases).

The localization of the kidneys is more correctly determined by the spine. The contours of normal kidneys on the radiograph are even and their shadows are homogeneous.

The shadow of the lumbar muscles normally on the radiograph has the form of a truncated pyramid, the top of which is located at the level of the body of the XII thoracic vertebra. A change in the contours or the disappearance of the shadow of these muscles may be a sign of a pathological process in the retroperitoneal space.

Unaltered ureters are not visible in the overview picture. The shadow of the bladder filled with urine has the shape of an ellipse.

Additional, i.e., pathological, shadows can be very diverse and refer to various organs and tissues. Any shadow that has one or another degree of density and is located in the area of the urinary tract should be interpreted as a possible calculus. Often shadows in the projection of the pelvis are caused by phleboliths - vein stones, calcified fibromatous nodes of the uterus or calcified vessels. It is possible to resolve the issue of the relation of the detected shadow to the urinary tract using radiopaque research methods.

Intravenous urography - This is an x-ray study that is used to assess the pathology of the kidneys, bladder, urethra. These structures make up the urinary tract. On conventional x-rays, the urinary tract is not well visualized. However, with intravenous urography, a contrast agent is injected into a vein. The contrast enters the bloodstream, concentrates in the kidneys, and is excreted in the urine through the ureter.

The contrast blocks the x-rays in accordance with the structure of the kidneys, ureter, bladder, which is found on the x-ray as a white image.

The x-rays taken are called intravenous urograms, sometimes they are called intravenous pyelograms.

What is intravenous urography used for?

Intravenous urography is indicated in the following situations:

Kidney stones. Stones in the kidney or ureter can be visualized quite clearly with intravenous urography.

Urinary tract infection. For recurrent bladder or kidney infections, ES can help find the cause of the obstruction or other urinary tract abnormalities.

Blood in the urine. This can occur for various reasons such as infection, inflammation, swelling of the kidney. The EU will help determine the cause.

Obstruction or damage to any level of the urinary tract can often be detected with EU.

What preparation is necessary before intravenous urography?

Your kidneys must be able to secrete the contrast agent. So this procedure rarely performed in renal failure. Before the procedure, you may need a blood chemistry test to confirm that you do not have kidney failure.

Tell your doctor if you have any allergies, especially to contrast media containing iodine.

You should not eat for a few hours before the test. This ensures that your intestines are sufficiently empty of food, which makes the x-ray picture clearer.

You may need to take laxatives about one day before the test. This is necessary to clear the intestines for a clearer image on the x-ray.

You must sign an agreement to this procedure.

If you have diabetes and are taking metformin, you must stop taking metformin 2 days before your procedure. This is necessary as the combination of metformin and contrast agent can cause damage to the kidney tissue (You should discuss this with your doctor and how to manage your diabetes during this period).

How is intravenous urography done?

You will be asked to take off your clothes and lie down on the couch. A contrast agent is injected into a vein in your arm. Some burning sensation may occur. The contrast penetrates into the kidneys and ureter. Several X-rays will be taken, usually every 5-10 minutes. Between exposures, you remain on the couch and may be asked to stand up to empty your bladder before the final exposure. The procedure usually takes 30-60 minutes. However, delayed snapshots are sometimes taken after a few hours. You can go home immediately after the procedure is over. After the procedure, you can eat.

Undesirable effects and risks of intravenous urography

You may experience a feeling of warmth and a metallic taste in your mouth after the contrast is injected, which usually goes away quickly.

An allergic reaction to paint is rare. It can be expressed slightly, for example, as a rash and moderate swelling of the lips.

More serious manifestations, such as shortness of breath and a drop in blood pressure, are rare. It must be emphasized that serious adverse effects rarely occur and the department where the procedure is performed always has all the necessary medicines to eliminate this condition.

A rare complication is renal failure.

Some other information about excretory urography:

In pregnant women, if possible, no x-ray examinations should be performed, since there is a risk that the contrast agent will cause abnormal development of the unborn child.

What are, how and why are urethrography and cystography performed?

urethrography - this is a type of contrast x-ray examination, which is used to diagnose diseases of the urethra (urethra), such as narrowing or strictures, neoplasms, stones and foreign bodies, as well as injuries, injuries and fistulas of the urethra.

Cystography is also a type of contrast x-ray examination that is used to diagnose diseases of the bladder and prostate such as stones and foreign bodies, tumors, diverticula, chronic cystitis and pathological shrinkage (atrophy with a decrease in functioning volume), hyperplasia or excessive distension, fistulas Bladder. With the help of cystography, it is possible to fix disorders of the bladder function, including abnormal contractions and the so-called vesicoureteral reflux (abnormal reflux of urine from the bladder into the ureter). Cystography is also used to determine the causes and plan treatment for various forms of urinary incontinence.

How are urethrography and cystography performed and how painful are they? Is special preparation required for these studies?

