Leukocytes in urine sediment microscopy. Inorganic urine sediment, salts and crystals. Preparation for research

10.10.2019

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

Red blood cells in urine

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

Norm: absent; with microscopy - up to 2 in the field of view

Erythrocytes in urine - excess of the norm:

stones of the urinary tract;
tumors of the genitourinary system;
glomerulonephritis;
pyelonephritis;
hemorrhagic diathesis (with intolerance to anticoagulant therapy, hemophilia, coagulation disorders, thrombocytopenia, thrombocytopathy);
urinary tract infections (cystitis, urogenital tuberculosis);
kidney injury;
arterial hypertension with involvement of renal vessels;
systemic lupus erythematosus (lupus nephritis);
poisoning with derivatives of benzene, aniline, snake venom, poisonous mushrooms;
inadequate anticoagulant therapy.

Leukocytes in urine

An increased number of leukocytes in the urine (leukocyturia) is a symptom of inflammation of the kidneys and / or lower urinary tract. In chronic inflammation, leukocyturia is a more reliable test than bacteriuria, which is often undetectable. With a very large number of leukocytes, pus in the urine is determined macroscopically - this is the so-called pyuria. The presence of leukocytes in urine may be due to an admixture of discharge from the external genital organs in the urine with vulvovaginitis, insufficiently thorough toilet of the external genital organs when collecting urine for analysis.

Norm: absent; with microscopy:

Men - 0 - 3 in sight
women, children< 14 лет - 0 - 5 в поле зрения

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

acute and chronic pyelonephritis, glomerulonephritis;
cystitis, urethritis, prostatitis;
stones in the ureter;
tubulointerstitial nephritis;
lupus jade;
rejection of a kidney transplant.

Epithelial cells in urine

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

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

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

Norm: absent;

microscopy: squamous epithelial cells:

women are isolated in the field of vision
men are isolated in the preparation

other epithelial cells - absent

Detection of renal epithelial cells:

pyelonephritis;
intoxication, intake of salicylates, cortisol, phenacetin, bismuth preparations, poisoning with salts of heavy metals, ethylene glycol);
tubular necrosis;
rejection of a kidney transplant;
nephrosclerosis.

Cylinders in urine

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

Granular cylinders are formed as a result of the destruction of tubular epithelial cells. Finding them in a patient at rest and without fever is indicative of renal disease.

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

Erythrocyte casts are formed when erythrocytes are layered on the hyaline casts, leukocyte - leukocytes. The presence of erythrocyte casts confirms the renal origin of hematuria.

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

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

Cylindroids- long formations of mucus. Single cylindroids are found in urine at normal levels. A significant number of them occur in inflammatory processes of the mucous membrane of the urinary tract. They are often observed when the nephritic process subsides.

Norm: hyaline cylinders are single, the rest are absent

Hyaline casts in urine:

renal pathology (acute and chronic glomerulonephritis, pyelonephritis, kidney stones, renal tuberculosis, tumors);
congestive heart failure;
hyperthermic conditions;
high blood pressure;
taking diuretics.

Granular cylinders (nonspecific pathological symptom):

glomerulonephritis, pyelonephritis;
diabetic nephropathy;
viral infections;
lead poisoning;
fever.

Wax cylinders:

amyloidosis of the kidneys;
nephrotic syndrome.

Erythrocyte casts (renal hematuria):

acute glomerulonephritis;
kidney infarction;
renal vein thrombosis;
malignant hypertension.

Leukocyte casts (renal leukocyturia):

pyelonephritis;
lupus nephritis with systemic lupus erythematosus.

Epithelial casts (most rare):

acute tubular necrosis;
viral infection (eg, cytomegalovirus);
poisoning with salts of heavy metals, ethylene glycol;
overdose of salicylates;
amyloidosis;
kidney transplant rejection reaction.

Bacteria in urine

The excretion of bacteria in the urine is of significant diagnostic value. Bacteria persist in the urine for no more than 1-2 days after the start of antibiotic therapy. The first morning urine sample is preferable for research. It is possible to determine the type of bacteria and assess the level of bacteriuria, as well as to identify the sensitivity of microorganisms to antibiotics using bacteriological culture of urine.

Norm: negatively

Bacteria in urine:

infections of the urinary system, pyelonephritis, urethritis, cystitis).

Yeast fungi

candidiasis, which occurs most often as a result of inappropriate antibiotic therapy.

Reference values: negatively

Inorganic urine sediment (crystals), salts in urine

Urine is a solution of various salts that can precipitate (form crystals) when urine stands. Low temperature favors crystal formation. The presence of certain crystals of salts in the urinary sediment indicates a change in the reaction to the acidic or alkaline side. Excessive salt content in urine contributes to the formation of calculi and the development of urolithiasis. At the same time, the diagnostic value of the presence of salt crystals in urine is usually small. Increased doses of ampicillin and sulfonamides lead to the formation of crystals.

Under physiological conditions, uric acid is found with a high concentration of urine, after a plentiful meat meal, after profuse sweating.

Norm: absent

Uric acid and its salts (urates):

highly concentrated urine;
acid reaction of urine (after exercise, meat diet, fever, leukemia);
uric acid diathesis, gout;
chronic renal failure;
acute and chronic nephritis;
dehydration (vomiting, diarrhea);
in newborns.

Hippuric acid crystals:

eating fruits containing benzoic acid (blueberries, lingonberries);
diabetes;
liver disease;
putrefactive processes in the intestines.

Ammonia-magnesia phosphates, amorphous phosphates:

alkaline urine reaction in healthy people;
vomiting, gastric lavage;
cystitis;
Fanconi's syndrome, hyperparathyroidism.

Calcium oxalate (oxaluria occurs with any urine reaction):

eating foods rich in oxalic acid (spinach, sorrel, tomatoes, asparagus, rhubarb);
pyelonephritis;
diabetes;
ethylene glycol poisoning.

Leucine and Tyrosine:

severe metabolic disorder;
phosphorus poisoning;
destructive liver diseases;
pernicious anemia;
leukemia.

Cystine:

congenital disorder of cystine metabolism - cystinosis.

Fat and fatty acids:

degenerative changes in the epithelium of the renal tubules;
eating a lot of fish oil.

Cholesterol:

hiluria;
fatty degeneration of the kidneys;
echinococcosis of the kidneys;
cystitis;
cholesterol stones.

Bilirubin:

hepatitis;
liver cancer;
infectious diseases;
phosphorus poisoning.

Hematoidin:

chronic bleeding along the urinary tract, especially if the blood stagnates anywhere.

Mucus in urine

Mucus is secreted by the epithelium of the mucous membranes. Normally present in urine in small amounts. In inflammatory processes, the content of mucus in the urine increases. An increased amount of mucus in the urine may indicate a violation of the rules for proper preparation for taking a urine sample.

Norm: insignificant amount.

Urine is a metabolic product formed in the kidneys as a result of filtration of the liquid part of the blood, as well as the processes of reabsorption and secretion of various analytes. It consists of 96% of water, the remaining 4% are dissolved in it nitrogenous metabolic products of proteins (urea, uric acid, creatinine, etc.), mineral salts and other substances.

General analysis of urine in children and adults includes an assessment of the physicochemical characteristics of urine and sediment microscopy. This study allows you to assess the function of the kidneys and other internal organs, as well as to identify the inflammatory process in the urinary tract.

Physicochemical studies of urine include an assessment of the following indicators:

Colour;
transparency of urine;
specific gravity (relative density);
protein concentration;
glucose concentration;
the concentration of bilirubin;
urobilinogen concentration;
concentration of ketone bodies;
concentration of nitrites;
concentration of hemoglobin.

Microscopy of urinary sediment includes the assessment of the following items:

The assessment of the physical properties of urine, such as smell, color, turbidity, is carried out by the organoleptic method. The specific gravity of urine is measured using a urometer, refractometer or assessed by "dry chemistry" methods (test strips) - visually or on automatic urine analyzers.

Urine color

An adult has yellow urine. Its shade can range from light (almost colorless) to amber. The saturation of the yellow color of urine depends on the concentration of substances dissolved in it. With polyuria, 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 changed color of urine occurs when:

hematuria - a type of "meat slop";
bilirubinemia (beer color);
hemoglobinuria or myoglobinuria (black color);
leukocyturia (milky white color).

