The norm of leukocytes in the urine and the reasons for their increase. Elevated leukocytes in the urine: normal, reasons for the increase in the indicator Urinalysis leukocytes 1 3

Leukocytes - white blood cells, protectors human body, the level of which will indicate whether a person is healthy or not.

They create barriers for enemy microorganisms, which can cause the disease to begin to progress.

In addition, cells are involved in tissue regeneration and in maintaining immunity. It should be noted that many factors can affect the number of leukocytes in the urine.

Their number begins to increase at night. In addition, the growth of leukocytes is affected by nervousness, physical activity and eating different foods. That is why all tests should be collected in the morning, before meals. What is the norm of leukocytes in urine? healthy person, read on.

The bone marrow is responsible for the production of white blood cells in the body. This is where they are born different types cells.

Certain types of cells are responsible for their area of ​​work in lymphatic system. Therefore, during a laboratory blood test, it is not the number of white cells that is determined, but their ratio.

This is called the white blood cell formula. The role of lymphocytes is difficult to overestimate. They recognize pathogenic or foreign substances in the blood, remember foreign microbes and develop protection against them.

How many leukocytes in urine are considered normal? A healthy woman should not have leukocytes in her urine, but the norm may still be 3 units in the field of view, and for a man from zero to five.

If the patient passes a urine test according to Nechiporenko, the norm increases to four thousand. The level of white blood cells in children should be higher than in adults. Only by the age of 13 does the percentage of leukocytes become the same.

The normal number of leukocytes in a child is from 1 to 8 units. For newborns, it is considered normal to have up to 8 units in the field of vision in girls and up to 5 units in the field of vision in boys. However, more often in a healthy baby, the norm for leukocytes is 1-2 units per field of view.

In the field of view, among the red blood cells, leukocytes are also visible. They are a thousand times smaller than red blood cells, they differ in size, shape of nuclei, presence of cytoplasm and color.

During leukocyturia, the number of leukocytes exceeds the number of red blood cells, and they become more mature and begin to accumulate.

The leukocyte formula of urine is calculated under a microscope, while a small smear of urine is significantly enlarged. The smear is stained using the Romanovsky-Giemsa method.

If lymphocytes predominate in the analysis, this indicates an immune genesis; if the number of neutrophils predominates, this indicates pyelonephritis or an inflammatory process in the urethra; if eosinophils predominate, this indicates interstitial nephritis which arose as a result of taking medications.

In most cases, increased level leukocytes in the urine is quite justified when a person has, for example, kidney failure. With such diseases, doctors direct patients to take a urine test to check whether the level of white blood cells exceeds the permissible number.

But sometimes their increase can be detected by chance, this happens when tests are taken from infants.

If the level of leukocytosis in the urine of infants increases, they are re-administered a test to monitor the dynamics of the development of the disease.

Leukocyte, its components and factors influencing changes in their level

1. Basophils, carriers of histamine and heparin.
2. Eosinophils destroy histamine and are involved in allergic reactions.
3. Neutrophils are the most active microphagocytes.
4. Lymphocytes, immune cells.
5. Monocytes turn into macrophages.

The leukocyte formula is not established immediately after birth. Two crossings of neutrophils and lymphocytes are noted.

From 3-5 days after the baby is born, there are more neutrophils in the baby’s urine than lymphocytes. From 5 days to 5 years, there are much more lymphocytes than neutrophils. From 5-7 years of age, the ratio of leukocytes is established, which corresponds to the urine of an adult.

Depending on the presence of influencing factors environment, there are changes in the level of leukocytes in a woman who is carrying a child. The number of cells is also influenced by internal indicators, such as nervousness, physical and psychological fatigue. In addition, pregnant women need to adjust their diet.

If we talk about classical indicators, then during the period of bearing a child, the indicator of leukocytes in the urine should be from 1-2.

Starting from the 6th month of pregnancy, their number increases significantly. This happens due to a number of reasons that accompany pregnancy due to decreased immunity.

Therefore, pregnant women should take a urine test once a month, and in the last weeks of pregnancy once a week.

Hidden infections can cause bleeding, develop purulent foci and lead to impaired fetal development.

Ilya Mechnikov was the first to discover the role of cells that protect the body. His laboratory research was quite simple: he inserted a rose needle into a starfish larva and noticed how billions of small cells were trying to destroy and throw out the foreign body. What kind of heroes are these? Mechnikov called them leukocytes, and concluded that such an attack should be carried out in more complex organisms, including the human body.

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Leukocytes in urine analysis are one of the main indicators of the study. A pathology in which the number of leukocytes increases is called leukocyturia. Most often, this means that an inflammatory reaction is developing in the body. How are leukocytes indicated in a urine test, and what can deviations from the norm indicate?

Leukocytes in urine

Leukocytes are white blood cells involved in immune and inflammatory reactions. White blood cells are produced in the lymph nodes and red bone marrow. In urine analysis there are different designations for these cells - LEU and WBC (white blood cells).

An increased level of leukocytes, especially in repeated urine tests, requires a detailed examination of the patient.

