Decoding urine analysis in Latin. Features of conducting and deciphering urine analysis in adults. Material for research

Update: December 2018

Urine is a human waste product. Its formation occurs in the kidneys; it is a complex and lengthy process. Excess water, waste (uric acid, urea), ions (sodium, potassium, chlorine), vitamins and hormones are removed from the body with this fluid.

A general urine test plays an important role for a doctor; it helps determine kidney function, and also allows one to judge the state of the gastrointestinal tract, cardiovascular system, and others.

Urine collection rules

Human urine is normally sterile; bacteria can only enter it when passing through the urinary tract or from dirty dishes. Collecting this biological fluid is a very intimate process that is carried out independently; children or seriously ill people usually need help. How to properly collect urine?

• material is collected in the morning, immediately after sleep, on an empty stomach;
• It is recommended that the previous urination was at least 5-6 hours ago;
• before urinating, the patient must toilet the external genitalia (women wash the perineal area with soap and water, and men wash the head of the penis and the external opening of the urethra);
• Sample collection is prohibited during menstruation;
• an average portion of urine is collected, its volume is approximately 50-100 ml;
• the first drops are flushed into the toilet, as they contain epithelium that has peeled off from the mucous membrane;
• the material is collected in a dry, clean, transparent container with a wide neck and a tight lid;
• urine should not be taken from a duck, urinal, chamber pot, etc.;
• collection dishes must be thoroughly washed and rinsed free of detergents, as they can affect the analysis results;
• the collected liquid must be immediately delivered to the laboratory; its shelf life is no more than one and a half hours;
• On the eve of the examination, it is undesirable to eat vegetables and fruits containing pigments (carrots, beets), as well as alcohol and chocolate.

Indications for the purpose of the study

• inflammatory processes in the genitourinary system (glomerulonephritis, interstitial nephritis, cystitis,);
• spicy and
• some neoplasms (myeloma, melanoma, pituitary tumor);
• obstructive jaundice (, acute cholangitis);
• sugar and ;
• acute pancreatitis.

Usually, an ultrasound of the kidneys is also prescribed at the same time (see).

Table of norms for general urine analysis

Interpretation of a general urine test

Daily diuresis

This is the amount of urine excreted per day. It depends on the volume of fluid drunk and moisture loss through the lungs, skin and intestines. Normal daily urine volume at different ages:

Disorders of daily diuresis:

How many times a person urinates per day also plays an important role. Normally, this number is 4-5 times a day.

A change in the frequency of urination occurs in the following cases:

• pollakiuria (more than 5 times a day) - happens if you drink a lot of water, as well as with inflammation of the genitourinary system;
• olakiuria (less than 3 times a day) – this condition is possible due to insufficient water intake or neuro-reflex disorders;
• dysuria (see) - occurs with cystitis, urethritis, pyelonephritis, etc. (see,).

Transparency

Urine should be clear, if it is cloudy, then it is possible:

• The presence of protein in the urine - amyloidosis, pyelonephritis, glomerulonephritis
• The presence of red blood cells - kidney cancer, urolithiasis, prostatitis, pyelonephritis, glomerulonephritis
• Bacteria in urine - cystitis, pyelonephritis
• The presence of leukocytes - pyelonephritis, cystitis
• Epithelium in urine - pyelonephritis
• Precipitation of salts (phosphates, urates, oxalates)

Color

The color of the liquid we secrete is provided by the pigment urochrome (a product of bilirubin metabolism). A change in the color of the material may indicate various pathologies; it is also observed when consuming certain foods and medications:

• reddish, red, the color of “meat slop”- indicates the presence of red blood cells (hematuria), that is, blood in the urine (urolithiasis, cystitis, glomerulonephritis), as well as in hereditary porphyrinuria, lead intoxication, severe toxicosis, taking anti-tuberculosis drugs (rifampicin), phenacetin, iron supplements, sulfazole, red streptocide, amidopyrine.
• dark yellow with a brownish or greenish tint– release of bile pigments during mechanical (bile stagnates and does not flow from the gallbladder into the intestine), hemolytic anemia.
• dark yellow - concentrated urine, usually occurs with low fluid intake, increased sweating, and also when eating carrots. With (vomiting, diarrhea, high temperature), as well as with fasting, in children with a lack of breast milk, with heart and liver diseases.
• greenish yellow– an abundance of pus (pyuria);
• dirty brown– pyuria with an alkaline reaction;
• black and brown-black– release of hemoglobin in hemolytic anemia (hemoglobinuria), melanin in melanoma, melanosarcoma, Marchiafava-Micheli disease, naphthol poisoning
• white, whitish– large amounts of phosphates (phosphaturia), fats (lipuria) or lymph (tumors of the urinary system or renal tuberculosis).
• clear, pale urine– harmless reasons: taking diuretics and products (see), drinking plenty of fluids. Pathological causes - diabetes insipidus, impaired concentrating function of the kidneys;
• pink – the presence of phenolphthalein in an alkaline reaction;
• dark brown – use of sulfonamides (biseptol), metronidazole, bearberry-based drugs;
• greenish-brown– taking indomethacin, amitriptyline;
• orange-yellow - after the introduction of vitamins B, C, multivitamin complexes, as well as eating food with beta-caratine - persimmons, apricots, carrots, bright orange fruits and vegetables.

Smell

Usually the material has a special specific smell. A change in it indicates certain diseases. For example, an ammonia smell means an inflammatory process of the genitourinary system (urethritis, pyelonephritis) or a decaying tumor. And with diabetes mellitus, the smell of “soaked apples” or acetone occurs.

Urine specific gravity (sg)

The determination of relative density is of great clinical importance, since this value reflects the ability of the human kidney to concentrate and dilute. The specific gravity of urine is measured by the substances found in it (various salts, sugar,).

Urine pH reaction

The urine of a healthy person has a neutral or slightly acidic reaction. Its change is associated, first of all, with the nature of the diet (meat or vegetables), as well as with a number of diseases. It should be remembered that if urine stands at room temperature for a long time, this leads to its alkalization and destruction of formed elements, thereby changing the results of the analysis.

What diseases can change the pH of the material?

Total protein

The presence of a small amount of protein in the material is possible during psycho-emotional stress, physical overexertion, sports competitions, taking a cold shower or bath (orthostatic proteinuria). An increase in total protein in the urine over 0.14 g/day (proteinuria) is a serious sign of the presence of certain diseases (see).

Special types of proteins can be determined in the test liquid:

• Bence-Jones protein – for myeloma, Waldenström microglobulinemia;
• β2-microglobulin – in case of damage to the renal tubules.

