Specific gravity of urine decoding. What does the specific gravity of urine show? Red blood cells, blood in the urine - possible causes of the appearance

01.05.2019

Today, not a single examination of a patient is complete without passing laboratory tests, which include a general urine test. Despite its simplicity, it is very indicative not only for diseases of the genitourinary system, but also for other somatic disorders. The specific gravity of urine is considered one of the main functional indicators of kidney function and allows you to assess their filtration function.

Urine formation

Urine in the human body is formed in two stages. The first of these, the formation of primary urine, occurs in the renal glomerulus, where blood passes through numerous capillaries. Since this is carried out under high pressure, filtration takes place, separating blood cells and complex proteins, which are retained by the walls of capillaries, from water and molecules of amino acids, sugars, fats and other waste products dissolved in it. Further, following the tubules of the nephron, the primary urine (from 150 to 180 liters per day can form) undergoes reabsorption, that is, under the action of osmotic pressure, water is again absorbed by the walls of the tubules, and the useful substances in it again enter the body due to diffusion. The remaining water with urea, ammonia, potassium, sodium, uric acid, chlorine and sulfates dissolved in it is secondary urine. It is she who through the collecting ducts, the systems of small and large renal cups, the renal pelvis and the ureter enters the bladder, where it accumulates and then is excreted into the environment.

How is the specific gravity determined?

To determine the density of urine in the laboratory, a special device is used - an urometer (hydrometer). For the examination, urine is poured into a wide cylinder, the resulting foam is removed with filter paper and the device is immersed in a liquid, being careful not to touch the walls. After stopping the immersion of the urometer, lightly press on it from above and when it stops oscillating, mark the position of the lower meniscus of urine on the scale of the device. This value will correspond to the specific gravity. When making a measurement, the laboratory assistant must also take into account the temperature in the office. The fact is that most urometers are calibrated to operate at 15 ° C. This is due to the fact that with an increase in temperature, an increase in the volume of urine occurs, respectively, its concentration decreases. When decreasing, the process goes in the opposite direction. In order to remove this error? for every 3 ° above 15 °, 0.001 is added to the obtained value and, accordingly, for every 3 ° below, the same value is subtracted.

Normal specific gravity

The indicator of relative density (this is another name for specific gravity) characterizes the ability of the kidney, depending on the needs of the body, to dilute or concentrate primary urine. Its value depends on the concentration of urea and salts dissolved in it. This value is not constant, and during the day its value can change significantly under the influence of food, drinking regimen, processes of fluid excretion with sweat and respiration. For adults, the specific gravity of urine will normally be 1.015-1.025. The density of urine in children is somewhat different from that of adults. The lowest numbers are recorded in newborns in the first days of life. For them, the normal specific gravity of urine can vary from 1.002 to 1.020. As the child grows, these indicators begin to rise. So, for a five-year-old child, indicators from 1.012 to 1.020 are considered the norm, and the specific gravity of urine in children of 12 years old practically does not differ from the values in adults. It is 1.011-1.025.

If the specific gravity of urine is low

Hypostenuria, or a decrease in specific gravity to 1.005-1.010, may indicate a decrease in the concentration of the kidneys. It is regulated by antidiuretic hormone, in the presence of which the process of water absorption is more active, and, accordingly, a smaller amount of more concentrated urine is formed. And vice versa - in the absence of this hormone or a small amount of it, urine is formed in large volumes, which have a lower density. The reason that the specific gravity of urine is lowered may be the following conditions:

diabetes insipidus;

acute pathology of the renal tubules;

chronic renal failure;

polyuria (a large volume of urine excreted), which occurs as a result of drinking plenty of fluids, when taking diuretics or when large exudates are absorbed.

Why is the specific gravity decreasing?

It is customary to distinguish three main reasons leading to a pathological decrease in the specific gravity.

Polydipsia - excessive water intake, which leads to a decrease in the concentration of salts in the blood plasma. In order to compensate for this process, the body increases the formation and excretion of urine in large volumes, but with a reduced salt content. There is such a pathology as involuntary polydipsia, in which there is a low specific gravity of urine in women with an unstable psyche.

Causes with extrarenal localization. These include neurogenic diabetes insipidus. In this case, the body loses the ability to produce antidiuretic hormone in the required quantities and, as a result, the kidneys lose the ability to concentrate urine and retain water. In this case, the specific gravity of urine can be reduced to 1.005. The danger is that even with a decrease in water intake, the amount of urine does not decrease, which leads to dehydration. The same group of causes can include damage to the hypothalamic-pituitary region due to trauma, infection, or surgery.

Reasons associated with kidney damage. A low specific gravity of urine often accompanies diseases such as pyelonephritis, glomerulonephritis. Other nephropathies with parenchymal lesions can be attributed to the same group of pathologies.

Hypersthenuria, or an increase in the specific gravity of urine, can usually be observed with oliguria (a decrease in the volume of urine excreted). It can occur due to insufficient fluid intake or with large fluid losses (vomiting, diarrhea), with an increase in edema. Also, an increased specific gravity can be observed in the following cases:

in patients with glomerulonephritis or cardiovascular insufficiency;

with intravenous administration of mannitol, radio-opaque substances;

with the withdrawal of certain drugs;

an increased specific gravity of urine in women can be with toxicosis of pregnant women;

against the background of proteinuria in nephrotic syndrome.

Separately, it is necessary to mention the increase in urine density in diabetes mellitus. In this case, it can exceed 1.030 against the background of an increased volume of excreted urine (polyuria).

Functional tests

To determine the functional state of the kidneys, it is not enough just to do a urinalysis. The specific gravity can change during the day, and in order to determine exactly how much the kidneys are able to excrete or concentrate substances, functional tests are performed. Some of them are aimed at determining the state of the concentration function, others - excretory. It often happens that violations affect both of these processes.

Dilution test

The test is carried out subject to the patient's bed rest. After an overnight fast, the patient empties the bladder and drinks 20 milliliters of water per kilogram of his weight within 30 minutes. After all the liquid has been drunk and then at intervals of one hour 4 times, urine is collected. After each urination, the patient additionally drinks the same volume of fluid that was excreted. The samples taken are assessed by the number and specific gravity.