There are five types of leukocytes, each with its own physical and functional characteristics:

Leaving the bloodstream, leukocytes penetrate into any organs and tissues. In healthy people, white cells enter the urine through the lining of the ureters and Bladder, sections of the renal glomeruli and the tubular system in small quantities. With the development of an inflammatory reaction due to the destruction of tubules and cellular infiltration, conditions are created for the excessive release of leukocytes from the source of inflammation into the urine. In this case, the presence of white blood cells is detected in the urine during laboratory tests.

Leukocytes in a general urine test

The day before the test, you should avoid significant physical activity and try to limit stress. Visiting baths and saunas is contraindicated. Fatty and fried foods, as well as any foods that can change the color of urine (carrots, beets and other brightly colored vegetables and fruits, synthetic vitamins) should be excluded from the diet 1-2 days before the test. Also, do not drink alcohol, coffee, sweet and carbonated drinks. All medications should be stopped if possible (consult your doctor in this regard). If you cannot take a break from taking it, you need to make full list medications you are taking and inform your doctor about it, who will give you a referral for analysis. Women during menstruation are advised to postpone the urine test for several days.

The material is collected on an empty stomach; at least 12 hours must have passed since the last meal. For general analysis, the first morning urine is required. To ensure that the biomaterial is not contaminated with secretions, careful hygiene of the external genitalia must be carried out before collecting urine. You should take care of the container in advance. It must be sterile, free of residues detergents. It is best to use special disposable containers that are sold at the pharmacy. Some laboratories provide such containers when registering for research.

When collecting material, you need to flush a small amount of urine into the toilet, and then, without stopping urination, place a container and collect 100-150 ml, and the container should not touch the skin. This is done to prevent bacteria from the external genitalia from entering the material. Urine collected for analysis can be stored in a cool place for no longer than 1.5–2 hours.

To detect hidden leukocyturia, use additional methods research - Amburger and Addis-Kakovsky samples.

In the urine of a healthy person, leukocytes are found in quantities of no more than 10 per field of view. The norm of leukocytes in adults in a single portion of urine is no more than 7 per field of view in men, and no more than 10 in women. To determine normal results in children, you can use a table of the norm of leukocytes in urine by age.

The level of white blood cells in the urine may increase during teething in infants and children 5–6 years of age.

Normal levels of leukocytes in urine in different samples

The Amburger test helps determine the number of formed parts of blood excreted in the urine in 1 minute. To obtain reliable data, an analysis of 5–10 ml of urine collected over 3 hours is performed. Normally, urine when examined according to Amburge contains up to 2000 leukocytes.

Addis-Kakovsky tests - method quantification formed elements in the daily volume of urine. In a healthy patient, no more than 2,000,000 leukocytes are excreted in the urine per day.

An increased content of leukocytes in a urine test (especially in repeated tests) requires a detailed examination of the patient. Usually prescribed additional research: Ultrasound abdominal cavity and organs genitourinary system, radiography chest, cystoscopy, excretory urography, general and biochemical blood tests, etc.

Many factors can affect the composition of urine and distort the test results. These include drinking and eating regimen, intake medicines, physical and emotional stress.

Increased number of leukocytes in urine

An increase in leukocytes in the urine, i.e. leukocyturia, can be true or false. In a true case, white blood cells are formed in the urinary system; in a false case, the result of the analysis is affected by contamination of the collected biomaterial with secretions from the external genitalia.

Depending on the presence of the pathogen, infectious, or bacterial and non-infectious, or abacterial (sterile) leukocyturia is distinguished. The latter is characterized by an increased number of white blood cells in the absence of bacteria in the urine.

Based on the number of detected leukocytes, they are distinguished the following types leukocyturia:

• insignificant– up to 40 in the field of view;
• moderate– up to 100;
• significant– the entire field of view is covered with leukocytes.

When there are 100 or more leukocytes in the field of view, they speak of pyuria - the discharge of pus in the urine. The number of leukocytes in this condition can reach 500 or more.

Depending on what types of white blood cells predominate, leukocyturia occurs:

• neutrophilic– with inflammation of the kidneys, bladder, ureters or urethra, on initial stage acute glomerulonephritis, with pyelonephritis and tuberculosis;
• lymphocytic– for infectious lesions of the kidneys and urinary tract, autoimmune diseases;
• mononuclear– with interstitial nephritis, on late stages glomerulonephritis;
• eosinophilic– eosinophils are increased in cystitis and abacterial glomerulonephritis and indicate the addition of an allergy to the inflammatory process.

Causes of leukocyturia

An increased content of leukocytes in the urine is characteristic of the following diseases:

• pyelonephritis;
• glomerulonephritis;
• interstitial nephritis;
• kidney transplant rejection;
• kidney tuberculosis;
• cystitis;

• Symptoms accompanying leukocyturia

  Depending on the accompanying symptoms, it can be assumed what pathology caused the increase in the level of leukocytes in the urine test.

  

  About development infectious pathology urinary system indicates:

  • urinary disturbance;
  • burning, pain when urinating;
  • pain in the lower abdomen or lumbar region;
  • strong smell of urine;
  • change in the color of urine, the appearance of mucus, flakes, streaks of blood;
  • fever, symptoms of intoxication.

