Urinalysis in children according to Zimnitsky. Urinalysis according to Zimnitsky is the most indicative method for checking the excretory function of the kidneys

11.09.2019

In addition to the basic clinical analysis of urine, special tests are used that examine in more detail the individual functions of the urinary system and are prescribed in the diagnosis of certain diseases.

The most used today are:

urinalysis according to Zimnitsky;
three glass test;
Sulkovich's test;
bacteriological examination for sterility;
Addis-Kakovsky method.

Let's consider these diagnostic methods in more detail.

Table of contents: We recommend reading:

The study of urine according to Zimnitsky allows you to evaluate the concentration ability of the kidneys. It is used in addition to the clinical analysis of urine.

Indications for appointment:

acute and chronic renal failure;
suspicion of an existing chronic;
clinical manifestations of chronic;
additional diagnosis of diabetes insipidus;
chronic heart failure and.

Note:analysis is necessary to assess the activity of the kidneys, and not to make a diagnosis.

Normally, the kidneys excrete urine, which contains high concentrations of toxins and protein metabolism products. These include urea, creatinine, uric acid, glucose isomers, protein substances, and other substances in small amounts. The concentration indicators are units of the relative density of urine.

Purpose of the test: determination of the specific gravity of the elements and compounds in the urine during the daily cycle, since the indicators change at different intervals. Dynamic monitoring of them allows you to draw conclusions about the activity of the kidneys.

Normally, the density of urine is in the range of 1003-1035 g / l. The higher the density, the more dissolved organic compounds it contains.

Analysis according to Zimnitsky reveals the daily volume of urine, density at different times of the day, the amount of urine excreted at different time intervals. These data allow us to draw conclusions about the violations of the kidneys.

Relative density is determined in different portions of urine, which are collected every three hours throughout the day.

Method for collecting urine for analysis according to Zimnitsky

What is necessary:

8 clean glass vessels (jars);
clock;
paper and a pen to record the amount of liquid you drink.

The first morning portion is not counted. Then a sampling is made every three hours, a total of 8 times. Each serving is priced separately. The amount of three-hour urine averages from 50 to 300 ml.
Urine collection rules:

The first urine collection is carried out from 9.00 to 12.00, then every three hours: until 15.00, 18.00, 21.00, 24.00, 3.00, 6.00, 9.00 (last portion).
Jars with contents are placed in stages in the refrigerator for storage.
After filling, the jars are delivered to the laboratory.
For analysis, a record of the amount of fluid taken is provided.

In one jar, the patient urinates, if necessary, several times in the prescribed time interval. If there were no urges for 3 hours, the jar is left empty. If in 3 hours there was not enough capacity of the “planned” dishes, then fill in an additional one and mark it.

Note:On the eve of delivery, you should not take diuretics. It is also necessary to consult a doctor about the possibility of combining the test with taking other drugs.

Deciphering the results of the Zimnitsky test

The laboratory evaluates the total amount of urine, as well as the individual amount in portions, the density of each portion, as well as daytime diuresis (from 6 am to 6 pm), and nocturnal diuresis (from 6 pm to 6 am)

Normally, daytime diuresis predominates over nighttime. Morning urine density above 1.018 is typical for normal kidney concentration.

The physiological limits of density are between 1001 - 1040. Under normal drinking conditions, the density is - 1012-1025.

In the case of the specific gravity of urine that does not change throughout the day, a condition occurs called isosthenuria. Significance in the diagnosis of diseases has a variant hypoisostenuria. With it, the density is reduced to less than 1012-1014 g/l. Occurs when the renal tubules are unable to concentrate urine filtrate. Occurs in all types of renal failure. The opposite state hyperisostenuria, characterized by a high specific gravity, is recorded in case of poisoning with salts of heavy metals, hyperparathyroidism, and diabetes mellitus.

Analysis according to Zimnitsky is able to identify such conditions as:

Hypostenuria. At a density below 1012 g / l, which is observed in all portions, it can be concluded that the ability of the kidneys to concentrate is impaired. This condition is characteristic of chronic pyelonephritis and glomerulonephritis, renal amyloidosis. It also develops in chronic heart failure accompanied by hypertension, with diabetes insipidus.
Hyperstenuria. The density of urine is above 1035 g/l. This type of abnormality is characteristic of diabetes mellitus, with blood diseases caused by its destruction (hemolysis, anemia), with gestosis (toxicosis of different stages of pregnancy), and also occurs in some forms of glomerulonephritis.
Polyuria - a condition in which the volume of urine is more than 1,500-2,000 ml. Also, this deviation can be fixed when more than 80% of the fluid taken per day is excreted in the urine. Polyuria occurs with the development of renal failure, diabetes and diabetes insipidus.