If in healthy people the specific gravity of urine (norm) in women and men should not fall below 1.015, then against the background of water load, the density can be 1.001-1.003, and after its cancellation it rises from 1.008 to 1.030. In addition, during the first two hours of the test, more than 50% of the liquid should be released, and at its completion (after 4 hours) - more than 80%.

If the density exceeds 1.004, then we can talk about a violation of the dilution function.

Concentration test

To carry out this examination, drink and liquid food are excluded from the patient's diet for a day and include food with a high protein content. If the patient suffers from severe thirst, it is allowed to drink in small portions, but not more than 400 ml per day. Every four hours, urine is collected, assessing its amount and specific gravity. Normally, after 18 hours without fluid intake, the relative density should be 1.028-1.030. If the concentration does not exceed 1.017, then we can talk about a decrease in the concentration function of the kidneys. If the indicators are 1.010-1.012, then isostenuria is diagnosed, that is, a complete loss of the kidney's ability to concentrate urine.

Zimnitsky test

The Zimnitsky test allows you to simultaneously assess both the ability of the kidneys to concentrate and the ability to excrete urine and to do this against the background of a normal drinking regimen. For its implementation, urine is collected in portions every 3 hours during the day. In just a day, 8 portions of urine are obtained, in each of which the amount and specific gravity are recorded. Based on the results, the ratio of nighttime and daytime diuresis is determined (normally it should be 1: 3) and the total amount of excreted fluid, which, along with monitoring the specific gravity in each portion, makes it possible to assess the work of the kidneys.

The specific gravity of urine (the norm for women and men is given above) is an important indicator of the ability of the kidneys to function normally, and any deviation makes it possible with a high degree of probability to determine the problem in time and take the necessary measures.

1. Amount of urine

Diuresis is the volume of urine generated over a certain period of time (daily or minute urine output).

The amount of urine delivered for a general analysis (usually 150-200 ml) does not allow any conclusions to be drawn about violations of daily urine output. The amount of urine delivered for general analysis affects only the ability to determine the specific gravity of urine(relative density).

For example, to determine the specific gravity of urine using a urometer, at least 100 ml of urine is required. When determining the specific gravity using test strips, you can do with a smaller amount of urine, but not less than 15 ml.

2. Color of urine

Normal urine is yellow.

The saturation of the yellow color of urine depends on the concentration of substances dissolved in it. With polyuria, the dilution is greater, therefore the urine has a lighter color, with a decrease in urine output it acquires a rich yellow tint.

The color changes when taking medications (salicylates, etc.) or eating certain foods (beets, blueberries).

Pathologically altered urine coloration occurs with hematuria (a type of meat slop), bilirubinemia (the color of beer), with hemoglobinuria or myoglobinuria (black), with leukocyturia (milky white).

3. Clarity of urine

Normally, freshly released urine is completely clear..

Turbidity of urine is due to the presence in it of a large number of cell formations, salts, mucus, bacteria, fat.

Cloudy urine can also indicate microhematuria, but in most cases it is a sign of infection (i.e. bacteriuria). Note: Urinalysis can be used as a preliminary test for urinary tract infection in asymptomatic patients. In the course of the studies carried out, it turned out that the sensitivity of visual examination of urine samples for the diagnosis of bacteriuria is 73%.

4. Smell of urine

Normal urine odor is mild, nonspecific.

When urine is decomposed by bacteria in the air or inside the bladder, for example, in the case of cystitis, an ammonia odor appears.

When urine that contains protein, blood, or pus decays, such as in bladder cancer, the urine smells like rotten meat.

In the presence of ketone bodies in the urine, the urine has a fruity odor, reminiscent of the smell of rotting apples.

5. Urine reaction

Normal urine reaction is acidic.

Fluctuations in urine pH are due to the composition of the diet: a meat diet causes an acidic reaction of urine, a vegetable diet - an alkaline one. With a mixed diet, mainly acidic metabolic products are formed, therefore it is believed that the normal reaction of urine is acidic.

It is necessary to store urine before the general analysis in a cold room and no more than 1.5 hours. With prolonged standing in a warm room, urine decomposes, ammonia is released and the pH shifts to the alkaline side. An alkaline reaction underestimates the relative density of urine. In addition, leukocytes are rapidly destroyed in alkaline urine.

An alkaline urine reaction is characteristic of a chronic urinary tract infection, and is also noted with diarrhea, vomiting.

The acidity of urine increases with febrile conditions, diabetes mellitus, tuberculosis of the kidneys or bladder, renal failure.

6. Specific gravity of urine (relative density of urine)

Normally, the morning urine portion should have a specific gravity in the range of 1.018-1.024.

The relative density of urine (the density of urine is compared with the density of water) reflects the functional ability of the kidneys to concentrate and dilute and can be used as a screening test for mass examinations of the population.

Figures for the relative density of morning urine equal to or exceeding 1.018 indicate the normal concentration ability of the kidneys and exclude the need for its study using special methods. High or low figures of the specific gravity (density) of morning urine necessarily require clarification of the reasons for these changes.

Analysis decoding

High specific gravity of urine

The relative density of urine depends on the molecular weight of the particles dissolved in it. Protein and glucose increase urine specific gravity. For example, diabetes mellitus can be suspected only by one general urine test with relative gravity numbers from 1.030 and above against the background of polyuria.

Low specific gravity of urine

The formation of urine is regulated by the concentration mechanism of the kidneys and the antidiuretic hormone (ADH) produced by the pituitary gland. In the presence of antidiuretic hormone, more water is absorbed and as a result, a small amount of concentrated urine is produced. Accordingly, in the absence of antidiuretic hormone, water absorption does not occur and large volumes of diluted urine are excreted.

