Analysis of urine

A general urine analysis is a study that is carried out in a special laboratory and is prescribed to the patient in the process of diagnosing a disease. Urine analysis consists of the following stages:

• Organoleptic examination - includes an analysis of the amount of urine, its color, smell, foam and transparency.
• Physico-chemical analysis of urine - makes it possible to determine the specific gravity and level of urine acidity.
• A biochemical urine analysis is carried out to detect protein in the urine.
• Microscopic urine analysis allows you to determine the degree of presence of red blood cells and leukocytes.

It is the data obtained in the analysis of urine that serves to recognize chronic nephropathy, especially latent, and also allow assessing activity and, when performing in dynamics, the rate of progression of kidney damage and a response to the therapy.

[1], [2]

Collection of urine

Explore the average portion of morning urine. Microscopy should be done no later than 2 hours after urine collection. If immediate microscopy is impossible, urine should be preserved at low temperatures to prevent the reproduction of bacteria and lysis of cellular elements (red blood cells, leukocytes, cylinders). To maintain the integrity of red blood cells and leukocytes, obviously alkaline urine is acidified. If it is impossible to fulfill the rules for collecting urine, for example, in patients with consciousness disorders, it is recommended to carry out catheterization of the bladder.

[3], [4], [5], [6], [7]

How to take urine analysis?

For analysis, morning urine is usually taken. Before emptying the bladder, it is necessary to carry out the procedure of intimate hygiene using soap. The urine should be drained into a plastic container that is sold in a pharmacy. Urine analysis is usually carried out no later than an hour and a half after urine collection. Before taking urine analysis, it is forbidden to take medications, as this can affect the results, you cannot leave urine at minus temperature.

Urine analysis by Nechiporenko

Analysis of urine by Nechiporenko allows you to detect inflammatory processes occurring in the urinary tract and determine the level of the content of leukocytes, red blood cells and cylinders. Normally, the following indicators are allowed: leukocytes - up to 2000 ml in men's sex and up to 4000 ml in female persons; red blood cells - up to 1000 ml; Cylinders - up to 20 ml. Before you take the urine, it is necessary to pre-prepare a dry plastic container, in which you need to collect about 200 ml of morning urine (at least fifty-hundred milliliters). The urine analysis is carried out as follows: shaken the assembled urine, then selected a little into the test tube, which is centrifugged for several minutes, then the upper part is collected, and 1 milliliter of urine with the sediment is left in the tube, which is thoroughly stirred and placed in a special camera, after which the number of leukocytes, red blood cells and cylinders are calculated.

Urine analysis during pregnancy

In case of pregnancy, women have to take urine analysis almost every week. The genitourinary system of a pregnant woman is subjected to a double load, since during pregnancy the uterus not only increases, but also compression on the kidneys, the bladder associated with the growth and arrangement of the fetus. Therefore, the delivery of urine analysis during pregnancy is a mandatory regular procedure. For pregnant women, the presence of a small amount in the urine of the protein may be the norm, although there is no protein in the urine in the usual state. If more than three hundred mg of protein is found in the urine in a pregnant woman, this can signal the pathologies of the kidneys, including chronic ones, which could exacerbate during pregnancy. In such cases, inpatient treatment is prescribed. Proteinuria (protein in the urine), which occurs at the 32nd week of pregnancy, can signal the development of nephropathy, be accompanied by an increase in pressure, impaired functioning of the placenta. In the urine of pregnant women, various bacteria are often found. Bacteriuria can cause the development of pyelonephritis, which can cause a threat of premature birth. Of particular importance is the analysis of urine for asymptomatic bacteriuria, since only in this way can hidden pathologies be detected. There should not be leukocytes in the urine of pregnant women; an increased level of salts may also indicate about the disorders of the genitourinary system. If ketone bodies were detected in the urine of the pregnant woman, this may indicate the development of toxicosis. With a lack of potassium, as well as toxicosis in the urine, the level of acidity can be lowered. An analysis of urine during pregnancy includes the study of coloring and transparency, density, epithelium, bilirubin, red blood cells and cylinders. In the case of adverse results, additional urine tests are prescribed - according to the Nechiporenko method, as well as bacterial urine and others.

Microscopy of urinary sediment

The study of the constituent elements of urinary sediment is of great practical importance, including to establish the level of localization of the pathological process in the urination system. Elements of urine sediment are divided into organic (cellular elements, cylinders) and inorganic (crystals of various salts).

Among organic elements of urine sediment, epithelial cells, red blood cells, white blood cells and cylinders are examined.

Epithelial cells

Epithelial cells are differentiated by the type of epithelium. Cells of flat epithelium come from the lower uric tract; An increase in their content of more than 1-2 in the field of view, especially their large number of their inflammatory processes in the bladder or urethra. A source of cellular epithelium cells - renal pelvis and ureters; An increase in their number is observed with pyelonephritis and urethritis. The cells of the renal tubular epithelium are rounded, their detection as part of complexes with cylinders or in large groups indicates their renal origin. This type of cells is detected with various kidney diseases (tubulo-stistical nephritis, chronic glomerulonephritis, including lupus).