Clarity of urine

Normally, freshly collected 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.

Urine smell

Normally, the smell of urine is not sharp. 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.

Urine reaction

The kidneys excrete "unnecessary" substances from the body and retain the necessary substances to ensure the exchange of water, electrolytes, glucose, amino acids and maintain the acid-base balance. The reaction of urine - pH - largely determines the efficiency and peculiarity of these mechanisms. Normal urine reaction is weakly acidic (pH 5.0-7.0). It depends on many factors: age, diet, body temperature, physical activity, kidney condition, etc. The lowest pH values are in the morning on an empty stomach, the highest after meals. When eating predominantly meat food, the reaction is more acidic, when eating vegetable food, it is alkaline. With prolonged standing, urine decomposes, ammonia is released and the pH shifts to the alkaline side.

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

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

Specific gravity (relative density) of urine

Relative density reflects the functional ability of the kidneys to concentrate and dilute urine. Normal functioning kidneys are characterized by wide fluctuations in the specific gravity of urine during the day, which is associated with periodic intake of food, water and loss of fluid by the body. The kidneys under various conditions can excrete urine with a relative density of 1.001 to 1.040 g / ml.

Distinguish:

hypostenuria (fluctuations in the specific gravity of urine less than 1.010 g / ml);
isostenuria (the appearance of a monotonous nature of the specific gravity of urine corresponding to that of primary urine (1.010 g / ml);
hypersthenuria (high specific gravity).

The maximum upper limit of the specific gravity of urine in healthy people is 1.028 g / ml, in children - 1.025 g / ml. The minimum lower limit for the specific gravity of urine is 1.003-1.004 g / ml.

To assess the chemical composition of urine, diagnostic test strips (the "dry chemistry" method) produced by various manufacturers are usually used. The chemical methods used in test strips are based on color reactions that change the color of the test area of the strip at different analyte concentrations. Color change is determined visually or by reflective photometry using semi-automatic or fully automated urine analyzers, the results are assessed qualitatively or semi-quantitatively. If a pathological result is found, the study can be repeated using chemical methods.

Protein

Protein is normally absent in urine or is present in concentration that cannot be detected by conventional methods (traces). There are several types of proteinuria (the appearance of protein in the urine):

physiological (orthostatic, after increased physical activity, hypothermia);
glomerular (glomerulonephritis, the action of infectious and allergic factors, hypertension, cardiac decompensation);
tubular (amyloidosis, acute tubular necrosis, interstitial nephritis, Fanconi syndrome).
prerenal (multiple myeloma, muscle necrosis, erythrocyte hemolysis);
postrenal (with cystitis, urethritis, colpitis).

Glucose

Normally, there is no glucose in the urine. The appearance of glucose in urine can have several reasons:

physiological (stress, intake of an increased amount of carbohydrates);
extrarenal (diabetes mellitus, pancreatitis, diffuse liver damage, pancreatic cancer, hyperthyroidism, Itsenko-Cushing's disease, traumatic brain injury, strokes);
renal (renal diabetes, chronic nephritis, acute renal failure, pregnancy, phosphorus poisoning, some drugs).

Bilirubin

Bilirubin is normally absent in urine. Bilirubinuria is detected in parenchymal lesions of the liver (hepatitis), obstructive jaundice, cirrhosis, cholestasis, as a result of the action of toxic substances.

Urobilingen

Normal urine contains low concentration (traces) of urobilinogen. Its level rises sharply in hemolytic jaundice, as well as in toxic and inflammatory lesions of the liver, intestinal diseases (enteritis, constipation).

Ketone bodies

Ketone bodies include acetone, acetoacetic and beta-hydroxybutyric acids. An increase in the excretion of ketones in the urine (ketonuria) appears when there is a violation of carbohydrate, lipid or protein metabolism.

Nitrite

Hemoglobin

Normally, it is absent in urine. Hemoglobinuria - the result of intravascular hemolysis of erythrocytes with the release of hemoglobin - is characterized by the release of red or dark brown urine, dysuria, and often back pain. With hemoglobinuria, erythrocytes are absent in the urine sediment.

Microscopy of urine sediment

Urine sediment is divided into organized (elements of organic origin - erythrocytes, leukocytes, epithelial cells, cylinders, etc.) and unorganized (crystals and amorphous salts).

Research methods

The study is carried out visually in a native preparation using a microscope. In addition to visual microscopic examination, research using automatic and semi-automatic analyzers is used.

Erythrocytes

During the day, 2 million erythrocytes are excreted in the urine, which in the study of urine sediment is normally 0-3 erythrocytes in the field of view for women and 0-1 erythrocytes in the field of view for men. Hematuria is an increase in red blood cells in the urine above the indicated values. Allocate macrohematuria (the color of urine is changed) and microhematuria (the color of the urine is not changed, erythrocytes are detected only by microscopy).

In the urinary sediment, erythrocytes can be unchanged (containing hemoglobin) and altered (devoid of hemoglobin, leached). Fresh, unchanged erythrocytes are characteristic of urinary tract lesions (cystitis, urethritis, stone passage).

The appearance of leached erythrocytes in the urine is of great diagnostic value, because they are most often renal in origin and occur in glomerulonephritis, tuberculosis, and other kidney diseases. To determine the source of hematuria, a three-glass test is used. When bleeding from the urethra, hematuria is greatest in the first portion (unchanged red blood cells), from the bladder - in the last portion (unchanged red blood cells). With other sources of bleeding, red blood cells are distributed evenly in all three portions (leached red blood cells).

Leukocytes

Leukocytes in the urine of a healthy person are contained in small quantities. The norm for men is 0-3, for women and children 0-6 leukocytes in the field of view.

An increase in the number of leukocytes in the urine (leukocyturia, pyuria) in combination with bacteriuria and the presence of clinical symptoms indicates inflammation of an infectious nature in the kidneys or urinary tract.

Epithelial cells

Epithelial cells are almost always found in the urinary sediment. Normally, in the analysis of urine, no more than 10 epithelial cells in the field of view.

Epithelial cells are of various origins:

squamous epithelial cells enter the urine from the vagina, urethra, their presence is of no particular diagnostic value;
cells of the transitional epithelium line the mucous membrane of the bladder, ureters, pelvis, large ducts of the prostate gland. The appearance in the urine of a large number of cells of such an epithelium can be observed with urolithiasis, neoplasms of the urinary tract and inflammation of the bladder, ureters, pelvis, large ducts of the prostate gland;
cells of the renal epithelium are detected with damage to the renal parenchyma, intoxication, febrile, infectious diseases, circulatory disorders.

Cylinders

A cylinder is a protein coagulated in the lumen of the renal tubules and includes any contents of the lumen of the tubules in its matrix. The cylinders take the form of the tubules themselves (cylindrical cast). Normally, there are no cylinders in a urine sample taken for general analysis. The appearance of casts (cylindruria) is a symptom of kidney damage.

There are cylinders:

hyaline (with overlapping erythrocytes, leukocytes, renal epithelial cells, amorphous granular masses);
grainy;
waxy;
pigmented;
epithelial;
erythrocyte;
leukocyte;
fatty.

Fugitive sludge

The main component of unorganized urine sediment is salts in the form of crystals or amorphous masses. The nature of the salts depends on the pH of the urine and other properties of the urine. For example, with an acidic reaction of urine, uric acid, urates, oxalates are found, with an alkaline reaction of urine - calcium, phosphates, uric ammonium. The unorganized sediment has no special diagnostic value; indirectly, one can judge the patient's tendency to urolithiasis. In a number of pathological conditions, crystals of amino acids, fatty acids, cholesterol, bilirubin, hematoidin, hemosiderin, etc. may appear in the urine.

The appearance of leucine and tyrosine in the urine indicates a pronounced metabolic disorder, phosphorus poisoning, destructive liver disease, pernicious anemia, and leukemia.

Cystine is a congenital disorder of cystine metabolism - cystinosis, liver cirrhosis, viral hepatitis, hepatic coma, Wilson's disease (congenital copper metabolism defect).

