Urine sediment is normal. Reasons for the appearance of sediment. Specific gravity or relative density

When a patient comes for a preventive examination to a therapist, or is examined to identify the causes of deterioration in health, he must be prescribed a test of biological fluids. During such diagnostics, microscopy of urine sediment is almost always performed, which is an additional research activity.

During the study of urine, a specialist will conduct a detailed study, count and assess the quality of the sediment elements that are present in its composition. Thanks to this, it will be possible to confirm or refute the primary diagnosis, and subsequently adjust the health status.

Urine microscopy requires compliance with all collection rules and adherence to deadlines for delivery of biological material to the laboratory. If urine is transported later than two hours, the test result may be incorrect. The morning urine sample must be used for analysis.

Collect biological fluid in a clean and dry container. You can purchase suitable sterile containers at almost any pharmacy. When microscopy of urine sediment is prescribed, the interpretation will be correct only if all the rules of intimate hygiene are first followed.

What does a microscopic examination of urine sediment look like? Source: vokabula.rf

Hematuria (increased blood content in the urine);
Pyuria (presence of purulent exudate in urine);
Bacteriuria (high level of pathogenic bacteria);
Hemoglobinuria (critically high hemoglobin levels);
Cylindruria (excessive content of protein casts in urine).

Microscopic examination of urine, to obtain correct results, requires adherence to an algorithm. Initially, from the container containing the entire volume of urine, no more than 10 ml of biological fluid is taken using a pipette, and always from the very bottom. After this, it is subjected to centrifugation for 5-7 minutes (1500 rpm).

As a result of all manipulations, material suitable for research is obtained. When urine microscopy is performed, the interpretation involves studying one drop using low and high magnification. All data that was obtained is subsequently taken into account when making a diagnosis. They also help in identifying infectious and inflammatory processes and metabolic disorders.

Interpretation

A general urine analysis with sediment microscopy is characterized by a high level of information content. When deciphering the results, be sure to take into account the influence of certain external factors, for example: taking medications, visiting a bathhouse or sauna, increased physical activity, and dieting.

Microscopic examination can reveal pyuria and hematuria. Source: levitra.net.ua

All constituent elements are classified into organic and non-organic, depending on their type of origin. It is also worth noting that for each substance in medicine there are generally accepted standards, deviation from which is the reason for the most complete examination of the patient.

Hemoglobin

When a urine sediment microscopy analysis is prescribed (photos describing the results can be viewed in each laboratory individually), first of all, attention is paid to the absence or presence of hemoglobin in the biological material. If it is determined, then it is considered a pathological deviation from the norm.

This condition indicates that breakdown products of red blood cells enter the urine. This occurs with the progression of influenza, pneumonia or infection in the acute stage. But one should not discount the impact of external factors, including hypothermia, injury, and poisoning.

When urine microscopy is analyzed, the decoding also involves studying the color of the biological material. Urine takes on a distinct red-brown hue. Against this background, pain in the lumbar region of the back may also appear. This often happens with an unsuccessful blood transfusion, when the biomaterials of the donor and recipient do not match.

Red blood cells

During a microscopic examination of urine sediment, unchanged or leached red blood cells may be detected in the urine. Depending on the level of hemoglobin concentration in the composition of the biomaterial, if these are leached substances, then there are no red blood cells in them.

Norm and deviation of the number of red blood cells in the urine. Source: lechenie-simptomy.ru

Urine microscopy analysis cannot be performed during menstrual bleeding, since unnecessary secretions may enter the biological material. There are also other reasons for the development of hematuria, including:

Kidney disease or injury;
Diathesis;
Presence of stones in the kidneys;
The presence of tumors in the organs of the genitourinary system;
Infectious processes affecting the pelvic organs;
Poisoning of various types.

When urine microscopy is performed and the number of red blood cells is assessed, no more than three of them can be detected in female urine, and one in men. In all other cases, hematuria is diagnosed, in which the color of urine may be changed or remain the same.

Leukocytes

Normal sediment microscopy should not show the presence of leukocytes in the biological material in quantities from 0 to 5 in women, and from 0 to 3 in men. In situations where the upper limits are exceeded, then the patient may progress to pyuria (presence of pus) or leukocyturia.