[8], [9]

Red blood cells

Erythrocytes detect in the precipitate of urine of healthy faces in the amount of 0-1 in the field of view.

The presence of a patient with macrohematuria is judged by a characteristic change in urine color; To distinguish it with myoglobinuria and hemoglobinuria, there are special tests (“hematuria”).

[10], [11], [--], [13], [14 -] [16]

Leukocytes

Leukocyturia - an increase in the content of leukocytes in urinary sediment (norm - 0-1 in the field of view of a microscope in men and up to 5-6 in women). To accurately determine the source of leukocyturia, differential diagnostic tests are used to establish the population composition of urinary precipitate leukocytes.

An infectious leukocyturia is distinguished, characteristic of many infectious and inflammatory diseases of the urinary system (including pyelonephritis). The infectious nature of the leukocyturia can be approximately by detecting bacteria-bacteriuria in urinary sediment (more than 1x10 ⁵/ml of urine). When sowing urine, false negative results are often obtained due to the fact that even insignificant violations of the rules of the fence and storage of samples are affected by the accuracy of this method. Aseptic leukocyturia, characteristic of many forms of chronic glomerulonephritis, analgesic nephropathy; Sometimes observed with amyloidosis.

Cylinders

The cylinders are formed when the Tamm-Horsfall Uromboid is combined (protein secreted by epithelialocytes of the ascending knee of the Henle loop in normal), plasma proteins that have passed the glomerulus membrane, and specific components (cells, fat particles).

• Hyalin cylinders consist only of protein molecules, they are found in various kidney diseases and normal (not more than 100 in 1 ml of urine).
• Waxy cylinders consist of plasma proteins and act as a sign of chronic nephropathy.
• Cell cylinders (red blood cells, leukocyte) always have an kidney origin and indicate the lesion of the kidney parenchyma.
• Fat cylinders are detected with significant proteinuria, including nephrotic syndrome.
• Grain cylinders are a sign of kidney disease.

[17], [18], [19], [20]

Inorganic elements of urine sediment consist of crystals of various salts

The detection of uric acid crystals, calcium oxalate, amorphous urates and phosphates, as well as tripelphosphates in itself is not a sign of kidney damage, urine analysis and clinical data should be taken into account.

The presence of cholesterol, cystine, tyrosine and leucine in the urine always indicates the lesion of the kidneys. Cholesterol crystalluria is observed in patients with nephrotic syndrome; The crystals of Tyrosin and Leucine indicate a prognostically unfavorable liver damage.

Bacteria, fungi, protozoa and parasites are also found in urinary sediment. Bacteriuria is most significant in combination with leukocyturia; To clarify its genesis, it is advisable to conduct a bacteriological study of urine. Of the mushrooms in uric precipitation, representatives of the genus Candida are most often found, especially in patients with diabetes or immunosuppressive therapy. Sometimes they find amoeba; In the presence of dysuria, this indicates the genitourinary amoebiasis. Schistosoma haematobium egg detection indicates an invasion of the urinary tract.

[21], [22], [23], [24], [25], 26 [27]

General urine analysis: normal indicators

The normal color of urine ranges from light yellow to dark yellow. Too intense yellow color usually indicates increased urine density, which is usually observed during dehydration, too bright urine, on the contrary, suggests that the density is low. This means that there is a probability of renal failure. Any changes in the color of urine from pale pink to dark brown can be indicators of serious pathological processes. At the same time, taking some drugs, as well as abundant consumption of beets and carrots, can also affect the color of urine. If during the analysis it was found that the urine is not transparent, this can be explained by the presence of bacteria, red blood cells, salts, fat, mucus, etc. if you shake it, foam will appear on it. If the foam is muddy, abundant and persistent, this may mean that there is protein in the urine. Normally, foam is transparent and quickly soluble. If in the urine the protein level is more than 0, 033 g/l, this is considered a deviation from normal indicators.

Deciphering urine analysis

Urine analysis includes the assessment of the following parameters.

• Color, transparency.
• Relative density.
• Chemical tests:
  • PH;
  • Protein;
  • Glucose;
  • Ketone bodies;
  • Hemoglobin (determined, as a rule, with the corresponding change in urine color);
  • Urobilinogen;
  • Mioglobin (determined, as a rule, with an appropriate change in urine color).
• Microscopy:
  • Crystals - urates, phosphate, oxalat or calcium carbonate, tripel phosphate, cystine, medicinal;
  • Cells - leukocytes, red blood cells, cells of the canal epithelium, urinary tract, atypical cells;
  • Cylinders - hyalin, granular, erythrocyte, leukocyte, epithelial, waxy, granular, lipid;
  • Infectious agents - bacteria, fungi, parasites.

Urine analysis implies a mandatory determination of protein content, cellular elements (red blood cells, leukocytes), bacteria and some other indicators. In addition, with the help of additional research methods in the urine, active forms of leukocytes are found, as well as the content of chemokins, growth factors and vasoactive molecules.

