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Clinical analysis of urine decoding the norm. General urine analysis - transcript. Indications for the appointment of a urine test

General, or clinical, urinalysis is an important laboratory medical study that contributes to a more accurate diagnosis of most diseases. It is prescribed for differential diagnostics for suspected diabetes mellitus, for any diseases of the genitourinary system, for viral infections, for all disorders of the endocrine system, for monitoring the dynamics during the treatment of diseases, as well as for preventive examinations.

How to collect and pass a general urine test correctly?

The biological fluid called urine is produced by the kidneys in the human body. Blood plasma is filtered by the glomeruli of renal capillaries, then water and many constituents are reabsorbed from it by the proximal tubules and biological fluid is produced by the distal kidney channels.

According to the results of urine analysis, one can judge the state of the genitourinary organs and the health of the whole organism, since the compositions of urine and blood are interrelated.

For the analysis results to be adequate, it is important to collect it correctly!

A brief instruction on how to collect a general urine test is as follows:

Before you begin to collect the analysis, you should conduct a thorough toilet of the external genitalia.
You need to stock up on a container for collecting urine - a clean jar.
During a night's sleep, a certain amount of biological fluid collects in the bladder. It should be used to pass a general clinical urine test.
The night before, you should avoid eating urine-staining foods such as beets, for example, and you should also not consume alcoholic beverages.
You should not drink diuretics before taking the test.
In order for a general urine analysis to give objective results, it is necessary to collect not only the average, but the entire portion of morning urine.
The collected urine should be kept cool, preventing it from overheating or freezing.
In order for the analysis indicators to be accurate, it is necessary to deliver the collected urine to the laboratory for research no longer than 2 hours after collection.

Morning urine is collected on an empty stomach for general analysis! Before taking the test, you should not eat or drink anything, and you also do not need to take medications!

Any medications or foodstuffs will affect the biochemical parameters, therefore, the analysis indicators will be unreliable.

Clinical general urine analysis is useful information for specialists about the state of systems and organs of the human body, about the level of hormones, enzymes, the presence of toxic substances in the urine, about the composition of metabolic products, salts, and water.

The study of urine for a general analysis includes its microscopic examination, fixation of the chemical and physical parameters of the biological fluid produced by the kidneys.

Typical mistakes that patients make when they want to take a general urine test are as follows:

In the morning, first urinate, and then collect urine for analysis.
Do not pre-wash the genital area.
Take contaminated dishes for urine.
Collect less than 50 ml of the morning urine sample.
Before drinking water, medicines, alcohol, and eating foods that stain urine.
Long-term storage of the contents in a container before delivery to the laboratory.
The sampling of the analysis is not in the morning, immediately after waking up, but during the day.
Postponing on the eve of the analysis of sports or emotional overload.
Being in too hot or too cold conditions before urine collection.

All indicators of the general analysis of urine - what each indicator means

In the clinical analysis of urine, there are many different indicators. All of them can be divided into three main groups:

Indicators of the physical properties of the biological fluid excreted by the kidneys.
The presence of organic matter in the urine.
Urinary sediment.

Physical properties of urine

The physical properties of urine include its color, odor, clarity, density, and acidity.

The clarity of urine and its color determined by laboratory technicians by eye, the relative density is measured using a test strip, or an instrument with a urometer.

To determine acidity the urinary environment also applies a test in the form of a special strip.

What is the smell of urine - determined by a simple sniffing method.

Each indicator is considered in comparison with the standard of the norm. So, normally urine should be yellow in color, regardless of the color saturation and its shades. It can be amber yellow or light yellow or deep yellow.

The color of urine is influenced by its density. The higher the density, the more intense the yellow color of the biological fluid. Urine acquires an atypical color under the influence of certain food or medicinal substances.

Medications can change the color of urine to green, brown, red, and even black. In particular, medications containing iron, as well as amidopyrine and antipyrine, change the color of urine to shades of pink or brown. And methylene blue introduced into the body in any way - in shades of blue.

Different foods provoke the appearance of different colors of human urine. Rhubarb and bay leaves in large quantities can turn urine brown or green. Beets and carrots make it brown or red. These changes are not pathological, but are considered the norm.

The smell of normal urine is not harsh, although it is very specific. When the container with urine is in the open air, the oxidation process takes place, and ammonia vapor is formed. The smell of urine becomes harsh. Many scented foods, or those that contain essential oils, affect the change in smell. These include asparagus, radish, garlic and onions. Valerian and horseradish also give a pungent smell to urine. All this corresponds to the norm, but complicates the processing of analyzes.

Transparency without any turbidity is inherent in fresh urine of a healthy organism. The longer the biological renal fluid stands, the more turbidity appears in it. This is due to the content of various salts in the urine and is the norm.

The relative density of urine is used to judge the concentration characteristics of the kidneys. This is a very important indicator that can physiologically change in the presence of vomiting or diarrhea, accompanied by dehydration. Reduces the density of urine vegetable and fruit diet, and increases the consumption of meat in large quantities.