Urethrography and cystography are ascending and descending, and can also be performed in a static and dynamic mode (the so-called voiding urethrocystography or a study that is performed during urination). These studies are performed in the x-ray room, with the patient lying on the x-ray table. The tests are carried out and/or supervised and interpreted by a urologist. For ascending research options, an X-ray contrast agent (Urografin™, Ultravist™, Omnipack™, etc.) is injected by a urologist into the urethra and into the bladder with a special syringe through a catheter. At the command of the doctor who performs the study, an x-ray is taken. With descending variants of urethrography and cystography, an x-ray contrast agent is injected into a vein and after filling the bladder with x-ray contrast urine, its x-ray is taken. Descending urethrography is always voiding, i.e. performed during urination. To get images good quality sometimes multiple x-rays or x-rays are required.

Urethrography and cystography in all cases are painless or completely painless and do not require anesthesia. In some particularly pain-sensitive men and women with interstitial cystitis, an anesthetic is injected into the urethra and bladder (we use Cathegel™ or 2% lidocaine). No special preparation for urethrography and cystography is required. Procedures are performed on an outpatient basis.

Isotope renography - a safe, inexpensive, fairly objective method for a separate study of the function of the kidneys and upper urinary tract.

As an isotope, nephrotropic drugs are used, that is, selectively excreted by the kidneys, labeled with radioactive iodine. Hippuran has found the greatest use. Due to the short half-life (20 min) and the low dose of radioactivity required for one study, it can be repeated many times, which is especially valuable also in the postoperative period. There are practically no contraindications to the use of the method.

On the renographic curve normal kidney There are three phases, or segments: vascular, secretory (tubular) and excretory (excretory). The vascular segment (AV) reflects the degree of blood filling, vascularization of the kidney and perirenal space. The duration of this phase is normally 20 s. The secretory (SC) segment reflects the transport of hippuran from the capillary bed of the kidneys into the tubules and into the upper urinary tract. The duration of this phase is 2–4 min, and the height is approximately V3 of the height of the first segment. The excretory (excretory) segment (C) reflects the process of release of hippuran into the lumen of the tubules and urinary tract.

The interpretation of the renogram is carried out on the basis of its form (qualitative analysis) and the evaluation of numerical indicators, the most common of which are:

Tmax - the time to reach the maximum rise of the curve (normally 3-4 minutes);

T 1/2 is the half-life of the isotope from the kidneys (from the moment the maximum of the curve is reached until it falls by half of this value; normally 6-8 minutes);

blood clearance - half-purification time (normally 8 minutes).

Lengthening of the time of the dotor segment of the renogram is noted more often with significantly pronounced stenosis of the renal artery. With complete occlusion, thrombosis of the renal artery, an "afunctional" type of curve is observed, characterized by a sharp decrease in the size of the vascular segment with an almost complete absence of a secretory rise in the curve and a slight decline in the excretory phase.

Although the method of isotope renography has a fairly high sensitivity, functional changes are recorded on the renogram if the renal artery is at least 50% stenotic. Both false-positive and false-negative renographic findings are possible, since with a good development of collateral vessels, the presence of a normal renogram before surgery with severe renal artery stenosis is not excluded. We have seen similar cases.

The most reliable data of radioisotope renography (coincidence with the results of angiography in an average of 85-90% of patients) are observed with unilateral occlusive lesions of the renal artery (A. A. Kramer, 1968; A. I. Matveeva et al., 1970; Kaufman et al. , 1969, etc.). First of all, the decrease in the height of the vascular segment and the lengthening of the time of the maximum rise of the curve are characteristic. With bilateral lesions, the evaluation of the results of isotope renography is difficult and the diagnostic value of this study is much less.

Although there are no changes in the isotope renogram that are purely specific for vasorenal hypertension, the very fact of the presence of these changes is decisive. The method has great importance for the differential diagnosis of renovascular hypertension only in combination with other methods.

Isotope renography makes it possible to quickly and easily identify impaired renal function and their degree, which is of great importance in solving practical issues of surgical treatment, as well as for monitoring its effectiveness and timely diagnosis of complications, in particular, thrombosis of the reconstructed vessel in the postoperative period.

Kidney scintigraphy (nephroscintigraphy)

Kidney scintigraphy or radionuclide kidney scan (renoscintigraphy, nephroscintigraphy) is a diagnostic method that involves injecting a small amount of a radioactive medical preparation (radiotracer) into the body and taking an image of the kidneys using a gamma camera. The resulting images can help in the diagnosis and treatment of various kidney diseases.

Purpose of kidney scintigraphy (nephroscintigraphy)

While most research methods - such as x-rays, ultrasound or computed tomography (CT) - provide information about the structure of the kidneys, radionuclide research provides an opportunity to study the function of the kidneys. Candidates for renal scintigraphy may include patients with acute or chronic renal failure, urinary obstruction, renal artery stenosis, kidney transplant, kidney injury, reflux nephropathy, renal vascular disease and/or hypertension, or congenital anomalies .

Precautions When Performing a Kidney Scan (Nephroscintigraphy)

Renal scintigraphy requires the use of radioactive material; therefore, in pregnant women or women who suspect they are pregnant, renal scintigraphy should be done only when absolutely necessary. Women should tell their doctor if they are breastfeeding. The doctor recommends that the woman suspend breast-feeding for a period of time that depends on the type and dose of the radioactive drug.

