Normal urinalysis. General urine analysis: how to decipher it yourself? The specific gravity of urine is increased - causes
It is currently one of the most commonly used diagnostic procedures. This method It is used in the diagnosis of a wide range of diseases, as it is very informative and allows you to assess the state of various organs. Before conducting an analysis, it is recommended that you familiarize yourself with its features, as well as important rules that must be observed in order to obtain a reliable result.
Analysis of urine - effective method diagnosis of various diseases
The delivery of urine for analysis is carried out for the purpose of its laboratory research, which is necessary for the diagnosis of a number. In addition, the procedure can be used as a method of testing the effectiveness of the prescribed treatment.
There are such types of urine tests:
- Physico-chemical
- Microbiological
- biochemical
- Organoleptic
- Urinary sediment examination
In most cases, it is performed in combination with other diagnostic procedures, which is necessary for an accurate diagnosis. This research method can be used for diseases of various groups of organs, as well as a variety of disorders and disorders.
The analysis is assigned in such cases:
- Having symptoms of bladder disease or
- Diagnosis of kidney diseases
- Oncological neoplasms
- Inflammatory process of the mucous membranes of the genital organs
- Autoimmune diseases
- Hormonal disorders
- Diseases of the cardiovascular system
In addition, various indicators can characterize the work of organs, as well as indicate the qualitative composition of the blood, the presence of pathological cells in it.
Urinalysis is a common diagnostic method that is used for various diseases in combination with other methods.
Most often, the delivery of a urine test occurs after receiving the necessary referral. As a rule, you can get a referral, both in public medical institutions and in private ones, from a general practitioner. In addition, the analysis may be prescribed by a cardiologist, gastroenterologist, urologist, and others, depending on which disease is being diagnosed. The delivery of urine for research can be carried out for preventive purposes.
Preparation for analysis
Proper preparation for urinalysis is the key to a reliable result
For many people, giving urine for the purpose of research is a familiar procedure, since it is often prescribed during routine examinations. In view of this, it is certainly known that there are a number of limitations that should be considered before collecting material for analysis.
Only in this case, the diagnostic results will be reliable, and will be able to provide detailed information about the patient's condition.
Because of what the reliability of the results may be low:
- The use of sweets. Before taking urine for analysis, you should not eat sweets, as this affects the content in the urine, which in turn is one of the most important indicators. An overestimated diagnostic result may indicate the presence, because of which it will be necessary to perform the tests again.
- Lots of liquid. Within a few hours before collecting materials, the person being examined should stop drinking heavily. Because of a large number fluid concentration of various substances in the urine may vary. In addition, the substance may change in color, acquire an odor or other properties.
- spicy foods. Most dishes containing garlic, onions, horseradish, hot spices have a specific smell. This property is often reflected in the smell of urine during analysis, which can lead to a decrease in the reliability of the results.
- Fruits and vegetables with dyes. There are a number of natural products, which include colorants. They cannot be eaten before the test, since the dyes are excreted from the body mainly with urine, which in turn affects its color.
- Alcohol and smoking. It is contraindicated to take alcoholic beverages 2-3 days before taking the material for analysis. You must stop smoking 1-2 hours before the procedure.
- Significant physical activity. Before testing, serious physical activity. In addition, experts recommend preventing the effects of stress, as this increases the concentration of proteins and certain proteins in the blood, which can distort the diagnostic results.
- Menses. It is forbidden to give urine for analysis to women during menstruation. First of all, this is due to the fact that in the first days of a new menstrual cycle, a hormonal surge occurs, which affects the state of the urinary fluid. In addition, urine can mix with blood clots and egg decay products, which will also affect the objectivity of the diagnostic results.
It is important to note that the number of restrictions can be large, depending on which type of analysis is used.Fulfillment of the presented requirements allows to obtain best material for examination, as a result of which the diagnostic procedure will be as reliable and informative as possible.
Collection of material
After preliminary preparation, urine should be taken for examination. It should be remembered that only a concentrated substance is used for analysis, that is, urine that accumulates during sleep. That is why most often the collection of material is carried out early in the morning, as soon as the person wakes up.
Before emptying the bladder, you should take care of the cleanliness of the genitals. This is necessary in order to exclude the possibility of foreign bacteria entering the material for. The first few seconds after the start of the urination process should be skipped, and only then collect the right amount - about 70-100 ml.It should be remembered that special plastic mini-containers with sealed lids are used to collect and transport urine. You can buy such a device at any pharmacy. Directly during the procedure, it is not recommended to bring the container too close to the genitals.