Clinical general analysis of urine for children who are just born, normally at first has a low relative density.

The normal density of urine also differs depending on the seasons. It is lower in winter and increases in summer. Higher urine density is normal in men, while it is lower in women and children.

The relative density standard for a healthy person ranges from 1003 to 1028 units.

The acidity of urine is indicated by the letters pH and is normally equal to seven, that is is neutral. Neutral acidity of urine is characteristic of a mixed nutritious diet, when the food contains both meat and vegetable food, as well as baked goods. Normal acidity for children and adults can range from 5-7 units, which corresponds to a weakly acidic environment. Babies who are still fed milk may have both neutral and alkaline urinary environment.

More than seven units of the indicator of urine acidity increase brown bread, alkaline mineral waters, soda, food saturation with vegetables. Exposing dishes with urine outdoors for a long time also shifts the reaction of the urinary environment towards alkaline. The urinary environment is oxidized more strongly from white bread and a large amount of fat in food, from excess in the diet of foods high in protein, from heavy physical exertion and starvation.

Organic matter in urine

A general urine analysis also involves the detection of organic substances in its contents using test strips and modern laboratory equipment. Automatic analyzers are used as equipment, allowing you to immediately find out in what concentration the following substances are in the biological fluid:

Bilirubin.
Protein.
Ketone bodies.
Glucose.
Bile pigments (acids).
Indikan.
Urobilinogen.

Test strips do not show concentration. Thanks to them, you can only find out the presence or absence of organic matter in the composition of urine. If the test strip responds positively to any substance, further testing allows you to determine the percentage of its content.

Of the ingredients listed above, only protein and urobilinogen should be present in normal healthy urine. Moreover, the normal concentration of urobilinogen is in the range of 6-10 μmol per day, and the protein concentration should not exceed 0.03 grams.

The appearance of high protein in the urine can be triggered by bacteria, leukocytes and red blood cells, as well as sperm. The effect on increasing the degree of protein concentration is also exerted by strong emotions, physical exertion and sudden changes in temperature at the threshold of stress, at which the human body is either supercooled or overheated.

Urinary sediment - elements of urinary sediment

Urinary sediment is examined last when processing the urinalysis. To make it easier to obtain, the remainder of the biological renal fluid is passed through a centrifuge. Then, under a microscope, the resulting contents of the sediment are examined and find out if there are:

Epithelium.
Slime.
Particles of bacterial origin.
Salt crystals.
Leukocytes.
Red blood cells.
Cylinders.

The epithelium in the urinary sediment can be kept flat (from the urethra
channel), renal and transitional (from the kidneys, bladder and ureters). Normally, the renal epithelium should be absent. And there are no more than three cells of squamous and transitional epithelium in a healthy analysis, both in men and women. If elementary hygiene rules were not followed during the collection of the analysis, the number of squamous epithelial cells increases. Identification of renal epithelium in the analysis indicates kidney disease.

The same goes for mucus. Normally, it is absent in the general analysis. If mucus is found in the urine, it is necessary to look for the pathology of the genitourinary organs.

Healthy women and men also do not have bacteria in their urine. The appearance of particles of bacterial origin in the clinical analysis of a biological fluid indicates the presence of an inflammatory infectious process in the body.
Salt crystals should normally be present in the urine. Their number depends on a person's diet and on how much clean drinking water he drinks per day.

Salts precipitated into normal urinary sediment are urates, oxalates and triple phosphates.

Leukocytes in normal urine should also be present. In healthy men, they are normally from 0 to 3 in one field of view, in healthy women, a little more - from 0 to 5. An increase in the number of leukocytes above normal indicates the current disease in the body.

Erythrocytes in the analysis of urine of healthy people, on the contrary, should be absent.
Single erythrocytes, detected in several fields of vision, are maximally permissible. The appearance of erythrocytes in the urine can be both pathological and physiological. Physiological causes include taking certain medications, standing still for a long time, walking for a long time, and excessive physical exertion. With the exclusion of physiological causes, pathological factors are an alarming signal of a disease of internal organs.

Cylinders in a normal clinical analysis of urine, only hyaline can be found. Their appearance is influenced by strenuous sports training or hard physical work, dousing with cold water, working in hot workshops or being a person in hot conditions. All other types of cylinders should not be in healthy urine.

These include cylinders:

Red blood cells.
Leukocytic.
Epithelial.
Waxy.
Grainy.

All the above data correspond to the general analysis of urine in healthy adults. Clinical general analysis of urine in children is somewhat different in indications.

Decoding of indicators of general urine analysis - table of norms for adults and children

In the results of a clinical analysis of urine, specialists put down certain symbols, each of which denotes one of the main indicators. Normative designations are written next to it, then the values of this particular analysis, individual for each person, are indicated.

The study of urinalysis data takes an important place in the diagnosis of pathological changes in the kidneys, heart disease. Valuable additional information due to the general analysis of urine can be obtained in case of dysfunctions of other organs. Almost all disease processes in the body are reflected in the properties of urine. Re-examination of laboratory parameters allows you to assess the stages of pathological processes, the effect of drug therapy.