  Kidney stone disease is accompanied by the following manifestations:

  • cloudiness of urine (possibly the appearance of blood or pus in it);
  • sharp pain in the lower back spreading along the ureter;
  • frequent urination;
  • disturbance of urine outflow;
  • nausea, vomiting;
  • temperature increase;
  • promotion blood pressure.

  At acute pyelonephritis leukocyturia is accompanied by:

  • gradually increasing or acute pain in the lumbar region on one side;
  • painful urination;
  • change in the color and odor of urine;
  • cloudiness of urine, the appearance of pus in it;
  • nausea, vomiting;
  • chills, increased body temperature;
  • joint pain.
  • pyuria;
  • regular and situational dull pain in the lower back of low intensity;
  • cloudy urine;
  • transient dysuria;
  • muscle pain;
  • weakness, loss of appetite.

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A general urine test is the basis for diagnosing any disease. The rate of leukocytes in urine shows the level of protection against viruses. An increased number of white blood cells in the blood and urine signals a disease in the body. How many leukocytes are considered normal depends on the gender and age of the patient. And despite its simplicity, a general urine test quickly and effectively determines the necessary information.

Functions of leukocytes

Leukocytes are the first to signal the state of a person’s immunity. They serve as a barrier to fungi, bacteria, foreign cells and viruses. White blood cells are generated bone marrow And lymph nodes. In urine, leukocytes are determined based on the results of a general analysis. Often in the internal environment of a healthy person there are no leukocytes or their number is minimal. A general urine test determines the condition of the body based on a number of indicators. The table of standards regulates the maximum content of elements in the sample being tested.

Table of indicators of general urine analysis, according to the norm

The number of leukocytes in the general analysis

A small number of leukocyte cells in the sample is acceptable. This is explained by the following phenomena:

• White blood cells enter the urine from the blood. Their number does not affect health if the permeability of the vascular walls is normal.
• According to some studies, some cells in leukocytes serve as “scouts” - they penetrate the urine and, in the presence of viruses, signal a problem by releasing substances of a special composition.

Acceptable leukocyte norms for women are up to 6 cells, normal levels for men are 2-3. In children, these numbers also depend on gender - up to 10 for girls and up to 7 for boys. The difference in norms is explained by the peculiarities anatomical structure: in women, the urinary and genital organs are located nearby and bacteria migrate freely, distorting the parameters of urine tests.

Urine analysis in adults is considered doubtful if the drug contains from 3 to 10 units. In such cases, a repeat study is carried out. If the indicators are too high the second time, the patient is sick. In case of increased leukocytes, further examination is carried out - ultrasound of the kidneys, urine culture in various media, scraping of the epithelium. Preparing for a urine test includes certain rules. If hygiene measures were not observed when collecting material, the result may be distorted. Anyway antibacterial therapy can only be prescribed by a urologist if comprehensive results are available.

What do you mean by the increase in the rate of leukocytes in the urine?

An increased content of leukocytes and erythrocytes signals an infection in the urogenital tract. There is a risk of the following diseases:

• pyelonephritis, urolithiasis;
• infection at the level of the ureter;
• cystitis or cancer;
• inflammation of the urethra;
• gynecological infections.

There are cases when the leukocyte content greatly exceeds the norm - 30-40 units. If there is no bacteriuria, then the result is caused by a recent course of antibiotics, renal tuberculosis, nephritis, or the banal collection of a sample in a non-sterile container. Do not neglect the rules for taking the test. By spending 2-2.5 minutes performing simple manipulations, you can ensure an accurate result on the first try.

If an infection is suspected, at least two tests are taken - a general urine test and a Nechiporenko test. There is no need to be lazy, because the picture of the disease will be incomplete without a detailed examination.

Results of analysis according to Nechiporenko

If leukocytes are increased, the doctor may refer you for a Nechiporenko test. This method ensures high accuracy of results. The patient collects an average portion of the first morning urine. The laboratory assistant places the resulting sample in a centrifuge, after a sediment appears, takes 1 millimeter of the sample and counts the components. Methods of research and measurement of parameters vary, so to obtain comparable indicators, it is better to take all tests in one laboratory.

Elevated readings indicate possible diagnoses:

1. Pyelonephritis - infection renal pelvis. The patient complains of dull pain in the area of ​​one or both kidneys, weakness, and fever.
2. Cystitis. The infection is concentrated in the bladder. The patient is worried about pain when urinating, discomfort, and frequent urges. The color of urine may change, and sometimes traces of pus are present in the analysis.
3. Nephrolithiasis or kidney stones. Symptoms - attacks acute pain in the lumbar region, especially after a shake, there is an increased temperature, sometimes there are traces of blood in the urine, which is confirmed by an increased level of red blood cells.

Age and white blood cell count

The permissible norm of leukocytes in the urine of women is 0−6 units. On critical days, it is not recommended to take an analysis, since if the sample preparation rules are not followed, there is a chance of getting distorted results (if traces of menstrual blood get into the sample). Sometimes a repeat test is done if the leukocytes in the urine are elevated.