Description of performing a kidney scintigraphy (nephroscintigraphy)

Renal scintigraphy is performed in the nuclear medicine department of a hospital or clinic. The patient is placed in front of or under the gamma camera. A gamma camera is special equipment that captures the radiation (gamma rays) emitted by a radioactive medical product that has accumulated in the patient's body and forms an image. A radioactive drug is injected intravenously. Immediately after the injection, a study begins - the blood flow in each kidney is assessed. Receive a sequence of images at certain intervals, which depend on the radioactive drug used. A kidney scan is performed to determine the patient's glomerular filtration rate. Kidney scintigraphy uses a radioactive medical product called technetium DTPA (Tc99m DTPA). This radioactive medicine can also reveal a blockage in the urine collection system in the kidneys.

The radioactive medical drug technetium, DMSA (Tc99m DMSA), is used to study renal tubular function.

Renal scintigraphy takes from 45 minutes to three hours, depending on the purpose of the study. Most often, the duration of kidney scintigraphy ranges from an hour to an hour and a half. It is important to understand that renal scintigraphy can detect impaired renal function, but cannot always determine the nature of this disorder. Radionuclide studies of the kidneys are useful in providing information on how the various structures of the kidney work, which in turn can help make a correct diagnosis.

As a rule, images are obtained in a direct projection, but it is possible to obtain images at oblique angles. If necessary, the patient can be positioned to obtain renal motility data, i.e. sitting or lying down while taking images. If obstruction (blockage) or kidney function is being evaluated, a diuretic (drug to induce urination) such as Lasix is given. If hypertension or renal artery stenosis is assessed, then Captopril or Enalopril (ACE inhibitors, angiotensin-converting enzyme inhibitors) is administered.

Preparation for kidney scintigraphy (nephroscintigraphy)

Renal scintigraphy does not require any special preparation. For some types of examinations, the patient must drink additional fluids and empty the bladder before the examination. If the patient has recently undergone another radionuclide study, then it is necessary to refuse repeated studies for a certain period of time so that residual radioactivity does not accumulate. The patient must remove all metal objects from the area of interest.

After kidney scintigraphy (nephroscintigraphy)

Patients can return to normal activities immediately after a kidney scan. Most of the radioactive medical preparations are excreted through the urinary system, so increasing fluid intake after a kidney scan will help eliminate the radioactive drug from the body more quickly.

Complications of kidney scintigraphy (nephroscintigraphy)

Nuclear medicine research is safe. Unlike some of the contrast agents used in renal x-rays, radioactive drugs rarely cause side effects. There are no long-term effects of radioactive drugs, as they decay rapidly and have no immediate functional effects on body tissues. With the introduction of radioactive drugs, blood pressure may temporarily rise or fall, or an urge to urinate may appear.

Results of kidney scintigraphy (nephroscintigraphy)

Renal scintigraphy shows normal renal function in relation to the patient's age and health status, as well as the relative position, size, configuration, and localization of the kidneys. Primary blood flow images reflect the circulation in both kidneys. Patients in whom renal scintigraphy suggests damage or obstruction require other diagnostic tests, such as CT (computed tomography) or ultrasound, to obtain additional information. In addition, if the kidneys are the wrong size, have an unusual contour, or are unusually located, other imaging modalities may be required.

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Urine is a metabolic product formed in the kidneys as a result of filtration of the liquid part of the blood, as well as the processes of reabsorption and secretion of various analytes. It consists of 96% water, the remaining 4% are nitrogenous products of protein metabolism dissolved in it (urea, uric acid, creatinine, etc.), mineral salts, and other substances.

A general urine test in children and adults includes an assessment of the physicochemical characteristics of urine and sediment microscopy. This study allows you to evaluate the function of the kidneys and other internal organs, as well as to identify the inflammatory process in the urinary tract

Physical and chemical studies of urine include an assessment of the following indicators:

Colour;
transparency of urine;
specific gravity (relative density);
protein concentration;
glucose concentration;
bilirubin concentration;
urobilinogen concentration;
concentration of ketone bodies;
nitrite concentration;
hemoglobin concentration.

Microscopy of the urinary sediment includes the evaluation of the following objects:

Grade physical properties urine, such as smell, color, turbidity, is carried out by an organoleptic method. The specific gravity of urine is measured using a urometer, refractometer, or evaluated by the methods of "dry chemistry" (test strips) - visually or on automatic urine analyzers.

urine color

Urine in an adult yellow color. Its shade can range from light (almost colorless) to amber. The saturation of the yellow color of urine depends on the concentration of substances dissolved in it. With polyuria, urine has a lighter color, with a decrease in diuresis, it acquires a rich yellow hue. Color changes upon admission medicines(salicylates, etc.) or the use of certain food products(beets, blueberries).

Pathologically changed color of urine occurs when:

hematuria - a type of "meat slop";
bilirubinemia (beer color);
hemoglobinuria or myoglobinuria (black color);
leukocyturia (milky white).

Urine clarity

Normally, freshly collected urine is completely transparent. Turbidity of urine is due to the presence in it of a large number of cell formations, salts, mucus, bacteria, and fat.

