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Microscopic examination of urine sediment bacteria. Nitrite in urine. What components are detected by microscopy

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

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 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

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. 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

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 properly stored urine samples indicates an infection of the urinary tract.

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.

Microscopy is the third (final) stage of a general urine analysis. The results can be seen on the form.

Although there are relatively few sediment indicators, it is their deviation from the norm that most often serves as the reason for the appointment of specific urine samples.

What is microscopy and for what purpose is it carried out

The simplest in the understanding of the patient is a laborious and difficult procedure. After evaluating the physical (density, color,) and chemical (protein, glucose, bilirubin,) characteristics of the provided urine, they begin to obtain urinary sediment. It goes like this:

  1. The liquid is settled for 1-2 hours.
  2. With a pipette, take 10 ml of urine from the bottom of the tube and place it in a centrifuge.
  3. After 5-7 minutes of processing at 1500 rpm, the liquid is drained, and the precipitate is placed on a microscope slide.

Sometimes, for a more accurate calculation of shaped elements, they are used, which differs from that described by some of the nuances of obtaining a sediment.

Microscopy serves for:

  • clarification of violations of the composition of urine, which can be suspected based on other indicators (color, smell, density), and their quantitative assessment;
  • detecting the presence of elements that are not obvious when viewed with the naked eye or exposed to chemicals.

The result of microscopy in itself will not be a reason for the diagnosis, but will allow to indicate the directions for further diagnosis of inflammation or metabolic disorders in the body.

Standards for the study of sediment

The detected precipitated structures can be divided into organic or organized (erythrocytes, leukocytes, epithelium) and inorganic (salts in an acidic or alkaline sediment, as well as crystallized "organic matter", bacteria, fungi). Normal sediment indicators can be summarized in the following table:

Precipitated substance Norm (in sight)
Erythrocytes 0–3
Leukocytes 0-2 for men; 1-6 for women.
Cylinders Single hyaline are allowed; No other types of cylinders.
Epithelium Flat: 1-2; Polymorphic (transitional): 1-2; Renal: absent.
Bacteria Absent
Fungi Absent
Slime Little or no
Fibrin films Absent
Crystalline salts (oxalates, phosphates, urates) Absent or insignificant:, urates, oxalates (acidic pH), phosphates (alkaline pH).
Amorphous salts (urates) Absent or insignificant amount (acidic pH)
Cystine Absent
Xanthine Absent
Leucine and Tyrosine Absent
Cholesterol Absent
Neutral fat and fatty acids Absent

Also, depending on the acidity in urine, crystals of urea, or carbonic lime, can be found, however, they have diagnostic value only in a number of special cases.

Decryption of the received data

Deviations of indicators from the norm upwards can be due physiologically (nutrition, exercise, pregnancy) or indicate pathology. The presence of excess red blood cells in the urine occurs against the background of:

  1. False hematuria associated with the use of dishes containing colored pigments or sources of bleeding in the genitals (menstruation or gynecological diseases in women);
  2. Renal hematuria- caused by damage (necrosis) of the basement membrane of the kidneys, or rather, glomerulonephritis or. Erythrocytes in this case will be flattened (deformed) due to passage through the membrane; Glomerulonephritis is a group of pathologies that have a primary (hereditary), infectious, intoxication nature. They can also be provoked by systemic diseases (vasculitis) or.
  3. that has already passed through the renal filter - with acute cystitis, the presence of stones in the kidneys or urinary tract, benign () or malignant tumors, trauma to the urinary tract with calculi, blood clotting disorders. A physiological explanation is also possible - an overdose of anticoagulants (Heparin, Warfarin).

(up to 60-100 formed elements in the field of view or - leukocytes all over, pus in the urine) are indicators of:

  • the presence of foci of inflammation in the kidneys or urinary tract (,), a purulent process in the peri-renal tissue ();
  • aseptic inflammation characteristic of chronic glomerulonephritis or;
  • mycoplasmosis, ureaplasmosis, chlamydia (general clinical analysis is not able to identify the causative agents of these diseases).

A certain number of leukocytes may appear in the urine if the rules for taking the analysis are violated or if the external genital organs are inflamed (vulvitis, vaginitis).

