General analysis of urine in pyelonephritis. Indications of urine analysis in case of infectious inflammation of the kidneys. Urinalysis for pyelonephritis

General analysis urine with pyelonephritis makes it possible to identify the pathogen, and this is extremely necessary in the selection of drugs for treatment. Pyelonephritis is a very common infectious and inflammatory disease that consistently affects the pelvis first, and then spreads to the immediate tissues of the kidneys. This disease often occurs along with comorbidities kidneys, like urolithiasis disease or glomerulonephritis. Distinguish pyelonephritis in acute, chronic and purulent form.

Urinalysis for pyelonephritis - indicators.

In addition, leukocyturia manifests itself even in the case of obstruction of the urinary tract with pyelonephritis. For the first symptoms this disease include pain in the affected area (that is, in the lumbar zone where the kidneys are located) and intoxication cider (chills, fever, loss of appetite, general weakness, vomiting and frequent nausea). Children have abdominal pain. Plus, in the analysis of urine with pyelonephritis, an indicator of the presence of the disease is erythrocyturia. It manifests itself after necrotic papillitis, in acute forms of cystitis and in case of damage to the fornic apparatus.

The next type of study of pyelonephritis is biochemical analysis urine. This method allows us to more accurately determine the causes of occurrence in the body. infectious agent, they also make it possible to determine the tolerance of the virus to antibacterial drugs. In addition, in the diagnosis of the disease, the method of Gram staining of urine is used: in this case, it is possible to establish in the shortest possible time which type of pathogen is present in the affected organism. A similar analysis for pyelonephritis in terms of indicators will show antibodies and antigens to a specific type of infection.

Urinalysis in chronic pyelonephritis.

Chronic pyelonephritis can be caused by microorganisms various kinds, the most common are viruses, fungi and E. coli. A general blood test for this disease shows a reduced amount of hemoglobin, red blood cells, leukocytosis, increase in ESR and shift left to leukocyte formula. In the analysis of urine, hypostenuria appears quite early (this is a small specific gravity of urine), as well as polyuria. Such changes are most noticeable in the case of taking a Zimnitsky sample. At the same time, urine has alkaline reaction.

In case of exacerbation of chronic pyelonephritis, leukocyturia is noted (when the number of leukocytes in a milliliter of urine is 20 * 103 or more), and more than thirty percent of active leukocytes. In the remission phase, there may be no leukocytes. When analyzed according to Nechiporenko, leukocyturia predominates over erythrocyturia.

Urinalysis in acute pyelonephritis.

In acute pyelonephritis, urinalysis can detect pyuria (that is, pus) or bacteriuria - these two diagnostic indicators are extremely important. In addition, proteinuria and hematuria may be noted (in rare cases gross hematuria occurs). When analyzing urine sediments, you can see cylinders (leukocyte, hyaline, or granular - in the case of severe course), epithelial tubular cells, and leukocytes.

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The clinical picture of pyelonephritis, or an inflammatory process in the renal parenchyma and pelvicalyceal system, is determined by the intensity pathological changes in the organ. The formation of foci of infiltration, necrosis and sclerosis in acute or chronic form of pathology occurs with different speed, affecting one or both kidneys at once, as well as the tissues surrounding them (perinephritis). Therefore, the complex pathological signs how pyelonephritis manifests itself, although it is the same in essence, but in various patients has its own characteristics.

In addition, there is an upward trend in the number clinical cases when the disease proceeds erased, sluggishly, with minimal symptoms or without it at all. In these situations, the neglected course and late detection of pyelonephritis is very dangerous and even threatening to the patient's health. After all, the process of sclerosis or abscess formation (the formation of purulent foci) in the kidneys still takes place, despite the absence of obvious symptoms illness. A refusal medical assistance leads to the loss of kidney functionality and the formation of dangerous complications.

Pyelonephritis in such cases can be detected by chance, during dispensary events or when examining a person for other diseases. The leading role in this belongs to laboratory examination in particular, the study of blood and urine parameters. Especially meaningful information can provide a study of urine, so urinalysis for pyelonephritis can be called the most important stage of diagnosis.

How laboratory parameters change in pyelonephritis

Pus from the kidneys enters the urine and is detected during the study

Characteristic changes in urine and blood occur regardless of the intensity with which the pathological process is expressed clinically. Of course, there is some direct relationship between the severity of pyelonephritis and the degree of change laboratory indicators. But in those cases when the pathology is asymptomatic, the study of biological media always provides invaluable information.

Human blood, as a rule, reacts very quickly to any pathological processes in the body, including those in the urinary system. To determine the presence of shifts, clinical (or more simplified general) and biochemical blood tests are prescribed.

The inflammatory process in pyelonephritis, as in all other organs, is manifested by nonspecific changes in the blood. This increase total leukocytes, the appearance of young leukocyte forms, an increase in ESR. Such parameters cannot clearly indicate pyelonephritis, but their combination with a decrease in hemoglobin and a decrease in the level of red blood cells (signs of anemia) will still help to suspect this disease. Biochemical research blood can also provide some information about the possible presence of inflammation in the kidneys in the patient. This is an increase in the level of gamma globulins, uric acid, alpha globulins while reducing the amount of total protein.