Xanthine - Xanthinuria is caused by the absence of xanthine oxidase.

Bacteria

Normally, the urine in the bladder is sterile. When urinating, germs from the lower urethra enter it.

The appearance of bacteria and leukocytes in the general analysis of urine against the background of symptoms (dysuria or fever) indicates a clinically manifested urinary infection.

The presence of bacteria in the urine (even in combination with leukocytes) in the absence of complaints is regarded as asymptomatic bacteriuria. Asymptomatic bacteriuria increases the risk of a urinary tract infection, especially during pregnancy.

Yeast mushrooms

The detection of fungi of the genus Candida indicates candidiasis, which occurs most often as a result of irrational antibiotic therapy, the use of immunosuppressants, cytostatics.

In the urine sediment, eggs of the blood schistosome (Schistosoma hematobium), elements of the echinococcal bladder (hooks, scolexes, brood capsules, scraps of the bladder membrane), migrating larvae of intestinal acne (strongylids), washed off by urine from the perineum of the oncosphere tenidobius ) and pathogenic protozoa - Trichomonas (Trichomonas urogenitalis), amoeba (Entamoeba histolitika - vegetative forms).

Sample collection and storage conditions

For a general analysis, a morning urine sample is collected. The collection of urine is carried out after a thorough toilet of the external genital organs without the use of antiseptics. For the study, freshly collected urine is used, which was stored for no more than four hours before analysis. Samples are stable at 2–8 ° С for no more than 2 days. The use of preservatives is undesirable. Before testing, the urine is thoroughly mixed.

General urine analysis is a routine research method used in the diagnosis and control of the course of a number of diseases, as well as screening examinations. Urinalysis is one of the most effective methods for diagnosing abnormalities in kidney function.

The general analysis of urine includes an assessment of the physicochemical characteristics of urine and microscopy of the sediment. General analysis of urine in patients with diseases of the kidneys and urinary system is performed repeatedly over time to assess the condition and control therapy. Healthy people are advised to perform this test 1 to 2 times a year.

Do not underestimate its importance for determining other pathologies in the body of a modern person. These are diseases and inflammatory processes of the urinary tract (a study for a weakly acidic, neutral or alkaline reaction), the genitourinary system (an increased level of leukocytes), urolithiasis (the appearance of erythrocytes in the sample), diabetes mellitus (the presence of glucose in the urine), stagnant processes (the presence of mucus ) and much more.

There is no doubt that such a serious type of urine analysis must be carried out with maximum accuracy, using modern equipment and properly prepared material.

The general properties of urine are determined: (color, transparency, specific gravity, pH, protein, glucose, bilirubin, urobilinogen, ketone bodies, nitrites, hemoglobin);

Microscopy of urinary sediment: (epithelium, erythrocytes, leukocytes, casts, bacteria, salts).

Urine collection rules

Mayonnaise jars for urine analysis and other "classic" containers of clinics and folklore are irrevocably a thing of the past. To collect material, it is worth using special sterile containers and preservatives. Thus, the chances of foreign substances entering the sample are minimized, and the period of transporting the sample from the patient to the diagnostic equipment, which is acceptable for high-quality urine analysis, is significantly increased.

Further - preparation for the collection of material. The rules of personal hygiene at this moment become not only desirable, but obligatory: neither sweat nor secretion of the sebaceous glands should get into the urine. Antibacterial soap is not recommended in this case. Urine without impurities - the result of the study without errors. It is necessary to mention another type of impurities that can distort the results of a urine test: food and drugs. Do not eat beets, carrots and other natural dyes the night before. Remember that one of the main parameters of the study is the color of the urine. And, if it really differs from the norm, which is considered to be yellow and its shades, then let it give information not only about what you had dinner with.

Note that a violation of the norm for the presence of pigments can make the color of urine completely unexpected - blue, brown, red, even green.

Dark urine may indicate abnormal liver function, in particular with hepatitis. The liver stops destroying one of the enzymes, which, reacting with air, and gives such a color change.

If the urine turns red, it is most likely that there is blood in it. If it resembles milk diluted with water, there is an excess of fat in it. The pus contained in it gives a grayish tint. Green or blue color is one of the signs of putrefaction processes in the intestines. Foamy urine occurs only in men. There is nothing wrong: it happens when sperm gets into it. And, for example, no one has yet learned to control wet dreams or an excess of sperm.

Medicines. Even harmless aspirin in high doses can turn urine pink. It is especially undesirable to take antibacterial drugs and uroseptics on the eve of urine analysis. It is necessary to consult with your doctor about the pause in their use. Except when the main subject of research is just the concentration of drugs in the urine.

Alcohol greatly distorts the results of urinalysis.

Try to drink no more and no less fluids than usual the day before your urine test.

Do not live sexually 12 hours before taking the analysis.

Note also that it is undesirable to take a urine test during menstruation and within a week after procedures such as cystoscopy.

Remember that the main role in the diagnosis (for example, "an inflammatory process in the genitourinary system") is played not by the presence / absence of bacteria in the urine, but by their increased number: the characteristic growth in comparison with the norm (2 thousand bacteria in 1 ml) is 50 times (up to 100 thousand bacteria in 1 ml of urine).

Urine analysis is prescribed for:

Diseases of the urinary system;
- screening examinations during medical examinations;
- to assess the course of the disease, control the development of complications and the effectiveness of the treatment.
- Persons who have had streptococcal infection (tonsillitis, scarlet fever) are recommended to have a urine test 1 to 2 weeks after recovery. We recommend that healthy people have a urine test 1-2 times a year. Remember, treatment is always more expensive than prevention.

Collection of urine for general analysis preparation.

Before collecting urine, hygiene procedures are mandatory so that bacteria of the sebaceous and sweat glands do not get into the urine.

Collect strictly the morning portion of urine, allocated immediately after sleep, preferably the middle portion. The interval between collection of urine and delivery of material to the laboratory should be as short as possible.

To collect urine, a special kit is used (a sterile container and a test tube with a preservative), which, together with the collection instructions, must be purchased in advance at any INVITRO medical office at a security deposit.

Urine in a test tube with a preservative is taken throughout the day (according to the blood test schedule).

Indications

Diseases of the urinary system.
Screening examination during medical examinations.
Assessment of the course of the disease, monitoring the development of complications and the effectiveness of the treatment.
Persons who have had streptococcal infection (tonsillitis, scarlet fever) are recommended to have a urine test 1 to 2 weeks after recovery.

Decoding the results of a general urine test

Urine color.

Normally, the urine pigment urochrome gives the urine a yellow color of various shades, depending on the degree of urine saturation with it. Sometimes only the color of the sediment can change: for example, with an excess of urates, the sediment has a brownish color, uric acid - yellow, phosphates - whitish.

Increasing the color intensity- a consequence of the loss of fluids by the body: edema, vomiting, diarrhea.
Discoloration of urine may be the result of the release of coloring compounds formed during organic changes or under the influence of dietary components, drugs taken, contrast agents.

Urine color	State	Dyes
Straw yellow		-
Dark yellow	Edema, burns, vomiting, diarrhea, congestive edema with heart failure	High concentration of urochromes
Pale, watery, colorless	Diabetes insipidus, decreased concentration function of the kidneys, taking diuretics, overhydration	Low concentration of urochromes
Yellow-orange	Taking vitamins of the group, furagin	-
Reddish, pink	Eating brightly colored fruits and vegetables, such as beets, carrots, blueberries; medicines - antipyrine, aspirin	-
Red	Renal colic, kidney infarction	The presence of red blood cells in the urine - fresh hematuria, the presence of hemoglobin, porphyrin, myoglobin
The color of the "meat slop"	Acute glomerulonephritis	Hematuria (altered blood)
Dark brown	Hemolytic anemia	Urobilinuria
Red brown	Taking metronidazole, sulfonamides, bearberry preparations. Poisoning with phenols	-
Black	Markiafava-Micelli disease (paroxysmal nocturnal hemoglobinuria) Alcaptonuria. Melanoma	Hemoglobinuria Homogentisic acid Melanin (melanuria)
Beer color (yellow-brown)	Parenchymal jaundice (viral hepatitis)	Bilirubinuria, urobilinogenuria
Greenish yellow	Mechanical (obstructive) jaundice - gallstone disease, pancreatic head cancer	Bilirubinuria
Whitish	The presence of phosphates or lipids in the urine	-
Lactic	Kidney lymphostasis, urinary tract infection	Hiluria, pyuria

Clarity of urine

Reference values: complete.
Clouding of urine can be the result of the presence in the urine of erythrocytes, leukocytes, epithelium, bacteria, fatty droplets, precipitation of salts (urates, phosphates, oxalates) and depends on the salt concentration, pH and storage temperature of urine (low temperature promotes the precipitation of salts) ... If you stand for a long time, the urine can become cloudy as a result of bacteria growth. Normally, slight turbidity can be caused by epithelium and mucus.