The collected material for analysis should be delivered to a medical facility no more than 2 hours after collection.
During transportation, it is not recommended to shake the contents of the container strongly, to expose it to thermal effects. If circumstances do not allow you to invest in a two-hour time period, you can donate urine directly at the hospital in special rooms.
At the moment, the question of how to collect urine for analysis in children is relevant. In boys, this problem is solved quite quickly, since to collect analyzes it is enough to follow the indicated rules and collect the required amount of liquid in a container. In girls, the procedure can cause certain difficulties. The best option The solution is to ask her to urinate in a pot and then pour the urine into a sterile container.
If necessary, parents can use special urinals, which are a container that is attached to the child's body with Velcro. They are used to collect fluid, both in girls and boys, and allow you to completely get rid of the problems associated with this procedure. Before using urinals, it is necessary to wipe the child's genitals with a cotton pad or napkin to prevent bacteria from entering.In general, urine collection for analysis should be done in the morning, and for this, special sterile containers should be used, which can be purchased at a pharmacy.
Decoding: norm and deviation of indicators
Deviation from the norm of urinalysis indicators is a sign of the disease
The results of a laboratory study of urine are provided to the patient in the form of a table, which presents the actual data on various indicators. Their set may differ depending on the specific type.
Indicators and norms in the analysis of urine:
- Color. This criterion is only conditional, since the color data of the urinary fluid does not always accurately reflect its properties. A light yellow color is considered normal, which indicates the absence of dyes, blood clots, bacteria or fungi.
- (BLd). In the absence of any pathologies, these blood components are absent in the urine. If they are present, a repeat urine test should be performed. The allowable number is 1-2 units per field of view.
- (Bill). The presence of bilirubin indicates diseases. Normally, this substance is absent in the urine.
- (LEU). The number of leukocytes should not exceed 6 units in the field of view. Exceeding this norm indicates an inflammatory disease.
- Bacteriuria (NIT). in the urine healthy person bacteria are completely absent, or are observed in a very small amount. High rate bacteriuria is evidence of infection in the urinary tract, which can lead to the development of inflammation.
- Protein content (PRO). Normally, substances of this group are absent. The presence of proteins indicates dysfunction. May indicate the development of hormonal diseases.
- Ketones (KETs). In the absence of diseases, ketone bodies in the urine are not observed. Their presence may indicate various diseases, including diabetes.
- (GLU). The normal indicator is the complete absence of glucose particles in the urine. The presence of such substances indicates a carbohydrate excess, as well as diseases.
- Urobilinogen (UBG). The presence of slight traces of urobilinogen is normal. An increase in the concentration of this substance is a symptom of liver damage, intravascular destruction of red blood cells, and organ diseases.
- Degree of acidity (pH). Normally, the indicator should be 5.0-6.0 pH. An increase in pH above 7.0 indicates dysfunction. A decrease in pH less than 5 is a sign of diabetes mellitus and urolithiasis.
- Fluid Density (S.G). This indicator may vary depending on the amount of fluid consumed by a person. The ideal indicator is the density from 1010 to 1030.
It should be remembered that only a specialist can make an accurate interpretation of the results, taking into account the individual and age characteristics of each patient.
LEU in urinalysis
Normally, the number of leukocytes in the field of view should not exceed 6 units. If this figure is higher, this is evidence of leukocyturia, which, in turn, is a symptom of a number of diseases. With leukocyturia, urine has a greenish color with a pronounced unpleasant odor. During the patient may experience pain, and the frequency may increase.
Elevated levels of LEU in the analysis of urine may indicate such diseases:
- Inflammatory diseases
- The presence of urolithiasis
- Diseases of the urinary tract
- Prostatitis
- Venereal diseases
- Fungal tissue lesions
In rare cases, an increase in white blood cells in women may be due to pregnancy, as well as physiological processes that occur during breastfeeding.
Useful video - White blood cells in the urine are increased: pyelonephritis.
If the number of leukocytes in the results of a urine test is below normal, it is recommended to perform additional diagnostic procedures to determine the state of the lymphatic system, and in particular the red bone marrow, which is responsible for the production of these substances. Diabetes, radiation sickness, typhoid can lead to a decrease in LEU levels. In rare cases, the violation can be triggered by taking certain medications.
If the level of leukocytes deviates from the norm, the patient is assigned additional diagnostic procedures, which is necessary to identify the causes of such a violation.
