Urinalysis: normal, transcript in children andadults how to collect analysis

Update: December 2018

Urine is a product of human life. Her education
occurs in the kidneys, it is a complex and lengthy process. From the body
with this liquid is removed excess water, slags (uric acid,
urea), ions (sodium, potassium, chlorine), vitamins and hormones.

A general urine test plays a big role for the doctor,
it helps to determine the function of the kidneys, and also allows you to judge
condition of the gastrointestinal tract, cardiovascular system and
others.

Urine collection rules

Human urine is normally sterile, bacteria can get into it.
only when passing through the urinary tract or from dirty
dishes The collection of this biological fluid is a very intimate process
which is carried out independently, children usually need help
or seriously ill people. How to collect urine?

  • material is collected in the morning, immediately after sleep, on an empty stomach;
  • It is recommended that the previous urination be, at least,
    5-6 hours ago;
  • the patient must have an external toilet before urinating
    genital organs (women washed with soapy water
    crotch, and men – the glans penis and the outer
    urethral opening);
  • sampling analysis is prohibited during menstruation;
  • the average portion of urine is collected, its volume is approximately
    50-100 ml;
  • the first drops merge into the toilet, as they contain
    exfoliated epithelium of the mucous membrane;
  • the material is collected in a dry, clean, transparent dish
    with a wide neck and a tight lid;
  • it is prohibited to take urine from a duck, a urinal, a night pot, and
    etc;
  • the dishes for the fence should be thoroughly washed and rinsed from
    detergents as they may affect the results
    analysis;
  • The collected liquid must be immediately transported to the laboratory.
    its shelf life is no more than one and a half hours;
  • on the eve of the survey it is undesirable to eat vegetables and fruits,
    containing pigments (carrots, beets), as well as alcohol and
    chocolate.

Indications for the purpose of the study

  • inflammatory processes of the genitourinary system (glomerulonephritis,
    пиелонефрит, интерстициальный нефрит, cystitis, камни в почках);
  • острая и chronic renal failure;
  • some neoplasms (multiple myeloma, melanoma, tumor
    pituitary gland);
  • obstructive jaundice (cholelithiasis, acute
    cholangitis);
  • сахарный и неdiabetes;
  • acute pancreatitis.

Usually, an ultrasound of the kidneys is also administered at the same time (see how
prepare for ultrasound of the kidneys, transcript).

Table of norms of the general analysis of urine

INDICATOR ON THE FORM OF ELECTRONIC ANALYSIS NORM
Colour Color Yellow (all shades, from straw yellow to yellow)
Smell Not sharp
ATнешний вид Clarity Transparent
Относительная плотность  или удельный вес SG ATзрослые – 1010-1025 (в утренней моче – 1018-1026)

  • Newborns – 1005-1017;
  • 1-4 years – 1007-1016;
  • 5-10 years old – 1011-1021;
  • 11-15 years – 1013-1024;
Acid-base reaction  pH
  • in children 4,5-8
  • in adults 5.11-7.08
Protein PRO
  • have no children
  • in adults 0-0,1389 g / l
Glucose GLU
  • have no children
  • in adults 0-1.0 mmol / l (0.33-0.154 g / l)
Ketone bodies или ацетон  KET
  • у детей  – отсутствуют
  • in adults, 0-0.52 mmol / l (0.02-0.05 g / day)
White blood cells LEU
  • in boys: Negative or 0-1-2 in sight
  • in girls: Negative or 0-2 and up to 8-10 in the PZ
  • In men: up to 5 p / zr
  • In women: up to 10-15 p / zr
Urobilinogen Ubg Up to 17 µmol / L (umo / L)
Red blood cells BLD
  • in children 0-1 / Negative
  • in adults 0-1-2-3 in sight
Epithelial клетки (плоский эпителий)  ep. или ep. cl.
Cylinders (гиалиновые cylиндры)  cyl
Bilirubin Bil None / Negative
Bacteria Nit
Salt crystals names of salts are written by hand
Mushrooms
Slime

 Deciphering urinalysis

Daily diuresis

This is the amount of urine released per day. It depends on the volume
fluid intake and moisture loss through the lungs, skin and intestines.
Normal daily urine volume at different ages:

  • 1 month – 330 ml;
  • 1-2 years – 470 ml;
  • 2-5 years – 560 ml;
  • 5-8 years old – 680 ml;
  • 8-11 years old – 850 ml;
  • 11-18 years old – 1000-1100 ml;
  • ATзрослые – 1400-1800 мл.