Reading time: 11 min.

The kidneys are a paired organ that has fine structure, therefore, the slightest change in the normal course of any internal processes leads to noticeable deviations in the performance of the urinary system.

About kidney pathologies urinary tract and some other organs can be identified by general analysis urine (in medical forms it is abbreviated to OAM). It is also called clinical.

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  1. Why is this test prescribed?

  Urine is a biological fluid in which the final waste products of the body are released from the human body.

  It is conventionally divided into primary (formed by filtration in the glomeruli from blood plasma) and secondary (formed by reabsorption of water, necessary metabolites and other solutes in the renal tubules).

  Disruption of this system entails characteristic changes in normal TAM indicators. Thus, the analysis can show:

  1. 1 Deviations in metabolism;
  2. 2 Signs of urinary tract infection;
  3. 3 Effectiveness of treatment and diet;
  4. 4 Dynamics of recovery.

  A person can contact a laboratory for a urine test on his own initiative if he notices sudden changes in his physical characteristics. But more often the patient receives a referral from a specialist at the clinic, who then deciphers the results obtained.

  OAM is included in the list of basic studies for preventive examinations population, medical examination, it is prescribed when applying for medical care to a specialist, during pregnancy, during hospitalization and in some other cases.

  A general urine test consists of a sequential study of:

  1. 1 Physical characteristics of the sample;
  2. 2 Chemical composition;
  3. 3 Microscopic examination of sediment.

  2. Patient preparation

  Before submitting the material for general (clinical) analysis, consult your doctor about the possible temporary cessation of taking certain pharmaceutical drugs. For example, diuretics should be stopped 48 hours before sample collection.

  Women should remember that menstruation usually skews the results. For testing, it is better to choose a time before your period or two days after the end of the discharge.

  The day before collecting biomaterial, avoid foods with a high content of pigments, alcohol, fatty, smoked foods, sex, and excessive physical and psycho-emotional stress. All this can distort the OAM results.

  For analysis, a morning urine sample is collected, optimally its middle part. Before collection, the patient must toilet the external genitalia (bath, shower, wet wipes).

  After the start of urination, it is better to flush the first portion into the toilet, collect the middle portion in a clean, sterile container (optimally in a sterile pharmaceutical container). The minimum volume of urine required for testing is 50 ml. There is a mark on the medicine cup to the level at which it is advisable to fill the container.

  In children early age It is often difficult to collect urine for analysis. Therefore, when collecting, you can use small tricks:

  1. 1 Buy special soft polyethylene containers with a sticky edge at the pharmacy. Not all children like this procedure, but for some it is acceptable.
  2. 2 Before picking up, take the baby to the bathroom and turn on the water. A child up to one year old can be breastfed beforehand, and an older baby can be given water to drink. Urination in babies is tied to feeding, so the task can be made easier.
  3. 3 Some children pee several times with intervals between peeings of 10-15 minutes. To collect material from such babies, it is better to prepare several containers so that you can collect the droplets in different dishes without staining them during manipulation.
  4. 4 Before the procedure, you can do a soft, stroking massage in the lower abdomen, in the bladder area.

  3. What should not be done when collecting urine?

  When collecting material for clinical urine analysis, it is not recommended:

  1. 1 Use untreated dishes, the contents of a potty, a diaper, a diaper, a plastic bag. This analysis is called “dirty”; it is not suitable for assessing the condition of the urinary system.
  2. 2 Use for analysis stale urine that has stood for more than 3 hours or has been in the refrigerator without a special preservative.
  3. 3 Collect material for OAM after defecation, during menstruation or after sexual intercourse.
  4. 4 Collect material for research during acute inflammatory diseases reproductive system, skin around the urethra and vagina (you must warn your doctor about this in advance). It will not be possible to collect such an analysis purely.
  5. 5 Do not use urinary catheter, if there is no urgent need for it (prostate cancer, prostate adenoma, bedridden seriously ill patient and other situations that are discussed by the attending physician). When placing a catheter at home, there is a high risk of secondary infection.

  The table below presents the main indicators, their standards and interpretation. Clinical urine analysis in women is practically no different from that in men, with the exception of some parameters. These small nuances are noted in the table.

  Index	Decoding	Norm
  BLd	Red blood cells	2-3 in the field of view in women (abbreviated as p/z) / Single in men
  LEU	Leukocytes	3-6 in p/z for women / Up to 3 - for men
  Hb	Hemoglobin	Absent (sometimes they write the abbreviation neg - negative)
  BIL	Bilirubin	Absent (neg)
  UBG	Urobilinogen	5-10 mg/l
  PRO	Protein	Absent or up to 0.03 g/l
  NIT	Nitrites	Absent
  G.L.U.	Glucose	Absent
  KET	Ketone bodies	Absent
  pH	Acidity	5-6
  S.G.	Density	1012-1025
  COLOR	Color	Light yellow

  Table 1 - Indicators assessed in clinical urine analysis

  4. Physical properties

  4.1. Quantity

  When assessing the total amount of urine excreted, it is necessary to take into account possible features each patient's diet. In an adult who adheres to a normal diet, daily diuresis ranges from 800 to 1500 ml.