The smell of urine

Normally, the smell of urine is mild. When urine is decomposed by bacteria in the air or inside the bladder, for example in the case of cystitis, an ammonia smell appears. As a result of putrefaction of urine containing protein, blood or pus, for example, with bladder cancer, the urine acquires the smell of rotten meat. If there are ketone bodies in the urine, the urine has a fruity odor, reminiscent of the smell of rotting apples.

Urine reaction

The kidneys excrete "unnecessary" from the body and retain the necessary substances to ensure the exchange of water, electrolytes, glucose, amino acids and maintain acid-base balance. The reaction of urine - pH - largely determines the effectiveness and specificity of these mechanisms. Normally, the reaction of urine is slightly acidic (pH 5.0–7.0). It depends on many factors: age, diet, body temperature, physical activity, kidney condition, etc. The lowest pH values are in the morning on an empty stomach, the highest - after eating. When eating predominantly meat food, the reaction is more acidic, when eating vegetable food, it is alkaline. With prolonged standing, urine decomposes, ammonia is released and the pH shifts to the alkaline side.

An alkaline urine reaction is characteristic of chronic urinary tract infections, and is also noted with diarrhea and vomiting.

The acidity of urine increases with fever, diabetes, tuberculosis of the kidneys or bladder, kidney failure.

Specific gravity (relative density) of urine

Relative density reflects the functional ability of the kidneys to concentrate and dilute urine. Normally functioning kidneys are characterized by wide fluctuations in the specific gravity of urine during the day, which is associated with the periodic intake of food, water and fluid loss by the body. kidneys in various conditions can excrete urine with a relative density of 1.001 to 1.040 g/ml.

Distinguish:

hypostenuria (fluctuations in the specific gravity of urine less than 1.010 g / ml);
isostenuria (the appearance of a monotonous nature of the specific gravity of urine corresponding to that of primary urine (1.010 g / ml);
hyperstenuria (high values of specific gravity).

The maximum upper limit of the specific gravity of urine in healthy people is 1.028 g / ml, in children - 1.025 g / ml. The minimum lower limit of the specific gravity of urine is 1.003–1.004 g/ml.

For rate chemical composition urine currently, as a rule, diagnostic test strips are used (the "dry chemistry" method), produced by different manufacturers. Chemical Methods, used in test strips, are based on color reactions, giving a change in color of the test area of the strip at different concentrations of the analyte. Color change is determined visually or by reflectance photometry using semi-automatic or fully automated urine analyzers, the results are evaluated qualitatively or semi-quantitatively. If a pathological result is found, the study can be repeated using chemical methods.

Protein

The protein is normally absent in the urine or present in a concentration undetectable by conventional methods (traces). There are several types of proteinuria (the appearance of protein in the urine):

physiological (orthostatic, after increased physical activity, hypothermia);
glomerular (glomerulonephritis, the action of infectious and allergic factors, hypertonic disease, decompensation of cardiac activity);
tubular (amyloidosis, acute tubular necrosis, interstitial nephritis, Fanconi syndrome).
prerenal (multiple myeloma, necrosis of muscle tissue, hemolysis of red blood cells);
postrenal (with cystitis, urethritis, colpitis).

Glucose

Normally, there is no glucose in the urine. The appearance of glucose in the urine can have several reasons:

physiological (stress, intake of an increased amount of carbohydrates);
extrarenal (diabetes mellitus, pancreatitis, diffuse liver damage, pancreatic cancer, hyperthyroidism, Itsenko-Cushing's disease, traumatic brain injury, strokes);
renal (renal diabetes, chronic nephritis, acute renal failure, pregnancy, phosphorus poisoning, certain drugs).

Bilirubin

Bilirubin is normally absent in the urine. Bilirubinuria is detected in parenchymal lesions of the liver (hepatitis), obstructive jaundice, cirrhosis, cholestasis, as a result of the action of toxic substances.

Urobilingen

Normal urine contains a low concentration (traces) of urobilinogen. Its level increases sharply with hemolytic jaundice, as well as with toxic and inflammatory lesions of the liver, intestinal diseases (enteritis, constipation).

Ketone bodies

Ketone bodies include acetone, acetoacetic and beta-hydroxybutyric acids. An increase in the excretion of ketones in the urine (ketonuria) appears when there is a violation of carbohydrate, lipid or protein metabolism.

Nitrites

Nitrites are absent in normal urine. In the urine, they are formed from nitrates of food origin under the influence of bacteria, if the urine has been in the bladder for at least 4 hours. The detection of nitrites in properly stored urine specimens is indicative of urinary tract infection.

Hemoglobin

Normally absent in urine. Hemoglobinuria - the result of intravascular hemolysis of red blood cells with the release of hemoglobin - is characterized by red or dark brown urine, dysuria, and often back pain. With hemoglobinuria, there are no erythrocytes in the urine sediment.

Microscopy of urine sediment

The urine sediment is divided into organized (elements of organic origin - erythrocytes, leukocytes, epithelial cells, cylinders, etc.) and unorganized (crystals and amorphous salts).