Relative density (specific gravity) of urine

The relative density (specific gravity) of urine depends on the amount of released organic compounds (urea, uric acid, salts) and electrolytes - Cl, Na and K, as well as on the amount of excreted water. The higher the urine output, the lower the relative density of urine. The presence of protein and especially glucose causes an increase in the specific gravity of urine. A decrease in the concentration function of the kidneys in renal failure leads to a decrease in the specific gravity (hypostenuria). The complete loss of concentration function leads to an equalization of the osmotic pressure of plasma and urine, this condition is called isostenuria.

Reference values (for all ages): 1003 - 1035 g / l.

Increased relative density (hypersthenuria):

glucose in urine with uncontrolled diabetes mellitus;
protein in the urine (proteinuria) with glomerulonephritis, nephrotic syndrome;
drugs and / or their metabolites in urine;
intravenous infusion of mannitol, dextran, or radiopaque contrast agents;
low fluid intake;
large fluid losses (vomiting, diarrhea);
toxicosis of pregnant women;
oliguria.

Decrease in relative density:

diabetes insipidus (nephrogenic, central, or idiopathic);
acute damage to the renal tubules;
polyuria (as a result of taking diuretics, drinking plenty of fluids).

urine pH.

Fresh urine from healthy people can have a different reaction (pH from 4.5 to 8), usually the reaction of urine is slightly acidic (pH between 5 and 6). Fluctuations in urine pH are due to the composition of the diet: a meat diet causes an acidic reaction of urine, the predominance of plant and dairy foods leads to alkalization of urine. Changes in urine pH correspond to blood pH; with acidosis, urine has an acidic reaction, with alkalosis - alkaline. Sometimes there is a discrepancy between these indicators.

With chronic lesions of the kidney tubules (tubulopathies), hyperchloric acidosis is observed in the blood, and the urine reaction is alkaline, which is associated with a violation of the synthesis of acid and ammonia due to damage to the tubules. Bacterial decomposition of urea in the ureters or storage of urine at room temperature will alkalize the urine. The reaction of urine affects the nature of salt formation in urolithiasis: at pH below 5.5, uric acid stones are more often formed, at pH from 5.5 to 6.0 - oxalate stones, at pH above 7.0 - phosphate stones.

Reference values:

0 - 1 month - 5.0 - 7.0;
1 month - 120 years old - 4.5 - 8.0

Increase:

metabolic and respiratory alkalosis;
chronic renal failure;
renal tubular acidosis (type I and II);
hyperkalemia;
primary and secondary hyperfunction of the parathyroid gland;
carbonic anhydrase inhibitors;
a diet high in fruits and vegetables;
prolonged vomiting;
urinary tract infections caused by microorganisms that break down urea;
the introduction of certain drugs (adrenaline, nicotinamide, bicarbonates);
neoplasms of the genitourinary system.

Decrease:

metabolic and respiratory acidosis;
hypokalemia;
dehydration;
starvation;
diabetes;
tuberculosis;
fever;
severe diarrhea;
taking medications: ascorbic acid, corticotropin, methionine;
a diet high in meat protein, cranberries.

Protein in the urine (proteinuria).

Protein in urine is one of the most diagnostically important laboratory signs of kidney disease. A small amount of protein in the urine (physiological proteinuria) may be present in healthy people, but the excretion of protein in the urine does not normally exceed 0.080 g / day at rest and 0.250 g / day during intense physical activity, after a long walk (marching proteinuria). Protein in urine can also be found in healthy people with strong emotional experiences, hypothermia. In adolescents, orthostatic proteinuria (in an upright position of the body) occurs.

Normally, most of the proteins do not pass through the membrane of the renal glomeruli, which is explained by the large size of protein molecules, as well as their charge and structure. With minimal damage in the glomeruli of the kidneys, there is primarily a loss of low molecular weight proteins (mainly albumin), therefore, with a large loss of protein, hypoalbuminemia often develops. With more pronounced pathological changes, larger protein molecules also enter the urine. The epithelium of the renal tubules physiologically secretes a certain amount of protein (Tamm-Horsfall protein). Some of the proteins in urine can come from the genitourinary tract (ureter, bladder, urethra) - the content of these proteins in the urine rises sharply during infections, inflammation or tumors of the genitourinary tract. Proteinuria (the appearance of protein in the urine in an increased amount) can be prerenal (associated with increased tissue breakdown or the appearance of abnormal proteins in the plasma), renal (caused by kidney pathology), and postrenal (associated with urinary tract pathology). The appearance of protein in the urine is a common nonspecific symptom of kidney disease. In renal proteinuria, protein is found in both daytime and nighttime urine. According to the mechanisms of occurrence of renal proteinuria, glomerular and tubular proteinuria are distinguished. Glomerular proteinuria is associated with a pathological change in the barrier function of the membranes of the renal glomeruli. Massive urinary protein loss (> 3 g / L) is always associated with glomerular proteinuria. Tubular proteinuria is caused by impaired protein reabsorption in the pathology of the proximal tubules.

Reference values: < 0,140 г/л.

The presence of protein in the urine (proteinuria):

nephrotic syndrome;
diabetic nephropathy;
glomerulonephritis;
nephrosclerosis;
impaired absorption in the renal tubules (Fanconi syndrome, heavy metal poisoning, sarcoidosis, sickle cell disease);
multiple myeloma (Bens-Jones protein in urine) and other paraproteinemias;
impaired renal hemodynamics with heart failure, fever;
malignant tumors of the urinary tract;
cystitis, urethritis and other urinary tract infections.

Glucose in the urine.

Glucose in urine is normally absent or found in minimal amounts, up to 0.8 mmol / l, since in healthy people all blood glucose after filtration through the membrane of the renal glomeruli is completely absorbed back into the tubules. When the concentration of glucose in the blood is more than 10 mmol / L - exceeding the renal threshold (the maximum ability of the kidneys to reabsorb glucose) or with a decrease in the renal threshold (damage to the renal tubules), glucose appears in the urine - glucosuria is observed.

Detection of glucose in urine has implications for the diagnosis of diabetes mellitus and for monitoring (and self-monitoring) antidiabetic therapy.

Note: the most accurate method is studies of general urine analysis using Multistix diagnostic strips (+ sediment microscopy). The reading of the result is carried out automatically using the analyzer (errors of visual determination are excluded). The principle of the method for determining glucose on them is glucose oxidase. The step of the test strip for the analysis of urine for glucose is as follows: first, there is a “negative” result, the next step is “5.5” (traces). If the true glucose value is between these values, then due to such a step of the test strip, the device issues it as a minimum positive value - 5.5.

Since the questions of doctors and patients about this threshold value of glucose concentration have become more frequent recently, the laboratory decided to give out not a number, but write "traces" when obtaining such a result. With such a response for glucose in urine, we recommend additional studies, in particular, this is the determination of fasting blood glucose, the study of daily urine excretion (hexokinase method), or, if prescribed by a doctor, a glucose tolerance test.

Reference values: 0 - 1,6.

"SEE COMM.":

< 1,7 - отрицат;
1.7 - 2.8 - traces;
> 2.8 - a significant increase in the concentration of glucose in the urine.