The result of a bad urinalysis should be the reason for the patient to see a doctor.

What are the rules for collecting and submitting urine?

Not all people know how to correctly take a urine test, what are the collection requirements that minimize distortion of the data obtained.

The biochemical composition of urine directly depends on the amount of fluid entering the body, climatic living conditions, and physical activity. Before the analysis, it is important to follow the rules for the delivery and storage of the studied biomaterial, which allow obtaining reliable data.

Before collecting urine for analysis, doctors recommend not to overeat for a day, especially not to abuse fatty, starchy and sweet foods. You should refrain from smoked and spicy foods. It is also important not to expose yourself to physical overload.

The urine is collected in a clean and dried container. It is best to take a medium "portion" of morning urine. Women should be aware that during the period of menstruation, they should refrain from conducting an analysis. In an emergency, it is best to use a soft catheter to drain urine. Catheterization is also used when it is impossible to empty the bladder on its own due to existing diseases.

The analysis must be carried out within a few hours after the sampling of the material. If this is not possible, then urine should be stored in a cool place. Preservatives can also be used that do not distort the test results.

The name and age of the patient must be marked on the dishes with the material.

Important:decoding of urine analysis is carried out only by a doctor who examines the patient and knows all the intricacies of the existing disease. It must be remembered that urinalysis results without examination can be misinterpreted.

Norms of urine analysis in adults, table:

INDICATOR	NORM	DEVIATION
The amount of urine in the morning portion	100-300 ml	less than 100 ml
		more than 300 ml
Transparency	complete	cloudy at the time of discharge
		flakes and threads
Color	straw yellow	orange red
		type of meat slop
		Brown
		black
		bright yellow
		transparent light yellow
pH	sour	neutral
		alkaline
Osmolarity	600-800 mmol / l	less than 600 mmol / l
		more than 800 mmol / l
Relative density (specific gravity)	1,018-1,025 (1018-1025)	above 1.025 (1025)
		below 1.018 (1018)
Acetone	No	there is
Protein	none (or trace amounts)	there is
Glucose	No	there is
Ketone bodies	No	there is
Leukocytes	men: 0-3 in sight, females: 0-5 in sight	5-20 in sight
		more than 20 in sight
Erythrocytes	no (or single)	less than 100 in the field of view
		more than 100 in sight

What indicators are assessed in the general analysis of urine

Clinical laboratories make it possible to assess the physical properties of urine, its chemical composition and microscopic diagnostics of urinary sediment. In addition to the general clinical analysis, the Nechiporenko method is used. With his help, an additional clarification of kidney diseases is carried out.

Organoleptic and physicochemical properties assessed by general urine analysis

The organoleptic properties of urine include color, smell, and the amount of fluid released. Physicochemical - density and chemical reaction.

The color of urine changes depending on its concentration and the presence of coloring substances. Wherein:

Urine smell is determined in the case of a long stay in the container. The speed of its development depends on the room temperature.

In the presence of certain diseases, different shades of urine odor may appear, as follows:

E. coli infection contributes to the development of fecal odor in the urine;
ketonuria - acetone odor;
isovalerian and glutaric acidemia - odor of sweaty feet;
trimethylaminuria - a shade of rotting fish;
tyrosinemia - a rancid fish stench;
phenylketonuria - mouse odor;
fistulas between the intestines or purulent cavities and the urinary tract - putrid stench;
- smell of ammonia vapors;

Diabetes mellitus is characterized by a fruity hue, due to the appearance of acetone in the urine.

Chemical reaction depends on the prevailing nature of the patient's diet . It is usually slightly acidic or neutral. . Diabetes mellitus, chronic heart failure , kidney problems, pregnancy can be acidic. A pronounced acid reaction occurring against the background of acidosis of the body is characteristic of severe infectious diseases accompanied by fever, with diseases of the intestinal tract, and starvation.

Alkalosis - a companion of chronic rapid breathing in diseases of the lungs, heart provokes an alkaline urine reaction. The same changes occur with indomitable vomiting, some renal diseases, pathology of the endocrine system, the use of diuretics, transfusions of large amounts of carbonate solutions for intravenous administration. Also, some food products can give an alkaline reaction of urine.

Density of urine an adult is in the range of 1.001 - 1.040 g / l . It is determined by the total concentration of physical compounds and organisms dissolved in it. These include proteins, pigments, glucose isomers, bacteria, blood cells.

Quantity excreted urine per day in a healthy person ranges from 1 liter to 2 liters, depending on the drinking load, air temperature. Diabetes mellitus is the main pathology in which a patient can excrete about 8 liters or more per day.

Note:at night, urinary excretion normally slows down. If the opposite trend is observed, then a chronic process in the renal tissue or possible mental pathology should be suspected.

Biochemical characteristics of the general analysis of urine

Important indicators that help the doctor in the diagnostic process are data on the content of protein components, metabolic products of bile pigments, isomers of glucose, acetone and other substances.