Research methods

The study is carried out visually in a native preparation using a microscope. In addition to visual microscopic examination, research is used with the help of automatic and semi-automatic analyzers.

red blood cells

During the day, 2 million erythrocytes are excreted in the urine, which, when examining the urine sediment, is normally 0-3 erythrocytes in the field of view for women and 0-1 erythrocytes in the field of view for men. Hematuria is an increase in red blood cells in the urine above the specified values. Macrohematuria is distinguished (urine color is changed) and microhematuria (urine color is not changed, erythrocytes are detected only with microscopy).

In the urinary sediment, erythrocytes can be unchanged (containing hemoglobin) and altered (deprived of hemoglobin, leached). Fresh, unchanged erythrocytes are characteristic of urinary tract lesions (cystitis, urethritis, stone passage).

The appearance of leached erythrocytes in the urine is of great diagnostic value, because they are most often of renal origin and occur in glomerulonephritis, tuberculosis, and other kidney diseases. To determine the source of hematuria, a three-cup sample is used. When bleeding from the urethra, hematuria is greatest in the first portion (unchanged erythrocytes), from the bladder - in the last portion (unchanged erythrocytes). With other sources of bleeding, erythrocytes are distributed evenly in all three portions (leached erythrocytes).

Leukocytes

Leukocytes in urine healthy person are contained in small quantities. The norm for men is 0-3, for women and children 0-6 leukocytes per field of view.

An increase in the number of leukocytes in the urine (leukocyturia, pyuria) in combination with bacteriuria and the presence of clinical symptoms indicates an inflammation of an infectious nature in the kidneys or urinary tract.

epithelial cells

Epithelial cells are almost always found in the urinary sediment. Normally, in the analysis of urine, no more than 10 epithelial cells in the field of view.

Epithelial cells have different origins:

squamous epithelial cells enter the urine from the vagina, urethra, their presence has no special diagnostic value;
transitional epithelial cells line the mucous membrane of the bladder, ureters, pelvis, large ducts of the prostate gland. The appearance in the urine of a large number of cells of such an epithelium can be observed when urolithiasis, neoplasms of the urinary tract and inflammation of the bladder, ureters, pelvis, large ducts of the prostate gland;
renal epithelial cells are detected in lesions of the kidney parenchyma, intoxication, febrile, infectious diseases, circulatory disorders.

cylinders

A cylinder is a protein coiled in the lumen of the renal tubules and includes any contents of the lumen of the tubules in its matrix. The cylinders take the form of the tubules themselves (cast cylindrical shape). Normally, there are no cylinders in the urine sample taken for general analysis. The appearance of cylinders (cylindruria) is a symptom of kidney damage.

There are cylinders:

hyaline (with the imposition of erythrocytes, leukocytes, renal epithelial cells, amorphous granular masses);
granular;
waxy;
pigment;
epithelial;
erythrocyte;
leukocyte;
fat.

unorganized sediment

The main component of unorganized urine sediment are salts in the form of crystals or amorphous masses. The nature of the salts depends on the pH of the urine and other properties of the urine. For example, with an acidic reaction of urine, uric acid, urates, oxalates are detected, with an alkaline reaction of urine - calcium, phosphates, ammonium urate. The unorganized sediment has no special diagnostic value; indirectly, one can judge the patient's tendency to urolithiasis. With a number pathological conditions crystals of amino acids, fatty acids, cholesterol, bilirubin, hematoidin, hemosiderin, etc. may appear in the urine.

The appearance of leucine and tyrosine in the urine indicates a pronounced metabolic disorder, phosphorus poisoning, destructive liver disease, pernicious anemia, and leukemia.

Cystine - a congenital disorder of cystine metabolism - cystinosis, cirrhosis of the liver, viral hepatitis, the state of hepatic coma, Wilson's disease (a congenital defect in copper metabolism).

Xanthine - xanthinuria is due to the absence of xanthine oxidase.

bacteria

Normally, the urine in the bladder is sterile. When urinating, microbes from the lower urethra enter it.

The appearance in the general analysis of urine of bacteria and leukocytes against the background of symptoms (dysuria or fever) indicates a clinically manifest urinary infection.

The presence of bacteria in the urine (even in combination with leukocytes) in the absence of complaints is regarded as asymptomatic bacteriuria. Asymptomatic bacteriuria increases the risk of urinary tract infection, especially during pregnancy.

yeast mushrooms

The detection of fungi of the genus Candida indicates candidiasis, which occurs most often as a result of irrational antibiotic therapy, the use of immunosuppressants, and cytostatics.

In the urine sediment, eggs of the blood schistosome (Schistosoma hematobium), elements of the echinococcal bladder (hooks, scolexes, brood capsules, fragments of the bladder membrane), migrating larvae of the intestinal acne (strongylides), washed with urine from the perineum of the teniid oncosphere, pinworm eggs (Enterobius vermiсularis ) and pathogenic protozoa - Trichomonas urogenitalis, amoeba (Entamoeba histolitika - vegetative forms).