Increased levels (glucosuria):

diabetes;
acute pancreatitis;
hyperthyroidism;
renal diabetes;
steroid diabetes (taking anabolic steroids in diabetics);
poisoning with morphine, strychnine, phosphorus;
dumping syndrome;
Cushing's syndrome;
myocardial infarction;
pheochromocytoma;
big trauma;
burns;
renal tubulointerstitial lesions;
pregnancy;
taking a lot of carbohydrates.

Bilirubin in the urine.

Bilirubin is the main final metabolite of porphyrins excreted from the body. In the blood, free (unconjugated) bilirubin in the plasma is transported by albumin, in this form it is not filtered in the renal glomeruli. In the liver, bilirubin combines with glucuronic acid (a conjugated, water-soluble form of bilirubin is formed) and in this form it is excreted with bile into the gastrointestinal tract. With an increase in the concentration of conjugated bilirubin in the blood, it begins to be excreted by the kidneys and is found in the urine. The urine of healthy people contains minimal, undetectable amounts of bilirubin. Bilirubinuria is observed mainly with damage to the liver parenchyma or mechanical obstruction of the outflow of bile. In hemolytic jaundice, the urine reaction to bilirubin is negative.

Reference values: negatively.

Detection of bilirubin in urine:

obstructive jaundice;
viral hepatitis;
cirrhosis of the liver;
neoplasm metastases in the liver.

Urobilinogen in urine.

Urobilinogen and stercobilinogen are formed in the intestine from bilirubin secreted with bile. Urobilinogen is reabsorbed in the large intestine and enters the liver through the portal vein system, and then is excreted together with bile again. A small part of this fraction enters the peripheral bloodstream and is excreted in the urine. Normally, in the urine of a healthy person, urobilinogen is determined in trace amounts - its excretion in the urine per day does not exceed 10 μmol (6 mg). When urine is standing, urobilinogen is converted to urobilin.

Reference values: 0 - 17.

Increased urinary excretion of urobilinogen:

increased hemoglobin catabolism: hemolytic anemia, intravascular hemolysis (transfusion of incompatible blood, infections, sepsis), pernicious anemia, polycythemia, resorption of massive hematomas;
an increase in the formation of urobilinogen in the gastrointestinal tract: enterocolitis, ileitis, intestinal obstruction, an increase in the formation and reabsorption of urobilinogen in infections of the biliary system (cholangitis);
increased urobilinogen in violation of liver function: viral hepatitis (excluding severe forms);
chronic hepatitis and cirrhosis of the liver;
toxic damage: alcoholic, organic compounds, toxins in infections, sepsis;
secondary liver failure: after myocardial infarction, heart and circulatory failure, liver tumors;
increased urobilinogen during liver bypass surgery: liver cirrhosis with portal hypertension, thrombosis, renal vein obstruction.

Ketone bodies in urine (ketonuria).

Ketone bodies (acetone, acetoacetic and beta-hydroxybutyric acids) are formed as a result of increased fatty acid catabolism. The determination of ketone bodies is important in the recognition of metabolic decompensation in diabetes mellitus. Insulin-dependent juvenile diabetes is often first diagnosed by the appearance of ketone bodies in the urine. With inadequate insulin therapy, ketoacidosis progresses. The resulting hyperglycemia and hyperosmolarity lead to dehydration, electrolyte imbalance, and ketoacidosis. These changes cause dysfunction of the central nervous system and lead to hyperglycemic coma.

Reference values: 0 - 0,4.

"SEE COMM."

< 0,5 - отрицат;
0.5 - 0.9 - traces;
> 0.9 - positive.

Detection of ketone bodies in urine (ketonuria):

diabetes mellitus (decompensated - diabetic ketoacidosis);
precomatose state, cerebral (hyperglycemic) coma;
prolonged fasting (complete refusal of food or a diet aimed at reducing body weight);
severe fever;
alcohol intoxication;
hyperinsulinism;
hypercatecholaminemia;
isopropranolol poisoning;
eclampsia;
glycogenosis types I, II, IV;
lack of carbohydrates in the diet.

Nitrite in urine.

There are no nitrites in normal urine. In urine, they are formed from foodborne nitrates under the influence of bacteria if the urine has been in the bladder for at least 4 hours. Detection of nitrite in urine (positive test result) indicates an infection of the urinary tract. However, a negative result does not always rule out bacteriuria. Urinary tract infection varies in different populations, depending on age and gender.

The increased risk of asymptomatic urinary tract infections and chronic pyelonephritis, other things being equal, are more susceptible to: girls and women; elderly people (over 70 years old); men with prostate adenoma; people with diabetes; patients with gout; patients after urological operations or instrumental procedures on the urinary tract.

Reference values: negative.

Hemoglobin in urine.

There is no hemoglobin in normal urine. A positive test result reflects the presence of free hemoglobin or myoglobin in the urine. This is the result of intravascular, intrarenal, urinary hemolysis of erythrocytes with the release of hemoglobin, or muscle damage and necrosis, accompanied by an increase in plasma myoglobin levels. Distinguishing hemoglobinuria from myoglobinuria is quite difficult, sometimes myoglobinuria is mistaken for hemoglobinuria.

Reference values: negatively.

The presence of hemoglobin in urine:

severe hemolytic anemia;
severe poisoning, for example, sulfonamides, phenol, aniline. poisonous mushrooms;
sepsis;
burns.

The presence of myoglobin in urine:

muscle damage;
heavy physical activity, including sports training;
myocardial infarction;
progressive myopathies;
rhabdomyolysis.

Microscopy of urine sediment.

Red blood cells in the urine.

Reference values: < 2 в поле зрения.

Erythrocytes in urine - exceeding the reference values:

stones of the urinary tract;
tumors of the genitourinary system;
glomerulonephritis;
pyelonephritis;
hemorrhagic diathesis (with intolerance to anticoagulant therapy, hemophilia, clotting disorders, thrombocytopenia, thrombocytopathy);
urinary tract infections (cystitis, urogenital tuberculosis);
kidney injury;
arterial hypertension with involvement of renal vessels;
systemic lupus erythematosus (lupus nephritis);
poisoning with derivatives of benzene, aniline, snake venom, poisonous mushrooms;
inadequate anticoagulant therapy.

Leukocytes in the urine.

Reference values:

men:< 3 в поле зрения;
women, children< 14 лет: < 5 в поле зрения.

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

acute and chronic pyelonephritis, glomerulonephritis;
cystitis, urethritis, prostatitis;
stones in the ureter;
tubulointerstitial nephritis;
lupus jade;
rejection of a kidney transplant.

Epithelial cells in the urine.

Epithelial cells are almost constantly present in urine sediment. Epithelial cells originating from different parts of the genitourinary system differ (usually they secrete squamous, transitional and renal epithelium). Squamous epithelial cells, characteristic of the lower genitourinary system, are found in the urine of healthy people and their presence usually has little diagnostic value. The amount of squamous epithelium in the urine increases with a urinary tract infection. An increased number of transitional epithelial cells can be observed with cystitis, pyelonephritis, and kidney stones. The presence of renal epithelium in the urine indicates damage to the renal parenchyma (observed in glomerulonephritis, pyelonephritis, some infectious diseases, intoxications, circulatory disorders). The presence of more than 15 renal epithelial cells in the field of view 3 days after transplantation is an early sign of the threat of allograft rejection.

Reference values:

squamous epithelial cells: women -< 5 в поле зрения;
men -< 3 в поле зрения;
transitional epithelium cells -< 1;
renal epithelial cells - absent.

Detection of renal epithelial cells:

pyelonephritis;
intoxication (taking salicylates, cortisone, phenacetin, bismuth preparations, poisoning with heavy metal salts, ethylene glycol);
tubular necrosis;
rejection of a kidney transplant;
nephrosclerosis.

Cylinders in urine.

Cylinders - elements of the sediment of a cylindrical shape (a kind of casts of the renal tubules), consisting of protein or cells, may also contain various inclusions (hemoglobin, bilirubin, pigments, sulfonamides). According to the composition and appearance, several types of cylinders are distinguished (hyaline, granular, erythrocytic, waxy, etc.). Normally, the cells of the renal epithelium secrete the so-called Tamm-Horsfall protein (absent in the blood plasma), which is the basis of the hyaline casts. Sometimes hyaline casts can be found in healthy people.