  Diuresis directly depends on the volume of fluid drunk. Typically, 60-80% of what you consume per day is eliminated from the body. The normal ratio of daytime to nighttime diuresis is 3:1 or 4:1.

  A condition characterized by increased urine output (more than 2000 ml per day) is called polyuria.

  A similar phenomenon is observed normally:

  1. 1 When large quantities drunk over the past day;
  2. 2 With nervous excitement or overstrain.

  Polyuria can be observed in the following pathological conditions:

  1. 1 Kidney diseases (CKD, stage of resolution of acute renal failure);
  2. 2 Relief of edema, for example, against the background of diuretics;
  3. 3 Diabetes insipidus and diabetes mellitus;
  4. 4 Nephropathies (amyloidosis, myeloma, sarcoidosis);
  5. 5 Taking certain medications.

  The reverse condition is called oliguria. With oliguria, less than 500 ml of urine is excreted per day.

  Physiologically it can occur with:

  1. 1 Reduce fluid intake;
  2. 2 Loss of fluid through sweat in the heat;
  3. 3 Significant physical activity.

  It is noted in the following pathologies:

  1. 1 Cardiac decompensation;
  2. 2 Poisonings;
  3. 3 Excessive loss of water from the body (for example, during profuse diarrhea, vomiting);
  4. 4 Burns;
  5. 5 Shock conditions;
  6. 6 Fever of any origin;
  7. 7 Kidney damage of infectious, autoimmune and toxic origin.

  Anuria is a condition in which urine production stops completely.. Anuria is typical for:

  1. 1 Initial stage of acute renal failure;
  2. 2 Acute blood loss;
  3. 3 Uncontrollable vomiting;
  4. 4 Stones in the urinary tract with obstruction of the lumen;
  5. 5 Oncological diseases accompanied by obstruction and compression of the ureters.

  Nocturia is a condition in which nocturnal diuresis significantly prevails over daytime. Nocturia is typical for:

  1. 1 Diabetes insipidus and diabetes mellitus;
  2. 2 Many kidney diseases;

  4.2. Urinary frequency

  In addition to the daily amount of urine, pay attention to the frequency of urination. Normally, this process is performed by a person 4-5 times during the day.

  Pollakiuria is characterized by frequent trips to the toilet. Observed when:

  1. 1 Drink plenty of liquid;
  2. 2 Urinary infections.

  Olakiuria is the opposite condition to that described above. Characteristic for:

  1. 1 Low intake of fluid into the body;
  2. 2 Neuro-reflex disorders.

  Strangury is painful urination.

  Dysuria is a urination disorder that combines symptoms such as changes in urine volume, frequency and appearance pain. She usually accompanies.

  4.3. Color

  Is a direct reflection of concentration. In a healthy person, deviations in color from straw yellow to amber are allowed.

  The color of urine is also influenced by special substances, the basis of which are blood pigments. A dark yellow color is observed when the amount of coloring substances dissolved in it significantly exceeds the norm. Characteristic of such conditions:

  1. 1 Edema;
  2. 2 Vomiting;
  3. 4 Burns;
  4. 4 Stagnant kidney;
  5. 5 Diarrhea.
  1. 1 Diabetes mellitus;
  2. 2 Diabetes insipidus.

  The dark brown color is explained by an increase in the level of urobilinogen. Is a diagnostic criterion hemolytic anemia. Urine may turn dark brown when taking sulfonamides.

  Dark, practical black color can indicate several conditions:

  1. 1 Alkaptonuria (due to homogentisic acid);
  2. 2 Acute hemolytic kidney;
  3. 3 Melanosarcoma (obtains this shade due to the presence of melanin).

  Urine turns red if it contains fresh blood or red pigments. This is possible with:

  1. 1 Kidney infarction;
  2. 2 Renal failure;
  3. 3 Damage and trauma to the urinary tract;
  4. 4 Taking certain medications (for example, rifampicin, adriamycin, phenytoin).

  The appearance of “meat slop” is explained by the presence of altered blood, which is characteristic of acute glomerulonephritis.

  A greenish-brown tint (compared to the color of beer) appears if bilirubin and urobilinogen enter the urine. This deviation from the norm often indicates parenchymal jaundice.

  If the shade is rather greenish-yellow, which may indicate the presence of bilirubin alone, and is considered a symptom of obstructive jaundice.

  4.4. Transparency

  Normally, urine is clear. However, in the presence of pathological components and impurities (proteins, leukocytes, erythrocytes, epithelium, bacteria, salts), it can be cloudy, cloudy and milky.

  Several manipulations can be carried out in advance to narrow the range of possible substances that make up the sediment to certain salts.

  When, when heated, the test tube with the test material becomes transparent again, we can conclude that it contained urates.

  If the same happens upon contact with acetic acid, we can assume the presence of phosphates in the sample. If an identical effect is observed when mixed with hydrochloric acid, then there are .

  For more accurate data, microscopy of the sediment is performed.