Degrees of increase in total protein in urine:

Glucose

The presence of glucose in the urine (glucosuria) is directly related to blood sugar levels: the more glucose in the blood, the more of it will be excreted from the body. Glucosuria is the first sign of DIABETES MELLITUS! Also, sugar in the urine may increase if:

• acute pancreatitis;
• thyrotoxicosis;
• renal diabetes;
• steroid diabetes, Itsenko-Cushing's disease;
• sepsis;
• brain tumors;
• pheochromacytoma;
• the action of toxic substances (morphine, strychnine, phosphorus, chloroform).

But not in all cases glucosuria indicates a disease. Normally, this condition occurs when overeating sweets, under constant stress, and in pregnant women.

Ketone bodies

Ketone bodies are products of fat metabolism. Normally, a very small amount of them is formed in the body. Ketones include: acetone, β-hydroxybutyric acid and acetoacetic acid.

The detection of ketones in the urine (ketonuria or) indicates the following:

• uncompensated diabetes mellitus;
• low-carbohydrate diet, fasting, cachexia;
• excessive production of steroid hormones in tumors of the brain and adrenal cortex;
• acetonemic vomiting in children;
• dysentery;
• thyrotoxicosis;
• acromegaly;
• eclampsia in pregnant women;
• intoxication.

Leukocytes in urine

The detection of a large number of these cells in the urine always indicates an inflammatory process in the urinary system, be it cystitis or pyelonephritis. If the number of white blood cells is more than 60 per field of view, it is called pyuria (pus in the urine). The analysis may include both neutrophils and lymphocytes. In chronic inflammation, leukocytes are a more reliable indicator than bacteria, which are not always detected.

Red blood cells in urine

In the urine of a healthy person, red blood cells are absent or are detected in the form of single cells (0-1-2-3 in the field of view). Normally, their appearance is associated with heavy physical labor and sports. In women, red blood cells may be included in the analysis during menstruation or pregnancy.

Depending on the number of red blood cells in the urine, the following are distinguished:

• mild erythrocyturia - up to 20 cells in a microscope;
• moderate severity – from 20 to 200 cells;
• pronounced erythrocyturia (hematuria) - more than 200 cells in the field of view.

Depending on which part of the urinary system the red blood cells enter the urine, they are found leached or unchanged. Reasons for the presence of red blood cells in urine:

• kidney injuries - tear, bruise, rupture
• urolithiasis disease
• kidney infarction
• urethritis, cystitis, acute glomerulonephritis
• bladder cancer, kidney cancer, prostate cancer

Why does blood appear in urine?

• glomerulo- and pyelonephritis (acute and chronic);
• urolithiasis disease;
• acute cystitis;
• kidney infarction;
• kidney and bladder cancer;
• prostate adenoma;
• trauma to the genitourinary system;
• hemorrhagic diathesis;
• systemic lupus erythematosus;
• hemorrhagic fever (Ebola, Crimean, Congo);
• kidney amyloidosis;
• poisoning with benzene, aniline, snake venom;
• kidney tuberculosis;
• lipoid nephrosis.

Epithelium

Epithelial cells are always found in the analysis. They get there by sloughing off the mucous membrane of the urinary tract. Depending on the origin, transitional vtc (bladder), squamous (lower urinary tract) and renal (kidney) epithelium are distinguished. An increase in epithelial cells in the urinary sediment indicates inflammatory diseases and poisoning with heavy metal salts.

Cylinders

The casts are so-called “protein casts” of the urinary tract. Depending on the appearance and origin there are:

Bilirubin in urine

Bilirubin cannot normally be found in the urine, since it is excreted into the intestinal lumen as part of bile. When the level of bilirubin in the blood is elevated, the kidneys take over the function of removing it. Causes of bilirubin in urine:

• hepatitis
• destruction of red blood cells in malaria, hemolytic disease, toxic hemolysis, sickle cell anemia
• cholelithiasis

Urobilinogen in urine

Urobilinogen is a substance formed from bilirubin released with bile in the intestinal lumen. From the intestine, it partially returns to the blood and enters the liver through the bloodstream, where it is excreted again with bile. If the liver is not able to bind all the incoming urobilinogen, part of it enters the general bloodstream, then this urobilinogen is excreted from the body by the kidneys. Reasons for the release of urobilinogen in the urine:

• liver failure
• inflammation of the intestines - colitis, enterocolitis
• massive destruction of red blood cells

Hemoglobin in urine

Hemoglobin is a protein involved in the transfer of oxygen to cells; it is found inside the red blood cell. When severe destruction of red blood cells occurs, a large amount of hemoglobin is released into the blood, and the spleen and liver do not have time to break it down. In this case, free hemoglobin is excreted in the urine. Also, during myocardial infarction, when muscle tissue is compressed, myoglobin (similar in structure to hemoglobin) can be released into the blood, which is also partially excreted by the kidneys. The causes of hemoglobin in urine are:

• malaria
• burns
• blood transfusion
• hemolytic disease
• damage to muscle tissue - contusion with hematoma, crash syndrome
• poisoning with sulfa drugs, phenol, mushrooms

Salt crystals

There are many ions and salts dissolved in urine. Excess of them leads to the formation of sediment and stones, which cause urolithiasis. The following are most often found in material sediment:

Bacteria and fungi

The detection of over 50,000 bacteria in 1 ml of material indicates inflammation of the urinary tract. Then the patient is recommended to undergo a urine culture to determine the specific type of microorganisms and their sensitivity to antibiotics. The presence of fungal mycelium in the analysis indicates candidiasis or a decrease in local immunity after taking antibiotics.

Slime

Normally there should be no mucus in the urine. Its presence indicates an acute or chronic inflammatory process of the genitourinary system.

In the end, I would like to add that a general urine test is an important diagnostic indicator. A person can independently pay attention to changes in urine and consult a doctor. Even healthy people are recommended to take this test at least once a year. It should also be remembered that a single result is not an indicator of pathology. It is very important to take tests over time in order to make a final conclusion about the presence of the disease.

Urine analysis allows you to obtain data on the state of the urinary system and includes: microscopic examination of sediment, its physical (color, density, transparency) and chemical properties.

A general urine test (UU) 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, red blood cells, protein, nitrites, white blood cells and glucose are not detected in the urine.

Urinalysis in adults

On urine test results in adults, factors such as drinking alcohol the day before, physical stress, taking medications, and vaginal secretions in women getting into a container with urine can influence this. Therefore, before taking the test, it is necessary to exclude unfavorable factors and perform genital hygiene before collecting diagnostic material.

Norm

A urine test is normal if:

• BIL, KET, BLD, PRO, NIT, LEU, GLU – absent (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 know that a general clinical urine test determines only the general picture of possible pathology. Additional research methods are needed to make an accurate diagnosis.