In the first case, the patient’s health condition is serious, as the inflammatory process progresses in the body. To determine exactly where the outbreak is located, you will need to take a three-glass urine sample. If pyuria is in the first glass, then damage to the prostate or urethra has occurred; if pyuria is in the third glass, cystitis is diagnosed. An excess of leukocytes suggests the development of pathologies of the kidneys or bladder.

Epithelium

Urine analysis with sediment microscopy also makes it possible to identify the presence or absence of epithelial cells in urine. As for single values, they can normally be present, and this happens quite often. The classification here also provides for the distribution of cells by nature of origin.

Epithelial cells in urine under microscopy.

A general urinalysis is a set of various diagnostic tests aimed at determining the general properties of urine, as well as its physicochemical and microscopic examination. In this case, indicators such as color, smell, transparency, reaction (pH), density, content of protein, glucose, ketone bodies, bilirubin and its metabolic products in the urine are determined. The presence of cellular elements, as well as salts and casts, is determined in the urine sediment.

Synonyms Russian

Clinical urine analysis, OAM.

English synonyms

Complete Urinalysis.

Research method

"Dry chemistry" method + microscopy.

Units

Cells/μl (cells per microliter).

What biomaterial can be used for research?

The average portion of morning urine, the first portion of morning urine, the third portion of morning urine.

How to properly prepare for research?

Avoid taking diuretics for 48 hours before urine collection (in consultation with your doctor).
Women are advised to donate urine before menstruation or 2-3 days after it ends.

General information about the study

Urine is the end product of the kidneys, which is one of the main components of metabolism and reflects the state of the blood and metabolism. It contains water, metabolic products, microelements, hormones, desquamated cells of the tubules and mucous membrane of the urinary tract, leukocytes, salts, and mucus. The combination of physical and chemical parameters of urine, as well as analysis of the content of various metabolic products in it, makes it possible to assess not only the function of the kidneys and urinary tract, but also the state of certain metabolic processes, as well as identify disturbances in the functioning of internal organs. This information can be obtained by deciphering a general urine test.

Microscopy of urine sediment is a qualitative and quantitative determination of a number of insoluble compounds (organic and inorganic) in urine. The indicators available for study provide additional information regarding metabolism, as well as infectious and inflammatory processes.

The dry chemistry method is based on the effect of changing the color of the reaction zone of the test strip as a result of the reaction of the dye present in the reaction zone with urine protein molecules. The reaction zone is a porous strip soaked in a reagent solution and dried. The reagents include substances that stabilize the pH (buffer) and a dye. When the reaction zone is saturated with urine, the dry components dissolve and react with the components of the urine. If there is no protein in the urine, the reaction zone remains colorless or slightly yellowish, since the dye molecules absorb light in the blue region of the spectrum. If the urine sample with which the reaction zone is impregnated contains protein molecules, then the dye molecules form complexes with the latter and their absorption spectrum shifts to the red side, which allows the reaction to be assessed and a report to be compiled on the analyzed indicators.

It must be remembered that the results of a general urine test can be correctly interpreted and their compliance with standards assessed only by the attending physician, taking into account clinical and laboratory data, objective examination data and the conclusions of instrumental studies.

What is the research used for?

For a comprehensive examination of the body.
For the diagnosis and differential diagnosis of kidney and urinary tract diseases.
In order to evaluate the effectiveness of treatment of diseases of the urinary organs.
For the diagnosis of metabolic diseases, water and electrolyte imbalances.
For the diagnosis of diseases of the gastrointestinal tract.
For the diagnosis of infectious and inflammatory diseases.
To assess and monitor the patient’s clinical condition during surgical and/or therapeutic treatment.

When is the study scheduled?

With a comprehensive examination and monitoring of patients of various profiles.
During a preventive examination.
For symptoms of a disease of the urinary system (changes in the color and odor of urine, frequent or rare urination, an increase or decrease in the daily volume of urine, pain in the lower abdomen, pain in the lumbar region, fever, swelling).
During and after the course of treatment for pathologies of the kidneys and urinary tract.
While taking nephrotoxic drugs.

What do the results mean?

Interpretation of a general urine test:

Reference values (normal indicators)

Color: from straw yellow to yellow.

Transparency: transparent.

Protein: not detected or less than 0.1 g/l.

Glucose: not detected.

Bilirubin: not detected.

Urobilinogen: not detected or traces.

Ketone bodies: not detected.

Nitrites: not detected.

Reaction to blood: not detected.