Sample collection and storage conditions

For general analysis, a morning portion of urine is collected. Urine collection is carried out after a thorough toilet of the external genitalia without the use of antiseptics. For the study, freshly collected urine is used, which was stored for no more than four hours before analysis. The samples are stable at a temperature of 2–8 °C for no more than 2 days. The use of preservatives is not recommended. Before the study, urine is thoroughly mixed.

Urinalysis is a standard laboratory test. The doctor writes a referral for almost any disease and even when passing medical boards. If the decoding of the indicators is carried out correctly, it is possible to diagnose many diseases, primarily of the genitourinary system. Any doctor will be able to decipher urine tests and draw conclusions. The norms for adults and children are prescribed in every textbook and manual on medicine.

In order to avoid distortions in the study, it is necessary to properly prepare for the delivery of urine. First of all, it is worth understanding that it is the morning portion that is needed. Immediately before collecting a urine test, you need to carry out a toilet of the external genitalia. This applies to everyone: men and women. Often, it is precisely because of the neglect of this action that the indicators are distorted, and their decoding is much more difficult.

The toilet of the external genital organs must be carried out using plain soap and warm water. Women should understand that during menstruation you should not take such tests. Indeed, in this case, erythrocytes will enter the urine, which will completely ruin the study and can lead to a false diagnosis.

Urine must be collected in a sterile container for analysis. A special jar is sold at any pharmacy. It is equipped with a lid, so it is easy to store and transport tests in it. Sometimes patients may ask how long urine is stored at home. All experts recommend delivering the jar to the clinical laboratory within 1-2 hours.

After preparing the container and holding the toilet of the external genital organs, the first portion of urine must be flushed down the toilet. And then fill the jar. To carry out the analysis, it will be enough to collect 50-100 ml of urine, and the decoding of the indicators will turn out to be reliable.

It is not necessary to store the collected urine for a long time, it is better to immediately go to the laboratory, where the delivery and collection of tests takes place.

Urinalysis in adults (norm, deviations, interpretation) in the table

Indicator	Norm	Deviation	Possible reasons for rejection
The amount of urine in the morning portion	100-300 ml	less than 100 ml	variant of the norm; severe heart failure; general dehydration (with high relative density of urine); terminal stage of chronic renal failure (low relative density of urine); acute renal failure.
		over 300 ml	variant of the norm; polyuria with pyelonephritis; renal failure (with low relative density of urine); diabetes mellitus (high relative density of urine).
Transparency	complete	cloudy at the time of extraction	pyelonephritis; lower urinary tract infection; salt release.
		flakes and threads	pyelonephritis; lower urinary tract infection.
Colour	straw yellow	orange red	bilirubinemia (hemolytic conditions, hepatitis, cirrhosis, cholestasis).
		type of meat	pyelonephritis; passage of stones; kidney tuberculosis; kidney cancer.
		brown	protein breakdown (prolonged compression syndrome, hemolysis).
		black	hemoglobinuria (hemolysis).
		bright yellow	taking medication.
		transparent light yellow	violation of the concentration function of the kidneys; plentiful drink; pyelonephritis; taking diuretics; kidney failure.
pH	sour	neutral	severe urinary tract infection; profuse vomiting; low protein diet.
		alkaline	urinary tract infection; profuse vomiting; carrying out alkalizing therapy; low protein diet.
Osmolarity	600-800 mmol/l	less than 600 mmol/l	loss of salts in polyuria (pyelonephritis, diuretics, renal failure).
		more than 800 mmol/l	diabetes.
Relative density (specific gravity)	1,018-1,025 (1018-1025)	above 1.025 (1025)	variant of the norm; glycosuria; high proteinuria; dehydration.
		below 1.018 (1018)	variant of the norm; pyelonephritis; taking diuretics; plentiful drink; kidney failure.
Acetone	No	there is	diabetes.
Protein	none (or trace amounts)	there is	purulent infection; injury; heart attack; diabetic, hypertensive nephropathy; tumors; glomerulonephritis; pyelonephritis; congestive heart failure; kidney failure; renal vein thrombosis.
Glucose	No	there is	physiological, alimentary hyperglycemia; diabetes; liver damage; "tubular nephropathy"; kidney failure.
Ketone bodies	No	there is	diabetes.
Leukocytes	men: 0-3 in sight, women: 0-5 in sight	5-20 in sight	pyelonephritis; infection of the lower urinary tract without severe exacerbation; glomerulonephritis; any nephropathy.
		over 20 in sight	pyelonephritis; cystitis; urethritis; prostatitis in the acute stage.
red blood cells	no (or single)	less than 100 in sight	glomerulonephritis; pyelonephritis; urolithiasis disease; hypernephroid cancer; severe infection.
		over 100 in sight	urolithiasis disease; IgA - nephropathy; rupture of a kidney cyst; nephropathy with sepsis; acute renal failure; tumors of the kidneys and bladder; kidney tuberculosis; kidney infarction; thrombosis of the renal veins; systemic vasculitis; pyelonephritis.

Physical indicators of the general analysis of urine

First of all, the physical parameters of urine are measured in the laboratory. These include: color, smell, determination of transparency, density and ph. For the convenience of all procedures, urine is stored on a special table with various devices for determining physical properties. There are special standards by which the laboratory assistant can easily see the deviations of a certain urinalysis.