There are three main groups of reasons for a decrease in the specific gravity in the general analysis of urine:

excess water intake
neurogenic diabetes insipidus
nephrogenic diabetes insipidus

1. Excess water intake (polydipsia) causes a decrease in the concentration of blood plasma salts. To protect itself, the body secretes large volumes of diluted urine. There is a disease called involuntary polydipsia, which usually affects women with an unstable psyche. The leading signs of involuntary polydipsia are polyuria and polydipsia, low relative density in the general urine analysis.

2. Neurogenic diabetes insipidus- insufficient secretion of an adequate amount of antidiuretic hormone. The mechanism of the disease is the inability of the kidneys to retain water through the concentration of urine. If the patient is deprived of water, the urine output is almost not reduced and dehydration develops. The relative density of urine may drop below 1.005.

The main causes of neurogenic diabetes insipidus are:

Hypopituitarism - insufficiency of the function of the pituitary gland or hypothalamus with a decrease or cessation of the production of tropic hormones of the anterior pituitary gland and antidiuretic hormone.

The most common reason for a decrease in the specific gravity of urine is idiopathic neurogenic diabetes insipidus... Idiopathic neurogenic diabetes insipidus is most often found in young adults. Most of the underlying disorders leading to neurogenic diabetes insipidus can be identified by concomitant neurological or endocrinological symptoms (including cephalalgia and visual field disturbances or hypopituitarism).
Another common cause of a decrease in the specific gravity of urine is damage to the hypothalamic-pituitary region due to head trauma, neurosurgical intervention in the pituitary gland or hypothalamus. Or damage as a result of a brain tumor, thrombosis, leukemia, amyloidosis, sarcoidosis, encephalitis after an acute infection, etc.
The intake of ethyl alcohol is accompanied by a reversible suppression of ADH secretion and short-term polyuria. Diuresis occurs 30-60 minutes after drinking 25 g of alcohol. The volume of urine depends on the amount of alcohol taken in a single dose. Continuous use does not lead to persistent urination, despite the existence of a constant concentration of alcohol in the blood.

3. Nephrogenic diabetes insipidus- a decrease in the concentration of the kidneys, despite the normal content of antidiuretic hormone in the blood.

The main causes of nephrogenic diabetes insipidus are:

The most numerous subgroup among patients with nephrogenic diabetes insipidus is made up of persons with parenchymal kidney disease (pyelonephritis, various types of nephropathies, tubulointerstitial nephritis, glomerulonephritis) and chronic renal failure.
Metabolic Disorders:
- Connes syndrome- combination of polyuria with arterial hypertension, muscle weakness and hypokalemia. The relative gravity of urine can range from 1003 to 1012).
- Hyperparathyroidism- polyuria, muscle weakness, hypercalcemia and nephrocalcinosis, osteoporosis. The relative density of urine decreases to 1002. Urine, due to the significant content of calcium salts, often has a white color.
Rare cases of congenital nephrogenic diabetes insipidus. The relative density of urine may drop below 1.005.

Urine formation

How is the specific gravity determined?

Normal specific gravity

If the specific gravity of urine is low

diabetes insipidus;

acute pathology of the renal tubules;

chronic renal failure;

polyuria (a large volume of urine excreted), which occurs as a result of drinking plenty of fluids, when taking diuretics or when large exudates are absorbed.

Why is the specific gravity decreasing?

It is customary to distinguish three main reasons leading to a pathological decrease in the specific gravity.

in patients with glomerulonephritis or cardiovascular insufficiency;

with intravenous administration of mannitol, radio-opaque substances;

with the withdrawal of certain drugs;

an increased specific gravity of urine in women can be with toxicosis of pregnant women;

against the background of proteinuria in nephrotic syndrome.

Functional tests

Dilution test

If in healthy people the specific gravity of urine (norm) in women and men should not decrease below 1.015, then against the background of water load, the density can be 1.001-1.003, and after its cancellation it rises from 1.008 to 1.030. In addition, during the first two hours of the test, more than 50% of the liquid should be released, and at its completion (after 4 hours) - more than 80%.

If the density exceeds 1.004, then we can talk about a violation of the dilution function.

Concentration test

Zimnitsky test

Specific gravity of urine in health and disease

You were given the results of the research in the laboratory. What can a person who understands little about medicine feel when looking at these incomprehensible numbers? First of all, confusion. Of course, it is not difficult to determine an increase or decrease in a particular indicator, because the normal values are indicated in the same form. To interpret the figures obtained, certain knowledge is required. Let's take a well-known urine test. The first thing that attracts attention is the specific gravity of urine. What does this indicator say?

The specific gravity of urine (also called the relative gravity of urine) indicates the ability of the kidneys to concentrate substances in the urine that are intended to be removed from the body. These include, in particular, urea, urine salts, uric acid and creatinine. The specific gravity of urine is normally in the range from 1012 to 1027, it is determined using a urometer. The measurement is carried out in a laboratory. Recently, the determination of the density of urine is carried out on special equipment using methods of dry chemistry.

If more fluid is excreted from the body than usual, then the concentration of solutes in the urine decreases. Consequently, the specific gravity of urine also decreases. This condition is called hypostenuria. It can be noted in healthy people who consume large amounts of fluids after taking diuretic foods (watermelons, melons). Fans of various diets may experience a decrease in the indicator (due to a lack of protein foods in the diet, especially during fasting).

With various kidney diseases, their ability to concentrate various substances in the urine is impaired, therefore, the decrease in specific gravity is not due to excessive fluid intake, but to impaired renal function (pyelonephritis or glomerulonephritis, nephrosclerosis). Hypostenuria occurs in patients during the period of resorption of edema or effusion, when the fluid accumulated in the tissues quickly leaves the body. A decrease in urine density occurs while taking diuretics. A monotonous specific gravity during the day should alert the doctor in relation to pyelonephritis (especially in combination with nocturnal urine output).

An increase in relative density above 1030 is called hypersthenuria. A similar condition occurs in people with insufficient fluid intake. The specific gravity of urine, the rate of which is directly proportional to a person's drinking regime, can increase in the hot season, when a person sweats profusely, therefore, loses a lot of moisture. High numbers of this laboratory indicator are typical for workers in hot shops: cooks, blacksmiths, metallurgists.