Nocturia. Occurs when the amount of urine at night prevails over the daytime. This deviation occurs with heart failure. Nocturia can occur with increased drinking regimen. In this case, the density will be reduced. If at least one serving contains a value of 1020 g / l and above, then one should not think about a violation of the concentration function of the kidneys. Normally, the volume of daytime urine is about 65-70%, and night - 30-35%.
Oliguria. Decrease in daily urine less than 1500 ml. This condition is caused by heart failure, advanced stages of kidney failure.

The study is used to clarify the location of inflammation in the genitals and bladder. The method is outdated and is used in rare cases when it is impossible to conduct more modern studies.

The analysis is carried out in the morning, before eating and drinking. Before urine collection, a toilet of the external genitourinary organs without the use of detergents is necessary. The day before, three clean jars are prepared with markings (1,2,3). Urine is collected sequentially in three vessels: in the first (1) - an insignificant part, in the second (2) - the main one, and in the third (3) - the remainder.

The collected material is immediately delivered to the laboratory, where it is examined under a microscope to determine the content of erythrocytes and leukocytes.

Deciphering the analysis of a three-glass sample

Detection of leukocytes and (or) erythrocytes:

in 1 portion - it is typical for the presence of inflammation in the urethra;
in 2 servings - for inflammation in the bladder;
in 3 servings - for the inflammatory process in the bladder, prostate gland, kidneys;
in all portions - characteristic of inflammation of the kidneys or mixed pathology.

Sulkovich's test

Using this research method, the content in the urine is determined calcium. The indicator of the content of this mineral is important in the additional diagnosis of rickets. Also, this analysis can be used to control and correct the dose of vitamin D consumed by the child.

The test is carried out by introducing Sulkovich's reagent containing oxalic acid into the urine of a patient, as a result of which a cloudy precipitate forms when interacting with calcium.

Sulkovich urinalysis method

Urine is collected in a dry and clean dish. Before collecting urine, a thorough toilet of the genitals is carried out. A small amount of urine is released in a trickle into the toilet, the rest is collected in a jar.

On the eve of the test, you should not take mineral water, milk, herbs, alcoholic drinks, coffee, otherwise the test may give distorted results. Within 3 days before the test, it is required to limit the consumption of foods rich in calcium (nuts, legumes, etc.).

Deciphering the result of the Sulkovich test

According to the degree of turbidity, the result is evaluated in points (from 0 to 4):

0 points - clear urine - no calcium in the urine - hypocalcemia.
1-2 points - slight turbidity - normal result.
3-4 points - strong turbidity - hypercalcemia.

In some laboratories, the result is evaluated with pluses.

The sample has an inaccurate result, and, if necessary, is supplemented by a biochemical blood test.

The study is prescribed for suspected development of thyroid diseases (hypo-hyperthyroidism), vitamin D abuse, to detect tumors that produce calcium.

The examination is carried out to assess the degree of purity of urine, as well as to detect a specific type of pathogen. The same method can determine the sensitivity of microbes to antibiotics.

Urine, flowing through the internal mucous membranes of the urethra, washes away the mucus and microorganisms that are on them. Bacteriological examination allows you to establish the presence of the pathogen and its quantity.

For the study, 5-7 ml of morning urine, collected only on an empty stomach, after the toilet of the perineum, is necessary. The second portion is used.

Urine is placed in vessels with nutrient media, and after a while the grown colonies of microorganisms are evaluated.

Deciphering the bacteriological analysis of urine for sterility

The result is evaluated according to the following data:

The number of detected colonial microorganisms up to 1000 corresponds to the presence of normal flora.
From 1000 to 10000 - there is an opportunistic flora that can cause an inflammatory process.
More than 100,000 - pathogenic microorganisms in the urine, there is an acute inflammatory process.

In the case of the growth of a colony consisting of different elements, the infection is considered chronic. In difficult cases, additional identification of the pathogen is carried out by re-sowing on special nutrient media. However, this addition lengthens the time of diagnosis, but at the same time specifies the type of antibiotic used.