It is important to remember that timely diagnosis is a necessary measure, since in the future, violations of the concentration of leukocytes can cause
Urinalysis allows you to obtain data on the state of the urinary system and includes: microscopic examination of the sediment, its physical (color, density, transparency) and chemical properties.
A general urine test (OAM) is aimed at identifying indicators such as UBG (urobilinogen), KET (ketones), PRO (protein), NIT (nitrites), LEU (leukocytes), BLD (erythrocytes), GLU (glucose), SG ( density or specific gravity), pH (reaction), BIL (bilirubin), squamous epithelium, casts, mucus, color.
Normally, bilirubin, ketones, erythrocytes, protein, nitrites, leukocytes and glucose in the urine are not detected.
Urinalysis in adults
On the urinalysis results in adults, factors such as drinking alcohol the day before, physical overstrain, taking medications, and getting vaginal secretions in women into a container with urine can influence. Therefore, before passing the analysis, it is necessary to exclude adverse factors, and before collecting diagnostic material, perform hygiene of the genital organs.
Norm
Urinalysis is normal if:
- BIL, KET, BLD, PRO, NIT, LEU, GLU - absent (they are marked with the “Neg” symbol on the form);
- UBG less than 17 umol/L;
- SG - within 1.008 - 1.030;
- pH - 5 -7.
You should be aware that a general clinical urinalysis determines only the overall picture possible pathology. Additional research methods are needed for an accurate diagnosis.
Decryption
Physical properties: color, density and transparency must comply with the following parameters:
- Color - from light yellow to yellow;
- Density - 1.008 - 1.030 g / l;
- Transparency - transparent or slightly cloudy.
In the study of chemical properties, normal indicators are:
- pH (medium) - acidic (from 5 to 7);
- The protein is contained in small quantities and is not determined chemically;
- Urobilin - less than 17 umol / l.
Everything the rest of the indicators must be zero.
General table of indicators
| Indicator | Norm | Reasons for the high content | Reasons for low content or absence |
| Overall density SG | 1.008 – 1.030 g/l | More than 1.030 g / l - with insufficient fluid intake, impaired renal function, edema, acute glomerulonephritis, diabetes mellitus. | 1.010 - 1.011 - in case of impaired renal function; Less than 1.005 - diabetes insipidus; Less than 1.015 - with diets, fluid intake in large quantities, a decrease in edema. |
| Urobilinogen UBG | Not more than 17 ppm/l; In the forms of the old sample, the content of urobilin is fixed, + - weakly positive, ++ - positive, +++ - sharply positive, which indicates the degree of urobilinuria | Functional disorders of the liver: hepatitis, intoxication (poisoning with alcohol, chemical compounds, with sepsis); cirrhosis, liver failure. | ___ |
| Bilirubin BIL | not defined | Hepatic and obstructive jaundice | ___ |
| Ketone bodies KET | not defined | Diabetes 1 and 2 types, a strong increase in ketones is observed in coma; Long-term diets, alcohol poisoning, postoperative period | ___ |
| Erythrocytes BLD | Not detected | Pyelonephritis and glomerulonephritis in the process of exacerbation, prostatitis, trauma and inflammation in the kidneys and urinary tract, tuberculosis, heart attack, kidney cancer. | No more than 3 in the field of view, which can happen with physical overexertion |
| Protein PRO | Less than 0.002 g/l | Infections and foci of inflammation in the kidneys and urinary tract, kidney tuberculosis, amyloidosis, bleeding, hypertension, long-term anemia. | ___ |
| Nitrite NIT | not defined | Infection of the urinary tract with pathogenic bacteria | ___ |
| Leukocytes LEU | Up to 3 for men and up to 5 for women | Kidney disease in the acute and latent phase: pyelonephritis, glomerulonephritis; inflammation of the urinary tract, amyloidosis and renal tuberculosis | ___ |
| Glucose GLU | Not detected | Renal diabetes | ___ |
| pH reaction | 5 — 7 | Diabetes mellitus, prolonged fasting, kidney tuberculosis, functional disorders of the kidneys | Cystitis, hematuria, after vomiting and gastric lavage, |
Epithelium
Are you testing in a private clinic?
YesNot
In the urine of healthy people traces of squamous epithelium are determined in a single quantity. An increased content is found in the presence of foci of inflammation in the bladder and renal pelvis, the formation of stones in the organs of the urinary system.