Decoding

Physical properties: color, density and transparency must meet the following parameters:

• Color – from light yellow to yellow;
• Density – 1.008 – 1.030 g/l;
• Transparency – transparent or slightly cloudy.

When studying chemical properties, the following are considered normal indicators:

• pH (medium) – acidic (from 5 to 7);
• Protein is contained in small quantities and cannot be determined chemically;
• Urobilin – less than 17 mol/l.

All other indicators should be equal to zero.

General table of indicators

Epithelium

Are you getting tested in a private clinic?

YesNo

Traces of squamous epithelium are detected in the urine of healthy people in a single quantity. Increased levels are detected in the presence of foci of inflammation in the bladder and renal pelvis, and 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.

Red blood cells 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 gross hematuria. A small amount of red blood cells can only be determined in the laboratory.

Normally, red blood cells are not detected, perhaps isolated 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 kidney injuries. Often, traces of blood in the urine of men indicate inflammation of the prostate in the acute stage.

Urobilinogen UBG

Urobilinogen is contained in freshly released urine, and when it stands 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 typical when the liver is damaged, when it loses the ability to excrete it with bile, as well as when the bile duct is blocked (for example, by 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 an amount exceeding the norm is called proteinuria, which is classified into renal and urinary tract proteinuria.

To differentiate proteinuria, additional examination of urine sediment is necessary (according to Nechiporenko, Addis-Kakhovsky). Only with a cumulative analysis of all indicators (erythrocytes, casts, 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 can be detected in small quantities if the patient consumed protein foods or performed heavy physical exercise the day before the test. If traces of protein are detected in the urine, the patient is prescribed a repeat test.

Total Density SG

SG in healthy people can range from 1.010 to 1.025. Deviations from the norm in a single study cannot have a decisive clinical significance. Detailed tests are required aimed at daily determination of density and its fluctuations: Reiselman, Zimnitsky, dry eating, water tests.

An increased RPL of urine is observed in cases of dehydration, diabetes mellitus, and edema that occurs due to pathologies of the heart and kidneys.

Low OPl - with excessive drinking, decreased swelling, long-term fasting, kidney failure, diabetes insipidus.

When are Zimnitsky tests prescribed?

The Zimnitsky analysis is prescribed to study kidney functionality.

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 urine density between the highest and lowest values ​​is not less than 0.012;
• Daytime diuresis is twice as prevalent as nighttime diuresis;
• The daily amount of urine is not less than 65% and not more than 85% of the fluid consumed;
• The allowed minimum density of urine is 1.005, the maximum is 1.030.

Deviations 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 casts. Normal values ​​per 1 ml of urine: red blood cells no more than 1000, white blood cells< 4000, цилиндров < 20.

Exceeding normal values ​​indicates leukocyturia and hematuria, which is observed in the pathological condition of the urinary system.

GENERAL URINE ANALYSIS

A general urine test is included in the list of mandatory tests that should be performed on all patients who initially apply, regardless of the expected diagnosis.

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

Standards for general urine analysis (standards for deciphering general urine analysis)

Indicators: Result

Amount of urine delivered for analysis: Has no diagnostic value

Urine color: Various shades of yellow

Urine clarity: Clear

Urine odor: Mild, 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: Absent

Glucose in urine: Absent

Ketone bodies in urine: Absent

Bilirubin in urine: Absent

Urobilinogen in urine: 5-10 mg/l

Hemoglobin in urine: Absent

Red blood cells in urine (microscopy): 0-3 per field of view for women

0-1 in sight for men

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

0–3 in view for men

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

Casts in urine (microscopy): Absent

Salts in urine (microscopy): None

Bacteria in urine: None

Mushrooms in urine: None

Sample collection and preparation for general urine analysis

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

The container for collecting urine for analysis must be clean and dry. In poorly washed dishes, urine quickly becomes cloudy and becomes alkaline.

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

Urinalysis according to Nechiporenko

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

Why is urine analysis performed according to Nechiparenko?

A Nechiporenko urine test is usually prescribed after a general urinalysis if deviations from the norm were detected in the clinical analysis. Urinalysis according to Nichiporenko will allow us 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 analysis performed?

To analyze Nicheporenko’s urine, doctors use 1 milliliter of the patient’s urine sample and count the number of urine components (per 1 milliliter): red blood cells, leukocytes and casts using a special counting chamber.

Nechiporenko urine analysis standards:

Red blood cells - 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 formed elements of urine can confirm or refute the results of a general urine test. The studies carried out ensure maximum accuracy of the diagnosis.

How to take a urine test according to Nechiporenko?

After a thorough toilet of the genital organs, collect an average portion of urine: 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 container.

Material for research: average portion of morning urine.

Urinalysis time according to Nechiporenko: 1.5 hours.

An increase in leukocytes in urine analysis 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), increased body temperature, weakness, headaches, loss of appetite, etc. In urine analysis according to Nechiporenko, with pyelonephritis, not only an increase in leukocytes is observed, but also hematuria (increased number red blood cells in the urine), pyuria (presence of pus in the urine), bacteriuria (presence of bacteria in the urine), proteinuria (excretion of protein in the urine).

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

An increase in red blood cells in urine analysis 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, with acute glomerulonephritis, gross hematuria (urine the color of “meat slop”) is noted. The main symptoms of acute glomerulonephritis are the following: the appearance of blood in the urine, increased blood pressure, severe edema, and a decrease in the amount of urine excreted (oliguria). A urine test reveals hematuria (presence of red blood cells in the urine), proteinuria (presence of protein in the urine), cylindruria (presence in the urine of cylinders “covered” with red blood cells - red blood cell casts).

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, swelling, blood in the urine.

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

4. Tumors of the kidneys and urinary tract cause hematuria. Tumors can be benign (papilloma, fibroma, hemangioma) and malignant. Hematuria with kidney tumors differs from hematuria with 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 begins suddenly and also disappears suddenly. Other symptoms of a kidney tumor are: 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 (gross hematuria - 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 urine when analyzed according to Nechiporenko

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

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

2. Pyelonephritis is an inflammatory disease of the kidneys. With pyelonephritis, urine analysis according to Nechiporenko usually shows leukocyturia (an increase in white blood cells in the urine), bacteriuria (the presence of bacteria in the urine) and cylindruria. In pyelonephritis, the most common forms are simple (or hyaline) casts, as well as epithelial casts (casts on which there are epithelial cells of the renal tubules).

3. Poisoning with nephrotoxic (poisonous to the kidneys) substances is also the cause of the appearance of casts in the urine. With toxic kidney damage, so-called waxy casts are observed in the urine. Waxy casts consist of cells from destroyed kidney tubules.

What does the Zimnitsky test determine?