Violations of daily diuresis:

Патологический syndrome AT чем его суть With каких заболеваниях встречается

Polyuria

The increase in excreted fluid over 2000 ml per day
  • polyuric stage of acute renal failure;
  • diabetes;
  • неdiabetes;
  • convergence of edema;
  • diuretic drugs

 Oliguria

 Reducing the volume of urine to 300-600 ml
  • oliguric stage arrester;
  • loss of moisture with sweat, vomiting, diarrhea;
  • accumulation of water in internal organs and cavities (exudative
    pleurisy, ascites, pericarditis);
  • the action of nephrotoxic substances (lead, arsenic, bismuth,
    ethylene glycol)

 Anuria

 Decrease in diuresis to 50 ml or its complete absence
  • severe blood loss;
  • shocks (anaphylactic, traumatic, cardiogenic);
  • incompatible blood transfusion;
  • acute kidney damage (glomerulonephritis, interstitial
    nephritis);
  • urolithiasis disease (полная закупорка мочевыводящих
    ways);
  • syndrome длительного сдавливания (краш-syndrome)

 Ishuria

Urine is retained in the bladder either impossible
self urination
  • adenoma and prostate cancer;
  • acute and chronic prostatitis;
  • the formation of adhesions in the urethra;
  • violation of the innervation of the bladder (multiple sclerosis,
    injuries, unsuccessful operations, difficult labor, neurogenic
    infections)

ATажную роль также имеет, сколько раз человек мочится в день. AT
Normally, this number is 4-5 times a day.

Changing the frequency of urination happens in such cases:

  • pollakiuria (more than 5 times a day) – it happens if you drink a lot
    water, as well as inflammation of the genitourinary system;
  • olakiuria (less than 3 times a day) – this condition is possible with
    inadequate use of water or neuro-reflex
    violations;
  • dysuria (see burning and pain with frequent urination) –
    возникает при cystitisах, уретритах, пиелонефритах и пр. (см. частое
    мочеиспускание у мужчин, cystitis у женщин).

Transparency

Urine should be clear, if it is cloudy, then it is possible:

  • Наличие белка в моче – amyloidosis, пиелонефрит,
    glomerulonephritis
  • Наличие эритроцитов – рак почки, мочевого пузыря, мочекаменная
    болезнь, простатит, пиелонефрит, glomerulonephritis
  • Bacteria в моче – cystitis, пиелонефрит
  • Наличие лейкоцитов – пиелонефрит, cystitis
  • Epithelium в моче – пиелонефрит
  • ATыпадение в осадок солей (фосфаты, ураты, оксалаты)

Colour

Colour выделяемой нами жидкости обеспечивает пигмент урохром
(product of exchange of bilirubin). The change in color of the material may
testify about various pathologies, also observed when
eating certain foods and drugs:

  • красноватый, красный, цвет «мясных помоев» – говорит о наличие
    erythrocytes (hematuria), that is, blood in the urine (urolithiasis
    болезнь, cystitis, glomerulonephritis), а также при наследственной
    porphyrinuria, lead intoxication, with severe toxicosis,
    taking anti-TB drugs (rifampicin), phenacetin,
    preparations of iron, sulfazole, red streptocide,
    amidopirina.
  • dark yellow with a brownish or greenish tint –
    excretion of large amounts of bilirubin and bile pigments with
    obstructive jaundice (bile stagnates and does not flow from the bile
    bladder into the intestine), liver disease, hemolytic
    anemia.
  • темно-желтый – концентрированная моча, обычно бывает при малом
    fluid intake, perspiration, and
    eating carrots. With обезвоживании (рвота, диарея, высокая
    temperature), as well as fasting, in children with a lack of breast
    milk, in diseases of the heart and liver.
  • greenish-yellow – abundance of pus (pyuria);
  • dirty brown – pyuria in alkaline reaction;
  • black and brown-black – hemoglobin secretion in hemolytic
    anemia (hemoglobinuria), melanin in melanoma, melanosarcoma,
    Markiafav-Micheli’s disease, naphthol poisoning
  • white, whitish – a large amount of phosphates (phosphaturia),
    fat (lypuria) or lymph (tumors of the urinary system or
    kidney tuberculosis).
  • clear, pale urine – harmless causes: diuretic intake
    means and products (see diuretic folk remedies), plentiful
    drink. Патологические причины – несахарный диабет, нарушение
    kidney concentrating function;
  • pink – the presence of phenolphthalein in alkaline reactions;
  • dark brown – use of sulfonamides (biseptol),
    metronidazole, bearberry based preparations;
  • greenish-brown – taking indomethacin, amitriptyline;
  • оранжево-желтый – после введения витаминов группы AT, С,
    поливитаминных комплексов, а также приема пищи с бета-каратином –
    persimmon, apricots, carrots, bright orange fruits and vegetables.