In men, an increase in the number of epithelial cells is observed with inflammation of the urethra and prostate gland.
Erythrocytes BLD
The presence of a large number of red blood cells (blood) in the urine is indicated by a change in its color to red-brown - this condition is called macrohematuria. A small content of red blood cells can only be determined by laboratory testing.
Normally, erythrocytes are not detected, perhaps single manifestations, no more than 3 in the field of view. The reasons for the content of red blood cells are: infectious and inflammatory diseases of the kidneys and urinary tract, malignant tumors and injuries of the kidneys. Often, traces of blood in the urine in men indicate inflammation of the prostate in the acute stage.
Urobilinogen UBG
Urobilinogen is contained in fresh urine, and when it is left for a long time, it turns into urobilin, which is present in the body of a healthy person in small doses.
An increased content of urobilin is characteristic in violation of the liver, when it loses the ability to excrete it with bile, as well as in case of blockage of the bile duct (for example, with a stone).
Diagnosis of urobilinuria in medical practice is important to identify the causes of jaundice and detection of liver damage.
Protein PRO
The urine of a healthy person contains less than 0.002 g/l protein. The content of this element in excess of the norm is called proteinuria, which is classified into renal and urinary tract proteinuria.
To differentiate proteinuria, an additional study of the urine sediment is necessary (according to Nechiporenko, Addis-Kakhovsky). Only with a cumulative analysis of all indicators (erythrocytes, cylinders, leukocytes) can the cause of the protein content be identified, these are: pathological conditions of the kidneys (pyelonephritis, glomerulonephritis, tuberculosis, amyloidosis and pathological conditions of other organs: anemia, hypertension, heart failure.
Protein in small quantities can be detected if the patient consumed protein foods or performed heavy physical exercises the day before the test. If traces of protein are determined in the urine, the patient is prescribed a second analysis.
Overall density SG
The SG score in healthy people can range from 1.010 to 1.025. Deviations from the norm in a single study may not be of decisive clinical importance. Detailed analyzes are required aimed at daily determination of density and its fluctuations: Reizelman, Zimnitsky, dry eating, water tests.
Increased OPL of urine is observed with dehydration, diabetes mellitus, edema that occurs with pathologies of the heart and kidneys.
Low OPL - with excessive drinking, reduced swelling, long-term fasting, kidney failure, diabetes insipidus.
When are Zimnitsky tests scheduled?
An analysis according to Zimnitsky is prescribed to study the functionality of the kidneys.
The diagnostic factors of this method are: the density of urine and changes in its numerical indicators in different portions, and diuresis - the ratio between the amount of fluid consumed and excreted in 24 hours.
Normal indicators:
- The difference in the density of urine between the highest and lowest values is not less than 0.012;
- Daytime diuresis is twice as high as nighttime;
- The daily amount of urine is not less than 65% and not more than 85% of the fluid consumed;
- The minimum density of urine is allowed - 1.005, the maximum - 1.030.
Abnormalities indicate kidney disease: pyelonephritis and glomerulonephritis.
Urinalysis according to Nechiporenko
The Nechiporenko method is used in diagnostic practice to determine the number of leukocytes, erythrocytes and cylinders. Normal values per 1 ml of urine: erythrocytes no more than 1000, leukocytes< 4000, цилиндров < 20.
Exceeding normal values indicates leukocyturia and hematuria, which is observed in the pathological condition of the urinary system.
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. General clinical analysis of urine includes the study of the physical, chemical properties of 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, not only an increase in leukocytes is observed, but also hematuria (an increase in the number erythrocytes 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 that is 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 (oliguria). In the analysis of urine, 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 erythrocytes - erythrocyte cylinders) is noted.
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 bladder decreases), 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 breath. 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, calculate the amount of glomerular filtration (characterizes the excretory function of the kidneys) and tubular reabsorption.
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 - 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 violations of the concentration ability of the kidneys.
A persistent drop in CF to 40 ml / min in chronic kidney disease 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 the device " artificial kidney or 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 of the 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.
Contrast blocks 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. Therefore, this procedure is rarely performed in kidney 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.
Three phases, or segments, are distinguished on the renographic curve of a normal kidney: 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 stenotic by at least 50%. 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 easily and quickly identify renal dysfunction 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 of research, which involves the introduction of a small amount of a radioactive medical preparation (radioactive label) into the body and obtaining an image of the kidneys using a gamma camera. The resulting images can help in diagnosis and treatment. various diseases kidneys.