Cylinders are a kind of casts of tubules formed by shaped or amorphous formations that have passed through them. They can be proteinaceous (hyaline or waxy), or they can be deformed cellular structures (erythrocytic, epithelial, or leukocytic). The decoding of deviations from the norm is as follows:


They are classified by types and reasons for their appearance as follows:

  1. Flat found in the form of layers - inflammatory processes in the bladder or urethra.
  2. Transitional(cylindrical) - line, bladder, ureters, prostate and prostatic urethra (in men). Their presence indicates the appropriate localization of the focus of inflammation.
  3. Renal- are a sign of tubule damage - or.

- this is always a deviation from the norm, however, it can be interpreted in different ways, namely, as:


Yeast fungi in urine is always a deviation, indicating the development of an infection caused by opportunistic microorganisms of the genus Candida. Among the external factors for the reproduction of fungi - long-term use of antibiotics, cytostatics, corticosteroids, internal - endocrine disorders.

A small amount of mucus is secreted by the lining of the urinary tract. Many mucous filaments in the sediment are an additional marker of the inflammatory process in the urogenital organs.

Fibrinous films, filaments, or clots of an insoluble specific protein most often indicate acute cystitis.

The salts found in urine can be classified into ordered crystals or amorphous structures. The composition of the salt sediment depends on the pH of urine - there are varieties that are never found in acidic or, conversely, alkaline urine.

When in the sediment, the following are of diagnostic value:


Alkaline urine contains:

  1. Amorphous phosphates- the prerequisites for the appearance are the characteristics of the diet: an excess of calcium in the body, the abuse of products containing phosphorus, the predominance of vegetable proteins in the diet, overeating. Additionally, they may indicate an inflammation of the bladder.
  2. Triple phosphates- crystal structures. The reasons for the appearance are similar to amorphous phosphates.

Regardless of acidity, urinary sediment may contain:

The results of microscopy make it possible to identify or suspect the presence of pathologies even in the absence of clinical manifestations.

How to pass correctly

Even this, the most trivial study, requires a responsible approach to the preparation and collection of biomaterials from the patient. The following procedure will help to get a reliable result:

  1. During the day on the eve of delivery, stop using coloring products (carrots,) and any medications (especially aspirin, antibiotics,). An exception is the option when the analysis must confirm the concentration of a certain drug. Drinking alcohol is also unacceptable.
  2. Avoid physical overload and overheating of the body (bath, sauna).
  3. 12 hours before delivery, it is advisable to abstain from sexual activity.
  4. Transfer analysis in case of "critical days", fever or passage.
  5. In the morning, on the day of collection, ensure an adequate hygienic condition of the external genital organs - without the use of aggressive or antibacterial soap (do not empty the bladder).
  6. Collect a urine sample. To do this, release some urine into the toilet, then substitute, fill it with about 100 ml. The container should not touch the skin or mucous membranes.
  7. The biomaterial can be stored for no more than 2 hours at a temperature of 5-18 degrees. During this time, the container must be delivered to the laboratory.

A general urinalysis, including microscopy, is a complex and informative study. It is equally effective for preventive examinations, monitoring the course of pathologies or the process of therapy. A few simple preparatory rules and accuracy in collecting material will not allow random factors to distort the result.

Urine sediment and microscopy A general urine test consists of several stages, each of which is aimed at determining deviations from the norms accepted by doctors. First, they look at the physical properties of the liquid - color, transparency, odor, specific gravity.

Microscopy of urine sediment- a procedure during which the sediment is aspirated from the container with liquid (it must first stand for 1 to 2 hours) with a pipette, and then centrifuged for 5-7 minutes. Further, the composition is considered and calculated in detail.

Revealing deviations from normal indicators at this stage can also indicate various pathologies - it often happens that the physical and chemical properties of the liquid are in order, and the sediment indicates a disease. In such situations, doctors prescribe additional studies to clarify or refute the diagnosis.

What components pay attention to

The sediment consists of solid microparticles that are suspended in the urine - these are cells, crystals, various amorphous deposits. This research parameter is divided into two types:

  • Organized, which includes organic elements - these are cylinders, epithelial cells, leukocytes, erythrocytes;
  • Not organized - not organic elements, which include various salts, fungi, bacteria, mucus.