Granular casts are formed as a result of destruction of tubular epithelial cells. Finding them in a patient at rest and without fever is indicative of renal disease. Waxy cylinders are formed from compacted hyaline and granular cylinders. Erythrocyte casts are formed by layering erythrocytes on the hyaline casts, leukocyte - leukocytes. Epithelial casts (rarely) are derived from renal tubular cells. Their presence in the analysis of urine a few days after the operation is a sign of rejection of the transplanted kidney. Pigment cylinders are formed when pigments are included in the cylinder and are observed in myoglobinuria and hemoglobinuria.

Reference values: absent.

Hyaline casts in urine:

renal pathology (acute and chronic glomerulonephritis, pyelonephritis, kidney stones, renal tuberculosis, tumors);
congestive heart failure;
hyperthermic conditions;
high blood pressure;
taking diuretics.

Granular cylinders (nonspecific pathological symptom):

glomerulonephritis, pyelonephritis;
diabetic nephropathy;
viral infections;
lead poisoning;
fever.

Wax cylinders:

chronic renal failure;
amyloidosis of the kidneys;
nephrotic syndrome.

Erythrocyte casts (renal hematuria):

acute glomerulonephritis;
kidney infarction;
renal vein thrombosis;
malignant hypertension.

Leukocyte casts (renal leukocyturia):

pyelonephritis;
lupus nephritis with systemic lupus erythematosus.

Epithelial casts (most rare):

acute tubular necrosis;
viral infection (eg, cytomegalovirus);
poisoning with salts of heavy metals, ethylene glycol;
overdose of salicylates;
amyloidosis;
kidney transplant rejection reaction.

Bacteria in urine

The excretion of bacteria in the urine is of significant diagnostic value. Bacteria persist in the urine for no more than 1 - 2 days after the start of antibiotic therapy. The first morning urine sample is preferable for research. It is possible to determine the type of bacteria and assess the level of bacteriuria, as well as to identify the sensitivity of microorganisms to antibiotics using bacteriological culture of urine.

Reference values: negatively.

Bacteria in urine: infections of the urinary system (pyelonephritis, urethritis, cystitis).

Yeast fungi... Detection of yeast of the genus Candida indicates candidiasis, which occurs most often as a result of inappropriate antibiotic therapy.

Inorganic urine sediment (crystals), salts in the urine.

Reference values absent.

Uric acid and its salts (urates):

highly concentrated urine;
acid reaction of urine (after exercise, meat diet, fever, leukemia);
uric acid diathesis, gout;
chronic renal failure;
acute and chronic nephritis;
dehydration (vomiting, diarrhea);
in newborns.

Triple phosphates, amorphous phosphates:

alkaline urine reaction in healthy people;
vomiting, gastric lavage;
cystitis;
Fanconi's syndrome, hyperparathyroidism.

Calcium oxalate (oxaluria occurs with any urine reaction):

eating foods rich in oxalic acid (spinach, sorrel, tomatoes, asparagus, rhubarb);
pyelonephritis;
diabetes;
ethylene glycol poisoning.

Mucus in the urine.

Reference values: insignificant amount.

The elements of urine sediment are separated into inorganic and organic sediment. Inorganic sediment includes all salts that have settled in the urine in the form of crystals or amorphous salts, as well as crystals of organic substances, such as urea, creatinine, uric acid, amino acids, pilican and pigments. All cellular elements (epithelial cells, casts, erythrocytes, leukocytes) belong to organic sediment.

Inorganic urine sediment

Character inorganic urine sediment depends on the reaction of urine. In acidic urine, crystals are precipitated that are never found in alkaline urine, and vice versa. A special group is made up of sediments that occur exclusively in urological diseases.

Acidic urine in the sediment contains amorphous urates, crystals of uric acid, calcium oxalate, calcium hydrogen phosphate, urea, creatinine, amino acids, indican and pigments,

Uric acid salts (urates) fall out in the form of a brick-red amorphous precipitate with an acidic reaction of urine or in the cold. Crystals of acidic sodium urate and ammonium can take the form of star-shaped bundles or small-spherical formations.

Calcium oxalate (calcium oxalate)- transparent, colorless and strongly refracting light crystals, resembling postal envelopes in shape. They are found in urine after eating food rich in oxalic acid (sorrel, tomatoes, asparagus, green beans), with diabetes mellitus, nephritis, gout.

Acidic calcium phosphate- large prismatic crystals arranged like rosettes.

Urea- the most important nitrogen-containing component of urine; per day it is released 10-35 g. Microscopy of urine sediment reveals urea in the form of long colorless prisms.

Creatinine. The content of creatinine in urine is 0.5-2 g per day. Its crystals are shaped like lustrous prisms.

Uric acid. The daily excretion is from 0.4 to 1 g. In the urine sediment, you can observe various forms of uric acid crystals in the form of rhombuses, bars, weights, sheaves, ridges, barrels, sometimes beautiful druses, brushes, hourglasses, gymnastic weights, which are almost always are yellowish in color.

Very rarely, uric acid is found in the form of colorless crystals; then it can be taken for crystals of phosphate ammonia-magnesia. However, it should be remembered that from the addition of 10% potassium hydroxide, the crystals of uric acid dissolve, and from the addition of concentrated hydrochloric acid, they again fall out in the form of very small pale-colored rhombic crystals.

Hippuric acid occurs in human urine intermittently. In daily urine, its content ranges from 0.1 to 1 g. Its crystals are in the form of milky-white rhombic prisms, located singly or in groups in the form of brushes.

In alkaline urine, amorphous phosphates, ammonia-magnesia phosphate, acidic ammonium urate and calcium carbonate can be found in the sediment.

Amorphous phosphates are lime phosphate and magnesia phosphate, precipitating in the form of colorless small grains and balls, grouping in irregular heaps. They resemble urates, but unlike them they dissolve easily when acids are added and do not dissolve when heated.

Acid ammonium urate Is the only uric acid salt found in alkaline urine. Most often, its crystals are shaped like a star, dope fruit or plant roots; less often in the form of gymnastic weights.

Carbonic lime(calcium carbonate) is found in the urine sediment in the form of small balls connected in pairs in the form of gymnastic weights or in bundles of 4-6 or more balls. When hydrochloric acid is added to urine, crystals dissolve rapidly with the release of carbon dioxide bubbles.

Ammonia Magnesia Phosphate(tripelphosphate) - its crystals almost always have the form of colorless three-four or hexagonal prisms, similar to coffin covers. Tripel phosphate crystals are observed when eating plant foods, drinking alkaline mineral waters, inflammation of the bladder, and also during alkaline fermentation of urine.

Cystine. Crystals of cystine have the form of regular, colorless transparent hexagonal plates lying side by side or one above the other, resembling a hexagonal pencil in cross section. They are insoluble in water, alcohol and ether, but they are soluble in mineral acids and ammonia, which allows them to be distinguished from similar crystalline forms of uric acid.

The presence of the amino acid cystine (cystinuria) in the urine is associated with a violation of protein metabolism and a hereditary defect in its reabsorption in the tubules (tubulopathy). In the diagnosis of cystinuria, one should not rely solely on the study of urine sediment under a microscope. It is necessary to recognize cystine using a chemical reaction used in the study of cystine stones.

Xanthine rarely occurs in urine sediment and becomes of practical importance only when the excretion of xanthine bodies leads to the formation of renal and bladder stones. Xanthine crystals are in the form of small, colorless rhombuses, reminiscent of a whetstone. They are similar in appearance to uric acid crystals, but do not give a murexin test and are equally well soluble both in potassium and sodium alkalis, and in ammonia and hydrochloric acid, while uric acid crystals do not dissolve in acids or in ammonia.

Leucine and Tyrosine. With phosphorus poisoning, acute yellow atrophy of the liver, indomitable vomiting of pregnant women, scarlet fever and some other infectious diseases, leucine and tyrosine can be found in the urine. Crystals of leucine appear as shiny small balls with radial and concentric stripes, like a cross-section of a tree. Often small balls of leucine and tyrosine are deposited on the surface of larger ones. Tyrosine crystals are thin, silky-shiny needles, collected in the form of delicate yellowish bundles or stars with an irregular radiant arrangement of needles.