Specific gravity: 1.003 - 1.030.

Reaction: 5.0 - 7.5.

Leukocytes: none or traces detected.

Urine sediment examination

Bacteria: not detected or a small amount.

Epithelium is flat

Leukocytes

Red blood cells: 0 - 11 cells/µl.
Cylinders: not detected.
Mucus: small amount.
Crystals (oxalates): none.

Color

The color of urine normally ranges from straw to deep yellow. It is determined by the presence of coloring substances in it - urochromes, the concentration of which mainly determines the color intensity. A rich yellow color usually indicates a relatively high density and concentrated urine. Colorless or pale urine has low density and is excreted in large quantities.

Discoloration of urine is sometimes associated with a number of pathological conditions. A dark color may indicate the presence of bilirubin or a high concentration of urobilinogen. Various shades of red may appear when blood is passed through the urine. Some medications and foods also make your urine appear different shades of red and yellow. The whitish color of urine may be due to the admixture of pus, the precipitation of salts, the presence of leukocytes, cells and mucus. Blue-green shades of urine may be a consequence of increased decay processes in the intestines, which is accompanied by the formation, absorption into the blood and release of specific coloring substances.

Reaction

The acid-base reaction (pH), like some other indicators of general urine analysis, depends on food and certain metabolic processes. Animal foods cause acidification of urine (pH less than 5), while dairy and vegetable foods contribute to its alkalization (pH more than 7). The kidneys can also affect the acidity of urine.

In addition, acidification of urine is caused by a violation of the salt balance of the blood (hypokalemia) and certain diseases (diabetes mellitus, gout, fever, etc.).

Excessive alkaline urine reaction can occur with inflammatory/infectious diseases of the kidneys and urinary tract, massive loss of salts (due to vomiting, diarrhea), impaired renal regulation of urine acidity or blood impurities in it.

Specific gravity

Urine specific gravity (relative density) reflects the ability of the kidneys to concentrate and dilute urine. It depends significantly on the volume of fluid consumed.

The specific gravity of urine exceeds the norm, for example, when blood filtration through the kidneys deteriorates (kidney disease, weakened heart function), large fluid losses (diarrhea, vomiting) and accumulation of soluble impurities in the urine (glucose, protein, drugs, as well as their metabolites). It may decrease due to certain kidney diseases and disturbances in hormonal regulation of the process of urine concentration.

Transparency

Normally, urine should be clear. It can become cloudy due to the admixture of red blood cells, leukocytes, epithelial cells of the urinary tract, fat droplets, acidity and precipitation of salts (urates, phosphates, oxalates). During long-term storage, urine sometimes becomes cloudy due to bacterial growth. Normally, slight turbidity is due to the presence of epithelium and mucus.

Color

Color urine normally ranges from straw to deep yellow and depends on the content of urochromes. A deep yellow color usually indicates relatively high density and concentrated urine. Colorless or pale urine has low density and is excreted in large quantities. A dark color may indicate the presence of bilirubin or a high concentration of urobilinogen. Various shades of red appear when blood is excreted in the urine. Some medications and foods also make your urine appear different shades of red and yellow. The whitish color of urine is due to the admixture of pus, the precipitation of salts, the presence of leukocytes, cells and mucus. Blue-green shades are the result of increased decay processes in the intestines, which is accompanied by the formation of specific coloring substances, their absorption into the blood and release.

Protein

Causes of proteinuria:

Violation of the filtration barrier - loss of albumin (glomerulonephritis, nephrotic syndrome, amyloidosis, malignant hypertension, lupus nephritis, diabetes mellitus, polycystic kidney disease)
Decreased reabsorption - loss of globulins (acute interstitial nephritis, acute renal necrosis, Fanconi syndrome)
Increased production of filterable proteins (multiple myeloma, myoglobinuria)
Isolated proteinuria without renal impairment (due to fever, exercise, prolonged standing, congestive heart failure, or idiopathic causes)

Bilirubin appears in the urine in case of liver pathology, obstruction of the biliary tract.

Urobilinogen turns urine yellow.

Reasons for the increase:

hemolytic anemia,
enteritis,
liver dysfunction.

Reasons for the downgrade:

decreased liver function (decreased bile production),
obstructive jaundice,
intestinal dysbiosis.

Nitrites

Reasons for the increase: the presence of bacteria in the urine.