Protein in urine analysis

In the urine of a healthy person, protein is not detected.

The reason for its appearance (proteinuria) may be:

renal- in case of ingestion of protein from blood plasma in inflammatory kidney diseases, sharp external stimuli (extreme cold, stress, physical overload);
extrarenal- protein enters the urine from the urinary ducts.

Urinalysis for protein is a very important and valuable diagnostic indicator.

Examination of urine for sugar

Normally, urine does not contain sugar... Its detection may indicate the intake of a large amount of carbohydrates in food. Then we are talking about physiological glucosuria.

Pathological glucosuria can be caused by:

diabetes;
pituitary gland diseases;
pathology of the adrenal glands.

It is worth considering if ketone bodies appear in the general urine analysis:

acetone;
acetoacetic acid;
beta-hydroxybutyric acid

Their presence confirms the diagnosis of diabetes mellitus, acute inflammatory processes of kidney and liver tissue. For diabetes mellitus, the presence of ketone bodies is a formidable sign of the development of one of the types of lumps.

Microscopy of urinary sediment in the general analysis of urine

This method evaluates the appearance of blood elements in the urine.

Analysis of urine for red blood cells

The presence of erythrocytes in the urine, both unchanged (with hemoglobin contained) and altered (free from hemoglobin, colorless) is called hematuria.

There are two types of this state:

macrohematuria - erythrocytes are in the urine in large quantities, which is why it acquires a reddish tint (meat slops);
microhematuria - erythrocytes are detected only in the field of view of the microscope.

The appearance of unchanged red blood cells is characteristic of:

kidney infarction;
renal tissue process;
traumatic injuries;
malignant tumors;
inflammation of the bladder and urethra.

Determination of the level of the source of erythrocytes is carried out with a three-glass test:

if the blood is in the first portion, it means that the source of blood is the urethra;
if the blood is in three portions, there is a kidney pathology;
if the blood is only in the last portion, then we are talking about an inflammation of the bladder or a tumor process.

Analysis of urine for the content of casts and epithelial cells

The cylinders are casts of the globulin structure that follow the shape of the renal tubules.

In urine, 2 types of cylinders can be determined:

hyaline - indicators of chronic nephritis;
epithelial cell - desquamated cells of the renal tubules. Among them there are: granular cylinders, waxy cylinders (flat homogeneous structures).

An increase in the number of cylinders (cylindruria) occurs with pathological processes in the kidney tubules. Especially the number of these cells increases with nephrosis.

Epithelial cells in the general analysis of urine are:

flat (rounded with a small core). In urine appear from the mucous membrane of the genitals;
transitional - lining the mucous membranes of the bladder and renal pelvis;
renal (irregularly shaped with a yellowish tinge) - characteristic markers of kidney damage in infectious diseases and poisoning.

Analysis of urine for leukocytes

The urine of healthy persons may contain a single amount leukocytes... When a laboratory assistant detects accumulations of white blood cells in the entire field of view of the microscope, then the doctor has every reason to suspect the patient has pyuria - pus in the urine. This condition can be observed in severe forms of inflammatory kidney disease - pyelonephritis, with purulent pathology of the bladder and urinary tract.

You can understand where the source of pyuria is thanks to a three-glass sample, similar to determining the source of blood in urine.

Urine analysis according to Nechiporenko is an additional and clarifying method for determining the degree of leukocyte count in urine (leukocyturia).

The urine is collected in the morning portion, after the preparation and procedure of the toilet of the external urinary organs. An average portion of morning urine is collected. For analysis, 5 ml of material is used, which is centrifuged for 10 minutes.

After this part of the analysis, the liquid content is drained, and the concentrate is placed in the Goryaev chamber to count the number of erythrocytes, leukocytes and cylinders. The resulting number of elements is multiplied by 250.

If the number of leukocytes exceeds 2000 in 1 ml, then it is possible to suspect the patient has an inflammation of the bladder, the presence of kidney stones.

If the number of erythrocytes is more than 1000 in 1 ml, then the patient, if there are other signs, can be confirmed with a kidney infarction.

The appearance of cylinders also confirms renal pathology, depending on the predominance of a certain shape - hyaline, granular, waxy, erythrocytic and epithelial.

Norms of urine tests in a child

Norms of urine analysis in a child, table:

Indicators	results
Color	Straw to dark yellow
Smell	Unsharp
Appearance	Transparent
Relative density	1.010 to 1.025
pH	5 to 7.0
Protein	0.00 - 0.14 g / l
Glucose	0.00 - 1.00 mmol / l
Ketone bodies	0 - 0.5 mmol / l
Bilirubin	0 - 8.5 μmol / l
Urobilinogen	0 - 35 μmol / l
Hemoglobin	Missing
Bacteria (nitrite test)	Absent
Erythrocytes	0 to 2 per field of view
Leukocytes	0 to 5 per field of view
Epithelial cells	0 to 5 per field of view

When visiting a doctor with complaints of malaise, the results of a general urine analysis are considered, the indicators of which are normal if there are no violations in the body of a woman or a man. Not one doctor can do without this. Any disturbance in the functioning of organs and systems will cause changes in the normal parameters of urine. Find out how and why to take a full analysis.