Cholesterol usually observed in urine with fatty degeneration of the liver, renal echinococcosis and hiluria. Cholesterol crystals have the appearance of racing colorless rhombic tablets with cut corners and step-like ledges.

Bilirubin. Bilirubin crystals are found in urine, which is rich in bile pigments, in jaundice caused by severe illness or toxic liver damage. They are thin needles, often collected in bundles, less often - rhombic plates from yellow to ruby-red and, as a rule, are located on the surface of leukocytes and epithelial cells. Bilirubin crystals easily dissolve in chloroform and alkalis and give the Gmelin reaction.

Organic urine sediment

The main elements of organic urine sediment are leukocytes, erythrocytes, epithelial cells, casts.

Epithelial cells. Cells of squamous, transitional and renal epithelium can be found in urine sediment.

Squamous epithelial cells in the form of large polygonal, less often roundish cells with one relatively large nucleus and light fine-grained protoplasm can be located in the form of individual specimens or in layers. They enter the urine from the vagina, external genital organs, urethra, bladder and overlying parts of the urinary tract, are almost always found in the urine of healthy people and therefore have no particular diagnostic value. However, if they are located in layers, then this indicates metaplasia of the mucous membrane and can be observed with leukoplakia of the bladder and upper urinary tract.

The cells of the transitional epithelium (polygonal, cylindrical, "caudate", round) have different sizes and a rather large nucleus. Sometimes they show degenerative changes in the form of coarse granularity and vacuolization of protoplasm. The transitional epithelium lines the mucous rim of the bladder, ureters, renal pelvis, large ducts of the prostate gland and the prostatic urethra.

Therefore, cells of the transitional epithelium can appear in the urine in various diseases of the genitourinary organs. The role of "tailed" cells in the diagnosis of the inflammatory process in the renal pelvis is currently denied, since they can originate from any part of the urinary tract.

The cells of the renal epithelium differ from the epithelium of the underlying urinary tract in smaller size (they are 1.5-2 times larger than leukocytes), have a polygonal or rounded shape, a granular protoplasm and a large nucleus. In the cytoplasm of cells, degenerative changes are usually expressed: granularity, vacuolization, fatty infiltration and fatty degeneration.

The cells of the renal epithelium belong to the cubic and prismatic epithelium lining the renal tubules, and are found in the urine with damage to the renal tissue, intoxication, and circulatory disorders. However, it can be difficult and sometimes impossible to distinguish the renal epithelium from the epithelium of the underlying genitourinary tract. With greater certainty about the renal origin of epithelial cells, one can speak with the simultaneous content of granular and epithelial casts in the urine sediment.

Fibrinuria. The presence of fibrin films in the urine is observed in inflammatory diseases of the urinary tract, especially often in acute cystitis. With fibrinuria, filaments of fibrin or fibrin clot formation can be found in the urine.

Erythrocyturia. Normally, erythrocytes in the urine sediment are absent in its general analysis, however, with the quantitative determination of corpuscles, 1 ml of a healthy person's urine can contain up to 1000, and in daily urine up to 1 million erythrocytes.

Only in cases where erythrocytes are found in each field of view of the microscope, or their number exceeds 2000 in 1 ml of urine or 2 million in daily urine, can we speak with confidence about erythrocyturia. Erythrocytes have the appearance of fairly regular double-contoured discs, faintly colored in yellow. They lack granularity and core.

In highly concentrated or acidic urine, they shrink, become uneven, jagged, like a mulberry. In hypotonic or alkaline urine, erythrocytes swell and the central lumen disappears. At the same time, they often burst, lose blood pigment ("leach out") and become completely colorless. This is in most cases a sign of renal hematuria, as well as the presence of blood casts.

In order to determine the source of hematuria, a three-glass test is performed. A large admixture of blood in the first portion (initial hematuria) indicates the localization of the pathological process in the posterior part of the urethra, in the last portion (terminal hematuria) - diseases of the bladder neck. The same content of erythrocytes in all portions of urine (total hematuria) indicates a pathological process in the kidney, upper urinary tract or bladder.

Cylindruria. In the urine sediment, there may be true casts: hyaline, epithelial, granular, waxy, consisting of protein and representing casts of renal tubules, and false casts formed from salts - urates, leukocytes, bacteria, mucus. True cylindruria is characteristic mainly of glomerulonephritis and nephrosis.

Hyaline casts are observed in various kidney diseases and are often found even in the absence of renal pathology due to physical exertion, fever. Therefore, the presence of hyaline casts is not a pathognomonic sign of a particular kidney disease.

Epithelial and granular casts appear in urine in cases of degeneration and desquamation of epithelial cells of the renal tubules or an inflammatory process in the kidneys. Waxy casts most often indicate a severe chronic process in the kidneys. Fat casts indicate fatty degeneration of the kidneys.

Laboratory diagnostics is aimed at studying pathological conditions and contains several stages.- This is the taking of a part of the urinary fluid from the bottom of the flask after it has been allowed to stand for at least 2 hours. Sediment diagnostics is the most effective and accurate method, which indicates the work of all vital systems, in particular, the functioning of the kidneys.

Many diseases of the genitourinary system at the primary stages proceed without pronounced symptoms, a microscopic examination will make it possible to accurately diagnose and begin timely treatment.

Examination of urine microscopy

Correctly collected urine is the basis for obtaining a reliable result; the correctness of the diagnosis depends on the preparatory stage and the time of delivery of the material for diagnosis. The collection of biomaterial for microscopy begins with a mandatory preparatory stage. Collect urine in a sterile container in the morning.

The result is a diagnostic marker:

to count the number of erythrocytes - hematuria;
counting the number of leukocytes - pyuria;
determining the number of bacteria;
detecting the presence of impurities, mucus.

Based on the results of the examination, doctors determine the quality of the functioning of the genitourinary system,renal failure... The diagnostic process takes place in several stages:

Urine settles for two hours, after which 10 milliliters of material is collected from the bottom of the flask.
The collected sample is placed in a centrifuge for 7 minutes.
The drop is placed under a microscope and study at different magnifications.

Such a diagnosis allows you to determine the foci of the inflammatory process and the presence of urinary tract infections. Microscopy reveals metabolic disorders, metabolic problems.

What is the study of urine microscopy for?

Urine is a final product that consists of many components and reflects the general state of the body's vital activity. The qualitative composition of the biomaterial excreted by the kidneys gives an exhaustive result on the functioning of internal organs. Decryption is carried out by a doctor after receiving a laboratory report.

Methods for the study of urine sedimentappoint in such situations:

Diagnosis of kidney diseaseimpossible without microscopy. The doctor makes appointments if there is a suspicion of the presence of pathologies of the genitourinary system.
Differential research is carried out on the basis of a general analysis of urine.
To diagnose the presence of inflammatory processes, infectious diseases.
Therapy of any disease is impossible without regular laboratory examination of urine. With the help of a simple method, the doctor monitors the patient's condition, determines the correctness of the prescriptions, the result of the general treatment.
Monitoring the patient's condition using urine analysis, preventing the occurrence of complications.
Before and after surgery the patient gives urine every day for diagnosis, as prescribed by the doctor.
During a medical examination, urine analysis is a mandatory diagnostic minimum.

Indicators that pay attention to when diagnosing

Microscopic examination is prescribed to study urine sediment,general medical research identified the indicators to which doctors pay attention first of all. The sediment is the microcomponents of cells, crystals, mucus, amorphous deposits. There are several types of microscopy:

the organized type studies the organic composition of urine;
not organized type - diagnoses the presence of fungi, bacteria, mucus.

When carrying out the method, the following indicators are studied and calculated:

The number of red blood cells in the urine- an important indicator of health, a minimum number of them is allowed.
The presence of leukocytes is permissible in urine, but only if their number does not exceed the established standards.
Epithelial cells divided into types, each subspecies is counted during diagnosis. The flat cell type is allowed in the urine sediment, other types indicate the development of the disease.
Hyaline casts in urine - allowed in small dose, other varietiesrenal cellsepithelium is unacceptable.
Bacteria in urine a healthy person is absent, if such components have been diagnosed, then additional diagnostics and examination are prescribed.
Salt, mucus is diagnosed by type and deciphered by a doctor.