Glucose

Reasons for the increase:

Diabetes mellitus, gestational diabetes
Other endocrine disorders (thyrotoxicosis, Cushing's syndrome, acromegaly)
Impaired tubular reabsorption in the kidneys (Fanconi syndrome)

Ketone bodies normally absent in urine. They increase in diabetes mellitus and indicate a deterioration in the patient’s condition. They may appear in the urine during fasting, severe restriction of carbohydrate intake, or prolonged rises in temperature (fever).

Reaction to blood. Normally, urine does not contain blood or its breakdown products (hemoglobin). Formed elements of blood (erythrocytes, leukocytes, etc.) can enter it from the vascular bed through the kidney filter (for example, in case of blood diseases or toxic conditions accompanied by hemolysis) and during the filtration of red blood cells from the blood (in case of kidney disease or bleeding from the urinary organs ).

Flat epithelium Normally occurs in the form of single cells. An increase in their number indicates an inflammatory process of the urinary tract.

Red blood cells are normally present in urine in small quantities.

Causes of hematuria:

Subacute infective endocarditis
Benign familial hematuria, benign recurrent hematuria
Kidney tuberculosis
Trauma, damage to the urethra by a urinary catheter
Renal vein thrombosis
Vasculitis
Kidney infarction
Polycystic kidney disease
Infection (cystitis, urethritis, prostatitis)
Neoplasms (kidney cancer, prostate cancer, bladder cancer)
Urolithiasis, or crystalluria
Systemic lupus erythematosus, lupus nephritis
Glomerulonephritis

Leukocytes found in small quantities in the urine of a healthy person.

Causes of leukocyturia:

Fever
Kidney tuberculosis
Glomerulonephritis
Interstitial nephritis, pyelonephritis
Urinary tract infection

Cylinders(indicate dysfunction of the glomerulus and tubules). A highly sensitive method used in urinalysis can detect a minimal number of casts in the urine of a healthy person.

Reasons for the appearance of casts in urine:

Kidney infarction
Glomerulonephritis
Nephrotic syndrome and proteinuria
Tubulointerstitial nephritis, pyelonephritis
Chronic renal failure
Congestive heart failure
Diabetic nephropathy
Malignant hypertension
Fever with dehydration, overheating
Intense physical activity, emotional stress
Heavy metal poisoning
Kidney amyloidosis
Kidney tuberculosis
Kidney transplant rejection
Lipoid nephrosis
Paraproteinuria in myeloma

Slime secreted by the cells lining the inner surface of the urinary tract and performs a protective function, preventing chemical or mechanical damage to the epithelium. Normally, its concentration in urine is insignificant, but during inflammatory processes it increases.

Crystals appear depending on the colloidal composition of urine, pH and other properties, and may indicate disturbances in mineral metabolism, the presence of stones or an increased risk of developing urolithiasis, nephrolithiasis.

Bacteria indicate a bacterial infection of the urinary tract.

What can influence the result?

Failure to comply with the rules for submitting material (for example, failure to comply with hygiene procedures, taking an analysis during menstruation).

Diagnosis of autoimmune kidney damage
Antibodies to glomerular basement membrane

Who orders the study?

General practitioner, therapist, pediatrician, urologist, nephrologist, gastroenterologist, cardiologist, neurologist, surgeon, obstetrician-gynecologist, endocrinologist, infectious disease specialist.

Literature

Morozova V. T., Mironova I. I., Martishevskaya R. L. Urine examination. – M.: RMAPO. – 1996, – 84 p.
Fischbach F.T., Dunning M.B. A Manual of Laboratory and Diagnostic Tests, 8th Ed. Lippincott Williams & Wilkins, 2008: 1344 p.
Hauss O. Bringing Urinalysis into the 21st Century: From Uroscopy to Automated Flow Cytometry. Sysmex Journal International Vol. 18 No.2 (2008).
Wilson D. McGraw-Hill Manual of Laboratory and Diagnostic Tests 1st Ed. Normal, Illinois, 2007: 666 p.

Reading time: 11 min.

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

Pathologies of the kidneys, urinary tract and some other organs can be determined by a general urine test (abbreviated to OAM on medical forms). It is also called clinical.

Show all

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 Deviations in metabolism;
2 Signs of urinary tract infection;
3 Effectiveness of treatment and diet;
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 during preventive examinations of the population, clinical examination, it is prescribed when seeking medical help from a specialist, during pregnancy, during hospitalization and in some other cases.