Hypersthenuria also occurs with thickening of the blood, which occurs due to profuse vomiting or diarrhea. In patients with heart diseases, fluid accumulates in the body, as a result of which diuresis decreases and the specific gravity of urine increases. In patients with diabetes mellitus, high specific gravity figures are often detected in laboratories. In this case, this indicates a large amount of glucose in the urine.

The indicator also indirectly indicates how much the patient adheres to the recommended drinking regimen. This is important for patients with kidney disease and urolithiasis.

A single change in the indicator is not decisive for the diagnosis, since daily fluctuations in specific gravity can range from 1004 to 1028, and this is normal.

Density of urine. Decoding a general urine test

A person has to deal with various medical services throughout his life. This can be a consultation with a medical specialist, examination of any biomaterials, examination of internal organs, taking various medications. Absolutely all people take a general urine test, it is prescribed to all people - from babies to pensioners. This is the most common and at the same time informative method of urine examination.

General urine analysis: what is this study?

The analysis data is an indicator of the functioning of the kidneys, therefore, at the slightest suspicion of their dysfunction, doctors prescribe this study. In addition, the results of the analysis may indicate other pathological processes in the body. This method can detect malfunctioning of organs, determining the general properties of urine and microscopy of urinary sediment. The main parameters by which the doctor draws conclusions about the patient's condition are as follows:

urine color;
its transparency;
density of urine;
the presence of protein;
acidity;
glucose indicators;
what is the patient's hemoglobin;
bilirubin;
ketone bodies;
urobilinogen;
nitrites;
the presence of salts in the urine;
epithelium;
the number of red blood cells;
leukocytes;
what bacteria are in the urine;
cylinders.

This study for patients with kidney pathologies is prescribed quite often in order to track the dynamics of changes in the functioning of the excretory system and the effectiveness of the medications used. A healthy person, ideally, should take this analysis 1-2 times a year for the timely detection of pathologies.

What are the rules for collecting analysis?

The research must be carried out with the utmost precision. It must be ensured from the beginning of the urine collection to the final results. Before collecting urine, it is necessary to carry out hygiene of the relevant organs. It should be noted that various food jars or containers are not suitable for analysis. To collect biomaterial, a special container is required, which is used only for this purpose. You can buy it at any pharmacy.

In the evening before taking the test, you need to limit the use of foods that can color the urine: beets, carrots and others. In addition, you need to monitor the use of various medications on the eve, as they can distort the test results. During the period of menstruation, the results can also be false, so you need to wait until the end of this period.

You can not drink alcoholic beverages in the evening before the analysis. The content of trace elements in urine can change significantly.

What can be identified with this analysis?

A general urine test is prescribed in order to determine the state of the body with suspicions of some pathology. This analysis is prescribed in the event of diseases of the urinary system, to determine the dynamics of the course of the disease and control it. The analysis helps to prevent possible complications in time, and also shows the effectiveness of the treatment. This research is also often used in examinations of people undergoing professional examinations.

Determination of urine density

The density of urine is the relative ratio of the density of two materials, one of which is considered as a reference. In this case, the sample is distilled water. The density of urine is usually unstable. The reason is that the density changes per day, this is due to the unevenness of the output of metabolic products dissolved in the urine.

When the blood is filtered, the kidneys form primary urine, most of which is reabsorbed and returned to the bloodstream. Based on the described process, the kidneys make a concentrate of secondary urine. The process described above is called the concentration function of the kidneys. If there is a violation of the latter, this will lead to a decrease in the relative density of urine. Concentration dysfunctions can be diabetes insipidus, some types of chronic nephritis and other diseases.

If protein, sugar, leukocytes, erythrocytes and the like appear in the urine, this contributes to an increase in the density of urine. The relative density of urine, or rather, its average value, depends on the age of the person. Also, the concentration function of the kidneys depends on age. Generally speaking, these two concepts are closely related.

Physiology of the occurrence of urine density

The density of urine, or rather, the process of its occurrence, consists of three stages. These are filtration, reabsorption and tubular secretion.

The first stage - filtration - occurs in the malpighian body of the nephron. It is possible due to the high hydrostatic pressure in the capillaries of the glomeruli, which is created due to the fact that the diameter of the inflowing arteriole is larger than that of the outflowing one.

The second stage is called reabsorption or, in other words, absorption in the opposite direction. It is carried out in the curled and smooth tubules of the nephron, where, in fact, the primary urine enters.

The final, third stage of urination is tubular secretion. The cells of the renal tubules, together with special enzymes, actively transfer toxic metabolic products from the blood capillaries into the lumen of the tubules: urea, uric acid, creatine, creatinine and others.

The rate of relative density of urine

The relative density of urine normally has a wide range. Moreover, the process of its formation will be determined by normally functioning kidneys. The relative density of urine tells a lot to a specialist. The rate of this indicator will fluctuate many times during the day. This is due to the fact that from time to time a person takes a variety of foods, drinks water and loses fluid through sweating, breathing and other functions. In various conditions, the kidneys excrete urine with relative density indices: 1.001 - 1.040. It is believed that the density of urine is normal. If a healthy adult drinks a sufficient amount of water, then the relative density of urine, the norm of which is indicated above, in the morning can have the following indicators: 1.015 - 1.020. Morning urine can be very saturated, as no fluid enters the body at night.

The density of urine is normal if its color is straw-yellow, transparent and has a faint odor. Her reaction should range from 4 to 7.

Why is hypersthenuria dangerous?

If a person has an increased urine density, this indicates that certain pathological processes occur in the body, which in one word are called "hypersthenuria". Such a disease will be manifested by an increase in edema, in particular, with acute glomerulonephritis or insufficient blood circulation in the kidneys. If there is a huge extrarenal fluid loss. This includes diarrhea, vomiting, large blood loss, burns over a large area, edema, abdominal trauma, intestinal obstruction. Hypersthenuria will also be indicated by the appearance in the urine of a large amount of glucose, protein, drugs and their metabolites. Toxicosis during pregnancy also becomes the cause of this disease. If you passed a urine test, the specific gravity of which was high (more than 1030), such a result will indicate hypersthenuria. Such results must be discussed with a doctor.