Urinary indicator rate, which is deciphered in the atlas of microscopy, this is the correct diagnostic minimum for making a diagnosis. The book contains important information about all indicators of the study, indicates additional methods when detecting specific components.

Urine sediment

Urine has a sediment, which does not always indicate the development of pathology; with individual characteristics of the organism, a characteristic color of urine and impurities is possible.

A white precipitate may indicate a high protein level, which is considered an abnormality. During pregnancy, the sediment is studied according to separate standards. The development of the fetus increases the load on the kidneys, which leads to an increase in some indicators.

Reasons for the appearance of sediment

The sediment appears when there are difficulties in the work of the genitourinary system, the reasons for the presence of sediment can be the following factors:

drug therapy;
non-compliance with the diet the day before the delivery of the material;
the material was collected incorrectly.

If the urine has a cloudy color and sediment, then such a factor indicates the presence of salt, epithelial particles, and is detected in many diseases. The change urine color - this is the signal of the body, the beginning of the development of the disease. Staining urine in a characteristic color depends on a person's nutrition, taking medications.

Composition and components of urine

To get a reliable result, urine collection spend in the morning. The collected material is sent to the laboratory, before taking a sample, the urine is settled for 2 hours. During the study, the appearance of the material, the component composition of the biomaterial, chemical constituents are taken into account:

The color of the urine depends on the pigments and can vary. The indicator is influenced by various factors, medications, the amount of liquid drunk, alcohol, smoking, chronic diseases. A change in the color of urine also indicates pathology , therefore, only a comprehensive conclusion will indicate the true state of the body.
The structure of urine plays an important role; in a healthy person, there is no turbidity of urine. The altered structure indicates the presence of impurities. Microscopy is used to make an accurate diagnosis.
Offensive odor. A healthy body excretes odorless urine, but it does not have any pronounced indicators.
A test is carried out for chemical reactions, the norm for a person is established by general recommendations.
To determine the protein, a reagent is added to the material; with the naked eye, you can detect the protein - the urine becomes cloudy.
Under normal conditions, there is no sugar in the urine, such a result can be found out simply by passing a quick test strip.

The composition of urine is carefully studied by laboratory assistants and deciphered by doctors. Each patient receives a detailed analysis result.

Decryption

Survey , microscopy suggests further extensive decryption that the doctor deals with. Before starting the decryption, the doctor is obliged to obtain complete information about the patient's lifestyle, the presence of bad habits, chronic diseases, adherence to the diet leads to a distortion of the usual standards. Excessive physical activity also affects the indicators.

Medicines, antibiotics affect the color and composition of urine. If you follow a diet or individual characteristics, you need to indicate this fact in the card or inform the doctor about it. High rates of components indicate such pathologies:

Increased red blood cell countindicates kidney disease, infectious diseases.
An increased leukocyte count indicates pyelonephritis , inflammatory processes.
The presence of epithelial cells indicatespoisoning with heavy metals.
Hyaline cylinders are high blood pressure, heart disease, physical activity.
A high concentration of bacteria indicates an infectious lesion.
Salt is a lack of fluid in the body, frequent diets, kidney disease.
Mucus is an inflammatory process, diseases associated with hypothermia.

The end result is affected by non-compliance with the rules for collecting and storing urine. Microscopy can re-appoint if mistakes were made. Deviations from the norm in an adult when deciphering, it indicates various factors that are determined when studying the general clinical picture of the patient.

The presence of hemoglobin

General, detailed urinalysis with sediment microscopyis prescribed for each chemical component when a high-quality result is obtained. Hemoglobin in urine indicates serious infectious foci. Hemoglobin is formed when the breakdown of red blood cells occurs, the presence of a component is a deviation from the norm. The appearance of hemoglobin is provoked by various factors, both external and internal:

flu, colds;
pneumonia;
injuries received;
intoxication of the body.

Characteristic symptoms appear, pain in the lower back, urine changes color, becomes with a red tint.

The presence of red blood cells

A high level of red blood cells is already evidence of the presence of pathology. To avoid possible false results, doctors do not recommend taking tests during the menstrual cycle. An increased level of red blood cells is hematuria, which has characteristic causes:

pathological manifestations in the kidneys;
bruises, trauma;
malignant neoplasms of the urinary system;
infectious diseases;
intoxication.

Normally, in humans, erythrocytes in urine are in scanty amounts, when violations occur, erythrocytes appear, indicating pathology.Cause of blood in urineis the wrong collection of urine during menstruation.

The presence of leukocytes in the sediment

The presence of leukocytes causes clouding of urine, if the rates are increased, then pus particles are released along with the urine. This phenomenon always indicatesinflammatory process in the kidneys, glomerulonephritis... To accurately diagnose the focus of inflammation, additional examination methods are prescribed. The three-glass test will allow you to accurately determine the localization of the disease, the level of distribution of pyuria.

Epithelium in sediment

A single presence of epithelial cells is considered normal. There is a classifier of the epithelium, which divides them into subspecies according to the nature of their occurrence. If the renal epithelium was found in the urine, then this indicates serious diseases of the genitourinary system. Polymorphic epithelium indicates infections cysts, oncology.

Availability of cylinders

Hyaline casts in urineare manifested in urine in many diseases of the urinary system. These components can be present only in small amounts in the urine of a healthy person. Excessive physical activity is the only reason for the appearance of cylinders. The reasons for the appearance of a substance in a significant amount are kidney pathologies, poor blood circulation, and infectious foci.

Salt on urine microscopy

Uric Salt Crystalscannot exceed the established rate from 20 to 40 mg. If the excretory system malfunctions, the balance changes, and the amount of salt increases significantly. Salt is in different forms, therefore, pay attention to the presence of phosphates, urates, oxalates. The presence of each species indicates a disease.

Extra options

Bacteria are also considered to be an important indicator of a person's health status. Diagnostics with a microscope allows you to determine the presence of mucus, bacteria. There can be no bacteria in the urine if the person is completely healthy. With the help of microscopy, only the presence of bacteria is determined, in order to determine the species, an additional analysis is prescribed. The reasons for the presence of bacteria are infections,cystitis. Mucus in urineappears after hypothermia.

Deviations from the norm

After diagnosis, deviations from the norm are allowed, which indicates various pathological conditions. The main reason for the deviations is diseases of the excretory system. Indicators fluctuate under various conditions of the body. The composition and structure of urine is influenced by:

pregnancy;
chronic diseases;
blood transfusion;
neoplasms, infections, inflammations.

Indicators can be influenced by both major changes in organism and dieting, wrong lifestyle. To correct deviations from the norm, refer to doctors for therapeutic appointments.

Inaccuracies in microscopy

Before decoding, the nuances of a person's life are taken into account, which can affect the result. Inaccuracies can arise for a number of understandable reasons:

taking medications;
non-compliance with the preparatory stage;
improper collection of urine;
adherence to a diet.

The structural composition of urine is influenced by the person's lifestyle, both external and internal factors are distinguished, which require competent correction by the doctor.Treatment of prostatitisstart after a full examination, delivery of laboratory analysis of urine for microscopy.

Indicators that are not normal

Deviation from the norm is allowed during pregnancy, when the kidneys are working in an enhanced mode. But each result requires special attention from the doctor, because the diagnostic marker indicates possible fetal pathologies.

Differences from the norm also appear in the case of individual characteristics, individual lifestyle. Vegetarians, when passing laboratory tests, indicate their diet in order to avoid distorting the result. For treatmentbladder diseasea urine test is required on a regular basis.

Why are excellent indicators from the norm dangerous?

If, after decoding, deviations from the norm are recorded, then the patient turns to the doctor for prescriptions and treatment. Excellent indicators from the norm may indicate pathologies or non-compliance with urine collection standards. The doctor will be able to explain the result by prescribing a re-analysis or additional diagnostic methods. (1 estimates, average: 5,00 out of 5)