A general urine test consists of a sequential study of:

1 Physical characteristics of the sample;
2 Chemical composition;
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 young children, it is often difficult to collect urine for analysis. Therefore, when collecting, you can use small tricks:

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 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 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 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 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 Use for analysis stale urine that has stood for more than 3 hours or has been in the refrigerator without a special preservative.
3 Collect material for OAM after defecation, during menstruation or after sexual intercourse.
4 Collect material for research during acute inflammatory diseases of the reproductive system, skin around the urethra and vagina (you must warn the doctor about this in advance). It will not be possible to collect such an analysis purely.
5 Do not use a urinary catheter unless there is an urgent need for it (prostate cancer, prostate adenoma, a bedridden seriously ill patient and other situations that are specified 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 the possible dietary characteristics of each patient. In an adult who follows 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 If you have drunk a lot over the past day;
2 With nervous excitement or overstrain.

Polyuria can be observed in the following pathological conditions:

1 Kidney diseases (CKD, stage of resolution of acute renal failure);
2 Relief of edema, for example, against the background of diuretics;
3 Diabetes insipidus and diabetes mellitus;
4 Nephropathies (amyloidosis, myeloma, sarcoidosis);
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 Reduce fluid intake;
2 Loss of fluid through sweat in the heat;
3 Significant physical activity.

It is noted in the following pathologies:

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

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

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

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

1 Diabetes insipidus and diabetes mellitus;
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 Drink plenty of liquid;
2 Urinary infections.

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

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

Strangury is painful urination.

Dysuria is a urination disorder that combines symptoms such as changes in urine volume, frequency and 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 Edema;
2 Vomiting;
4 Burns;
4 Stagnant kidney;
5 Diarrhea.

1 Diabetes mellitus;
2 Diabetes insipidus.

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

Dark, practical black color can indicate several conditions:

1 Alkaptonuria (due to homogentisic acid);
2 Acute hemolytic kidney;
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 Kidney infarction;
2 Renal failure;
3 Damage and trauma to the urinary tract;
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 Toxicosis of pregnant women;
2 Progressive edema;
3 Nephrotic syndrome;
4 Diabetes mellitus;
5 Use of radiopaque agents.

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

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

An alkaline reaction (pH>7) occurs when:

1 Vegetable diet;
2 Chronic renal failure;
3 Metabolic or gas alkalosis;
4 Hyperkalemia;
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 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 Renal - one that is a consequence of damage to the glomerular filter or dysfunction of the renal tubules. The diagnostic criterion for the severity of the pathological process is selectivity - the greater the number of large protein molecules found in secondary urine, the more serious the situation.
3 Postrenal proteinuria is a manifestation of inflammatory processes in the reproductive system and surrounding tissues (vulvovaginitis, balanitis, and so on).
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 Nutritional (large amounts come from food);
2 Emotional;
3 Medicinal.

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

1 Diabetes mellitus;
2 Thyrotoxicosis;
3 Pheochromocytomas;
4 Acute pancreatitis and other diseases of the pancreas;
5 Itsenko-Cushing's disease;
6 Cirrhosis of the liver;
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 Hemolytic anemia;
2 Transfusion of incompatible blood;
3 Internal injuries (crash syndrome);
4 Severe poisoning;
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 is a special indicator of urine analysis, which reflects the failure of metabolic processes occurring in the body. In this case, the following substances are detected: acetone, beta-hydroxybutyric, acetoacetic acids. Ketonuria occurs against the background of:

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

5.6. Determination of bilirubin (BIL)

Bilirubinuria is a 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 Cirrhosis;
2 Hepatitis;
3 Jaundice (parenchymal and mechanical);
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 Hepatitis;
2 Sepsis;
1 Hemolytic anemia;
4 Cirrhosis;
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 other cellular elements are counted.

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 distinguished, which manifests itself in kidney diseases of various origins, medicinal and toxic damage to the renal tissue, and non-glomerular, which is associated with the inflammatory process, injuries and oncological diseases.