The high density of urine does not carry a great danger to human life. But it can be of two types:

Kidney disorders such as nephrotic syndrome.
Absence of primary kidney pathology (glucosuria, myeloma, hypovolemic conditions, in which the reabsorption of water in the tubules increases as compensation, and therefore urine begins to concentrate).

What does hypostenuria indicate?

Hypostenuria is the opposite of hypersthenuria. It is characterized by decreased urine density. The cause is acute renal tubular damage, diabetes insipidus, persistent renal failure, or malignant hypertension.

Hypostenuria indicates that there has been a violation of the concentration ability of the kidneys. And this, in turn, speaks of renal failure. And if you have this disease, it is advisable to immediately consult a nephrologist, who will prescribe you timely and necessary treatment.

Urine density standards for children

As discussed in this article above, urine density norms are different for each age. Urine analysis of an adult is significantly different from that of a child. It can vary in many ways, but its main difference is in the norms. The relative density of urine in a child must meet the following standards:

In a one-day-old baby, the norm is from 1.008 to 1.018;

If the baby is about six months old, for him the norm will be 1.002-1.004;

From six months to one year of age, normal urine gravity is in the range 1.006 to 1.010;

At ages three to five, urine density limits will range from 1.010 to 1.020;

For children who are about 7-8 years old, 1.008-1.022 is considered the norm;

And those who are in the range of 10 to 12 years old, their urine density should correspond to the norm of 1.011-1.025.

It can be very difficult for parents to collect urine from their child, especially if he is very small. But in order to determine the density of urine, at least 50 ml must be delivered to the laboratory where such an analysis is carried out.

General urine analysis: decoding

Urine analysis helps to identify many diseases and draw a conclusion about the general state of human health. Decoding and results are communicated to the patient by the doctor. In this article, we will look at the most significant indicators.

Amount of urine

The first point from which the decoding of the general analysis of urine begins is its quantity. To determine the required indicators, you need only 100-200 ml of liquid. A larger number may affect the establishment of the specific gravity. The total amount of urine (diuresis) per day should be 1-2 liters. This is about 7 urinations.

Colour

Pigments interfere with urine analysis. Decoding can indicate a light or rich yellow color. Actually, this is the norm. Too dark color means there is no fluid in the body. The urine may be red in color, which indicates the presence of red blood cells in it. Green will indicate bilirubin. The color of the liquid also changes from certain drugs (pyramidon, naphthol, etc.) and food products (beets, rhubarb, blueberries).

Smell

The described smell, along with other indicators, is taken into account by the doctor when making a diagnosis. Fresh morning urine should not smell harsh. The smell of fruit occurs in diabetes mellitus, ammonia - in the case of cystitis, putrid - in gangrenous processes. This indicator is also influenced by drugs and food that are used and taken by a person.

Transparency

The clarity is also established by the urinalysis. Decoding involves the separation of the liquid into transparent (normal), translucent and turbid (indicates the presence of epithelium, bacteria, erythrocytes, salts, leukocytes).

Reaction (RN)

You can prevent the formation of kidney stones if you get a urinalysis on time. The main role in this case is played by the PH. The rate should be 6.25-6.61. It is neutral, slightly acidic. An indicator lower than 4, in fact, leads to the appearance of stones.

Specific gravity

With the help of this indicator, one can suspect such terrible diseases as heart failure, glomerulonephritis, diabetes mellitus (if the specific gravity exceeds the norm), as well as pyelonephritis (if the norm is too low). Ideally, the indicator should be between 1012 and 1025. During the day, the data may change.

Erythrocytes

Not everything is normal with human health if the presence of red blood cells was shown by a general urine test. The decryption should indicate their absence. Among the diseases in which red blood cells appear in the urine, there are tumors, stones in the ureters and kidneys, poisoning, lupus erythematosus, hypertension and others.

Leukocytes

The acceptable leukocyte count for men and women is different. So, for the first, it should be up to 3 in p. H., For the second, it is allowed up to 5 in p. H. Revealing their excessive amount allows one to suspect inflammatory diseases of the urinary system.

They can fluctuate within fairly wide limits, and these fluctuations can be physiological or pathological. Physiological fluctuations are a variant of the norm, and pathological ones reflect any disease.

An increase or decrease in relation to the norm of any indicator cannot be assessed unambiguously, and it is impossible to draw a conclusion about the presence of a disease. The test results can help to find out the possible cause of the disorders, which can be only at the stage of the syndrome, and not the formed disease. Therefore, the timely detection of abnormalities in the analyzes will help start treatment and prevent the progression of the disease. Also, test indicators can be used to monitor the effectiveness of treatment.

Consider the probable causes of changes in various indicators of the general urine analysis.

Causes of urine discoloration

In the presence of pathology, urine can change its color, which indicates a certain syndrome and disease.

The correspondence of urine colors to various pathological conditions of the body is reflected in the table:

Pathological color urine	Potential disease (cause of urine discoloration)
Brown, black	Hemolytic anemias (sickle cell, thalassemia, Minkowski-Shoffard anemia, Markiafava-Micelli disease, march anemia, syphilitic, hemolytic disease of newborns) Malignant neoplasms (melanosarcoma) Alcaptonuria Poisoning with alcohol, heavy metal salts, phenol, cresol, etc.
Red (the color of meat slops)	Kidney damage from trauma (blow, bruise, rupture, etc.) Renal colic Kidney infarction Acute kidney inflammation (glomerulonephritis, pyelonephritis)
Dark brown frothy (urine colored beer)	Botkin's disease Obstructive jaundice (blockage of the bile duct by a stone)
Orange, rose red	Hemolytic jaundice (hemolytic disease of the newborn) Porphyrias (violation of hemoglobin synthesis)
Brown (strong color tea)	Hemolytic jaundice Some types of hemolytic anemias
Colorless or white-yellow	Diabetes mellitus types 1 and 2 Diabetes insipidus
Milky (color of milk, cream)	High concentration of fats in urine (lipuria) Pus in the urine (pyuria) High concentration of phosphate salts

These color variations will help you navigate, but for an accurate diagnosis, you should take into account data from other examination methods and clinical symptoms.