These methods are simple, available for use in any medical institution, and have proven themselves well when examining a large number of people.

Addis-Kakovsky method

Allows you to diagnose kidney infections by counting red blood cells, white blood cells and cylinders in the urine.

Applies to:

renal polycystosis;
glomerulonephritis;
kidney stones;
chronic renal failure.

In practice, a simplified method of this analysis is used, the collection of which takes 10 hours. In the evening, a liter clean jar is prepared, the last urination is offered to the patient at 22.00. You should not go to the toilet at night, otherwise the results of the analysis will be distorted. In the morning, the toilet of the genitals is carried out, and at 8.00 the bladder is emptied into the prepared dishes, the collected material is immediately delivered to the laboratory.

Interpretation of the results of urinalysis according to the Addis-Kakovsky method

Evaluation of results in the norm:

leukocytes up to 2 million;
erythrocytes up to 1 million;
cylinders up to 20 thousand.

Perhaps this is one of the most capricious and difficult to collect and diagnose type of urine tests. Based on its results, a definitive diagnosis cannot be made and other more detailed diagnostic sources are required.

Although it is believed that the technique is quite easy, since some complex equipment is not required to interpret the results, its complexity lies in the many “side” factors that dramatically affect the final results. One of these "side" factors can be called the quality of urine collection, which the patient collects on his own. And this is the basis of the whole test.

In other words, the test will fail if the collection technology is violated. And it is easy to break it, even just picking up the wrong container is enough. False-positive results for nocturia can be obtained in many patients in winter, when the temperature in the apartment is relatively low, and we sleep under a warm blanket. From this contrast, blood flow can increase, which also speeds up all metabolic processes, including the functioning of the kidneys. Consequently, there will be more frequent urge to urinate at night.

It is for this reason that we did not really want to tell our readers about it, but due to numerous requests, we nevertheless decided to do it. Perhaps over time it will be canceled due to low information content.

It determines the quality of the main functional ability of the kidneys, namely, how they perform their main role - they secrete, concentrate or dilute urine excreted naturally.

During the day, the kidneys are able to "filter" a huge amount of fluid, thereby purifying the blood. To do this, they can osmotically concentrate and dilute urine, excreting everything superfluous with it and leaving in the blood a maximum of the necessary components that are involved in the metabolic process. If the organ begins to "jump", then this will certainly affect the excretory quality of the liquid, which can be seen from the daily diuresis.

This test can also be prescribed to diabetics if they suspect kidney failure or any inflammatory process progressing in the genitourinary system.

Indications for the use of the technique can also serve as:

suspicion of diabetes
signs of kidney failure
chronic form of glomerulonephritis and pyelonephritis
hypertonic disease

The test is carried out according to three main indicators:

urine specific gravity (relative density) of each sample taken
total urine output
quality of urine distribution during the day (in other words, how much is excreted for several hours at night and daytime)

Training

There are no special requirements for the test. Preliminary adherence to a diet, such as, for example, is not required, however, it is worth considering the fact that

excess fluid intake distorts the result.

Also, it is impossible to use any diuretics on the day of the study, even if they were prescribed by the attending physician.

In addition, you will need to prepare the following in advance:

8 empty urine containers
alarm
pen and notebook (diary) for notes

Bottles come in volumes: 25, 30, 60, 120, 250 ml. It is best to buy the maximum volume to collect all the liquid. Buy containers with a margin of 2 - 3 sterile jars. Even if they are not needed, they will still come in handy someday in the future, because their shelf life is practically unlimited.

How to collect urine for analysis

The most important thing is to correctly collect urine for the Zimnitsky test. The duration of the collection is 1 day.

The final result depends on how to collect urine correctly.

Moreover, it is important to collect exclusively all the urine, without pouring the excess into the toilet (we place what did not fit in 1 container in another additional one and number it with all the necessary notes).

To do this, we prepare 8 containers, each of which must indicate the last name, first name, patronymic (you can simply with initials) of the patient, the serial number and the time interval for which urine was collected in a particular jar.

If a person consumes an excess amount of liquid, then it can be mistakenly diagnosed, say,.

To avoid such false positive results, it is important to record everything in a diary.

Keep a clear record of exactly how much liquid and water-containing food you consumed during a given time (how much water, drinks, fruits, soups, etc.).