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:

2 Glomerulonephritis;
3 Renal tuberculosis;
5 Urethritis;
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 Flat epithelium enters the material from the external genitalia. Often observed with urethritis in men, in poorly collected samples in women.
2 Transitional epithelium is part of the mucous membrane of the urinary tract. Found in cystitis, neoplasms, pyelitis.
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 Hyaline (protein) appear when:
- dehydration of the body;
- nephropathy in pregnant women;
- fevers;
- poisoning with salts of heavy metals.
2 Waxy (protein) speaks of:
- nephrotic syndrome;
- amyloidosis.
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:

5 Urethritis;
4 Kidney stone disease;
5 Incorrect sample collection.

G.L.U.GlucoseAbsent KETKetone bodiesAbsent pHAcidity5-6 S.G.Density1012-1025 COLORColorLight yellow

Bibliography

1 Kozinets G.I. Interpretation of blood and urine tests and their clinical significance / G.I. Kozinets. - M.: Triad X, 1998. – 100 p.;
2 Yurkovsky O.I. Clinical analysis in medical practice / O.I. Yurkovsky, A.M. Gritsyuk. – K.: Technology, 2000. – 112 p.;
3 Medvedev V.V. Clinical laboratory diagnostics: Doctor’s reference book/ V.V. Medvedev, Yu.Z. Volchek / Edited by V.A. Yakovleva. – St. Petersburg: Hippocrates, 2006. – 360 pp.;
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 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), which was reported to him twice in the last six months by his attending physician.

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.

There is no history of serious illnesses, 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 mm Hg. An examination of the cardiovascular, respiratory, nervous systems, and 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 Most likely diagnosis.
2 What further tests should be ordered?
3 What recommendations should be given to the patient?
4 How to interpret the results of a biochemical blood test?

Problem solving and patient management tactics

Microscopic hematuria can occur as a result of a wide range of pathologies (for example, prostate diseases, urolithiasis), but its combination with arterial hypertension, proteinuria (increased protein in the urine), impaired renal function (increased levels of creatinine and urea) 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).

The most common causes of microhematuria:

1 Chronic glomerulonephritis, including immunoglobulin A (Ig A) nephropathy;
2 Thin basement membrane disease (benign hematuria);
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. There is often an association with Henoch-Schönlein purpura and other autoimmune diseases, alcoholic cirrhosis of the liver, infections, and 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 end-stage chronic renal failure within 20 years.

Thin basement membrane disease is a hereditary disease that is accompanied by the determination of red blood cells, protein in the urine (minimal proteinuria), and normal kidney function tests that do 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 at high risk for the progression of renal failure, with a high probability of undergoing 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 Patients with isolated hematuria under 50 years of age should be referred to a nephrologist.
2 Patients over 50 years of age are initially referred to a urologist to exclude pathologies of the bladder and prostate.
3 Even a slight increase in plasma creatinine indicates significant impairment of renal function.
4 Alcohol-induced liver damage is not accompanied by severe symptoms.

When diagnosing pathological conditions of various kinds, a general urinalysis is necessarily prescribed. Microscopy of urine sediment is part of a general clinical examination. The essence of this analysis is to count and assess the quality of urinary sediment elements in order to identify or refute most pathological conditions.

General information about the study

Properly collected and timely delivered (delivery time 1-2 hours) material to the laboratory affects the correct interpretation of the analysis. To carry out the analysis, you need a morning single portion of urine, stored in a sterile container for analysis. Be sure to perform intimate hygiene before starting the analysis.

Analysis indicator for suspected pathological conditions:

hematuria (red blood cell count);
pyuria (white blood cell count);
cylindruria (counting cylinders);
bacteriuria (number of bacteria)
hemoglobinuria. The presence of salt crystals, epithelial cells, mucus, and protozoa is also assessed.

The study makes it possible to assess the function of the kidneys and urinary tract, as well as identify disturbances in the functioning of internal organs.

The research procedure consists of the following stages:

Using a pipette, 10 ml of urine (which has stood for 1-2 hours) is collected from the bottom of the container.
The collected material is centrifuged at 1500 rpm. lasting 5-7 minutes.
The composition of one drop of sediment is analyzed using low and high magnification. The data obtained will help in diagnosing diseases, determining the ongoing inflammatory or infectious process, and changes in metabolism.

Interpretation of sediment analysis results: normal

It is important to consider that the result of urine sediment microscopy analysis may be influenced by some external factors, such as:

excessive physical activity;
taking medications (diuretics or antibiotics);
violation of the rules for collecting and delivering urine;
diet.