A urine test according to Zimnitsky allows the doctor to determine the ability of the kidneys to concentrate urine. The concentrating ability of the kidneys is a natural regulatory mechanism that allows the body to maintain a constant fluid environment. For example, with an increase in the amount of fluid in the body (drinking plenty of fluids, liquid food), the kidneys excrete a larger amount of diluted urine.

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

One of the most informative parts of a general urine analysis is sediment microscopy, in which the number of different elements located 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 fluid consumed, as well as on the concentrating ability of the kidneys. Normal urine density ranges from 1.003 to 1.035. During the day, a person consumes an unequal amount of fluid, so the density of urine changes at different times of the day: during the day, urine is less dense due to fluid consumption, 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 are released during the day. Using the Zimnitsky test, they determine how much urine is excreted during the day and how much at night. Daily fluctuations in diuresis (different amounts of urine excreted during the day and during the night) can reveal some abnormalities in the functioning of the kidneys or heart.

How is urine collected for the Zimnitsky test?

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

The subject is given 8 jars, each of which must contain urine after 24 hours. At 6 a.m. on the first day, the subject empties his 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 a.m. of the next day. A total of 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. It is recommended that urine tests be kept refrigerated until they are sent to the laboratory.

What are the standards for the Zimnitsky test?

Using the Zimnitsky test, several parameters of kidney function are assessed: 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 amount of 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 one serving is 50 ml. Or, in one portion of urine the density is 1.008, and in another portion it is 1.022.

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

When performing the 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 density of urine is the result of the Zimnitsky test, in which in none of the portions the density of urine does not exceed 1.012-1.013. Low urine density is called hyposthenuria and indicates a violation of the concentrating ability of the kidneys.

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

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

4. blood there is an increase in the level of creatinine, urea, etc.

5. Exacerbation of bilateral pyelonephritis, or inflammation of the pelvis of both kidneys is also the cause of decreased urine density. With pyelonephritis, the main symptoms are: periodic pain in the lumbar region, increased body temperature to high levels, headaches, nausea, etc.

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

Low urine density, which practically does not change depending on the time of day or the amount of fluid taken, is called hypoisosthenuria. With hypoisosthenuria, 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. This result of the Zimnitsky test indicates that the kidneys are not able to adapt to the changing conditions of fluid entering 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 secrete or absorb back (reabsorb) certain substances.

The test method consists of collecting urine from a patient in the morning on an empty stomach in a supine position for 1 hour and in the middle of this period of time taking 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 (GFR), calculated in this way, is 130-140 ml/min.

A decrease in CF is observed in acute and chronic nephritis, kidney damage due to hypertension and diabetes mellitus - glomerulosclerosis. The development of renal failure and an increase in nitrogenous waste in the blood occurs when the EF decreases to approximately 10% of normal. In chronic pyelonephritis, the decrease in CP occurs later, and in glomerulonephritis, on the contrary, earlier than the impairment of the concentrating ability of the kidneys.

A persistent drop in EF 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 connecting the patient to a machine." artificial kidney" or kidney transplant.

Tubular reabsorption normally ranges from 95 to 99% and may decrease to 90% or lower 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 with a primary wrinkled kidney (against the background of chronic glomerulonephritis, pyelonephritis) or a secondary wrinkled kidney (for example, observed with hypertension or diabetic nephropathy).

Review urogram covers the area from the upper poles of the kidneys to the beginning of the urethra. Any X-ray examination of a patient with a urological disease should begin with a survey image. Often, a diagnosis can be made just by looking at an overview image. When interpreting a plain radiograph, the skeletal condition must be taken into account. Of great diagnostic value is the identification of abnormalities in the development of the spine (lumbarization, sacralization, spina bifida), pathological changes in the musculoskeletal system (scoliosis, deforming spondylosis, spondylitis, tuberculosis, tumor metastases).

It is more correct to determine the location of the kidneys by the spine. The contours of normal kidneys on an x-ray are smooth and their shadows are homogeneous.

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

Unchanged ureters are not visible on the survey image. The shadow of the bladder filled with urine has the shape of an ellipse.

Additional, i.e. pathological, shadows can be very diverse and relate to different organs and tissues. Any shadow that has some 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. The question of the relationship of the detected shadow to the urinary tract can be resolved using radiocontrast research methods.

Intravenous urography - This is an x-ray examination that is used to assess the pathology of the kidneys, bladder, and urethra. These structures make up the urinary tract. With conventional X-ray examination, 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 x-rays according to the structure of the kidneys, ureter, and bladder, which appears on the x-ray as a white image.

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

What is intravenous urography used for?

Intravenous urography is indicated in the following situations:

Kidney stones. Kidney or ureteral stones can be clearly visualized with intravenous urography.

Urinary tract infection. If a bladder or kidney infection recurs, EUS can help find the cause of obstruction or other urinary tract abnormalities.

Blood in urine. This can occur for various reasons, such as infection, inflammation, kidney tumor. ES will help determine the cause.

Obstruction or damage at any level of the urinary tract can often be detected by EC.

What preparation is needed before intravenous urography?

Your kidneys must be able to produce contrast dye. Therefore, this procedure is rarely performed in patients with 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 agents containing iodine.

You should not eat for several hours before the test. This ensures that your bowels are sufficiently cleared of food, making the X-ray image clearer.

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

You must sign a consent to this procedure.

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

How is intravenous urography done?

You will be asked to remove your clothes and lie down on a couch. Contrast material is injected into a vein in your arm. Some burning may occur. The contrast penetrates into the kidneys and ureter. Several x-rays will be taken, usually every 5-10 minutes. You will remain on the couch between scans and may be asked to stand up to empty your bladder before the final scan. The procedure usually takes 30-60 minutes. However, sometimes delayed images are taken after a few hours. You can go home immediately after the procedure is completed. After the procedure you can eat.

Undesirable effects and risks of intravenous urography

After the contrast is administered, you may experience a feeling of warmth and a metallic taste in your mouth, but this usually goes away quickly.

An allergic reaction to paint is rare. It may be mild, such as a rash and mild swelling of the lips.

More serious manifestations, such as difficulty breathing and a drop in blood pressure, are rare. It must be emphasized that serious adverse effects are rare and the department where the procedure is performed always has all the necessary medications available to eliminate this condition.

A rare complication is renal failure.

Some other information about excretory urography:

If possible, no X-ray examinations should be performed in pregnant women, as there is a risk that the contrast agent will cause developmental abnormalities in the unborn child.

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

Urethrography is a type of contrast X-ray examination that is used to diagnose diseases of the urethra (urethra), such as narrowing or strictures, neoplasms, stones and foreign bodies, as well as damage, trauma and urethral fistulas.