What is a general urine test

In modern medicine, referrals for examination are often prescribed to monitor the biochemical parameters of blood and urine. Analysis in city polyclinics is free of charge and is performed by automatic analyzers. The doctor interprets the results. With the help of clinical laboratory methods, a urine test is carried out, which makes it possible to assess the physicochemical properties of the liquid and sediment. The forms indicate the patient's normal values and urine test results.

The procedure is carried out as follows:

During the analysis, color, transparency are assessed, specific gravity and pH are determined.
After sampling, the presence of protein, glucose, bilirubin, ketone bodies, nitrites is determined.
Microscopy of the sediment is carried out and the presence of formed elements (erythrocytes, cylinders, leukocytes), the presence of bacteria, epithelial cells is determined.
The analysis is carried out for all adult women and men, regardless of the disease and during preventive examinations, to determine the effectiveness of therapy in order to identify kidney pathologies.

How to collect a general urine test in adults

In the direction of the doctor, urine collection for a general analysis is carried out according to certain rules:

It is recommended to take the test in the morning, right after sleep, having previously carried out the preparation of the genitals.
The first stream in the morning must be released into the toilet, and the rest of the morning urine must be collected in a sterile container (it is better to use a special container).
The containers indicate the surname, name and patronymic of the patient, the date of collection.
Fresh urine should be delivered within a few hours.

Urine analysis rate

How to determine by the values whether there are disorders in the functioning of the body, consult online or find out in the table below:

Indicator name	Urine analysis is normal
Quantity
	straw, shades of yellow
Transparency	transparent
	not sharp
	normal acidity 4,8 - 7,5
Relative density
	no, or traces of protein

Ketone bodies
Bilirubin
Urobilinogen
Erythrocytes
Leukocytes
Epithelial cells
Cylinders

Decryption

How to decipher a urine test without the help of a doctor, if there is no way to immediately contact him for advice? Focus on the following factors:

Normal values. It should be borne in mind that each laboratory may have minor deviations from generally accepted standards, which depend on electronic equipment and alkaline and chemical reagents.
Indicators of the analysis of the patient's urine. If the numbers go beyond the limits of norms up or down, it is necessary to think about problems in the organs or systems of the body. Even if this does not affect the patient's well-being, the disease may be at an early stage.

Color

According to the norms, urine is light yellow in color. If the color changes, this does not always indicate a violation. Here are some reasons why the shade of the liquid changes:

Black tea-colored urine is noted with liver pathologies, massive destruction of red blood cells, for example, urinary tract infections or after blood transfusions.
Saturated, dark yellow urine acquires with dehydration or heart failure.
Colorless, like water - noted with increased fluid intake, diabetes mellitus or kidney disease.
Scarlet hues are given to urine by eating beets, grapes, carrots or blueberries.
The red color of urine indicates the presence of red blood cells and manifests itself in inflammatory processes in the kidneys, bladder cancer or ICD (urolithiasis).
Urine in the form of meat slops + the presence of a cloudy sediment indicates serious renal pathologies.
Black urine is found in Markiafava-Micheli disease, alkaptonuria and melanoma.

Transparency

Normal fluid excreted from the body is clear. This indicator is checked visually: the container is placed at eye level and a white sheet of paper or newspaper is placed behind. Clouding of urine can appear when:

the presence of blood corpuscles;
the appearance of protein (pyelonephritis or glomerulonephritis);
a large number of epithelial cells;
presence of sediment from urates, oxalates and phosphates.

Density

The specific gravity of the fluid depends on the amount of substances that are dissolved in the urine. The higher the concentration, the more the density differs. A decrease in specific gravity (low relative density) is facilitated by the presence of diabetes, renal failure, and high fluid intake. High or low density depends on salts, organic matter. The specific gravity increases with:

glomerulonephritis;
taking large doses of antibiotics;
dehydration of the body;
toxicosis;
the presence of urinary tract infections, kidneys.

Acidity

This parameter is measured very often. It changes because the kidneys remove hydrogen ions from the bloodstream during the filtration process. Acidity increases under the following conditions of the body:

violation of the daily acid-base balance;
chronic renal failure;
high levels of potassium in the blood;
an increase in parahormone content;
prolonged, profuse vomiting;
neoplasms in the kidneys, bladder.

The urine reaction is below normal with:

respiratory acidosis;
lack of potassium;
fasting or dehydration;
diabetes mellitus;
high body temperatures;
the use of medicines;
improper diet (if there is a lot of meat in the diet).

Protein

Normally, a clinical urinalysis does not include the presence of protein. Its presence up to 0.33 g / l is also normal. Possible reasons for the increase in protein concentration:

for diseases or damage to the kidneys, inflammatory diseases in the urethra or ureters;
in a healthy person after intense exertion or profuse sweating;
during pregnancy and in children 7-15 years old with poor physical development.