A blood test can provide some information about pyelonephritis

However, the study of urine can provide the most comprehensive information. Any pathological process in the kidneys, bladder or other part of the urinary tract naturally affects the state of urine and manifests itself in a change in its parameters. Therefore, a urine test for pyelonephritis, carried out in a timely manner and in compliance with all the rules for collecting this biological fluid, can directly affect the process of therapy.

Urinalysis is not only a diagnostic step that allows you to detect any form of renal pathology. It is also used as a means of monitoring the effectiveness of the treatment regimen prescribed to the patient, which helps to correct some therapeutic prescriptions, as well as to detect complications in a timely manner.

What changes occur in the urine in acute pyelonephritis

Pyelonephritis can be unilateral or bilateral, have various forms and the severity of the flow. Therefore, it is impossible to provide clear indicators or a range of urine parameters that would confirm the pathology with 100% accuracy. It is easier to start from a general urine test, which, in case of pyelonephritis, acute and chronic, does not correspond to generally accepted standards.

During laboratory diagnostics many parameters are evaluated: color, transparency, density, reaction, components urinary sediment, the presence of protein and sugar. If the pathology of the urinary system does not exist, then the indicators of the general analysis of urine are as follows:

In addition to a general urine test for pyelonephritis, which is also the most commonly prescribed in the diagnosis urinary syndrome and others renal pathologies, are considered quite informative the following ways urine tests:

• according to Zimnitsky;
• according to Nechiporenko;
• Amburzhe test;
• according to Addis-Kakovsky;
• Gedholt method;
• Griess nitrite test.

All these methods complement and refine the data obtained from the general analysis of urine in pyelonephritis, their indicators can be especially valuable in situations where the disease is latent or asymptomatic.

Acute pyelonephritis is characterized by an increase in the daily volume of urine excreted (polyuria). This is due to a failure in last step formation of urine, namely the process of reabsorption in distal parts renal tubules. In turn, the formation of edema and foci of cell infiltration in the tubular system leads to insufficient reabsorption. The result is bad reverse suction(reabsorption) of water and, as a consequence, polyuria. That is why, in most cases, the color of urine in pyelonephritis is lighter or colorless, and the specific gravity decreases due to a decrease in the concentration of urine (symptom of hypostenuria).

The reaction, or urine pH, also decreases, meaning it becomes more acidic. This is due to the presence of bacteria in it, mainly coli, which provide an acidic reaction.

Blood in the urine with pyelonephritis is detected, but not in a significant amount, so visually hematuria is not ascertained (erythrocytes exceed the norm by a maximum of two times). If a lot of pus is excreted in the urine, then it loses its transparency and becomes cloudy, and the urinary sediment becomes purulent character. In addition, the protein in the urine is determined in an amount not exceeding 1 g / l.

Gross hematuria is not characteristic of pyelonephritis

important diagnostic information also provides an examination of the urinary sediment. Regardless of the form of pyelonephritis, the number of leukocytes is increased, with microscopy they can completely cover the field of view, often located in groups. However, if the inflammatory process has affected only one kidney, then at the height of leukocyte intoxication there may be few. Conversely, with a decrease in the intensity of inflammation, significant pyuria is diagnosed. It turns out interesting phenomenon characteristic for urinalysis with unilateral pyelonephritis: the patient feels better, but the laboratory parameters worsen.

The amount of epithelium, mainly transient and renal, also changes at different stages of the disease. It will definitely be more than 10 in sight, but especially sharp increase observed at the onset of inflammation. At the height of pyelonephritis, when pus fills the cups and pelvis, fewer epithelial cells are found. In addition to the epithelium, granular and hyaline casts, uric acid salts are present in urine tests.

Urinalysis for chronic pyelonephritis

Exacerbation or recurrence of a chronic form of inflammation of the kidneys is morphologically manifested by a combination of areas of infiltration, sclerosis, abscess formation and healthy foci of the parenchyma. Unlike acute pyelonephritis, the prolonged course of the inflammatory process causes sclerosis of the renal arterioles, which is additional factor leading to organ atrophy. Meanwhile, the gradual increase in pathological changes in the kidneys explains the fact that the patient may for a long time persist unchanged diuresis with normal. Only with an already significant lesion of the parenchyma and the glomerular-tubular system, urine tests will have certain diagnostic parameters.

Most typical changes urine at can be represented as follows:

• polyuria with hypostenuria (lots of urine with a low specific gravity, 1.0 to 1.012);
• pale color;
• pH acidic (well below 7.0);
• urine is cloudy, a lot of volumetric sediment;
• the appearance of protein;
• there are many leukocytes, erythrocytes, epithelium, bacteria in the sediment.

In general, a urine test for chronic pyelonephritis in the acute stage gives the same indicators as with acute form illness. In the period between exacerbations, that is, in the latent phase, chronic pyelonephritis has poorer urine laboratory parameters that can help in diagnosis. Leukocytes can only slightly exceed the norm, there are single erythrocytes, cylinders, transitional epithelium. In some cases, the tests may be good, without any pathological changes.