For example, the record might look like this: in the period from 09:00 to 12:00 in the morning I drank 250 ml of tea with milk, ate 2 apples; from 12:00 to 15:00 drank 2 cups of coffee (the total amount of coffee drunk was 200 ml) and 0.5 liters of plain water; from 15:00 to 18:00 - ate mushroom puree soup (300 ml), a glass of kefir (250 ml), etc.

Do not forget also that tea is a diuretic. Drinking a lot of it during collection is not recommended.

collection time

09:00 - 12:00	21:00 - 00:00
12:00 - 15:00	00:00 -03:00
15:00 - 18:00	03:00 - 06:00
18:00 - 21:00	06:00 - 09:00

On the very first day of collection, it is necessary to empty the bladder in the morning (around 06:00). The resulting portion does not need to be collected. This night urine is poured into the toilet. After that, all the liquid is collected from 09:00 to nine in the morning of the next day.

After each of the eight three-hour periods, the patient urinates into a separate jar.

If during this time he does not have the urge to urinate, then the jar is still numbered, the time period is fixed and it is left empty.

If the container is full, then you need to urinate into an additional container, and not drain into the toilet!

The collection ends at nine o'clock in the morning of the next day. After that, all banks on the same day are sent to the laboratory for analysis. You can't store urine for a long time!

Store collected only in the refrigerator. At room temperature, urine deteriorates quickly.

Decryption

Norm in men and women

It is desirable that the total daily volume of urine does not exceed 1 - 1.5 liters
Normal specific gravity ranges from 1012 to 1025 g/l
The fluctuation of individual jar portions can be from 50 to 250ml
Two-fold predominance of daytime diuresis over nighttime (about 2/3 during the day, and 1/3 of the total amount of fluid at night)
The difference between the maximum and minimum indicators of the relative density of urine should be at least 0.012 - 0.016g / l (for example, 1006 - 1020)
The ratio between the fluid that enters the body and the urine excreted in this case should not exceed 65 - 80%
Increased urine output after drinking fluids or watery foods

In children, normal indicators will be slightly lower. They largely depend primarily on age. The older the child, the closer his performance to adult values. Any doctor takes this feature into account in interpreting the results.

Deviations

Since the main diagnostic indicators are the volume and density of urine, any deviations from the norm may indicate the presence of some kind of problem. This gives every reason to conduct other detailed studies that will help make a more accurate diagnosis. No conclusions can be drawn based on this analysis alone.

Thus, the following deviations from the norm are distinguished, for which they are characteristic:

Polyuria

The excretion of the total volume of urine per day with a low specific gravity increases, at which there is an increase in the formation of primary urine as a result of renal filtration of the biological fluid.

It is determined when the daily volume of urine in the amount of 1500 to 2000 ml predominates over the normal values, or if the total amount of urine exceeds 80% of the fluid consumed during the day.

May indicate: renal failure, diabetes mellitus,.

Oliguria

When the volume of daily urine, which has a high specific gravity, decreases. If the kidneys do not cleanse the blood well, then the weight of the urine increases, and the volume will fall.

If, after the urge to urinate, less than 1000 ml per day is excreted and the total amount of urine in relation to the amount of fluid drunk is less than 65%.

Diagnose: renal, heart failure, arterial hypotension, massive destruction of red blood cells, poisoning.

nocturia

Night diuresis prevails over daytime (exceeds 1/3 of the total daily volume).

The nighttime volume of urine can increase in a number of cases with: violation of the concentration function of the kidneys, diabetes mellitus, heart failure.

Hypostenuria

As the name implies, this is a condition in which there is insufficient reabsorption of primary urine. As a result, urine is excreted, the density of which is less than 1012 - 1013g/l. in each of the jars.

What this can mean: exacerbation of the chronic form of poelonephritis, pronounced heart failure, renal failure with chronic complications (amyloidosis, hydronephrosis, diabetes insipidus, glomerulonephritis and pyelonephritis, leptospirosis, long-term effects on the kidneys of heavy metals).

This indicator can be reduced by taking diuretics or a large amount of tea.

Hyperstenuria

The opposite effect is when the density of urine increases. It is celebrated when at least in 1 jar the density exceeds 1035 g / l. This is possible when reabsorption is higher than glomerular renal filtration.

It is regarded as one of the signs in the following diseases: exacerbation of chronic glomerulonephritis, anemia,.

A similar condition is possible with: toxicosis of pregnant women, accelerated breakdown of red blood cells, blood transfusion.