To diagnose microalbuminuria, a standard express test is used to monitor its size, including on an outpatient basis.

Color and transparency of urine

Fresh urine is normal transparent. The cause of clouding of urine is set using additional tests.

• The disappearance of clouding after heating of urine to 60 ° C indicates the excessive content of urates and uric acid in it.
• If urine becomes transparent after adding 10% acetic acid, then there is an excess of phosphates in it.
• With an excess of oxalate, the turbidity disappears after adding diluted hydrochloric acid.
• If there is a large number of uniforms or mucus in the urine, then it becomes transparent only after filtering and centrifugation.
• Resistant to all high-quality samples and centrifugation of the turbidity indicates bacteriuria.
• On the surface of urine containing a large amount of protein, persistent foam is formed.

The urine of a healthy person is straw-yellow, the intensity of coloring depends on the degree of its breeding. The urine of the patient with chronic renal failure is almost colorless. The change in urine color is also due to the presence of various chemicals in it, including drugs and their metabolites, as well as pus, blood and lymph.

The reasons for changing urine color

Color

Cause

White Red/pink/brown Yellow/orange Brown/black Green, blue

Lymph, pus, phosphate crystals Red blood cells, hemoglobin, myoglobin, porphyrins, levodop, metiddop, metronidazole, phenacetin, phenolftalein, food dyes Bilirubin, urobilin, iron preparations, nitrofurantin, riboflavin, sulfasalazine, rifampicin, phenytoine Metghemoglobin, homogenzitic acid (with alkaptonuria), melanin (in patients with melanoma) Biliverdin, dyes (methylene blue and Carmin Indigo), triamteren, B vitamins, Indigan, phenol, chlorophyll, infection Pseudomonas aeruginosa

The milk-white color of urine is due to the ingress of a large number of lymph or fats into it. Massive excretion of uric acid salts causes orange (brick) or brown color of urine. With porphyria, the urine darkens when standing in the air.

The correct interpretation of the red urine is necessary. Fresh blood stains the urine in a red color, the hematuria of renal origin gives the urine a characteristic type of “meat slop” - one of the signs of glomerulonefurtia, including acute, myoglobin - red-brown color. In addition, the red urine is noted when using methyldopa, phenotiazin derivatives.

[28]

The smell of urine

Urine has a characteristic smell. Its change occurs with various diseases, including metabolic ones.

The reasons for changing urine smell

Smell	Cause
Sweet, rotting fruits	Keton bodies
Ammonia	Infection of the urinary tract bacteria splitting urea
Mold	Phenylketonuria
Sweat	The presence of Izovalerian or glutaric acids in the blood
Brown fat	Hypermetioninemia, tyrosinemia

[29], [30], [31], [32]

Acidity of urine

The reaction of urine varies widely (pH 4.5-8.5). The sharp-sized urine reaction indicates the possibility of urinary tract infection or renal tubular acidosis.

[33], [34], [35], [36]

Relative urine density

The relative density of urine in a healthy person varies from 1.002 to 1.030. This indicator depends on the food diet and the fluid consumption regime. The depression of the relative density of urine is an early sign of tubulo-stust nephritis and chronic renal failure. To accurately determine this indicator, it is necessary to conduct the Simnitsky test. With an increase in protein content in the urine by 4 g/l or glucose by 2.7 g/l, this indicator increases by 0.001.

Urine analysis in children: decryption

With a general urine analysis, children take into account such indicators as coloring, smell, transparency, specific gravity, level of red blood cells and leukocytes, the presence of protein, sugar, ketone bodies, salt, bacteria, and mucus. Normal indicators are the absence of an atypical smell in the urine and cloudings. If the urine has the smell of ammonia, this can signal about malfunctions with the bladder. The level of acidity in the urine of the child varies from 4.8 to 7.5. With diarrhea, vomiting, as well as the predominance of plant foods and physical strain in the diet, an alkaline reaction occurs. The increased acidity of urine is observed at temperature, diabetes or with excessive intake of protein. Normal indicators of urine density are dependent on the age of 1.003-1.025. Squirrel, sugar, red blood cells, cylinders, bacteria, salts and ketone bodies in the urine of the child should not be. Such components can appear in case of metabolic disorders, diseases of the kidneys, bladder, endocrine system, with vomiting, fever, diarrhea, constipation, nervous strain, anemia. The increased content of leukocytes may occur in inflammatory processes of the urinary system.

General urine analysis: decryption

Normal indicators for a healthy person:

• Color is moderate yellow, not too rich, but not too pale.
• Transparency is the norm.
• The smell is an improper.
• Acidity - pH less than 7.
• Density - from 1.018.
• Squirrel - no.
• Keton bodies - no.
• Bilirubin - no.
• Urobilinogen-five to ten mg/l.
• Hemoglobin - no.
• Erythrocytes - from zero to three in the field of view for female persons, from zero to one in the field of view for men.
• Leukocytes - from zero to six in the field of view of women, from zero to three in the field of view of men.
• Epithelium - from zero to ten in sight.
• Cylinders - no.
• Salt - no.
• Bacteria - no.