To determine the density, a special device is used - a urometer. It is lowered into a test tube with urine and indicators are easily read. The norm of specific gravity in adults is 1010-1025 g / l. At the same time, the indicators of healthy men and women do not differ.

The laboratory assistant determines the color of urine by eye. The form indicates: straw yellow, brown, red, pink, light yellow. It is the first option that is considered the norm. The change in the color of urine can be affected by taking multivitamins, medications, as well as menstruation.

The smell is determined by sniffing. For example, with diabetes, you can feel the unpleasant smell of acetone.

The transparency of the urine test is determined visually. Sometimes, during long-term storage, a precipitate of salts may form, in which case the decoding of this indicator may be difficult. Turbidity in the urine is usually caused by protein, which is considered an abnormality, an indicator of kidney disease.

The pH of urine tests is determined using indicator paper. The strip is placed in a test tube and the color is compared with a special standard. An acidic reaction is the norm for such an analysis. The laboratory assistant carefully notes all deviations in the form so that the doctor can immediately see a bad urine test and prescribe treatment to the patient in time.

Determination of organic substances in urine

When all the physical properties of the urine are determined, the indicators are entered on the form, it is time for organic analysis. Usually, laboratory assistants necessarily determine only glucose and protein, but the doctor can prescribe an extended urinalysis and indicate bilirubin, bile acids, and indican.

All these substances should not be present in the urine of a healthy person. Therefore, the laboratory assistant first of all conducts a qualitative analysis of urine using an indicator strip. If the standard shows that glucose or protein is available, then it is the turn of a qualitative determination of these indicators. It is worth remembering that there may be traces of protein in the urine - this is the norm, because usually this phenomenon is associated with human nutrition.

The appearance of protein in the urine can be provoked bacterial infection genitourinary system, increased physical and emotional stress, sudden changes in the temperature of the environment in which the person is located. The doctor must correctly read all the indicators in order to diagnose the disease.

After conducting a qualitative and quantitative indicator of urine analysis, the laboratory assistant proceeds to microscopy of the sediment. This The final stage conducting research.

Examination of urinary sediment

To obtain a precipitate, the laboratory assistant centrifuges the liquid. This procedure is very fast and does not require any effort or human intervention. The resulting precipitate is placed on a glass slide and carefully examined under a microscope.

The standard analysis includes the determination and quantification of:

epithelium;
mucus;
erythrocytes;
leukocytes;
cylinders;
salt crystals;
bacteria particles.

In total, there are three types of epithelial cells: flat, renal and transitional. The presence of transitional epithelium in the analysis is the norm. The number of flat cells should not exceed 3-5 pieces. But sometimes there is an excess of them, especially in women who have neglected the toilet of the external genitalia before passing urine. Often, with a large amount of squamous epithelium, which covers the entire field of view, the laboratory assistant asks to retake the urine test, while deciphering is very difficult. To prevent this from happening, doctors always ask you to familiarize yourself with the rules for collecting urine from men and women.

The presence of renal epithelium in the sediment is considered a pathology. The doctor must carefully study such a urine test, deciphering it may require a certain amount of time and experience. The renal epithelium usually indicates various kidney diseases in children and adults.

If long strands are visible in the field of view during microscopy, then the laboratory assistant notes the presence of mucus in the urine on the form. The norm is the complete absence of this indicator. The same is true with bacteria in the analysis of urine. Decoding is carried out by a doctor, the laboratory assistant only indicates the presence and approximate number of bacterial cells in the field of view of the microscope.

At the same time, the quantitative indicators of bacteria and mucus are indicated not in numbers, but in crosses. If pathological cells occupy almost the entire field of view, the laboratory assistant marks 4 crosses on the form, this is the maximum number that cannot be counted.

If salts of urates, oxalates and tripelphosphates are found in the urinary sediment, this is the norm for a healthy person. The number is also noted in the form from 1 to 4 crosses.

The detection of leukocytes in the urine is considered normal. Only in an adult male, their number should not exceed 3 cells per field of view, and in women - 5. A larger number of leukocytes indicates the presence of inflammatory processes in the patient.

In the analysis of urine, a single number of erythrocytes is allowed, which are detected in several fields of view during microscopy of the sediment. They can appear when taking certain medications, the doctor should always take this into account and try not to prescribe an analysis in this case.

Single cylinders may also be present in the urine:

granular;
erythrocyte;
epithelial;
waxy;
grainy.

Cylinders are formed from epithelial cells, leukocytes and erythrocytes. In adult patients, they may be present in the urine in the amount of 2-4 pieces in the field of view - this is the norm, the doctor does not pay attention to this indicator.

Thus, in order for the urine test to be carried out qualitatively, each patient must prepare a sterile container for donation and properly toilet the external genitalia.

The doctor, in turn, always has before his eyes the norms of indicators in order to correctly navigate and read the form. Indeed, often even such a simple general analysis can help in making a diagnosis and prescribing optimal and timely treatment.