An increase in relative density indicates that it contains many substances such as: protein, glucose, urea, sodium (salt). The more of them, the higher the density. Just 3g of protein increases the relative density level by 0.001g/l, and every 10 grams of glucose increases it by 0.004. Ideally, there should be no protein in the urine at all, just like a large amount of glucose. As blood passes through the kidneys, it is filtered. After this, primary urine is formed, which is similar in composition to blood plasma. It still has some protein in it. But after the end of processing (this process is called reabsorption), the output is secondary urine, in which there should not be any protein components.

This condition is characteristic of glucosuria, when a lot of protein appears in diuresis, and this may already indicate nephrotic syndrome or an uncompensated form of diabetes.

Urinalysis according to Zimnitsky is also prescribed during pregnancy, however, the frequency of urination in women in the position will be higher. Do not be afraid of this, this is the norm. The most important thing to pay special attention to is the relative density of urine. The higher it is, the higher the risk of developing kidney problems. If this type of study is suspected, pregnant women will not be prescribed.

The cost of the study is not high from 300 rubles and more.

Not always, based on the results of a general urine test, a doctor can evaluate the functioning of the kidneys, identify problems and make an accurate diagnosis. In some cases, additional analyzes of the biological fluid are prescribed. One of them may be the collection of a urine test according to Zimnitsky.

What is the essence of the analysis and how to prepare for it

The Zimnitsky test is one of the types of urine tests. The analysis is used to evaluate the functioning of the kidneys (the ability of organs to excrete and concentrate urine). The test is prescribed by doctors in cases where it is suspected that a person has inflammation of the urinary organs or kidney failure has begun to develop.

Special preparation for the analysis of urine according to Zimnitsky is not required. The patient needs to adhere to the usual nature of nutrition and drinking regimen. It is only necessary to stop taking diuretics and avoid excessive fluid intake. On the eve of the analysis, it is not recommended to drink more than 1000-1500 ml of water and various drinks.

If you ignore this rule, the results will be unreliable. There will be artificial polyuria (increased urine output) and the relative density of the biological fluid will decrease. It is recommended to exclude “coloring” foods (for example, beets) from food, and before you take a urine test according to Zimnitsky, you should give up spicy, salty foods that increase thirst.

What is a urine test for?

The main purpose for which the test is carried out is determination of the concentration of substances that are dissolved in urine. The biological fluid released during the day may differ in smell, color, volume. Knowing the density of urine, you can determine the concentration of substances contained in it. For example, the higher the indicator, the more organic substances are dissolved in the biological fluid.

Urine contains mainly nitrogenous compounds. Protein, glucose and other organic substances normally should not be present in the fluid excreted from the body. If they are detected, then this indicates a pathology of the organs of the urinary system.

The density of urine is not the only indicator that is examined during the test. Daily diuresis is also taken into account, the amount of night and day urine is determined. Fluctuations in the level of diuresis throughout the day may indicate the presence of various diseases.

Rules for the collection and storage of urine

The patient's biological fluid must be collected throughout the day. You have to do this even at night. To collect urine, you will need 8 clean and dry containers. On them, the patient indicates his last name and initials, the serial number of the portion and the time interval.

It is necessary to collect urine for analysis according to Zimnitsky as follows. At the first emptying after waking up between 06:00 and 09:00, body fluid is not taken.

Then, from 09:00, portions of urine are collected in the amount of 8 pieces:

from 09:00 to 12:00 - serving number 1;
from 12:00 to 15:00 - serving number 2;
from 15:00 to 18:00 - serving number 3;
from 18:00 to 21:00 - serving number 4;
from 21:00 to 24:00 - serving number 5;
from 24:00 to 03:00 - serving number 6;
from 03:00 to 06:00 - serving number 7;
from 06:00 to 09:00 - serving number 8.

During these time intervals, a person may experience several urges to urinate. All liquid is collected. This must be taken into account. Nothing can be poured down the toilet. If a particular bank is full, then an additional container is taken for collection. It indicates the corresponding time interval. It can also happen when a person does not want to go to the toilet at a certain time interval. In this case, the jar is left empty and sent in this form.

The volume of urine in each portion is measured and recorded. After the last portion is ready, all jars, including empty ones, are sent to the laboratory.