Glucose

A healthy adult or child should not have sugar in urine. The appearance of glucose in pregnant women from excessive consumption of confectionery is possible. If this substance is found, it is necessary to consult an endocrinologist to diagnose diabetes mellitus or determine another cause. If glucose appears in clinical analysis, this indicates the following possible diseases:

diabetes;
renal diabetes;
the presence of Cushing's syndrome;
pheochromocytoma.

Ketone bodies

So called hydroxybutyric and acetoacetic acids, acetone. In a healthy person, they are not determined, but appear when:

metabolic disorders;
alcohol intoxication;
diabetes mellitus;
prolonged fasting;
increased secretion of thyroid hormones;
abuse of animal proteins and fatty foods;
the presence of Itsenko-Cushing's disease.

Bilirubin

In the normal state of the body, bilirubin is excreted by the gallbladder with bile into the intestinal lumen. If its indicators increase to critical numbers, then the excretion of this substance begins through the kidneys. This is a sign of liver pathology with:

hepatitis;
cirrhosis of the liver;
liver failure;
cholelithiasis;
massive destruction of blood cells.

Urobilinogen

This organic substance is formed from bilirubin in the intestinal lumen, enters the liver with the bloodstream and is excreted again. When the organ is unable to bind all of the urobilinogen, some remains in the general bloodstream and is excreted by the kidneys. Reasons for the appearance:

blood transfusion;
sepsis;
inflammatory bowel processes;
liver failure.

Hemoglobin

It is a protein that carries oxygen. It is located in the middle of the red blood cell. If massive destruction processes occur, hemoglobin is released, and the liver is not able to break it down quickly. In this case, it partially exits with the help of the kidneys. Hemoglobin in urine appears in the following conditions:

hemolytic anemia;
malaria;
blood transfusion;
extensive muscle damage;
myocardial infarction;
burns;
poisoning with sulfonamides, mushrooms or phenol.

Leukocytes

kidney disease (chronic or acute);
urolithiasis disease;
urinary tract infections;
prostatitis;
tumors of the prostate;
inflammation of the urethra;
chronic infection of the genital organs.

Erythrocytes

Their main function is to deliver oxygen to tissues and organs. When single red blood cells appear, you should think about serious kidney or urinary tract disorders. If a person is healthy, they are absent. Red blood cells are found in the following conditions:

acute inflammation of the kidneys;
nephrotic syndrome;
kidney infarction;
tumors of the bladder, prostate, or kidney.

Epithelium

In the urinary sediment, various epithelial cells can be observed - renal, bladder, etc. If there are any, this indicates kidney damage (nephritis or nephrosis). Transitional renal epithelium indicates the presence of cystitis or other inflammation in the ureters. In women and girls, mucus is secreted in the urine sediment with pieces of squamous epithelium - it comes from the genital tract, therefore it does not signal pathological processes.

Cylinders

In the presence of serious pathologies in the kidneys, cylinders form in the urine. They are made up of red blood cells, desquamated cells, and protein. Cylinders are granular, hyaline and erythrocytic, epithelial and waxy:

Hyaline casts are found in pyelonephritis, acute or chronic glomerulonephritis, hypertension, while taking diuretics.
Granular can be found in the presence of glomerulonephritis, lead poisoning, viral infections.
Waxy ones appear in chronic kidney failure, amyloidosis, nephrotic syndrome.
Erythrocyte casts appear as a result of violations of the permeability of the vascular wall of the glomerulus of the kidney, with acute glomerulonephritis, kidney infarction, thrombosis of the veins of the kidneys.
Epithelial casts are formed when the kidney epithelium is rejected and speak of acute tubular necrosis, viral infections, heavy metal poisoning, salicylate overdose.

Salt

Excess minerals are excreted by the kidneys, inorganic substances interact with each other and salt precipitates, resulting in kidney stones. Among them are urates (uric acid), phosphates and oxalates, crystals of hippuric acid salts:

Urates are found in dehydration, the presence of uric acid diathesis or gout, chronic renal failure, nephritis, in newborns. You can lower them yourself by consuming plenty of water, vitamins A and B.
Oxalates appear with pyelonephritis, diabetes mellitus, ethylene glycol poisoning, with excessive consumption of foods rich in vitamin C. You can reduce their content by consuming more water, foods rich in magnesium, and B vitamins.
Crystals of hippuric acid appear after eating foods that contain benzoic acid (lingonberry or blueberry), with diabetes mellitus, dysbiosis, liver failure.
Phosphates are found with excessive consumption of fish, caviar, milk, pearl barley. To reduce their level, you need to limit the consumption of foods that contain calcium, vitamin D. You need to drink more mineral water (up to three liters), acidic juices.

Bacteria and fungi

Bacteria appear in the urine in the presence of a bacterial infection in the body: with urethritis, cystitis, pyelonephritis, prostatitis, vulvovaginitis. Sometimes their presence can be triggered by improper collection of liquid for analysis (dirty container). Fungi should not be, they appear with infectious fungal infections of the urinary tract, genital organs, immunodeficiency states or prolonged use of antibacterial agents.