Cystography is also a type of contrast X-ray examination that is used to diagnose diseases of the bladder and prostate gland such as stones and foreign bodies, tumors, diverticula, chronic cystitis and pathological wrinkling (atrophy with a decrease in functioning volume), hyperplasia or excessive distension, fistulas Bladder. Cystography can detect bladder function disorders, including abnormal contractions and so-called vesicoureteral reflux (pathological reflux of urine from the bladder into the ureter). Cystography is also used to determine the causes and plan treatment of 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 can be ascending or descending, and can also be performed in static and dynamic mode (the so-called voiding urethrocystography or a study that is carried out during urination). These studies are performed in the X-ray room, with the patient lying on the X-ray table. The tests are performed and/or supervised and interpreted by a urologist. In ascending research options, an X-ray contrast agent (Urografin™, Ultravist™, Omnipaque™, 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 performing the examination, an x-ray is taken. In descending versions of urethrography and cystography, an x-ray contrast agent is injected into a vein and after filling the bladder with x-ray contrast urine, an x-ray of it is taken. Descending urethrography is always voiding, i.e. performed during urination. To obtain good quality images, it is sometimes necessary to take several photographs or radiographs.

Urethrography and cystography in all variants are little or completely painless and do not require anesthesia. For some particularly pain-sensitive male patients, as well as female patients suffering from interstitial cystitis, an anesthetic is injected into the urethra and bladder (we use Kategel™ or a 2% lidocaine solution). No special preparation is required for urethrography and cystography. The procedures are performed on an outpatient basis.

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

Nephrotropic drugs are used as isotopes, that is, selectively secreted by the kidneys and labeled with radioactive iodine. Hippuran has found the greatest application. 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 of a normal kidney, three phases, or segments, are distinguished: vascular, secretory (tubular) and excretory (excretory). The vascular segment (AV) reflects the degree of blood filling and vascularization of the kidney and perinephric space. The normal duration of this phase is 20 s. The secretory (SS) segment reflects the process of 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 minutes, 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 renogram is interpreted based on its form (qualitative analysis) and evaluation of numerical indicators, the most common of which are:

Tmax - time to achieve the maximum rise in the curve (normally 3-4 minutes);

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

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

There is an increase in the time of the additional segment of the renogram, which often occurs with significantly severe 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 isotope renography method 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 good development of collateral vessels, the presence of a normal renogram before surgery in cases of severe stenosis of the renal artery cannot be excluded. We have seen similar cases.

The most reliable data from radioisotope renography (coincidence with the results of angiography on average in 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.). Characterized primarily by a decrease in the height of the vascular segment and an increase in the time of maximum rise of the curve. With bilateral lesions, assessing 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 renovascular hypertension, the very fact of the presence of these changes is decisive. The method is of 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.

Renal scintigraphy (nephroscintigraphy)

Renal scintigraphy or radionuclide scanning of the kidneys (renoscintigraphy, nephroscintigraphy) is a diagnostic test that involves injecting a small amount of radioactive medicine (a radioactive tracer) into the body and obtaining images 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 tests - such as X-rays, ultrasound or computed tomography (CT) - provide information about the structure of the kidneys, radionuclide testing provides the opportunity to study kidney function. Candidates for renal scintigraphy may include patients with acute or chronic renal failure, urinary obstruction, renal artery stenosis, kidney transplant, renal trauma, reflux nephropathy, renal vascular disease and/or hypertension, or congenital anomalies. .

Precautions when performing kidney scintigraphy (nephroscintigraphy)

Renal scintigraphy requires the use of radioactive material; Therefore, in pregnant women or women who suspect that they are pregnant, kidney scintigraphy is performed only when absolutely necessary. Women should tell their doctor if they are breastfeeding. The doctor recommends that the woman stop breastfeeding for a period of time, which depends on the type and dose of the radioactive drug.

Description of kidney scintigraphy (nephroscintigraphy)

Renal scintigraphy is performed in the nuclear medicine department of a hospital or clinic. The patient is positioned in front of or under the gamma camera. A gamma camera is a special piece of equipment that detects radiation (gamma rays) emitted by radioactive medicine that has accumulated in the patient's body and produces an image. A radioactive drug is injected intravenously. Immediately after the injection, the study begins - the blood flow in each kidney is assessed. A sequence of images is obtained at specific time 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 drug called technetium DTPA (Tc99m DTPA). This radioactive medicine may also reveal a blockage in the urine collection system in the kidneys.

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

Kidney 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 renal dysfunction, but cannot always determine the nature of this disorder. Radionuclide studies of the kidneys are useful for obtaining information about how different structures of the kidneys work, which in turn can help make the correct diagnosis.

Typically, images are obtained in a direct projection, but images can be obtained at oblique angles. If necessary, the patient can be positioned to obtain renal motility data, i.e. sitting or lying down while images are obtained. If obstruction (blockage) or kidney function is assessed, a diuretic (a drug to induce urination) such as Lasix is ​​given. If hypertension or renal artery stenosis is assessed, captopril or enalopril (ACEIs, angiotensin-converting enzyme inhibitors) are administered.

Preparation for kidney scintigraphy (nephroscintigraphy)

No special preparation is required for kidney scintigraphy. For some types of tests, the patient must drink extra fluid and empty their bladder before the test. If the patient has recently undergone another radionuclide study, then it is necessary to refrain from repeat studies for a certain period of time so that residual radioactivity does not accumulate. The patient must remove all metal objects from the examination area.

After kidney scintigraphy (nephroscintigraphy)

Patients can return to their normal lifestyle immediately after kidney scintigraphy. Most radioactive drugs are eliminated through the urinary system, so increasing fluid intake after a kidney scintigraphy will help clear the radioactive drug from the body more quickly.

Complications of kidney scintigraphy (nephroscintigraphy)

Nuclear medicine research is safe. Unlike some contrast agents used in kidney x-rays, radioactive medicines rarely cause side effects. There are no long-term effects of radioactive drugs, since they quickly decay and do not have any immediate functional effects on body tissues. When radioactive drugs are administered, your blood pressure may temporarily rise or fall, or you may feel the urge to urinate.

Results of kidney scintigraphy (nephroscintigraphy)

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

The importance of urine testing can hardly be overestimated both in terms of the volume and objectivity of the information obtained. For general analysis, the entire morning portion of urine excreted during free urination is collected. Urine is examined no later than 1-2 hours after collection. A general urine test includes: examination of the physical and chemical properties of urine, microscopic examination of urinary sediment.

Physical properties of urine

Urine color

The color of urine depends on the amount of fluid taken and the concentrating ability of the kidneys. Prolonged discharge of pale, colorless or watery urine is characteristic of diabetes insipidus and diabetes mellitus, chronic renal failure. Intensely colored urine is released during large extrarenal fluid losses (fever, diarrhea).