Elements that are present in sediment are usually classified as organized, having organic origin, and unorganized - inorganic sediment. For all identified elements of urinary sediment, there are certain standards, the excess of which indicates various pathological conditions.

Hemoglobin

The presence of hemoglobin in the urine indicates severe infectious diseases.

The presence of hemoglobin in urine sediment is considered a deviation, as it is considered a sign of the breakdown of red blood cells. Often caused by various diseases - influenza, pneumonia, acute infection. But external causes can also provoke its occurrence in urine, for example, hypothermia, injury, poisoning. In this case, the urine acquires a red-brown tint, and painful sensations may appear in the lumbar region. Very often, urine saturated with hemoglobin indicates a failed blood transfusion when the donor's blood is incompatible with the blood of the patient being received.

Red blood cells in urine sediment

Red blood cells in urine can be unchanged or leached. Their difference lies in the content of hemoglobin; leached ones do not contain it. Leached substances present in the microscopic material indicate disturbances in the functioning of the kidneys, while unaltered ones indicate disturbances in the functioning of the urinary tract. The normal indicator of red blood cells for females is 3, for males - 1. With other indicators, hematuria is noted. There are microhematuria (the color of the urine does not change) and macrohematuria (the urine changes color due to the presence of red blood cells). You should not conduct a microscopic examination of urine sediment during menstrual periods, as blood may enter the sample with urine. The causes of hematuria include:

kidney pathologies and injuries;
diathesis;
the presence of kidney stones;
tumors of the urinary system;
urinary tract infections;
poisoning of various kinds.

Leukocytes in urine sediment

A large number of white blood cells causes cloudy urine.

The limit values of leukocytes in urine are 0-5 for women, 0-3 for men. If the values are elevated, it means that pus is being excreted in the urine (pyuria or leukocyturia). Pyuria always indicates an inflammatory focus. To determine the approximate localization of ongoing inflammation, glass urine samples are prescribed, namely. The concentration of leukocytes in the first glass of urine is the initial pyuria, it indicates urethritis or prostatitis. Final pyuria is determined by the presence of leukocytes in the third glass and suggests cystitis. Excess leukocytes in three glasses - ailments of the kidneys and bladder.

Epithelium in urine sediment

Epithelial cells (epithelial cells) are found in urine quite often; their presence in single values is considered normal. Epithelial cells are classified according to the nature of their origin. The renal epithelium identified in the sediment is of great importance, since this type of epithelium comes from the renal tubules. This fact indicates serious kidney damage. An increase in the permissible values of squamous epithelium often indicates incorrect collection of analysis or an acute inflammatory process in the organs of the urinary system. Urine sediment containing polymorphic epithelium in values higher than permissible carries information about diseases of the urinary tract (oncology, cystitis, stones, intoxications).

Microscopy of urine components is carried out in the sediment formed after centrifugation of 10 ml of urine. Sediment consists of solid particles suspended in urine: cells, protein-formed casts (with or without inclusions), crystals, or amorphous deposits of chemicals.

5.2.1. Red blood cells in urine Red blood cells (blood cells) enter the urine from the blood. Physiological erythrocyturia is up to 2 red blood cells/μl of urine. It does not affect the color of urine. During the study, it is necessary to exclude contamination of urine with blood as a result of menstruation! Hematuria (the appearance of red blood cells, other formed elements, as well as hemoglobin and other blood components in the urine) can be caused by bleeding anywhere in the urinary system. The main reason for the increase in the content of red blood cells in the urine is renal or urological diseases and hemorrhagic diathesis.

Reference values: none; with microscopy - up to 2 in the field of view.Red blood cells in urine - exceeding reference values:

urinary tract stones;

tumors of the genitourinary system;

glomerulonephritis;

pyelonephritis;

hemorrhagic diathesis (with intolerance to anticoagulant therapy, hemophilia, coagulation disorders, thrombocytopenia, thrombocytopathies);

urinary tract infections (cystitis, urogenital tuberculosis);

kidney injury;

arterial hypertension with involvement of the renal vessels;

systemic lupus erythematosus (lupus nephritis);

poisoning with benzene derivatives, aniline, snake venom, poisonous mushrooms;

inadequate anticoagulant therapy.