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Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment based on the individual characteristics of a particular patient.

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When undergoing a medical examination or the occurrence of any disease, the doctor directs the patient to pass a general urine test. This is necessary to establish an accurate diagnosis or early detection of various pathologies. Indeed, despite the fact that urine is produced by the kidneys, it is an indicator of diseases of all organs and systems. And the correct interpretation of the analysis in adults allows you to identify even minor failures, not to mention the most serious diseases.

What urine should be normal

When examining urine, the doctor may use different test strips.

During a general urine examination, a laboratory assistant examines the liquid visually, uses various test strips and carefully examines it under a microscope. After all, the following characteristics have diagnostic value:

color;
transparency;
reaction;
smell;
relative density (specific gravity);
the presence of salts, glucose, protein, etc.

Normal urine is straw-yellow, transparent. It does not have a pronounced unpleasant odor, but if it stands, it acquires an ammonia smell (it is formed as a result of alkaline fermentation).

The relative density depends on the amount of fluid consumed, the quality of food, but normally it is 1010–1030 in an adult.

The urine reaction is neutral or slightly acidic. This parameter is power dependent. When eating a lot of meat products, urine becomes alkaline, but plant foods increase its acidity.

Be sure to study if there are substances in the urine that normally should not be there (glucose, etc.)

The deviation of each of these parameters from the norm signals various pathologies. But it is not enough just to know what urine should be normal. For an accurate diagnosis, it is necessary to correctly decipher, as evidenced by the obtained indicators.

Deciphering the physical parameters of urine

The color depends on the relative density: the higher it is, the more intense yellow urine will be. This parameter is influenced by the presence of red blood cells, pus, bacteria, bile pigments.

A change in the color of urine indicates various diseases:

Dark yellow. It happens with severe dehydration (vomiting), accompanied by congestion in the kidneys, edema.
A pale yellow color is typical for and.
The urine acquires a greenish-yellow, brown tint due to the presence of bile pigments, with pathology of the liver and gallbladder. If the liquid is beer-colored, the doctor will suspect parenchymal jaundice, and a greenish tint indicates drug-induced jaundice.
Red color occurs due to the presence of blood, with a kidney infarction, renal colic. Often in women, urine acquires this color during menstruation due to the mechanical ingress of blood from the perineum during urination. The color of the meat slops means that the patient has nephritis. Blood in the urine can also get into the urine for other reasons.
Dark, almost black urine occurs with.

The color is influenced by foods and medicines:

If the urine has acquired a purple hue, before going to the doctor, you need to remember if you have consumed beets the day before.
The pink color is due to aspirin.
Greenish blue - when taking methylene blue.
Drinking a decoction on bear ears (bearberry) will give a brown tint.

Therefore, when decoding the analysis, they must pay attention to other indicators.

Often, urine is clear, and turbidity occurs if it contains salts, mucus, epithelial cells. Normally, the appearance of a cloudy cloud is permissible. With a pronounced change in transparency, the sediment must be examined, it may contain:

blood cells;
epithelium;
bacteria;
slime;
salt.

To identify from which part of the urinary tract a cloudy sediment appears, a three-glass test is prescribed.

An unpleasant smell of urine is an indicator of various pathological processes:

If it smells, most likely, the metabolism is disturbed, and it is advisable to additionally examine the pancreas.
A putrid odor indicates gangrenous changes in the bladder or purulent-inflammatory diseases of the excretory system.
Just an unpleasant smell occurs if the patient has consumed horseradish, garlic the day before.

The relative density of urine depends on the ratio of the content of fluid, urea and sodium chloride. That is why it is less than the norm when there is a violation of the filtration function of the kidneys, renal failure. It increases due to severe dehydration, edema, or in the urine they find:

glucose;
protein;
salt;
increased content of urea and creatinine.

Specific gravity is an indicator of the concentration function of the kidneys. And if it does not correspond to the norm, the doctor may recommend additional studies (Zimnitsky's test, Folgart's test).

Decoding of chemical indicators

Urinalysis can detect a wide variety of diseases.

For the timely detection of various pathologies, urine is examined for the presence of elements that normally should not be in it, or they are contained in an insignificant amount:

Protein is normally absent or it is detected in an amount of less than 0.002 g / l (traces). It increases with:

kidney disease;
pathology of the urinary tract.

For diagnosis, it matters which protein was detected. For example, Bens-Jones protein appears due to Waldenstrom's macroglobulinemia, and β 2 -microglobulin due to damage to the renal tubules.

Glucose in the urine appears if its concentration in the blood is higher than 6.5 mM / L. And this happens when:

diabetes mellitus;
brain tumors;
sepsis.

In healthy people, glucosuria can also occur, but this happens due to the abuse of foods containing a lot of sugar, after the introduction of adrenaline or as a result of stress.

Ketone bodies (acetoacetic and β-hydroxybutyric acid, acetone) appear when:

febrile conditions;
hypothermia;
physical activity;
diabetes mellitus.