  4.5. Smell

  The smell of urine is usually specific and not strong. An ammonia odor may appear if there is bacterial contamination of the sample. A fruity smell (of rotting apples) is considered an indicator of the presence of ketone bodies.

  4.6. Relative density (SG)

  This indicator is considered very important, since it is used to judge the concentration function of the kidneys and its ability to dilute.

  The measurement is carried out using a specially designed device - a urometer. During the study, attention is primarily paid to the content of electrolytes and urea, and not to substances with high molecular weight (proteins, glucose, etc.).

  Normally, the relative density of the morning urine portion is determined in the range from 1.012 to 1.025. During the day it can fluctuate between 1001 - 1040, therefore, if a patient is suspected of having a decrease in the concentrating ability of the kidneys, it is usually prescribed.

  Hypersthenuria – an indicator higher than normal. Its cause may be:

  1. 1 Toxicosis of pregnant women;
  2. 2 Progressive edema;
  3. 3 Nephrotic syndrome;
  4. 4 Diabetes mellitus;
  5. 5 Use of radiopaque agents.

  Hyposthenuria - decreased specific gravity. Observed in the following conditions:

  1. 1 Malignant hypertension;
  2. 2 Chronic renal failure;
  3. 3 Diabetes insipidus;
  4. 4 Damage to the kidney tubules.

  Isosthenuria is a condition in which the density of urine is equal to the density of blood plasma (within 1010-1011).

  5. Chemical properties

  This is the second group of urine indicators that characterize the patient’s health status.

  5.1. Medium reaction (pH)

  Normally, urine pH ranges between 5-7. Acid reaction (pH<5) может быть следствием:

  1. 1 Increased consumption of meat products;
  2. 2 Metabolic or respiratory acidosis (as a consequence of various pathological processes), coma;
  3. 3 Acute glomerulonephritis;
  4. 4 Gout;
  5. 5 Hypokalemia.

  An alkaline reaction (pH>7) occurs when:

  1. 1 Vegetable diet;
  2. 2 Chronic renal failure;
  3. 3 Metabolic or gas alkalosis;
  4. 4 Hyperkalemia;
  5. 5 Active inflammatory processes in the urinary system.

  5.2. Protein Determination (PRO)

  Normally, it is not detected or an insignificant amount is detected. A condition in which this threshold is exceeded is called proteinuria. It is customary to distinguish several types of proteinuria:

  1. 1 Prerenal proteinuria is associated with pathological processes in the human body that are accompanied by an increase in protein concentration in the blood plasma (myeloma, for example).
  2. 2 Renal - one that is a consequence of damage to the glomerular filter or dysfunction of the renal tubules. Diagnostic criterion gravity pathological process is selectivity - the greater the number of large protein molecules found in secondary urine, the more serious the situation.
  3. 3 Postrenal proteinuria is a manifestation of inflammatory processes in the reproductive system and surrounding tissues (vulvovaginitis, balanitis, and so on).
  4. 4 Proteinuria can also be physiological, for example, during emotional overload, exposure to cold or sun, in children in a standing position, during long walking or running.

  5.3. Determination of glucose (GLU)

  Normally, this substance cannot be detected in urine due to its low content. Glucosuria is the name given to a condition in which glucose levels exceed 0.8 mmol/l. This occurs when the so-called renal glucose threshold is exceeded.

  That is, when its concentration in the blood exceeds 9.9 mmol/l, it freely passes the barrier and enters the urine. There are the following types of glucosuria:

  1. 1 Nutritional (large amounts come from food);
  2. 2 Emotional;
  3. 3 Medicinal.

  Pathological glucosuria is usually divided into renal (manifests when various diseases kidney) and extrarenal, which is considered a consequence of the following diseases:

  1. 1 Diabetes mellitus;
  2. 2 Thyrotoxicosis;
  3. 3 Pheochromocytomas;
  4. 4 Acute pancreatitis and other diseases of the pancreas;
  5. 5 Itsenko-Cushing's disease;
  6. 6 Cirrhosis of the liver;
  7. 7 Poisoning.

  5.4. Determination of hemoglobin (Hb)

  It is believed that hemoglobin is found in a portion of urine during the rapid breakdown (hemolysis) of red blood cells. Such a process may be infectious, immunological or genetic in nature. Most often, hemoglobinuria is detected with:

  1. 1 Hemolytic anemia;
  2. 2 Transfusion of incompatible blood;
  3. 3 Internal injuries (crash syndrome);
  4. 4 Severe poisoning;
  5. 5 Direct damage to kidney tissue.

  Hemoglobinuria is dangerous because it is an impetus for the development of acute renal failure.

  5.5. Determination of ketone bodies (KET)

  Ketonuria – special indicator urine analysis, which reflects the failure of metabolic processes occurring in the body. This reveals the following substances: acetone, beta-hydroxybutyric, acetoacetic acids. Ketonuria occurs against the background of:

  1. 1 Diabetes mellitus;
  2. 2 Carbohydrate fasting, diets;
  3. 3 Severe toxicosis (more often in children);
  4. 4 Dysentery;
  5. 5 Severe CNS irritation;
  6. 6 Overproduction of corticosteroids.