Another important point is that the patient needs to measure the amount of fluid consumed. Not only drunk water or juice is taken into account. The liquid contained in the food is also taken into account. This information is necessary for the doctor to correctly interpret the results.

It is necessary to store urine for analysis according to Zimnitsky in closed containers in a cool place. You can use a refrigerator. The storage temperature must not fall below zero.

Norms of the Zimnitsky test and interpretation of the results

When examining urine, several indicators are evaluated. For each of them there are certain rules:

The density of urine is an indicator expressing the amount of metabolic products dissolved in a biological fluid. Normally, it is 1.013–1.025.
daily diuresis. This term refers to the amount of urine excreted from the body during the day. Normally, this figure is 1500-2000 ml.
The ratio of urine output to the amount of fluid drunk per day. It should be 65-80%.
Daytime and nighttime urine volume. The first indicator is usually higher. Daytime urine is about 2/3 parts of the biological fluid collected per day, and nighttime urine is about 1/3 part.
Comparison of the amount of urine and its density during the day. Indicators for 24 hours should not be the same.

If the results of the urine test according to Zimnitsky are not deviated from the norm, then the functionality of the kidneys is not impaired. If abnormalities are detected, the patient may have serious health problems. Let's see what deviations can be found.

1. Changes in urine density

Hypostenuria is a low density of a biological fluid. Doctors talk about it when the corresponding indicator is less than 1.012. Deviation from the norm occurs in those people who have impaired renal concentration function.

Hypostenuria can occur for the following reasons:

taking diuretic medications;
tubulointerstitial nephritis, chronic pyelonephritis;
diabetes insipidus;
severe heart failure;
salt-free and protein-free diet for a long period of time.

A deviation is also an increase in the density of urine, also called hyperstenuria (a value above 1.025). It occurs if a significant amount of substances that have a high density have entered the urine. It can be protein or glucose.

Hyperstenuria occurs in the following conditions:

diabetes mellitus;
initial stages of glomerulonephritis;
nephrotic syndrome;
or .

2. Change in daily diuresis

Deciphering the analysis according to Zimnitsky includes an assessment of changes in daily diuresis. Polyuria, which refers to an increase in daily diuresis, may indicate the presence of diseases. In humans, with this deviation, more than 2 liters of urine is excreted from the body. Polyuria can be caused by:

diabetes insipidus;
increased fluid intake;
renal failure in a chronic form;
the use of diuretics;
pyelonephritis.

Oliguria is a significant decrease in the amount of fluid released per day (less than 400 ml per day). This deviation is due to:

restrictions on fluid intake;
increased sweating;
pyelonephritis;
glomerulonephritis;
profuse diarrhea;
fluid retention in people with heart failure.

A sharp decrease in urine output (up to 200–300 ml per day) or a complete cessation of its excretion from the body is called anuria. It can be caused by a violation of glomerular filtration, a decrease in bladder function with preserved kidney functionality.

3. The ratio of excreted urine to the volume of fluid drunk per day

If less than 65% of the total fluid intake is excreted in urine, then heart failure may be the cause. With this deviation, excess fluid does not leave the body, swelling occurs.

4. Volume of daytime and amount of nighttime urine

In the study of urine, an excess of nighttime diuresis over daytime or their equalization can be detected. Violation of the ratio may indicate the presence of heart disease, heart failure. The alignment of the values of night and daytime diuresis is a sign that the concentration ability of the urinary organs is impaired.

Thus, the Zimnitsky test is a simple urine test, the essence of which is to study various portions of the biological fluid collected per day. The analysis is informative, as it allows the doctor to detect renal complications that cannot be confirmed by a general analysis of the biological fluid. It is a must to take a test. Urinalysis according to Zimnitsky during pregnancy is especially necessary, because the consequences of kidney disease can be dangerous for the expectant mother and her baby.

Answers

Urine collection for the Zimnitsky test is carried out at certain hours during the day. In order to properly collect the required material, you need:

8 clean jars

Clock, preferably with an alarm clock (urine collection should take place at certain hours)

A notebook for recording the liquid consumed during the day (including the amount of liquid coming from soup, borscht, milk, etc.)

How to collect urine for research?

At 6 o'clock in the morning it is necessary to empty the bladder into the toilet.

Throughout the day, every 3 hours it is necessary to empty the bladder into jars.

Bladder emptying time 9:00, 12:00, 15:00, 18:00, 21:00, 24:00, 03:00, 06:00.