Smell

Usually the material has a special specific smell. Change
Its evidence of some diseases. For example, ammonia smell
means the inflammatory process of the urogenital system (urethritis,
pyelonephritis) or a decaying tumor. And with diabetes
there is the smell of “pickled apples” or acetone.

Urine specific gravity (sg)

Determination of relative density has an enormous clinical
value, since this value reflects the ability of the human kidneys
to concentration and dilution. The urine specific gravity is measured by
substances in it (various salts, sugar, urinary
acid).

The rate of the indicator for different ages Increase in relative density Decrease in weight
  • Newborns – 1005-1017;
  • 1-4 years – 1007-1016;
  • 5-10 years old – 1011-1021;
  • 11-15 years – 1013-1024;
  • ATзрослые – 1010-1025 (в утренней моче – 1018-1026).
УAT более 1026 называется гиперстенурия. This state
observed when:

  • increasing edema;
  • нефротическом syndromeе;
  • diabetes;
  • toxicosis of pregnant women;
  • introduction of radiopaque substances.
Снижение УAT или гипостенурия (менее 1018) выявляется при:

  • acute damage to the tubules of the kidney;
  • неdiabetes;
  • chronic renal failure;
  • malignant increase in blood pressure
  • taking some diuretics
  • heavy drinking

 Реакция pH мочи

Urine of a healthy person is neutral or slightly acid.
the reaction. Change ее связано, в первую очередь, с характером
nutrition (meat or vegetables), as well as a variety of diseases. Should
remember that if the urine is at room temperature for a long time, it’s
leads to its alkalization and the destruction of the uniform elements
most change the results of the analysis.

What diseases can change the pH of the material?

Кислая реакция (pH < 5,0) Alkaline reaction (pH ≥ 7.0)
  • under normal conditions (excessive consumption of meat
    food);
  • respiratory and metabolic acidosis (diabetic coma,
    acute heart failure, acute renal failure);
  • acute nephritis;
  • gout;
  • kidney tuberculosis;
  • hypokalemia;
  • taking certain medications (ascorbic acid,
    corticotropic hormone)
  • during vegetable diet, heavy use of alkaline
    mineral waters;
  • metabolic and respiratory alkalosis (profuse vomiting,
    lung hyperventilation);
  • acute period of inflammation of the genitourinary system;
  • hyperkalemia;
  • chronic renal failure;
  • under the action of sodium citrate, adrenaline, aldosterone,
    bicarbonate

Total protein

The presence of a small amount of protein in the material is possible with
psychoemotional stresses, physical overstrain, sports
taking a cold shower or bath (orthostatic
proteinuria). The increase in total protein in the urine of more than 0.14 g / day
(proteinuria) is a terrible sign of the presence of certain diseases (see
causes of mucus and protein in the urine).

Specific species may be detected in the test fluid.
proteins:

  • Bens-Jones protein – with multiple myeloma, microglobulinemia
    Waldenstrom;
  • β2-microglobulin – in case of damage to the renal tubules.