  5.6. Determination of bilirubin (BIL)

  Bilirubinuria – pathological condition, in which unchanged bilirubin is detected in the urine. When the mechanisms that utilize bilirubin fail, the kidneys take on part of the work. Bilirubinuria is typical of many liver diseases:

  1. 1 Cirrhosis;
  2. 2 Hepatitis;
  3. 3 Jaundice (parenchymal and mechanical);
  4. 4 Gallstone disease.

  5.7. Determination of urobilin bodies (UBG)

  Urobilinuria occurs when the liver does not function properly. However, intestinal pathology (where this substance is formed) and processes leading to the breakdown of red blood cells also contribute to the appearance of urobilinogen in the urine.

  A high content of urobilinogen bodies in the sample (UBG in the analysis form) is detected when:

  1. 1 Hepatitis;
  2. 2 Sepsis;
  3. 1 Hemolytic anemia;
  4. 4 Cirrhosis;
  5. 5 Intestinal diseases (inflammation, obstruction).

  6. Microscopic examination of sediment

  Microscopic examination of organized and unorganized urine sediment is of great importance in diagnosis. For this purpose, the laboratory technician lets the resulting sample sit for about two hours, then centrifuges it, drains the liquid, and examines a drop of sediment under a microscope.

  At low magnification, the cylinders within the field of view are counted, and at high magnification, leukocytes, erythrocytes and others cellular elements.

  Counting the number of cellular elements in a material greatly facilitates the use of Goryaev’s camera.

  6.1. Red blood cells (BLD)

  Normally there are, but their number is limited to one cell in the field of view in men and up to three in women).

  – a condition in which more red blood cells are found in the urine. There are macrohematuria (the presence of blood clots can be determined with the naked eye) and microhematuria (the presence of red blood cells can only be detected using a microscope).

  

  Figure 1 - Changed erythrocytes in urine under a microscope, native preparation. Source Masaryk University (https://is.muni.cz/do/rect/el/estud/lf/js15/mikroskop/web/pages/zajimave-nalezy_en.html)

  In addition, glomerular (renal) hematuria is isolated, which manifests itself in kidney diseases of various origins, medicinal and toxic lesions of renal tissue, and non-glomerular, which is associated with the inflammatory process, injuries and cancer.

  

  Figure 2 - Unmodified erythrocytes (native preparation, red arrow indicates erythrocyte and leukocyte). Source Masaryk University

  6.2. Leukocytes (LEU)

  In a healthy man, leukocytes in the urine are represented by a small number of neutrophils (up to three), in women there are slightly more of them (up to six).

  An increase in the level of white blood cells in the urine is called leukocyturia. This always indicates inflammatory processes in the kidneys or urinary tract, such as:

  1. 2 Glomerulonephritis;
  2. 3 Renal tuberculosis;
  3. 5 Urethritis;
  4. 6 Fever.

  If among all the cells there are noticeably more eosinophils, then they talk about the allergic genesis of the disease, if there are lymphocytes - about the immunological one.

  

  Figure 3 - Leukocytes in urine under a microscope

  6.3. Epithelium

  Normally, microscopy reveals up to 5-6 cells. However, the elements should be distinguished from each other, since they reflect different clinical manifestations:

  1. 1 Flat epithelium enters the material from the external genitalia. Often observed with urethritis in men, in poorly collected samples in women.
  2. 2 Transitional epithelium is part of the mucous membrane of the urinary tract. Found in cystitis, neoplasms, pyelitis.
  3. 3 Renal epithelium, present in large quantities in TAM, indicates the following conditions: acute and chronic kidney damage, intoxication, fever, infection.

  6.4. Cylinders

  These are protein or cellular elements originating from the tubular epithelium.

  1. 1 Hyaline (protein) appear when:
     • dehydration of the body;
     • nephropathy in pregnant women;
     • fevers;
     • poisoning with salts of heavy metals.
  2. 2 Waxy (protein) speaks of:
     • nephrotic syndrome;
     • amyloidosis.
  3. 3 Cellular casts can indicate problems of a very wide etiology and are a direct indication of more detailed analyzes.

  6.5. Slime

  Normally found in small quantities. At higher levels, mucus may indicate the following diseases:

  1. 5 Urethritis;
  2. 4 Kidney stone disease;
  3. 5 Incorrect sample collection.
  G.L.U.GlucoseAbsent KETKetone bodiesAbsent pHAcidity5-6 S.G.Density1012-1025 COLORColorLight yellow

Bibliography

1. 1 Kozinets G.I. Interpretation of blood and urine tests and their clinical significance / G.I. Kozinets. - M.: Triad X, 1998. – 100 p.;
2. 2 Yurkovsky O.I. Clinical analysis in medical practice / O.I. Yurkovsky, A.M. Gritsyuk. – K.: Technology, 2000. – 112 p.;
3. 3 Medvedev V.V. Clinical laboratory diagnostics: Doctor's Directory / V.V. Medvedev, Yu.Z. Volchek / Edited by V.A. Yakovleva. – St. Petersburg: Hippocrates, 2006. – 360 pp.;
4. 4 Zupanets I.A. Clinical laboratory diagnostics: research methods: Textbook. manual for students special. “Pharmacy”, “Wedge. Pharmacy", "Lab. Diagnostics" of universities /I.A. Zupanets, S.V. Misyurova, V.V. Propisnova et al.; Ed. I.A Zupanca – 3rd ed., revised. and additional – Kharkov: NUPh Publishing House: Golden Pages, 2005. – 200 pp.; 12 s. color on;
5. 5 Morozova V.T. Urine examination: Textbook. allowance / V.T. Morozova, I.I. Mironova, R.L. Shartsinevskaya. – M.: RMAPO, 1996. – 84 p.

