Qualitative changes in urine

Not all urological diseases occur with any changes in urine, but in some cases qualitative changes in urine act as leading symptoms. For example, in inflammatory diseases of the genitourinary organs (pyelonephritis, cystitis, urethritis, tuberculosis of the urinary tract), pyuria (leukocyturia) is considered an obligatory symptom.

An equally important sign of urological disease is hematuria (blood in the urine).

Changes in urine quality are of great importance in the diagnosis of urological diseases.

To determine the qualitative change in urine, it is necessary to examine freshly excreted urine.

• Normal freshly passed urine should be clear.
• In the presence of pathological impurities (pus, bacteria, salts, mucus, blood), the properties of urine change: it becomes cloudy, and may contain blood.

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Forms

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Cloudy urine

The significance of a symptom should be assessed in combination with other clinical signs. Turbidity of urine may be associated with an increase in the content of salts - phosphates, oxalates, urates. This fact can be confirmed by heating urine with the addition of acetic or hydrochloric acid: if it becomes transparent, then the turbidity is indeed caused by the presence of salts. In the absence of changes, a microscopic examination will help to establish the cause. The presence of pus in the urine (pyuria) indicates an inflammatory process in the kidneys and urinary tract. For an approximate determination of the localization of the inflammatory process in men (bladder, upper urinary tract, kidney, urethra, prostate), a three-glass test is used.

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Three-glass test

The three-glass test is performed in the morning. The patient must come to the doctor with a full bladder. Before the test, the head and foreskin of the penis must be treated with a disinfectant solution. Then the patient urinates, without interrupting the urine stream, first into one glass, then into another, leaving a small amount of urine in the bladder. In this case, its amount in the first portion should be greater than in the second. After this, the patient is given a prostate massage, and he urinates into the third glass (to obtain prostate secretion).

If the first portion is cloudy and the second is clear, then the inflammatory process is localized in the distal section of the urethra. If the urine is cloudy in both portions, then an inflammatory process in the kidney, bladder, urethra or prostate is possible. If pus is found only in the third portion, then the source of inflammation is located in the prostate or seminal vesicles.

Leukocytes in urine

With leukocyturia, a large number of microorganisms are most often found in the urine (bacteriuria). Their absence (aseptic pyuria) is observed in tuberculosis of the urinary tract.

Change in the relative density of urine

It is important to remember the need to determine the relative density of urine. With copious fluid intake, it decreases; with increased sweating, and when staying in a hot climate, the amount of urine decreases, and the relative density increases.

A persistent decrease in the relative density of urine (below 1010) hyposthenuria indicates a violation of the concentrating ability of the kidneys and may indicate chronic renal failure.

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Diagnostics qualitative changes in urine

Change in urine reaction

When examining urine, attention should be paid to its reaction; in a healthy person, the urine reaction is usually slightly acidic. The urine reaction changes depending on the nature of the food. With an alkaline urine reaction and the absence of leukocytes in it (during microscopic examination), an inflammatory process cannot be ruled out, since in an alkaline environment, formed elements, including leukocytes, disintegrate.

The color of normal freshly excreted urine is straw-yellow.

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