Causes of the appearance of turbidity in the urine

Violation of the transparency of urine is the appearance of turbidity of varying severity. Turbidity in urine can be represented by large amounts of salts, epithelial cells, pus, bacterial agents, or mucus. The degree of turbidity depends on the concentration of the above impurities.

From time to time, every person has cloudy urine, which is formed by salts. If you can't donate this urine for analysis in the laboratory, you can conduct a test to find out the nature of the turbidity.

To distinguish salt in urine from other turbidity options at home, you can slightly warm the liquid. If the haze is formed by salts, then it can either increase or decrease until it disappears. The turbidity formed by epithelial cells, pus, bacterial agents or mucus does not change its concentration at all when the urine is heated.

The reasons for the change in the smell of urine

The smell of fresh urine is normal - not harsh or irritating.

Most often, the following pathological urine odors are noted:
1. The smell of ammonia in urine is characteristic of the development of inflammation of the mucous membrane of the urinary tract (cystitis, pyelitis, nephritis).
2. The smell of fruits (apples) in the urine develops in the presence of ketone bodies in people with type 1 or type 2 diabetes.

Reasons for changing the acidity of urine

The acidity of urine (pH) can change to an alkaline and acidic region, depending on the type of pathological process.

The reasons for the formation of acidic and alkaline urine are reflected in the table:

Causes of changes in urine density

The relative density of urine depends on the function of the kidneys, therefore, a violation of this indicator develops in various diseases of this organ.

Today, the following options for changing the density of urine are distinguished:
1. Hypersthenuria - high-density urine, more than 1030-1035.
2. Hypostenuria - urine with a low density, in the range 1007-1015.
3. Isotenuria - low density of primary urine, 1010 or less.

A single excretion of urine with high or low density does not provide grounds for detecting hypostenuria syndrome or hypersthenuria. These syndromes are characterized by prolonged excretion of urine during the day and night, with high or low density.

Pathological conditions causing disturbances in urine density are shown in the table:

Hypersthenuria	Hypostenuria	Isostenuria
Diabetes mellitus type 1 or 2 (urine density can reach 1040 and higher)	Diabetes insipidus	Chronic renal failure severe degree
Acute glomerulonephritis	Resorption of edema and inflammatory infiltrates (period after the inflammatory process)	Subacute and chronic jade severe
Congestive kidney	Alimentary dystrophy (partial starvation, nutritional deficiencies, etc.)	Nephrosclerosis
Nephrotic syndrome	Chronic pyelonephritis
Edema formation	Chronic nephritis
Convergence of edema	Chronic renal failure
Diarrhea	Nephrosclerosis (renal degeneration tissue into the connective)
	Glomerulonephritis
	Interstitial nephritis

Determination of chemicals in urine for various diseases

As we can see, the physical properties of urine in the presence of any disease can change quite significantly. In addition to changes in physical properties, various chemicals appear in the urine, which are normally absent or present in trace amounts. Consider in which diseases there is an increase in concentration, or the appearance in the urine of the following substances:

protein;
bile acids (pigments);
indican;
ketone bodies.

Causes of protein in urine (proteinuria)

The appearance of protein in urine can be caused by various reasons, which are classified into several groups, depending on the origin. An abnormal increase in the concentration of protein in the urine above 0.03 g is called proteinuria. Depending on the protein concentration, moderate, moderate and severe proteinuria are distinguished. Moderate proteinuria is characterized by a loss of protein up to 1 g / day, average - 1-3 g / day, pronounced - more than 3 g / day.

Types of proteinuria

Depending on the origin, the following types of proteinuria are distinguished:

renal (renal);
stagnant;
toxic;
feverish;
extrarenal (extrarenal);
neurogenic.

The reasons for the development of various types of proteinuria are presented in the table:

Proteinuria type	The reasons for the development of proteinuria
Renal (renal)	pyelonephritis renal amyloidosis kidney stone disease kidney abscess kidney tuberculosis tumor or metastasis to the kidney nephritis (acute and chronic) nephrosis nephrotic syndrome eclampsia of pregnancy nephropathy of pregnancy paraproteinemic hemoblastosis (multiple myeloma, Waldenstrom macroglobulinemia, diseases of heavy chains, immunoglobulins, secreting lymphomas)
Stagnant	chronic heart failure neoplasms localized in the abdominal cavity
Toxic	The use of the following medicines in very high doses: salicylates, isoniazid, pain relievers and gold compounds
Feverish	A severe increase in body temperature caused by any disease
Extrarenal (extrarenal)	cystitis urethritis pyelitis prostatitis vulvovaginitis chronic constipation long diarrhea
Neurogenic	skull injury hemorrhage in the meningeal membrane myocardial infarction renal colic

Causes of the appearance of glucose (sugar) in the urine

The appearance of glucose in the urine is called glucosuria. The most common cause of glucosuria is diabetes mellitus, but there are other pathologies that lead to this symptom.

So, glucosuria is divided into the following types:
1. Pancreatic.
2. Renal.
3. Hepatic.
4. Symptomatic.
Pancreatic glucosuria develops against the background of diabetes mellitus. Renal glucosuria is a reflection of metabolic pathology, and it occurs from an early age. Hepatic glucosuria can develop with hepatitis, traumatic organ damage, or as a result of poisoning with toxic substances.

Symptomatic glucosuria is caused by the following pathological conditions:

concussion of the brain;
hyperthyroidism (increased concentration of thyroid hormones in the blood);
acromegaly;
Itsenko-Cushing's syndrome;
pheochromocytoma (tumor of the adrenal gland).