In most cases, the diagnosis of diseases begins with a general urine test. A person, upon detection of signs of the disease, independently turns to the laboratory for analysis. The doctor gives a referral for this study during an annual preventive examination. What is a urine test: decoding and normal values of its values.

Why is a urinalysis ordered?

Clinical urinalysis is characterized by low cost, ease of implementation, good information content, it is a popular method of non-invasive diagnostics. Based on what it shows, the doctor will make a diagnosis, prescribe an additional examination, and refer you for a consultation with other specialists.

Thanks to this analysis, physicians can identify abnormalities in the functioning of the urinary and cardiovascular systems, detect inflammatory processes, as well as a number of other diseases that are at an early stage. This option helps prevent the onset of symptoms.

Rules for collecting urine for analysis

There are diseases whose diagnosis begins with determining the color of urine, and then the decoding speaks of a particular pathology. Below is a table that characterizes the various deviations in the color of urine:

Colour	Reasons for the appearance
Colorless	Diabetes, diabetes insipidus, kidney failure, high fluid intake.
Dark yellow	Dehydration, acute infections, congestion in the kidney, excess urochrome, concentrated urine - insufficient fluid intake.
Dark red	Severe form of anemia.
Black or brown	Hemoglobin in the urine, liver cirrhosis, hepatitis, phenol poisoning, melanoma.
Red	Urolithiasis, tumor in the urinary system, cystitis, kidney infarction.
Meat slops	Infectious lesions of the kidneys.
beer	Bilirubin and urobilinogen in the urine, the development of parenchymal jaundice.
greenish yellow	Bilirubin in the urine, the development of obstructive jaundice.
Milky or white	Fats, pus, phosphates, chyluria.

Thus, shades of urine can show not only disorders in the functioning of the kidneys, but also the whole organism. And also the color of the liquid shows that a person simply adheres to the wrong drinking regime or has included coloring vegetables and fruits in his diet.

Transparency and smell of urine

Normal, but there are three degrees of transparency: complete, incomplete,. Turbidity indicates the presence in the analysis of urine, bacteria, fats, lymph.

It is important to determine whether the urine is cloudy or becomes cloudy over time. If immediately after urination there is clouding of the urine, this indicates the presence of pus, lymph, phosphates in it. If it becomes cloudy after a while, it means that there are in the biological fluid, they precipitate when it is heated.

Regarding the smell, it should be said that in the general analysis of urine, a specific, but not pungent smell is considered the norm. It varies depending on several factors:

Acidity

The study of urine also includes, that is, acidity, this indicator indicates the amount of hydrogen ions in the urine. pH measures the acid-base balance of the body.

Normal values are 7 units, but they can deviate into sour (< 7) или в щелочную (>7) side. In this case, they speak of acidosis and alkalosis, respectively.

Acidosis - increased acidity of urine, it is manifested by ketonuria (acetone and ketones in urine). It is caused by starvation, intestinal disorders. In severe cases, acidosis causes a serious hormonal imbalance - a lack of insulin production. It's called diabetic ketoacidosis.

Alkalosis - highly alkaline urine, occurs against the background of a metabolic disorder, when hydrogen ions are excreted from the body (severe vomiting, lack of water, injuries).

organic matter in urine

It is not necessary to have a medical education in order to independently decipher the results of the study. Having studied the indicators that the table contains, it is easy to decipher the urine test:

Indicator	Norm	Possible cause of abnormality
Protein	0.033 grams per liter	> 0.033 - Acute infections, poisoning, nephritis.
Blood	is absent	Urolithiasis, cystitis, tumors, prostate adenoma.
Glucose	200 mg/day	> 200 mg/day. Poisoning with chloroform, phosphorus, diabetes mellitus, excess steroids, acute pancreatitis.
Ketones	50 mg/day	> 50 mg/day. Infections, intoxication, diabetes mellitus, starvation, thyrotoxicosis.
Bilirubin	is absent	Mechanical and parenchymal jaundice.
Urobilinogen	6–10 µmol/day	>6–10 µmol/day. Hemolytic jaundice, liver toxicosis.
Hemoglobin	is absent	Sepsis, hypothermia, burns, poisoning, hemolytic anemia.
Leukocytes	0–3 in women; 0–5 in men; in one field of view.	>3 Inflammatory process in the body
red blood cells	Missing or single	Great physical exertion, prolonged standing or walking.
Epithelium transition renal	0–3 across multiple fields of view. 0–3 in multiple fields of view missing	Violation of hygiene. Violation of hygiene. Kidney pathology.
cylinders hyaline, granular, waxy, epithelial, leukocyte, erythrocyte	absent, except for 1-2 hyaline	Hot weather, hard physical labor, overexertion.
Phosphates	missing	Eating salty, spicy foods.
Slime	is absent	Pathology in the genitourinary system.

When, according to the interpretation, the norm takes place and the decoding of the analysis does not cause difficulties, but there are symptoms indicating a pathology, you should consult a doctor. To make an accurate diagnosis, you need to ask a specialist: “Please decipher my analysis” and report all the accompanying manifestations of the disease.

Clinical analysis of urine says a lot about the work of the body, but the detection of the disease is not limited to this, and the doctor, in most cases, uses additional diagnostic methods.