Massive ketonuria indicates hyperglycemic coma, decompensated severe diabetes mellitus.

In healthy people, ketone bodies are found with improper diet, if the ratio of consumed fats and carbohydrates does not correspond.

Bile pigments (bilirubin and urobilinogen) are normally found in small amounts in urine. Bilirubin is detected when:

obstructive jaundice;
cirrhosis of the liver;
cholestasis.

Normally, it is not detected by conducting a general analysis. But urobilinogen is excreted from the body in the urine, and therefore traces of it are found in the liquid. This pigment is absent when the bile duct is blocked. An increase indicates:

hemolytic jaundice;
toxic and inflammatory liver diseases;
extensive;
intestinal diseases (enteritis,).

By conducting a general analysis, the presence of erythrocytes is determined. Normally they are absent or they are single. Appear due to excessive physical exertion, in women during menstruation or due to gynecological diseases. The presence of red blood cells signals:

diseases of the kidneys and urinary tract;
violation of blood clotting;
heart failure;
intestinal tumors;
malaria;
smallpox;
hemorrhagic fever;

Taking medications (sulfonamides, urotropin) leads to the appearance of red blood cells in the urine.

When decoding the analysis, attention should be paid to other indicators. For example, if an increased number of erythrocytes and erythrocyte casts are detected, this indicates intrarenal hematuria. The absence of protein and casts indicates an extrarenal cause of the appearance of red blood cells.

Leukocytes are found in normal urine, but their content is not more than 3 (in men) and 6 (in women). High concentration is a consequence of acute inflammatory processes, infectious diseases of the urinary system. The localization of the pathological focus will help to determine the three-glass test. Often, an increase in leukocytes is accompanied by bacteriuria. But if bacteria are not detected (clean culture), then the patient is likely to have tuberculosis or lupus nephritis. An increase in leukocytes, protein and casts indicates renal disease.

Leukocytes can increase due to the use of medications:

aspirin;
ampicillin.

And also after taking heroin.

Epithelial cells are constantly present in urine, but in small numbers. An increase occurs with damage to the bladder, pelvis and renal parenchyma.

Cylinders are cell or protein casts of the renal tubules. They are of various types and their appearance is associated with certain diseases:

Hyaline. Typical for organic kidney disease (nephritis, urolithiasis), arterial hypertension, heart failure, heavy metal poisoning, fever. In healthy people, they appear due to hypothermia, physical stress.
Grainy. Indicate damage to the parenchyma of the kidneys, stagnant kidney, viral diseases, lead poisoning.
Waxy. Found at.
Leukocytic. Their appearance is associated with pyelonephritis, lupus nephritis.
Red blood cells. Evidence of acute progressive glomerulonephritis, kidney infarction, renal vein thrombosis, polyarthritis, severe arterial hypertension.
Epithelial. Appear with kidney necrosis. After allotransplantation, their presence indicates rejection.

A small amount of mucus is normal, especially in women. But if there is a lot of it, then one should suspect:

urethritis;
urolithiasis.

Salts found in the study of urinary sediment testify to various diseases:

Uric acid. Excessive amounts of it occur with gout, leukemia, viral hepatitis, chronic nephritis, dehydration, and eating meat.
Phosphates. Found after gastric lavage, overeating, in patients with cystitis,.
Oxalates. They are detected if the patient consumes mainly plant foods, with diabetes mellitus, ethylene glycol poisoning, pyelonephritis.

Salts contribute to the development of urolithiasis, therefore, it is imperative to establish the cause of their appearance, and if necessary, adjust the diet.

The value of urine analysis can hardly be overestimated both in terms of volume and objectivity of the information received. For a general analysis, collect the entire morning portion of urine, allocated during free urination. Urine is examined no later than 1-2 hours after collection. General urine analysis includes: examination of the physical and chemical properties of urine, microscopic examination of urinary sediment.

Physical properties of urine

Urine color

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

Pink-red or red-brown color, due to the admixture of "fresh" blood, occurs with urolithiasis, tumors, kidney infarction, tuberculosis. Excretion of urine of the "meat slop" type is typical for patients with acute glomerulonephritis. Dark red urine appears with massive hemolysis of erythrocytes. With jaundice, the urine becomes brown or greenish-brown ("beer color"). Black urine is typical for alkaptonuria, melanosarcoma, melanoma. Milky white urine appears with lipiduria.

Clarity of urine

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

Urine smell

With prolonged standing due to the formation of ammonia from urea, it acquires a pronounced ammonia odor. When protein, blood, pus decompose in urine, a putrid odor appears. Freshly discharged urine can also have a putrid odor in decaying cancer or a diverticulum of the bladder. The smell of acetone appears with decompensated diabetes mellitus, with protein starvation.

Urine reaction

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

Relative density of urine

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

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

A decrease in the relative density of urine is noted:

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

An increase in the relative density of urine is noted:

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

Chemical properties of urine

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

Proteinuria

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

In connection with diseases, proteinuria is divided into functional and pathological.

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

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

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

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

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

Glucosuria

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