A pink-red or red-brown color caused by the admixture of “fresh” blood occurs with urolithiasis, tumors, kidney infarction, and tuberculosis. Urine excretion that looks like “meat slop” is typical for patients with acute glomerulonephritis. Dark red color of urine appears with massive hemolysis of red blood cells. With jaundice, urine becomes brown or greenish-brown in color (“beer color”). Black urine is characteristic of alkaptonuria, melanosarcoma, and melanoma. Milky white urine appears with lipiduria.

Urine clarity

In pathology, turbidity of urine is associated with the presence in it of a large amount of salts, cellular elements, bacteria, mucus, and lipids. Turbidity that appears in standing urine is usually due to salts and is usually not significant.

Urine smell

When standing for a long time, due to the formation of ammonia from urea, it acquires a pronounced ammonia odor. When protein, blood, and pus decompose in the urine, a putrid odor appears. Freshly released urine may also have a putrid odor due to disintegrating bladder cancer or diverticulum. The smell of acetone appears in cases of decompensated diabetes mellitus and protein starvation.

Urine reaction

A sharply acidic urine reaction appears in diabetes mellitus, especially ketoacidosis; kidney tuberculosis; renal failure; acidosis; with hypokalemic alkalosis. Alkaline urine reaction is observed relatively rarely and is a consequence of: chronic urinary tract infection (breakdown of urea by bacteria); use of alkalizing therapy (sodium bicarbonate); alkalosis; hyperchloremic acidosis caused by damage to the renal tubules. The reaction of urine is important for the formation of urinary stones: a sharply acidic reaction (pH less than 5.5) predisposes to the formation of urate stones; in alkaline urine, oxalate and phosphate stones are more often formed.

Relative density of urine

This indicator reflects the concentration ability of the kidneys. The density of urine is determined relative to distilled water, the density of which is taken as 1.000.

The maximum relative density of urine gives an idea of ​​the concentration function of the kidneys. This kidney function is considered normal if the relative density of the most concentrated morning urine is above 1.018. In the case when morning urine has a density of less than 1.018, the study should be repeated, and if low relative density of urine is re-identified, a Zimnitsky test should be performed.

A decrease in the relative density of urine is observed:

• with excessive fluid intake;
• with a low-salt and low-protein diet;
• when swelling disappears;
• when taking diuretics;
• with pituitary insufficiency with a decrease in antidiuretic hormone in the blood;
• for kidney diseases with tubular damage (tubulointerstitial nephritis, polycystic kidney disease, Fanconi syndrome);
• prolonged excretion of low-density urine (if the above reasons are excluded) indicates chronic renal failure.

An increase in the relative density of urine is observed:

• with large extrarenal fluid losses (fever, diarrhea, uncontrollable vomiting);
• for diabetes mellitus (1% sugar in urine increases density by 4 notches);
• with high proteinuria (every 4 g/l of protein increases the density by 1 division).

Chemical properties of urine

In a chemical study of urine, the content of protein, glucose, ketone bodies and bile pigments is determined.

Proteinuria

Proteinuria is the excretion of protein in the urine in quantities exceeding normal values. This is the most common sign of kidney damage.

Based on its association with diseases, proteinuria is divided into functional and pathological.

Functional proteinuria occurs in patients with healthy kidneys. Functional proteinuria is low (up to 1 g/day), usually transient, isolated (there are no other signs of kidney damage), rarely combined with erythrocyturia, leukocyturia, cylindruria. There are several types of functional proteinuria:

• Orthostatic - according to the source - glomerular, occurs in young people 13-20 years old, does not exceed 1 g / day, disappears in the supine position. This type of proteinuria is diagnosed using an orthostatic test - the patient collects the first morning portion of urine without getting out of bed, then performs a small physical activity (walking up the stairs), after which the second portion of urine is collected for analysis. The absence of protein in the first portion and the presence of urine in the second portion indicate orthostatic proteinuria.
• Fever - according to the source - glomerular, up to 1-2 g/day. It is observed during febrile conditions, more often in children and the elderly, and disappears when body temperature normalizes.
• Proteinuria of tension (marching) - occurs after severe physical stress, is detected in the first portion of urine, disappears with normal physical activity.
• Proteinuria in obesity develops against the background of increased concentrations of renin and angiotensin. With weight loss and treatment with ACE inhibitors, it may decrease and even disappear.
• Pregnancy can lead to physiological proteinuria. Its level should not exceed 0.3 g/day.
• Idiopathic transient - detected in healthy individuals during a medical examination and is absent in subsequent urine tests.

Pathological proteinuria is detected in diseases of the kidneys, urinary tract and also when exposed to extrarenal factors and occurs in the following diseases: myeloma (Bence-Jones proteinuria), rhabdomyolysis, Waldeström macroglobulinemia, massive intravascular hemodisease, glomerulonephritis (primary and in systemic diseases), renal amyloidosis , diabetic glomerulosclerosis as well as hypertension, “congestive” kidney, interstitial nephritis, pyelonephritis, congenital tubulopathies (Fanconi syndrome).

According to the degree of severity (magnitude), proteinuria can be:

• Microalbuminuria - the excretion in urine of minimal albumin, only slightly exceeding the physiological norm (from 30 to 300 - 500 mg/day), is the first early symptom of diabetic nephropathy, kidney damage due to arterial hypertension, and kidney transplant rejection.
• Low (up to 1 g/day) and moderate (from 1 to 3 g/day) is observed in various diseases of the kidneys and urinary tract (glomerulonephritis, pyelonephritis, nephrolithiasis, kidney tumors, tuberculosis).
• High or nephrotic proteinuria is a protein loss of more than 3.5 g/day. The presence of high proteinuria combined with hypoalbuminemia is a sign of nephrotic syndrome.

Glucosuria

There are physiological and pathological glucosuria. Physiological glycosuria is observed when eating large amounts of sugar, when the concentration of glucose in the blood exceeds the renal threshold for it (9.9 mmol/l). As a rule, it is unstable, transient and is combined with a temporary increase in blood glucose. Physiological glycosuria can develop during pregnancy. The causes of pathological glycosuria are: diabetes mellitus, renal glycosuria (renal diabetes), interstitial nephritis, Fanconi syndrome.

Ketone bodies

With a lack of carbohydrates in the body (fasting, cachexia, a carbohydrate-free diet) or with insufficient absorption of them (diabetes mellitus), as well as disorders accompanied by acidosis and insufficient combustion of carbohydrates, the destruction of acetone bodies is delayed, they accumulate in the blood, and they begin to be excreted with urine.