In childhood, in addition to glucose, other types of monosaccharides - lactose, levulose or galactose, can be determined in the urine.

Causes of the appearance of bilirubin in urine

Bilirubin in urine appears with parenchymal or obstructive jaundice. Parenchymal jaundice includes acute hepatitis and cirrhosis. Obstructive jaundice includes various options for blocking the bile ducts with an obstacle to the normal outflow of bile (for example, cholelithiasis, calculous cholecystitis).

Causes of the appearance of urobilinogen in urine

Urobilinogen at a concentration exceeding 10 μmol / day is determined in urine with the following pathologies:

infectious hepatitis;
chronic hepatitis;
cirrhosis of the liver ;
tumors or metastases to the liver;
hemoglobinuria (hemoglobin or blood in the urine);
hemolytic jaundice (hemolytic disease of the newborn, hemolytic anemia);
infectious diseases (malaria, scarlet fever);
fever of any cause;
the process of resorption of foci of hemorrhage;
volvulus;
bile acids (pigments);
indican.

Causes of the appearance of bile acids and indican in urine

Bile acids (pigments) appear in urine when the concentration of direct bilirubin in the blood rises above 17-34 mmol / l.

The reasons for the appearance of bile acids in urine:

Botkin's disease;
hepatitis;
obstructive jaundice (calculous cholecystitis, gallstone disease);
cirrhosis of the liver.

Indikan is a product of decay of protein structures in the small intestine. This substance appears in the urine with gangrene, chronic constipation, all kinds of abscesses, abscesses and intestinal abscesses, malignant tumors or obstruction. Also, the appearance of indican in urine can be triggered by metabolic diseases - diabetes mellitus or gout.

Causes of the appearance of ketone bodies in urine

Ketone bodies include acetone, hydroxybutyric and acetoacetic acids.

The reasons for the appearance of ketone bodies in urine:

diabetes mellitus of moderate and high severity;
fever;
severe vomiting;
therapy with large doses of insulin for a long period of time;
eclampsia of pregnant women;
cerebral hemorrhage;
traumatic brain injury;
poisoning with lead, carbon monoxide, atropine, etc.

In the postoperative period, after a long stay under anesthesia, ketone bodies can also be detected in the urine.

Decoding microscopy of urinary sediment

One of the most informative fragments of a general urine analysis is sediment microscopy, in which the number of different elements in one field of view is counted.

Leukocytes, pus in the urine - possible causes of the appearance

An increase in the number of leukocytes more than 5 in the field of view indicates a pathological process of an inflammatory nature. An excess of white blood cells is called pyuria - pus in the urine.

The reasons causing the appearance of leukocytes in the urine:

acute pyelonephritis;
acute pyelitis;
acute pyelocystitis;
acute glomerulonephritis;
treatment with aspirin, ampicillin;
heroin use.

Sometimes, to clarify the diagnosis, urine is stained: the presence of neutrophilic leukocytes is characteristic of pyelonephritis, and lymphocytes - for glomerulonephritis.

Red blood cells, blood in the urine - possible causes of the appearance

Erythrocytes in urine can be present in varying amounts, and when their concentration is high, they speak of blood in the urine. By the number of erythrocytes in the urinary sediment, one can judge the development of the disease and the effectiveness of the treatment used.

The reasons for the appearance of red blood cells in the urine:

glomerulonephritis (acute and chronic);
pyelitis;
pyelocystitis;
chronic renal failure;
injury (bruise, rupture) of the kidneys, urethra or bladder;
tuberculosis of the kidney and urinary tract;
tumors;
taking certain medications (sulfa drugs, urotropin, anticoagulants).

In women, in the first days after childbirth, red blood cells are also detected in large quantities, but this is a variant of the norm.

Cylinders in urine - possible causes of the appearance

Among all types of cylinders, the appearance of hyaline is most often noted in the urinary sediment. All other types of cylinders (granular, waxy, epithelial, etc.) appear much less frequently.

The reasons for the detection of various types of cylinders in urine are presented in the table:

Type of cylinders urinary sediment	Causes of the appearance of cylinders in the urine
Hyaline	nephritis (acute and chronic) nephropathy of pregnancy pyelonephritis kidney tuberculosis kidney tumors kidney stone disease diarrhea epileptic seizure fever poisoning with mercuric chloride and heavy metal salts
Grainy	glomerulonephritis pyelonephritis severe lead poisoning viral infections
Waxy	chronic renal failure amyloidosis of the kidney
Erythrocyte	acute glomerulonephritis kidney infarction vein thrombosis of the lower extremities high blood pressure
Epithelial	necrosis of the renal tubules poisoning with salts of heavy metals, mercuric chloride intake of substances toxic to the kidneys (phenols, salicylates, some antibiotics, etc.)

Epithelial cells in the urine - possible causes of the appearance

Epithelial cells are not only counted, but divided into three types - squamous epithelium, transitional and renal.

Squamous epithelial cells in the urinary sediment are detected in various inflammatory pathologies of the urethra - urethritis. In women, a slight increase in squamous epithelial cells in the urine may not be a sign of pathology. The appearance of squamous epithelial cells in the urine of men undoubtedly indicates the presence of urethritis.

Transitional epithelial cells in the urinary sediment are detected in cystitis, pyelitis or pyelonephritis. Distinctive signs of pyelonephritis in this situation is the appearance of transitional epithelial cells in the urine, in combination with protein and a shift in the reaction towards the acidic side.

Renal epithelial cells appear in urine with serious and deep organ damage. So, most often, cells of the renal epithelium are detected in nephritis, amyloid or lipoid nephrosis or poisoning.

Pathologies leading to the excretion of salts in the urine

Crystals of various salts can appear in the urine and normally, for example, due to the peculiarities of the diet. However, in some diseases, the excretion of salts in the urine is also noted.

Various diseases that cause the appearance of salts in the urine are presented in the table:

The table shows the most common salts that are of diagnostic value.