The degree of increase in total protein in the urine:

Degree of increase Indicators What are the pathologies encountered
Easy 0.15-0.5 g / day
  • nephritic syndrome (acute glomerulonephritis);
  • chronic glomerulonephritis;
  • hereditary nephritis;
  • tubulopathy;
  • interstitial nephritis;
  • urolithiasis disease
Moderate 0.5-2.0 g / day
  • nephritic syndrome (acute glomerulonephritis);
  • chronic glomerulonephritis;
Pronounced More than 2.0 g / day
  • nephrotic syndrome in acute glomerulonephritis;
  • amyloidosis

Glucose

The presence of glucose in the urine (glycosuria) is directly related to the level
blood sugar: the more glucose in the blood, the more it will be
excreted from the body. Glycosuria – the first sign of SUGAR
DIABETES! Sugar in the urine may also increase with:

  • acute pancreatitis;
  • thyrotoxicosis;
  • renal diabetes;
  • steroid diabetes, Itsenko-Cushing disease;
  • sepsis;
  • brain tumors;
  • pheochromocytoma;
  • the action of toxic substances (morphine, strychnine, phosphorus,
    chloroform).

But not in all cases, glycosuria is evidence of disease.
Normally, this condition occurs when overeating sweet, with
constant stress and in pregnant women.

Ketone bodies

Ketone bodies – это продукты жирового обмена. Normal to
their body produces a very small amount. Ketones include:
acetone, β-hydroxybutyric acid and acetoacetic acid.

Detection of ketones in the urine (ketonuria or acetone in the urine) says
about the following:

  • uncompensated diabetes;
  • carbohydrate-free diet, fasting, cachexia;
  • excessive production of steroid hormones in brain tumors and
    adrenal cortex;
  • acetonemic vomiting in children;
  • dysentery;
  • thyrotoxicosis;
  • acromegaly;
  • eclampsia in pregnant women;
  • intoxication.

Leukocytes in the urine

Detection of a large number of these cells in the urine is always
talks about the inflammatory process in the urinary system, whether
then cystitis or pyelonephritis. If the number of white blood cells is more
60 in sight, it is called pyuria (pus in the urine).  AT
both neutrophils and lymphocytes can be analyzed. With
chronic inflammation of leukocytes is a surer indicator than
bacteria that are not always detectable.

Red blood cells in the urine

AT моче здорового человека эритроциты отсутствуют или
determined as single cells (0-1-2-3 per field of view). AT
normal, their appearance is associated with heavy physical labor,
sports. In women, red blood cells can get into the analysis when
menstruation or pregnancy.

AT зависимости от количества эритроцитов в моче выделяют:

  • light erythrocyturia – up to 20 cells in a microscope;
  • moderate severity – from 20 to 200 cells;
  • expressed erythrocyturia (hematuria) – more than 200 cells in the field
    view.

AT зависимости из какого отдела мочевыделительной системы
red blood cells enter the urine, they are found leached or in
unchanged form. Withчины наличия эритроцитов в моче:

  • kidney injuries – tear, bruise, tear
  • urolithiasis disease
  • kidney infarction
  • urethritis, cystitis, acute glomerulonephritis
  • bladder cancer, kidney cancer, prostate cancer

Почему  появляется кровь в моче?

  • glomerulo and pyelonephritis (acute and chronic);
  • urolithiasis disease;
  • acute cystitis;
  • kidney infarction;
  • cancer of the kidney and bladder;
  • prostate adenoma;
  • urinary trauma;
  • hemorrhagic diathesis;
  • systemic lupus erythematosus;
  • hemorrhagic fever (Ebola, Crimean, Congo);
  • amyloidosis почки;
  • poisoning with benzene, aniline, snake venom;
  • kidney tuberculosis;
  • lipoid nephrosis.

Более подробно в статье Withчины появления крови в моче

Epithelium

Epithelial cells are always found in the analysis. They fall
there, exfoliating from the mucous membrane of the urinary tract. AT
depending on the origin, transient vtc (urinary
bladder), flat (lower urinary ways) and renal
(kidney) epithelium. An increase in epithelial cells in the urinary sediment
talks about inflammatory diseases and salt poisoning
metals.