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 being 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, it may temporarily rise or fall arterial pressure or the urge to urinate.
Results of kidney scintigraphy (nephroscintigraphy)
Renal scintigraphy shows the normal function of the kidneys depending on 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.
Save to social networks:Urine is a biological fluid containing about 150 different elements. Its composition varies depending on the mental or physical state of the person, the fluid and food consumed.
Clinical urinalysis is a mandatory diagnostic procedure that is prescribed to almost all patients of any medical institution. This method of laboratory diagnostics allows you to obtain information about the various metabolic processes occurring in the human body, the functional state of the urinary system.
During the study of a sample of biological material, a measurement is taken relative density(specific gravity), the level of acidity of the medium and the content of protein, glucose, bile pigments, ketone bodies and some other indicators.
In modern laboratory centers, urine testing is performed on special devices - analyzers. The results of the study are given in the form of a table with Latin letters that are incomprehensible to patients, for example, urine analysis sg.
In our article, we will talk about the rules for collecting biological material, what diagnostic indicators of urine are measured during a general clinical study, and about the presence of which diseases their deviations from the norm can mean.
Indications for a urine test
A general urine test is prescribed to healthy people during annual dispensary examinations and to patients who have various complaints of deterioration in well-being.
Urine examination is carried out with:
- diagnosing pathological processes in the kidneys and urinary tract;
- detection of diseases of the prostate gland;
- obligatory examination before surgical interventions;
- recent diseases, in which a complication to the kidneys is possible;
- suspicion of the presence of diabetes mellitus, hepatitis, pancreatitis;
- assessment of the toxic state of the patient's body;
- monitoring the course of the disease and the effectiveness of the treatment.
For children, the study is carried out before a planned visit to the pediatrician and each vaccination, as well as for various ailments. This allows you to timely identify developing pathological processes in the child's body.
Expectant mothers need to regularly take a urine test - in addition to monitoring the general condition of the body and the urinary system, the study will allow timely detection of such a severe pathological condition like preeclampsia (late toxicosis)
How to properly collect biological material
The conditions for preparing for a general clinical examination of urine are simple - it is necessary to reduce physical activity and completely exclude the intake of alcoholic beverages. There are no special changes in the diet, it is recommended to limit:
- the use of sweets and foods that have a bright color (carrots, beets, pumpkins, etc.);
- drink mineral water, which can change the acidity of urine;
- taking vitamins, antipyretics and painkillers medicines-they can change the biochemical parameters of urine.
Women need to know one more rule - it is not recommended to pass urine during menstruation.
For a general analysis, you need to collect the morning portion of urine, for this you need:
- Purchase a special container at the pharmacy - a graduated transparent cup with a tight-fitting lid. Pediatric urinals are sold for collecting urine from young children.
- Make a thorough toilet of the external genitalia. During the collection of biomaterial, women should use a cotton swab - this method will help to avoid vaginal discharge from entering the urine, which can distort the results of the analysis.
- After urinating into the toilet for the first few seconds, complete urination into the prepared container, close it with a lid and deliver it to the laboratory center within 2 hours.
Research methodology
Under laboratory conditions, the studied sample of biomaterial is subject to the following types of studies:
- organoleptic - assessment of smell, color, transparency of urine, measurement of diuresis (sample volume);
- physico-chemical - the establishment of the specific gravity and acidity of urine;
- biochemical - determination of the presence of glucose, protein, ketones, hemoglobin, bile pigments, nitrites;
- microscopic - the study of the formed elements of the urinary sediment under a microscope.
The laboratory doctor enters the data obtained into the table of the urinalysis form, which is given to the patient, however, only a qualified specialist can read it
The patient's knowledge of the norms of urinary parameters will help to avoid unnecessary anxiety when receiving the results of the study. Deciphering the designations as a result of the study:
- SG in urinalysis means relative density;
- pH is the acidity of the medium;
- GLU, glucose concentration;
- PRO, total protein;
- LEU - indicator of the number of leukocytes;
- BLd - erythrocytes;
- URO – urea level;
- BIL - the presence of bilirubin;
- KET - ketone bodies;
- UBG, urobilinogen;
- NIT - nitrite.
Interpretation of analysis results
Let's sequentially consider the main diagnostic parameters of urine, which are studied in a general clinical study, their indicators are normal and the causes that cause various deviations.
Table of normal adult urine parameters
The norms of the results of the study of the urine of a child are almost identical to the norms of an adult. The differences are the daily volume and relative density, the indicators of which change as the baby grows up.