Bile pigments

Bile pigments - bilirubin, biliverdin - appear in the urine when conjugated (direct) bilirubin accumulates in the blood and are a sign of cholestasis. These pigments give urine its characteristic brown, dark yellow, or green color. Urobilin is formed in the intestines from bile pigments; it is found in small amounts in normal urine. Urobilin increases in the blood and appears in the urine in all conditions accompanied by increased breakdown of hemoglobin in the body (hemolytic jaundice, malaria) and in cases of impaired liver function (parenchymal jaundice). With obstructive jaundice, urobilin completely disappears from the urine and reappears when the outflow of bile is restored.

Epithelial cells

Urine sediment may contain 3 types of epithelial cells. Squamous epithelial cells originate from the lower parts of the urinary tract: the bladder, urethra, and in women also from the vagina and vulva. A significant number of cells, located in groups and closely adhered to each other, indicates desquamation of the epithelial cover of the urinary tract, which is most typical for inflammatory processes in the lower urinary tract.

Columnar epithelial cells originate from the ureter and are separated from the stratified epithelium of the lower urinary tract.

Renal tubular epithelial cells are observed in urine sediment in nephrotic syndrome, tubulointerstitial nephritis, and tubular necrosis. An increase in the content of degeneratively changed renal epithelial cells in urine sediment is observed at the beginning of a crisis of kidney transplant rejection.

Red blood cells

The presence of even single red blood cells in each field of view is pathological and is called hematuria. Massive hematuria may be accompanied by the formation of clots. Large, shapeless clots that are difficult to pass when urinating indicate bleeding from the bladder. Long, worm-like clots that form in the ureters are characteristic of bleeding from the kidney or renal pelvis. Sometimes worm-like clots are released in polycystic kidney disease and nephrolithiasis, in the latter case they are preceded by renal colic.

The content of red blood cells in urine sediment up to 100 in the field of view of a microscope does not change the color of urine and is called microhematuria. To detect microhematuria, a general urine test is not always sufficient. With moderate and especially minimal hematuria, it is necessary to resort to quantitative methods for studying urinary sediment over time. To assess microhematuria, it is preferable to use the Nechiporenko method, because it eliminates the loss of cells associated with urine storage. Hematuria occurs in the following diseases: thrombocytopenia and thrombocytopathies, hemophilia, disseminated intravascular coagulation syndrome, overdose of anticoagulants, nephritis, nephropathies, renal venous hypertension, destructive processes in the renal tissue (tumor decay, abscess, kidney infarction), as well as mechanical damage to the renal tissue (trauma , kidney stones), nephroptosis, anomalies in the development of renal vessels, cystitis, urethritis.

Leukocytes

In a healthy person, single leukocytes are found in the urine sediment (0-3 in the field of view in men and 0-5 in women). The release of leukocytes in the urine in quantities of more than 5 in the field of view of a microscope is called leukocyturia. The presence of more than 60 leukocytes in the field of view is called pyuria. If there is a slight leukocyturia, it is necessary to evaluate it quantitatively. The Nechiporenko and Kakovsky-Addis methods make it possible to more accurately determine the presence, severity and dynamics of leukocyturia. After identifying leukocyturia, its source is determined - from the urinary tract or kidneys. Massive leukocyturia, pyuria is almost always infectious, moderate leukocyturia (up to 30-40 in the field of view) can also be aseptic. Infectious leukocyturia is characteristic of acute and chronic pyelonephritis and cystitis. With a latent course of pyelonephritis, leukocyturia may not be detected. Aseptic leukocyturia is observed during exacerbation of chronic glomerulonephritis and chronic kidney transplant rejection.

Cylinders

Cylinders are formed in the distal tubules and are proteinaceous (hyaline and waxy), and cellular cylinders containing various inclusions in the protein matrix (epithelial cells, erythrocytes, leukocytes, fats, salts). Hyaline casts are the most common type of casts in kidney pathology. Their number increases sharply with proteinuria of pre- and renal origin. Waxy casts are found more often in chronic glomerulonephritis, but can also be observed in acute glomerulonephritis. Cellular casts are detected during inflammatory, destructive or hemorrhagic processes in the nephron; they always indicate the renal origin of their constituent cells. Erythrocyte casts appear in hematuria of glomerular origin (glomerulonephritis, vasculitis). Leukocyte casts are characteristic of acute and chronic pyelonephritis; they are rarely detected in glomerulonephritis, but in this case they consist of lymphocytes.

Eosinophilic casts are detected in acute drug-induced nephritis. Fatty casts are detected only in nephrotic syndrome. Granular casts are detected in glomerulonephritis, especially in nephrotic syndrome.

Inorganic sediment

Inorganic sediment is of little clinical significance. The nature of the inorganic sediment depends on the reaction of the urine. In an acidic environment, uric acid, urates, and oxalates are found; in an alkaline environment, amorphous phosphates, tripelphosphates, and ammonium urate are found.

With parenchymal and obstructive jaundice, bilirubin crystals may appear in the urine, and with severe damage to the renal parenchyma, leucine and tyrosine crystals may appear. Prolonged retention of blood in the bladder leads to the formation of hematoidin crystals in the urine. The presence of fat droplets in the urine (chyluria) is observed in certain types of tubular lesions—a disruption of the normal communication between the urinary and lymphatic tracts. In patients with nephrotic syndrome, birefringent lipid crystals are found in the urine, which are called “Maltese crosses” for their shape.

Norms

Physical properties of urine

Chemical properties of urine

Diseases for which a doctor may prescribe a general urine test

1. Diabetic nephropathy

   Microalbuminuria - the excretion in urine of minimal albumin, only slightly exceeding the physiological norm (from 30 to 300 - 500 mg/day), is the first early symptom of diabetic nephropathy. With nephropathies, hematuria occurs. The appearance of protein is noted.

2. Nephrotic syndrome

   The presence of high proteinuria combined with hypoalbuminemia is a sign of nephrotic syndrome. With nephrotic syndrome, renal tubular epithelial cells, fatty casts (only with nephrotic syndrome), granular casts, birefringent lipid crystals, which are called “Maltese crosses” for their shape, are observed in the urine.

3. Acute glomerulonephritis

   With glomerulonephritis, granular and erythrocyte casts may be detected in the urine. Rarely with glomerulonephritis, leukocyte casts are found, but in this case they consist of lymphocytes. In acute glomerulonephritis, waxy casts can sometimes be observed. Aseptic leukocyturia is observed during exacerbation of chronic glomerulonephritis.

4. Chronic tubulointerstitial nephritis

   With tubulointerstitial nephritis, there is a decrease in the relative density of urine. Cells of the renal tubular epithelium are observed in the urine.

5. Acute pyelonephritis

   Acute pyelonephritis is characterized by leukocyte casts in the urine and infectious leukocyturia. With a latent course of pyelonephritis, leukocyturia may not be detected. In terms of severity (magnitude), pathological proteinuria in pyelonephritis can be low (up to 1 g/day) and moderate (from 1 to 3 g/day).