Cylinders

Cylinders – это так называемые «белковые слепки» из мочевыводящих
ways. AT зависимости от внешнего вида и происхождения
distinguish between:

Title Where does it come from With каких болезнях встречается
Hyaline Renal tubules
  • a sharp decrease in urine pH;
  • intensive physical load;
  • work in hot climates;
  • glomerulonephritis;
  • orthostatic proteinuria;
  • nephropathy of pregnant women;
  • poisoning with heavy metal salts;
  • intoxication
Grainy Renal tubules
  • severe degenerative lesions of the tubules;
  • pyelonephritis;
  • nephrotic syndrome;
ATосковидные Formed from compacted hyaline and granular cylinders with
their delay in tubules
  • nephrotic syndrome;
  • amyloidosis почек;
  • chronic tubule pathology
Epithelial Epithelium почечных канальцев
  • nephrotic syndrome;
  • amyloidosis почек;
  • chronic tubule pathology
Erythrocyte Red blood cells
  • glomerulonephritis;
  • kidney infarction;
  • renal vein thrombosis
Pigment Hemoglobin, bilirubin, myoglobin
  • hemoglobinuria;
  • myoglobinuria
Leukocyte White blood cells
  • pyelonephritis;
  • lupus nephritis

Urinary bilirubin

Bilirubin is normally not in the urine because it
excreted into the intestinal lumen as part of bile. When is it in the blood
elevated bilirubin level, the function of its removal incur
kidneys. Withчины билирубина в моче:

  • cirrhosis of the liver
  • liver failure
  • hepatitis
  • destruction of red blood cells in malaria, hemolytic
    disease, toxic hemolysis, sickle cell anemia
  • gallstone disease

Urobilinogen in the urine

Urobilinogen is a substance formed from excreted with
the bile of bilirubin in the intestinal lumen. Part of the intestine he
returns to the bloodstream and with the blood flow enters the liver, where
excreted in the bile again. If the liver is to bind all that arrived
urobilinogen is not able, part of it enters the general bloodstream,
then this urobilinogen is excreted by the kidneys. Withчинами
excretion of urobilinogen in urine:

  • liver failure
  • intestinal inflammation – colitis, enterocolitis
  • massive destruction of red blood cells

Urine hemoglobin

Hemoglobin is a protein that is involved in the transport of oxygen to
cells, it is contained inside the erythrocyte. When does
severe destruction of red blood cells in the blood to release large
the amount of hemoglobin, and the spleen and liver do not have time
to split. With этом свободный гемоглобин выводится с мочой. Also
with myocardial infarction, when squeezing the muscle tissue into the blood can
myoglobin is released (similar in structure to hemoglobin),
which is also partially excreted by the kidneys. Withчинами 
hemoglobin in urine are:

  • malaria
  • burns
  • blood transfusion
  • hemolytic disease
  • muscle damage – contusion with hematoma, crash
    syndrome
  • poisoning by sulfa drugs,
    phenol, mushrooms

Salt crystals

AT моче растворено множество ионов и солей. Excess of them leads to
the formation of sediment and stones that cause urolithiasis.
AT осадке материала чаще всего встречаются:

Title солей When are determined
Urats (uric acid salts)
  • gout:
  • leukemia;
  • вирусные hepatitis;
  • болезнь ATакеза;
  • CKD;
  • urine acid diathesis
Phosphates (salts of phosphoric acid)
  • hyperparathyroidism;
  • syndrome Фанкони;
  • cystitis
Oxalates (salts of oxalic acid)
  • eating large quantities of fruits and vegetables;
  • pyelonephritis;
  • diabetes;
  • ethylene glycol poisoning

Bacteria and fungi

The detection of over 50,000 bacteria in 1 ml of material indicates
воспалении мочевых ways. Then the patient is recommended to pass back bacposiv.
urine to determine the specific type of microorganisms and their
antibiotic sensitivity. The presence of fungal mycelium in the analysis
indicates candidiasis or decreased local immunity after ingestion
antibiotics.

Slime

Normal mucus should not be in the urine. Its presence speaks of
acute or chronic urogenital inflammation
system.

AT конце хотелось бы добавить, что общий анализ мочи – важный
diagnostic indicator. A person can independently draw
attention to the change of urine and consult a doctor. Even healthy
people are advised to take this test at least once a year.
It should also be remembered that a single result is not an indicator
pathology. It is very important to be tested dynamically to make
the final conclusion about the presence of the disease.

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