Filled jars must be kept in the cold in a closed form (in the refrigerator).

On the morning of the next day, it is necessary to take all the jars with the contents to the laboratory, additionally giving records of the liquid consumed during the day.

Why is a Zimnitsky test performed?

The main task of the Zimnitsky test is to determine the concentration of substances dissolved in urine. We all notice that urine can differ during the day in color, smell, the volume during urination can be different, as well as the frequency during the day. By measuring the density of urine, it is possible to determine the total concentration of substances in it. Normal is the density of urine equal to 1003-1035 g / l. An increase in density indicates an increase in organic substances dissolved in it, a decrease indicates a decrease. The composition of urine includes mainly nitrogenous compounds - products of metabolic processes of protein in the body (urea, uric acid), organic substances, salts. The appearance in the urine of such substances as glucose, protein and other organic substances, which normally should not be excreted from the body, indicates a pathology of the kidneys or pathology of other organs.

Deciphering the result of the Zimnitsky test Norm of the Zimnitsky test

The total volume of daily urine is 1500-2000 ml.

The ratio of fluid intake to volume of urine excreted is 65-80%

The volume of urine excreted during the day is 2/3, at night - 1/3

The density of urine in one or more jars is above 1020 g / l

Urine density less than 1035 g/l in all jars

Low urine density (hyposthenuria)

In the event that the density of urine in all jars is below 1012 g / l, this condition is called hypostenuria. A decrease in the density of daily urine can be observed with the following pathologies:

Advanced stages of renal failure (with chronic amyloidosis of the kidneys, glomerulonephritis, pyelonephritis, hydronephrosis)

With exacerbation of pyelonephritis

With heart failure (3-4 degrees)

diabetes insipidus

High urine density (hyperstenuria)

High urine density is detected if the density of urine in one of the jars exceeds 1035 g / l. This condition is called hyperstenuria. An increase in the density of urine can be observed with the following pathologies:

Diabetes

Accelerated breakdown of red blood cells (sickle cell anemia, hemolysis, blood transfusion)

Toxicosis of pregnancy

Acute glomerulonephritis or chronic glomerulonephritis

Increase in daily urine volume(polyuria) The volume of urine exceeding 1500-2000 liters, or more than 80% of the liquid consumed during the day. An increase in the amount of urine excreted is called polyuria and may indicate the following diseases:

Diabetes

diabetes insipidus

kidney failure

The patient, turning to the doctor with certain complaints, is subject to referral for the delivery of universal tests that help determine the appearance of a developing pathology. There are alternative types of material collection required during the survey. Such is the analysis of urine according to Zimnitsky.

General information about the study

The study is used when the quality and correct functioning of the kidneys, the organs responsible for the elimination of decay products, are needed. Upon receipt of biological material, the nephrologist diagnoses or refutes the presence of pathology in the patient's body regarding the functionality of the kidneys.

The organs that perform excretory functions fail due to the exacerbation of a chronic disease. Urinalysis according to Zimnitsky helps prevent the development of kidney failure and other pathologies that can cause serious harm to health.

Such a study is proposed to be carried out if specialists suspect the appearance of the following diseases:

diabetes;
insufficiency of cardiac activity;
excessive swelling during pregnancy (last trimester);
hypertension.

The likelihood of developing pyelonephritis

Urinalysis of Zimnitsky is taken for diseases in adults, children of various ages, with suspicion of the development of renal failure or dysfunction.

The procedure is not subject to diagnosis and is of no interest to a specialist. Fluid indicators play an important role in determining the fact of pathology; physicians can only obtain them with the help of this analysis.

The check shows the amount of urine left from the body, its concentration indicators and what decay products are present in it. According to the last parameter, it is easy to determine which harmful products the patient is abusing.

What can the results show?

The study is carried out to identify indicators:

study of the amount of fluid secreted by the patient's body per day - diuresis;
the ratio of fluid consumed per day and excreted in the process of processing by the body;
diagnosis of diuresis overnight;
study of daily diuresis;
density - the indicator reveals what products the patient consumed and the substances released during life.

If the patient does not suffer from any chronic diseases, the indicators are within the established norm. The average liquid density range is 1.003–1.035.

The indicator depends on the ratio of fluid and incoming food in the body and excreted from it. If a person drinks more fluids and eats less, the density will be low. And if the patient consumes more food and less fluid, then the picture becomes the opposite. During the test, never use morning urine.