6. Diabetes insipidus

   Diabetes insipidus is characterized by prolonged production of pale, colorless or watery urine.

7. Polycystic kidney disease

   With polycystic kidney disease, there is a decrease in the relative density of urine. Sometimes, with polycystic kidney disease, worm-like clots are released.

8. Obstructive jaundice

   With jaundice, urine becomes brown or greenish-brown in color (“beer color”). With obstructive jaundice, urobilin completely disappears from the urine and reappears when the outflow of bile is restored; Bilirubin crystals may appear in the urine, and in case of severe damage to the renal parenchyma, leucine and tyrosine crystals may appear.

9. Hemolytic anemia

   With hemolytic jaundice, due to increased breakdown of hemoglobin in the body, urobilin increases in the blood and appears in the urine.

10. Benign neoplasm of the kidney

    With kidney tumors, pink-red or red-brown color of urine is noted, due to the admixture of “fresh” blood. When a kidney tumor disintegrates, hematuria occurs.

11. Chronic glomerulonephritis

    With glomerulonephritis, proteinuria in severity (magnitude) can be low (up to 1 g/day) and moderate (from 1 to 3 g/day). With glomerulonephritis, granular, red blood cell casts are observed in the urine. Leukocyte casts are rarely seen in glomerulonephritis, in which case they consist of lymphocytes. Waxy casts are found more often in chronic glomerulonephritis. Aseptic leukocyturia is observed during exacerbation of chronic glomerulonephritis.

12. Chronic renal failure

    Chronic renal failure is characterized by prolonged production of pale, colorless or watery urine; prolonged release of low-density urine. In renal failure, the urine reaction is sharply acidic.

13. Chronic pyelonephritis

    With pyelonephritis, proteinuria in severity (magnitude) can be low (up to 1 g/day) and moderate (from 1 to 3 g/day). Chronic pyelonephritis is characterized by leukocyte casts in the urine and infectious leukocyturia. With a latent course of pyelonephritis, leukocyturia may not be detected.

14. Obesity

    Proteinuria in obesity develops against the background of increased concentrations of renin and angiotensin. With weight loss and treatment with ACE inhibitors, it may decrease and even disappear.

15. Acute renal failure

    Proteinuria is characteristic.

16. Systemic lupus erythematosus

    Proteinuria (more than 3.5 g/day), erythrocyturia, and cylindruria are noted.

17. Scleroderma

    Hematuria, proteinuria, and cylindruria are noted.

18. Mixed connective tissue disease

    Hematuria, proteinuria, and cylindruria are detected.

19. Periarteritis nodosa

    Proteinuria, microhematuria, and cylindruria are noted.

Urinary tract infections are the second most common after respiratory diseases, so people very often have to deal with urine tests. So what should a urine test be and how to read it correctly?

Normal urine test table

Below are the standards (in the table):

Urinalysis, deciphering the norm

The color of urine can range from light to deep yellow. Darkening of urine can occur with a number of diseases. It may be caused by the presence of blood in the urine (for example, with), or an increase in various pigments (with various jaundice, hereditary diseases). The color may change after taking certain medications.

Urine is normally clear and has no specific odor. Relative density may change with insufficient or excessive fluid intake, but its change may also indicate certain diseases (for example,).

Normally, urine contains no glucose, no protein, and no ketone bodies or bilirubin. The presence of protein may indicate amyloidosis, various connective tissue diseases.

Ketone bodies can occur with, as well as with acetone syndrome in children (often it can be against the background of viral infections, severe dietary violations). The presence of bilirubin in urine most often indicates a problem with the liver.

Urinalysis, deciphering the leukocyte norm

The leukocyte norm differs between men and women. The normal urine test for women suggests up to 6 leukocytes (Leu), and for a man this figure is 3. An increase in leukocytes above the normal level most often indicates inflammation in the urinary tract (urethritis).

Urine analysis, red blood cells are normal

For women, the norm of red blood cells is up to 3, for men up to 1 (in the field of view). If their number is higher than this, then this indicates the presence of blood in the urine. Most often this is caused by the presence and tumors.

The presence of salts (most often oxalates) in the urine indicates that either the person has or has a predisposition to their formation.

The presence of cylinders in the urine also indicates various disorders. But the presence of hyaline casts can also occur after normal physical activity.

Urinalysis analysis

The analysis may be written in the form of abbreviated notations, in which case it is necessary to decipher it.

These designations may include:

• S.G urine density,
• pH is its acidity,
• BLd - red blood cells,
• PRO - protein,
• Bil - bilirubin,
• NIT bacteria,
• KET - ketones,
• GLU - glucose,
• LEU - leukocytes.

Biochemical urine analysis (normal)

A biochemical analysis is necessary in some cases if there are deviations in a general clinical urine test to clarify the violations. The main biochemical indicators are glucose (normally up to 0.05 g per 1 liter), amylase (normally from 10 to 1240 units), sodium (normally within 100 - 260 mmol), potassium (normally from 39.4 to 82 mmol). Important indicators of kidney function are creatinine (normally for women it ranges from 0.48 to 1.44 g/l, for men slightly more - from 0.6 to 1.6 g per liter) and urea (normally 333 - 587 mmol) .

Urinalysis (normal) in children

In children, the norms of urine test results are almost the same as those in an adult. But at the same time, the specific gravity of a child’s urine is lower than that of an adult, and these indicators change from lower to higher as the child grows, reaching the adult norm by 12 years. Thus, the general analysis of a newborn and infant (their norm) may be almost no different from the analysis of an older person.

Urinalysis is normal according to Nechiporenko

The Nechiporenko analysis is performed if specific deviations were found in the general clinical analysis. Normally, the indicators should be as follows:

• The number of leukocytes in 1 ml is no more than 2 thousand;
• the number of erythrocytes in 1 ml is not more than 1 thousand;
• the number of cylinders in 1 ml is no more than 20.

Urinalysis (normal) according to Zimnitsky

The Zimnitsky analysis shows the total amount of urine that is excreted throughout the day and changes in its specific gravity. Normally, the following patterns should exist: the amount of total daytime urine should be slightly greater than the amount at night, and the specific gravity should range from 1010-1025 during the day to 1035 at night.

Urinalysis (normal) during pregnancy

The norms for all urine tests in pregnant women correspond to the general norms for urine tests in women. However, an increase in some indicators may indicate other diseases that occur exclusively in pregnant women: toxicosis, nephropathy in pregnant women, and preeclampsia.

Urine analysis for diastase is normal

This urine indicator may indirectly indicate liver disease and other inflammatory diseases. Normally, it can vary within 16-64 units.