Mucus and bacteria in urine are possible causes of

Mucus in the urine is determined with urolithiasis or long-term chronic inflammation of the urinary tract (cystitis, urethritis, etc.). In men, mucus can appear in the urine with prostatic hyperplasia.

The appearance of bacteria in the urine is called bacteriuria. It is caused by an acute infectious and inflammatory process occurring in the organs of the urinary system (for example, pyelonephritis, cystitis, urethritis, etc.).
The general analysis of urine provides a fairly large amount of information that can be used to make an accurate diagnosis in combination with other techniques. However, remember that even the most accurate analysis does not allow diagnosing any disease, since for this it is necessary to take into account clinical symptoms and data from objective examinations.

Before use, you must consult a specialist.

Laboratory examination of urine, an integral part of modern diagnostics. One of the varieties of such analyzes is the analysis of urine for its specific gravity. A deviation of this parameter from the norm may indicate the causes of a particular disease, which is extremely important in diagnosis.

What does the specific gravity of urine say?

The relative specific gravity of urine shows the saturation of the suspended in it:

Urea;
Uric acid;
Creatinine;
Potassium, sodium in the form of their salts.

The relative specific gravity of urine is directly related to the amount excreted at a time and to the frequency of bladder emptying. Urine excreted often and in large portions has a low density and vice versa, small portions show a high concentration. The relative specific concentration of urine is a reliable indicator of kidney health, or rather, their ability to concentrate. For example, the reasons for the decrease in the relative density of urine may lie in diseases that cause kidney failure, accompanied by a decrease in their filtering and absorption properties. This condition is called hypostenuria. If the concentration of urine is increased, they speak of hypersthenuria.

Normal urine density readings

The rates depend on the gender and age category of the patient. For newborns, the normal density is 1008 - 1018 grams per liter of liquid, for children of two, three years old, 1007 - 1017, children of four, twelve years old are considered healthy at rates of 1012 - 1020 grams per liter.

For people of mature age and adolescents 13 and more years old, the indicators of the norm of the specific gravity of urine fluctuate between 1010 and 1020 g / liter.

Deviations from these norms give rise to at least a consultative examination by an endocrinologist and a nephrologist to find out the reason.

Specific gravity above normal

Hypersthenuria - this is the name of this phenomenon, expressed by a significant excess of the permissible urine density. It is diagnosed with a high specific gravity - above 1030 grams per liter of liquid. The reasons causing it can be:

Diabetes;
Glomerulonephritis with nephrotic syndrome;
Dehydration due to diarrhea, vomiting, severe overheating of the body, or insufficient fluid intake;
Large doses of antibiotics and other medications;
Toxicosis, including toxicosis during pregnancy;
Inflammation of the genitourinary system.

Symptoms of hypersthenuria:

A sharp decrease in single portions of excreted urine;
Changing the shade of urine towards dark tones, often interspersed with clots;
The onset of painful sensations in the abdomen;
Chronic weakness and lethargy;
General swelling without visible localization.

Specific gravity underestimated

The condition of a noticeable decrease in the relative specific gravity of urine, in comparison with the norm, is called hypostenuria. With it, the indicators of the specific gravity of urine are significantly less than the lower limit of the norm. Excessive drinking of water, juices and any other liquids can cause this deviation. Men, for example, often abuse beer, which may well affect the indicator of the relative specific concentration of urine in the direction of its strong decrease. If we talk about the pathological processes that contribute to hypostenuria, then the following can be distinguished:

Diabetes (sugar);
Regeneration of edematous infiltrates at the end of inflammatory processes;
Low-calorie diet with a lack of enzymes and vitamins, leading to a dystrophic state;
Prolonged pyelonephritis;
Chronic forms of renal failure;
Nephrosclerosis is a disease that provokes changes in the structural tissue of the kidneys (the formation of nodes);
Glomerulonephritis;
Interstitial nephritis;
Taking diuretics in violation of the doctor's recommendations;
Excessive passion for drinks.

Both hyperstenuria and hypostenuria can cause serious negative consequences, so it is advisable to identify it in the early stages. These conditions are relatively easy to diagnose, using the study of urine by the general method and according to the Zimnitsky scheme, therefore, people who have a predisposition to such problems should be regularly examined.

What to do in case of deviations in the specific gravity of urine from the norm?

It is advisable to treat such conditions in a hospital or at least with the constant supervision of a doctor - an endocrinologist, nephrologist or pediatrician. Patients with diabetes mellitus, at the slightest hint of a change in urine density, should be especially responsible for taking the advice of a doctor, since diabetes can provoke a rapid development of events and seriously complicate cure. In this case, it is very important to diagnose the cause of the pathology at an early stage of development and immediately begin to eliminate it.

In principle, the treatment of this disease does not differ from any other, since a thorough diagnosis reveals the cause, that is, a diseased organ that creates problems for the whole body, and allows in the future to prescribe a complex of therapeutic tactics. Prescribed drugs should act, first of all, directly at the source of the problem and as little as possible affect healthy organs.

If the problem is kidney failure, an indispensable factor in a successful cure is a gentle diet and a healthy lifestyle. The diet should be free from spicy, smoked, salted foods and contain as little culinary spices as possible. Quitting smoking and alcohol is not even discussed. Drug treatment, if unavoidable, should be carried out strictly according to the recommendations of the attending physician and under his constant supervision.

If the phenomenon of hypostenuria or hypersthenuria is observed in a patient in a chronic cycle, then such patients are registered with a doctor and require a systemic examination every three months with the obligatory delivery of urine and, possibly, blood tests.

Quite often, hypersthenuria in diabetes mellitus is a side symptom. The peculiarity of this pathology is an increased level of sugar in the blood, which leads to increased urination, and this, in turn, requires the consumption of more fluid to restore water balance. Ultimately, this can lead to malfunction of the kidneys and the entire urinary system.

If the patient has diabetes mellitus, then the treatment is monitoring the state of sugar in the blood, regular examination by a nephrologist in compliance with all his recommendations. Unfortunately, the disease is chronic and incurable, so you can only control its course, in order to avoid side effects in the form of disruption of the renal system.