Clinical task on the topic of the article:

A 45-year-old man visited a nephrologist for examination regarding microhematuria. Microhematuria was first identified 6 months ago (the patient changed jobs and underwent a medical examination for health insurance), as his attending physician informed him twice in the last six months.

Previous urine tests did not reveal any pathological changes. The patient has never reported gross hematuria (red-colored urine, blood in the urine), has not experienced any urinary tract symptoms, and currently feels in excellent shape.

No history serious illnesses, there are no symptoms of visual or hearing impairment. There is no mention of kidney disease in relatives in the family history. According to the patient, he drinks about 200 grams of vodka a week and smokes 30 cigarettes a day.

Inspection data

The patient has no signs of being overweight. Pulse – 70 beats per minute, blood pressure – 145/100 mmHg. Examination of cardiovascular, respiratory, nervous systems, abdominal organs did not reveal any abnormalities.

Fundoscopy (examination of the fundus) revealed tortuous arteries and veins of the fundus, perpendicular branching of the retinal arteries.

Research results

Questions

1. 1 Most likely diagnosis.
2. 2 What further tests should be ordered?
3. 3 What recommendations should be given to the patient?
4. 4 How to interpret the results of a biochemical blood test?

Problem solving and patient management tactics

Microscopic hematuria may result from wide range pathologies (for example, prostate diseases, urolithiasis), however its combination with arterial hypertension, proteinuria (increased protein in the urine), impaired renal function (increased creatinine and urea levels) indicates that the patient has chronic glomerulonephritis.

An increase in the level of GGTP in a biochemical analysis may indicate liver damage as a result of chronic alcohol consumption (here it is necessary to clarify the life history of this patient).

Most common reasons microhematuria:

1. 1 Chronic glomerulonephritis, including immunoglobulin A (Ig A) nephropathy;
2. 2 Thin basement membrane disease (benign hematuria);
3. 3 Alport syndrome.

Ig A nephropathy, the most common glomerulonephritis in developed countries, is characterized by diffuse mesangial deposits of IgA.

Patients often experience episodes of gross hematuria (red urine) in response to the development of inflammatory diseases of the upper respiratory tract.

In most cases, the triggering factor of the disease cannot be identified. Association with Henoch-Schönlein purpura and others is often observed autoimmune diseases, alcoholic cirrhosis of the liver, infections, oncology.

In this patient, immunoglobulin nephropathy may be combined with alcoholic liver disease, which requires clarification. 2 out of 10 patients with IgA nephropathy develop terminal stage chronic renal failure.

Thin basement membrane disease is a hereditary disease that is accompanied by the determination of red blood cells, protein in the urine (minimal proteinuria), normal indicators kidney function that does not deteriorate over time.

Electron microscopy reveals diffuse thinning of the glomerular basement membranes (normally the thickness of the basement membrane is 300 - 400 nm, while in patients with benign hematuria the thickness of the glomerular basement membranes is 150 - 225 nm).

Alport syndrome is a progressive hereditary disease (the gene is inherited on the X chromosome in a dominant manner, men are more often affected) of the glomeruli of the kidneys, which is associated with deafness and visual impairment.

This patient needs to undergo a kidney biopsy for histological verification and an accurate diagnosis.

Since the patient is over 40 years old, it is necessary to conduct a PSA test, transrectal digital examination (to exclude prostate cancer), and if bladder cancer is suspected, urine cytology, ultrasound, and cystoscopy of the bladder.

To assess the condition of the liver, it is necessary to perform an ultrasound examination and, if necessary, decide on a liver biopsy.

The patient should be advised to stop drinking alcohol and regularly monitor blood pressure. The patient should be regularly examined by a nephrologist, as he is in a group high risk according to the progression of renal failure, a high probability of entering hemodialysis and/or kidney transplantation.

The patient should be referred to a cardiologist for blood pressure profiling and antihypertensive therapy.

Moderately elevated creatinine levels indicate glomerular damage. Currently, there is no convincing evidence of the effectiveness of immunosuppressive therapy in patients with immunoglobulin (Ig A) nephropathy.

Key points

1. 1 Patients with isolated hematuria under 50 years of age should be referred to a nephrologist.
2. 2 Patients over 50 years of age are initially referred to a urologist to exclude pathologies of the bladder and prostate.
3. 3 Even a slight increase in plasma creatinine indicates significant impairment of renal function.
4. 4 Alcohol-induced liver damage is not accompanied by severe symptoms.