Zimnitsky's analysis shows

Preparatory stage

The analysis does not require complex preparation; eight small containers should be prepared for the patient, a sheet of paper to record the indicators of urine excreted, the amount of fluid drunk at one time. It is worth setting a clock, they will serve as a guide during the collection of material.

It is not recommended to specially increase the dose of the drunk liquid. It should not exceed the norm of two liters for an adult. The regulated amount includes coffee, tea and other consumed drinks.

Before starting to collect the liquid, all foods that contribute to the coloring of the material are excluded from the diet: beets, carrots, rhubarb, berries. Fatty or spicy foods are not recommended.

Collection of material

It is not difficult to take a urine test according to Zimnitsky, the main thing is the right attitude. But in reality, the matter should be approached with all responsibility, the indicators should be correctly recorded and provided to a medical worker for interpretation and obtaining relevant reliable information. Research according to Zimnitsky is determined within 1-3 days, it is the main task of the patient to collect urine correctly.

The ability to obtain the correct results and establish the appropriate diagnosis depends on the actions of the patient.

On the first day of the analysis, you need to get up at six in the morning, empty the bladder without collecting it in containers. Primary urine is not used for research, so it does not need to be collected.
The main thing is to clearly track the time when it is necessary to collect the analysis, therefore, after the initial trip to the toilet, it must be visited at 9:00, 12:00, 15:00, 18:00, 21:00, then at three and six in the morning.
It is important to wash before each delivery of the material. This is required for the purity of the liquid delivery, the procedure helps to avoid impurities in the sample.
It is important to remember that it is impossible to pour or mix the contents of the jars. Each container must correspond to a specific time when the material was collected.

It is also necessary for pregnant women to collect urine correctly, their condition makes it difficult to perform manipulations according to the standard regulations. The urine collection technique is standard: a woman empties her bladder into sterile jars. But the analysis of urine according to Zimnitsky during pregnancy differs in its methodology, since women want to relieve themselves of a small need several times, but there is no longer room in the jar. You must request a jar with the same number.

How to collect fluid for patients who have difficulty with urinary function? The algorithm of the patient's actions is simple: it is necessary to follow the time scale, the patient is not able to fill the jar at the specified time due to the lack of desire to empty, then it is necessary to hand over all the jars and the empty one, where the time is indicated. It should be understood that this is the same indicator, it complements the clinical picture. The algorithm of actions is simple, you just need to be scrupulous about the procedure for preparing the material.

The test in children is carried out within the standard framework: a day for collecting urine according to Zimnitsky signs for equal intervals of 3 hours, the child is explained the rules for emptying the bladder, and hygiene is monitored. Urine must be stored in a dark place, at an average temperature.

Interpretation

After a urine test according to Zimnitsky, decoding takes 1-2 days. In the process of interpretation, it is worth noting that the main thing is the ratio of the obtained indicators. Many patients find out during a urinalysis according to Zimnitsky the rate of fluid release. must be higher in terms of performance - up to 2 thousand ml than night - 650 ml.

The allowable range is from 1.013–1.025. These are not the only indicators that concern the specialist. Indicators indicating the norm: 300 ml was released per night, and twice as much during the daytime and at the same time the density of urine will be equal to the allowable indicator, which means that the patient does not have pathological changes in the body.

But depending on the group of patients, the indicators may differ due to the characteristics of the organism. Speaking about whether it is possible to interpret the results on your own, the answer is unequivocal - it is impossible, since there are many nuances that only a specialist nephrologist knows.

Depending on how large the deviation from the established norm is, the results can prevent the development of many diseases from diabetes to cirrhosis of the liver. The indicators are considered separately, their ratio is interpreted. If the analysis shows the presence of pathology, additional examinations are carried out to confirm the results.

After the interpretation is completed, the patient is sent either for further examination, or for consultation with another specialist and further correction of the treatment in order to more actively influence the body. This is a simple procedure that helps a person as quickly as possible to find out how severe the pathology is and determine further methods of treatment. If the development of unnatural processes in the body is detected, the patient is referred for consultations to other specialists.

Carrying out a urine sample according to Zimnitsky is a guaranteed way to improve the patient, with its help, doctors can easily make a diagnosis, carry out therapy and prevent the disease.

Doctors convey the rules for collecting urine to patients, this simplifies the study. The collection algorithm is elementary, it is worth listening to the doctors.