Causes of changes in the specific gravity of urine
The parameters of the relative density of urine (in Latin - special gravity) indicate the ability of the kidneys to filter and concentrate biological fluid. The indicators change throughout the day - at night, more concentrated urine is produced, in the daytime - the specific gravity is much lower.
Measurement of the specific gravity of urine - one of the stages of the general clinical analysis
An increase in the density of urine over 1030 g / l denotes medical term"hyper-stenuria", which indicates:
- dehydration of the body;
- excessive physical stress;
- diabetes;
- cardiovascular insufficiency;
- urinary tract infections;
- glomerulonephritis;
- urolithiasis.
The term "hypo-stenuria" means a decrease in density below 1005 g / l. This phenomenon is observed when:
- excessive fluid intake;
- diabetes insipidus;
- polyuria - increased urine production;
- decrease in the concentration ability of the kidneys;
- chronic pyelonephritis.
When performing a general clinical analysis of urine, the specific gravity is determined from a single portion. However, this figure alone does not provide complete information about the functioning of the kidneys during the day.
To assess daily diuresis, additional urine studies are carried out:
- a specific sample according to the Zimnitsky method;
- water load test;
- dry test.
In the absence of changes in the specific gravity of urine depending on the time of day, urologists conclude that the patient has isostenuria (the inability of the kidneys to concentrate urine), which is a sign of kidney failure.
Why does the acidity of urine change?
The reaction of urine is an important indicator of the acid-base balance in the human body. This is due to the fact that the kidneys provide a constant level of hydrogen in the blood and its acidity.
The pH level fluctuates throughout the day and depends on:
- volume of fluid consumed;
- body temperature;
- diet;
- general condition of the body.
To measure the acidity level of urine, there are special test strips that can be purchased at the pharmacy network and measure the pH at home
An increase in acidity (less than 4.0 - urine is acidic) is called acidosis, this condition is observed when:
- the predominance of meat products in the diet;
- prolonged fasting;
- a decrease in the level of potassium in the blood;
- diabetes mellitus;
- dehydration of the body;
- functional disorders of the kidneys.
A decrease in acidity (above 7.0 - alkaline reaction) is called alkalosis which is typical:
- for chronic renal failure;
- to increase the concentration of potassium in the blood;
- for malignant neoplasms in the urinary system;
- with an increase in the concentration of parathyroid hormones;
- with infections of the genitourinary system;
- with prolonged intoxication of the body.
Change in total protein
The medical term "proteinuria" means an increase in the concentration in the urine of globulin and albumin (the main proteins in blood plasma) of more than 0.028 g / l. This fact indicates a violation of the filtration function of the kidneys, which is observed when:
- infectious and inflammatory processes in the organs of the urinary system;
- bleeding;
- hypertension;
- prolonged anemia;
- amyloid dystrophy.
Estimation of the amount of protein in the urine is an important diagnostic point
The penetration of large proteins through the renal glomeruli is also possible for natural reasons:
- the predominance of protein foods in the diet;
- increased sweating;
- hypothermia;
Extrarenal origin of proteinuria is observed when:
- pregnancy;
- epilepsy;
- allergies;
- heart failure;
- leukemia.
Causes of glucosuria
Glucose in the urine of a healthy person is not detected. The reasons for its appearance can be situations that are not associated with pathological processes in the body:
- physical stress;
- stress;
- excessive consumption of carbohydrates.
Pathological glucosuria is divided into renal, which is characterized by the excretion of glucose in the urine at a normal level of its content in the blood, and extrarenal, in which the level of glucose in the blood is significantly higher than normal.
Renal observed with:
- chronic nephritis;
- renal diabetes;
- acute renal failure;
- phosphorus poisoning.
Causes of the extrarenal form:
- pancreatitis;
- diabetes;
- a malignant tumor in the pancreas;
- hyperfunction of the thyroid gland;
- acromegaly of the pituitary gland;
- hypercortisolism - an excessive amount of hormones of the adrenal cortex;
- Pheochromocytoma is a hormonal tumor of the adrenal medulla.
A single appearance of glucose in the urine does not have an important diagnostic value, its level must be measured systematically - for this purpose, an express test for determining glucose can be purchased at a pharmacy
Sources of leukocytouria
An increase in the number of leukocytes in the urine is always associated with the development of an inflammatory process in the organs of the urinary system and is observed when:
- cystitis - inflammation of the bladder;
- urethritis or prostatitis - damage to the urethra or prostate gland;
- pyelonephritis is a nonspecific inflammation of the kidneys.