5.2.2. Leukocytes in urine An increased number of white blood cells in the urine (leukocyturia) is a symptom of inflammation of the kidneys and/or lower urinary tract. In chronic inflammation, leukocyturia is a more reliable test than bacteriuria, which is often not detected. With a very large number of leukocytes, pus in the urine is determined macroscopically - this is the so-called pyuria. The presence of leukocytes in the urine may be due to the presence of secretions from the external genitalia in the urine due to vulvovaginitis, or insufficiently thorough toileting of the external genitalia when collecting urine for analysis.

Reference values: none; under microscopy: men - 0 - 3 in the field of view women, children< 14 лет - 0 - 5 в поле зрения

An increase in leukocytes in the urine is observed in almost all diseases of the kidneys and genitourinary system:

acute and chronic pyelonephritis, glomerulonephritis;

cystitis, urethritis, prostatitis;

stones in the ureter;

tubulointerstitial nephritis;

lupus nephritis;

kidney transplant rejection.

5.2.3. Epithelial cells in urine Epithelial cells are almost always present in urine sediment. Epithelial cells originating from different parts of the genitourinary system vary (usually squamous, transitional and renal epithelium are distinguished).

Squamous epithelial cells, characteristic of the lower parts of the genitourinary system, are found in the urine of healthy people and their presence usually has little diagnostic value. The amount of squamous epithelium in the urine increases with urinary tract infection.

An increased number of transitional epithelial cells can be observed in cystitis, pyelonephritis, and kidney stones.

The presence of renal epithelium in the urine indicates damage to the kidney parenchyma (observed in glomerulonephritis, pyelonephritis, some infectious diseases, intoxication, circulatory disorders). The presence of more than 15 renal epithelial cells in the field of view 3 days after transplantation is an early sign of the threat of allograft rejection.

Reference values: none; under microscopy: squamous epithelial cells:

women are the only ones in sight

men are the only ones in the preparation

other epithelial cells - absent

Detection of renal epithelial cells:

pyelonephritis;

intoxication, intake of salicylates, cortisol, phenacetin, bismuth preparations, poisoning with salts of heavy metals, ethylene glycol);

tubular necrosis;

kidney transplant rejection;

nephrosclerosis.

5.2.4. Casts in urine Cylinders are elements of cylindrical sediment (a kind of cast of renal tubules), consisting of protein or cells, and may also contain various inclusions (hemoglobin, bilirubin, pigments, sulfonamides). Based on their composition and appearance, there are several types of cylinders (hyaline, granular, erythrocyte, waxy, etc.).

Normally, renal epithelial cells secrete the so-called Tamm-Horsfall protein (absent in blood plasma), which is the basis of hyaline casts. Hyaline casts can be found in urine in all kidney diseases. Sometimes hyaline casts can be found in healthy people. As a pathological symptom, they acquire significance when they are constantly detected and in significant quantities, especially when erythrocytes and renal epithelium are superimposed on them.

Grainy cylinders are formed as a result of destruction of tubular epithelial cells. Their detection in a patient at rest and without fever indicates renal pathology.

Waxy cylinders are formed from compacted hyaline and granular cylinders in tubules with a wide lumen. They occur in severe kidney diseases with predominant damage and degeneration of the tubular epithelium, more often in chronic than in acute processes.

Red blood cell casts are formed when erythrocytes are layered on hyaline cylinders, leukocytes - leukocytes. The presence of red blood cell casts confirms the renal origin of hematuria.

Epithelial casts(rarely) formed when the tubular epithelium is detached. Occurs with severe degenerative changes in the tubules at the onset of acute diffuse glomerulonephritis, chronic glomerulonephritis. Their presence in a urine test a few days after surgery is a sign of rejection of the transplanted kidney.

Pigment(hemoglobin) casts are formed when pigments are included in the cylinder and are observed with myoglobinuria and hemoglobinuria.

Cylinders- long formations consisting of mucus. Single cylindroids are found in urine under normal conditions. A significant number of them occur with inflammatory

processes of the mucous membrane of the urinary tract. They are often observed when the nephritic process subsides.

Reference values: hyaline cylinders – single, the rest – absent

Hyaline casts in urine:

renal pathology (acute and chronic glomerulonephritis, pyelonephritis, kidney stones, renal tuberculosis, tumors);

congestive heart failure;

hyperthermic conditions;

high blood pressure;

taking diuretics.

Granular casts (nonspecific pathological symptom):

glomerulonephoritis, pyelonephritis;

diabetic nephropathy;

viral infections;