If you look microscopic photo of urine sediment, you can see a schematic representation of this division, ordered and presented in more detail.

During the study, the following components are considered and quantified separately:

Microscopic examination of urine sediment is an integral part of general clinical examination and is often the main method for diagnosing kidney and urinary tract diseases.

Microscopy of urine sediment is performed using conventional indicative and quantitative methods. Along with them, there are some special research methods.

An indicative method for the study of urine sediment

The approximate method is more common (used in general clinical analysis of urine), but less accurate and gives only an approximate idea of ​​the content of elements in the sediment. The results obtained depend on the amount of urine taken for centrifugation, the number of revolutions of the centrifuge, and the correct preparation of the preparations.

Microscopic examination should be carried out no later than 2 hours after urine collection; at a low relative density (less than 1010), it is recommended to perform microscopy immediately after its collection, since when standing, leukocytes and hyaline casts dissolve quickly.

The study begins with removing the sediment using pipettes or glass tubes with a diameter of 5 - 6 mm with melted edges. A balloon is put on the pipette and carefully immersed in the bottom of the bottle. Moving the pipette along the bottom of the bottle, collect the liquid with the sediment into the pipette, preventing it from getting into the balloon. From a pipette, urine (10-15 ml) is transferred into a centrifuge tube. Before each collection of urine sediment, the pipette should be rinsed with distilled water so as not to add elements of sediment from one analysis to another. The tubes with urine are centrifuged for 5 - 7 minutes at 1500 - 2000 rpm. After centrifugation, the tube is quickly overturned to remove the supernatant, then transferred to its original position so that the sediment remains at the bottom.

The sediment is stirred with a pipette (preferably a Pasteur one with a thin end and a small rubber balloon). A small drop of sediment is placed on a glass slide and covered with a coverslip, avoiding the ingress of air bubbles. Subject to these rules, the drug always has more or less the same dimensions (area and height). The prepared preparation is native (unstained).

It is not recommended: 1) to carry out microscopy of preparations without cover slips, as this deteriorates the optical system of the microscope (when transferred to high magnification, the lens is often wetted with urine); 2) prepare preparations from the entire sediment (an arbitrary size of the preparation does not give a correct idea of ​​the number of formed elements).

The urine sediment is evaluated first under low magnification (eyepiece 10x, objective 8x), and then transferred to high magnification (eyepiece 10x, objective 40x, with the condenser lowered).

A general overview of the drug is made under low magnification. At the same time, cylinders are detected and counted, a general idea of ​​the amount of salts, mucus, etc. is formed.

Under high magnification, the individual elements of the sediment are detailed, the number of leukocytes and erythrocytes in the field of view is approximately counted, and the final judgment about the sediment as a whole is made. To do this, you must view at least 10 - 15 fields of view. The result of such a study is entered into the form. The average numerical expression of the found number of elements (for example, erythrocytes, leukocytes, cylinders) is given approximately, indicating how many are in the field of view at high magnification of the microscope. With a small amount of sediment elements, indicate their number in the preparation. For other elements (epithelial cells, crystals, etc.), it is customary to assess: "large", "small" and "insignificant" amount.

Elements of urinary sediment, visible under a microscope, are divided into unorganized (various salts, organic compounds and medicinal substances that have settled in the urine in the form of crystals or amorphous bodies) and organized (cylinders and all cellular elements - erythrocytes, leukocytes, epithelial cells; among organized sediments urethral filaments, sperm and neoplasm elements may also be found).

Literature:

  • Handbook of Clinical Laboratory Research Methods, ed. E. A. Kost. Moscow "Medicine" 1975
  • L. V. Kozlovskaya, A. Yu. Nikolaev. Study guide on clinical laboratory research methods. Moscow, Medicine, 1985
  • Kraevsky VA Atlas of microscopy of urine sediments - Moscow, "Medicine", 1976
  • Guide to Practical Exercises in Clinical Laboratory Diagnostics. Ed. prof. M. A. Bazarnova, prof. V. T. Morozova. Kiev, "Vishcha school", 1988
  • A. Ya.Lubina, L.P. Ilyicheva et al. "Clinical laboratory research", M., "Medicine", 1984