Reasons for the presence of red blood cells in the urine
The appearance of red blood cells in the urinary sediment is called hematuria. The following types of red blood cells can be found in urine:
- fresh (unchanged) - observed in lesions of the urinary tract, which are caused by urolithiasis, cystitis, urethritis;
- leached (altered) - enter the urine as a result of the penetration of erythrocytes into the renal tubules, this fact indicates damage to the kidneys.
There are gross hematuria (which can be determined with the naked eye - urine acquires a bright scarlet hue) and microhematuria (erythrocytes are detected by microscopy)
To clarify the source of the appearance of erythrocytes and increase the number of leukocytes in urine, the patient is prescribed a study of three portions of urine isolated in one urination.
Detection of nitrites in urine
Nitrites are nitrogen salts, their formation occurs from nitrates that enter the human body when eating products that were grown with a large amount of fertilizers.
This process is possible in the presence of a large number of bacteria in the bladder. That is why, when nitrites are found in a general urine test, they speak of bacteriuria, which is a sign of a urinary tract infection.
The appearance of ketone bodies
The cause of ketonuria is a violation metabolic processes- protein, fat and carbohydrate. Most often, ketone bodies are found in:
- diabetes mellitus;
- acute pancreatitis;
- prolonged fasting;
- alcohol poisoning;
- hypercortisolism;
- thyrotoxicosis;
- injuries affecting the nervous system.
Natural ketonuria is observed in children and pregnant women as a result of uric acid diathesis (reduction in the excretion of uric acid by the kidneys).
Causes of changes in the level of urea
Urea - one of the main components of residual nitrogen, is an important indicator of the excretory ability of the kidneys. An increase in its concentration is observed with:
- eating food rich in proteins;
- thyrotoxicosis;
- postoperative period.
A decrease in the level of urea is typical for:
- liver diseases - hepatitis, cirrhosis, malignant tumors;
- kidney disease and kidney failure.
Why does the concentration of urobilinogen increase?
The formation of D-urobilinogen occurs in the intestine during the breakdown of the bile pigment (bilirubin).
Deciphering the results of a urine test is the task of the attending physician
An increase in urobilin in the urine is an important indicator of a high concentration of bilirubin in the blood and indicates the following pathologies:
- intestinal diseases - enteritis, colitis, constipation;
- liver diseases;
- hemolytic jaundice, which develops as a result of hemolysis (destruction of red blood cells inside the vessels).
Detection of bilirubin in urine
Normally, one of the main components of bile (bilirubin) is completely excreted into the intestine and is not found in the urine. Its appearance in urine is observed when:
- viral hepatitis;
- cirrhosis of the liver;
- stasis of bile (cholestasis);
- cholelithiasis;
- genetic pathology of the blood - von Willebrand's disease;
- renal failure;
- mechanical jaundice.
Summing up all of the above, I would like to say once again that a general clinical examination of urine is a very informative analysis. However, its results alone do not allow even the most qualified doctor to establish an accurate diagnosis. To date, only with the results of other laboratory and instrumental studies, clinical urinalysis is an important diagnostic tool.
Deciphering the general analysis of urine, with the advent of more advanced medical devices, has become difficult, without special skills and knowledge. Take your analysis in hand, what do you see? Personally, I see a lot English letters. Everyone who reads this article will be able to understand what they mean, we will give explanations of "incomprehensible abbreviations", as well as the norms and deviations of each of the indicators.
Abbreviations used in the general analysis of urine:
- BLd - erythrocytes;
- Bil - bilirubin;
- Uro - urea;
- KET - ketones;
- PRO - protein;
- NIT - nitrites (in the usual sense - bacteriuria);
- GLU - glucose;
- pH - acidity;
- S.G - density;
- LEU - leukocytes;
- UBG - urobilinogen.
- Erythrocytes - in the urine should be absent. If available, re-analysis, observation is required. The urine of women may contain blood that has entered there during the menstrual period, which gives the presence of red blood cells in the urine. Permissible no more than 1-2 erythrocytes in the field of view. An increase in the number of red blood cells in the urine is called hematuria. Its causes are as follows: bleeding into the urinary tract, tumors, stones in the kidneys and ureters.
- Bilirubin is normally absent in urine. Detected in parenchymal lesions of the liver ( viral hepatitis), mechanical (subhepatic) jaundice, cirrhosis, cholestasis. In hemolytic jaundice, urine usually does not contain bilirubin. It should be noted that only direct (bound) bilirubin is excreted in the urine.
- Ketones - the presence of ketone bodies in the urine (acetone) - are normally absent, if ketone bodies are detected, diabetes mellitus, starvation, lack of carbohydrates, hyperinsulism can be assumed. Occurs with the intensive consumption of body fat reserves. To the attention of those who are losing weight and starving! - can lead to hyperglycemic coma. In fact, 20-50 mg of ketone bodies (acetone, acetoacetic acid, beta-hydroxybutyric acid) are excreted in the urine per day, but they are not detected in single portions. Therefore, it is believed that normally in the general analysis of urine there should be no ketone bodies.
- Protein - its presence in the urine (normally there is no protein), a sign of kidney pathology. Protein enters the urine with pyelonephritis, nephrotic syndrome, amyloidosis of the kidneys. Protein in the urine can appear from the urinary tract and genital organs during inflammation, with cystitis, vulvovaginitis, prostate adenoma - in these cases it is usually not more than 1 g / l. If the urine of a woman during pregnancy contains protein, then this may be a sign of nephropathy in pregnant women. Normally, the protein content in the urine is so low that it can only be determined by ultrasensitive methods. Sometimes traces of protein are determined, however, this is a borderline condition and requires detailed study. The fact is that traces of protein are acceptable, but only in single analyzes.
- Nitrites (bacteriuria) - bacteria in the urine are normally absent or determined in small quantities. In a healthy person, the urine in the kidneys and bladder is sterile. When urinating, microbes from the lower urethra enter it, but their number is not more than 10,000 in 1 ml. Therefore, it is considered that bacteria are normal in the general analysis of urine are absent. A large number of bacteria may be evidence of a urinary tract infection. The presence of bacteria indicates infection of the genitourinary system, cystitis, nephritis.
- Glucose - normally should be absent, in the presence of glucose in the urine, manifestations of diabetes mellitus, receiving a large amount of carbohydrates from food, acute pancreatitis can be suspected.
- Acidity - the kidneys maintain a blood pH of 5.0-6.0 - a slightly acidic reaction. At a pH greater than 7, hyperkalemia, a deviation in thyroid function, an infection of the urinary system can be assumed, at a pH less than 5, hypokalemia, diabetes mellitus, urolithiasis, and renal failure.
- Density - with a density of more than 1030, one can assume the presence of glucose (diabetes mellitus), protein (glomerulonephritis), with a density of less than 1010 - renal failure, damage to the renal tubules. Since the density of urine depends on the amount of water drunk, this indicator is not of significant value in the diagnosis.
- Leukocytes - an increased content of leukocytes in the urine is called leukocyturia, it is also an indicator of nephritis and urethritis. This condition is observed in various inflammatory diseases of the urinary system. Too pronounced leukocyturia, when the number of these cells exceeds 60 in the field of view, is called pyuria. Almost all diseases of the kidneys and urinary system increase the content of leukocytes in the urine.
- Urobilinogen - Normal urine contains traces of urobilinogen. Its level increases sharply with hemolytic jaundice (intravascular destruction of red blood cells), as well as with toxic and inflammatory liver damage, intestinal diseases (enteritis, constipation). With subhepatic (mechanical) jaundice, when there is a complete blockage of the bile duct, there is no urobilinogen in the urine. Urobilinogen is formed from direct bilirubin excreted in the bile in the small intestine. Therefore, the complete absence of urobilinogen is a reliable sign of the cessation of bile flow into the intestine.
Below is also a table of normal urinalysis values:
| Result | Urine indicators |
| The amount of urine for analysis | Doesn't matter |
| urine color | Straw yellow |
| Urine clarity | transparent |
| The smell of urine | Unsharp, non-specific |
| Urine reaction or pH | Acidic, pH less than 7 |
| Specific gravity of urine | 1,018 or more per morning serving |
| Protein in the urine | Missing |
| Ketone bodies in urine | Missing |
| bilirubin in urine | Missing |
| Urobilinogen in urine | 5-10 mg/l |
| hemoglobin in urine | Missing |
| erythrocytes in urine (microscopy) |
0-3 in sight for women 0-1 in sight for men |
| Leukocytes in urine (microscopy) |
0–6 in the field of view for women 0–3 in the field of view for men |
| epithelial cells in urine (microscopy) In addition to the above...
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