Bacteria are determined in the urine with any form of the disease

To confirm the diagnosis, additional research urine. So, the Addis-Kakovsky method gives data on the content of leukocytes, cylinders and erythrocytes in daily urine, Nechiporenko - in 1 ml of urine, Ambyurge - in minute volume urine. The Gedholt method makes it possible to recognize latent leukocyturia. The Griess test, or nitrite test, helps not only to determine the presence of bacteria, but also to get an idea of ​​their number. If the test is positive, this means that 1 ml of urine contains 100,000 or more microbial bodies.

Laboratory diagnosis of pyelonephritis can help to recognize any form of this pathology. The results obtained are considered by the attending physician in combination with clinical picture, anamnesis and data from other additional studies.

There are chronic and acute pyelonephritis. The disease is one of the infectious, most often pathogens are microorganisms of the Escherichia coli group.

Symptoms of pyelonephritis depend on the course of the disease. In the acute form of the disease, the symptoms are as follows:

• begins suddenly, body temperature rises sharply (up to 40 ° C);
• there is unilateral pain in the lumbar region (in some cases, pain also occurs in the groin);
• both kidneys (or one of them) are enlarged, there are pain on palpation;
• in some cases, abdominal muscle spasms may occur;
• nausea, vomiting;
• painful and frequent urination;

In the chronic form symptoms of pyelonephritis the following:

• fatigue, passivity;
• pale complexion;
• feeling of heartburn;
• numerous burps;
• incomprehensible sensations in the kidney area;
• slight dry mouth.

It should be noted that the chronic form of pyelonephritis can lead to kidney failure, so it is important to recognize

It is difficult to detect, since the symptoms are less pronounced, occasionally the child may complain of pain in the lumbar region. In this case, you should take a closer look and consult a doctor.

If a disease is detected, it is necessary to pass the following tests with pyelonephritis:

• general urine analysis, attention is paid to: 1) the number of leukocytes in the urine, the norm for men is up to 3, for children and women - up to 6; 2) for the presence of bacteria - normally they should not be; 3) to 4) to the alkaline reaction of urine;
• urinalysis according to Nechiporenko;
• ultrasound procedure kidneys;
• magnetic resonance imaging and CT scan(in the case when ultrasound does not give a complete picture).

Except classical treatment important to observe proper nutrition with pyelonephritis. Exists great amount nutrition schemes that do not injure diseased kidneys and contribute to a speedy recovery.

At chronic pyelonephritis it is necessary to monitor the load on the kidneys, which is exerted by food products. In this case, spicy, highly salty and spicy dishes. No fried side dishes, food should only be boiled, stewing is allowed.

important product is milk, it promotes the formation of urine and does not irritate the urinary system. In addition, it contains a lot of protein and animal fats. Special attention should be given fermented milk products. They must be present in the diet, it can be fermented baked milk, kefir, sour cream and cottage cheese, as well as soft cheeses, they are usually lightly salted.

In addition, the patient is allowed to eat meat (chicken, rabbit meat, lean varieties beef), but meat broths better to avoid. Fish can be included in the diet in boiled form, preferably low-fat. Porridge should also be present in the diet, as well as vegetables and fruits. You can only cook vegetable oil.

At acute course pyelonephritis, especially in the early days, you must adhere to a diet: eat fresh vegetables and fruits (preference for diuretics - melon, watermelon, zucchini, pumpkin, citrus fruits are completely excluded), drink as much liquid as possible (this can be regular tea, dried fruit compote, rosehip tea, decoctions from medicinal herbs).

After improving health, it is allowed to introduce milk and dairy products into the diet, vegetables and fruits are still in without fail. Salty foods are prohibited.

After the symptoms of pyelonephritis disappear , cottage cheese, meat and fish (boiled) are gradually introduced into the diet. Spicy, strongly spicy, smoked and strongly salted dishes are prohibited for a long time.

Pyelonephritis is an infectious disease bacterial nature characterized by inflammation of the renal pelvis. The symptomatology is similar to the manifestations of other diseases of the urinary system, therefore, to make an accurate diagnosis, it is carried out complex diagnostics which includes laboratory research. Urine analysis for pyelonephritis is one of the mandatory.

Why is it necessary to take tests for pyelonephritis? The reason is simple: because main function kidneys - excretion from the body excess fluid and decay products, naturally, inflammatory processes also affect the characteristics of urine. This applies to its density, color, transparency, smell, and, of course, microbiological properties. In addition, the amount of fluid released is also taken into account, because it is important indicator kidney work.

What tests are prescribed for pyelonephritis:

• OAM (general urinalysis);
• according to Nechiporenko;
• according to Zimnitsky;
• by Gram.

The advantage of these studies is their high informativeness even on early stages pyelonephritis, short time obtaining results (usually the next day), the possibility of indirect diagnostics of the work of some other organs. In addition, these studies are not expensive, which is also important.

General urine analysis

It is carried out not only for inflammation of the kidneys, but also as part of the examination for any diseases, as well as for preventive examination adults and children.

Urine analysis indicators for pyelonephritis are also physical parameters: density, color, transparency, smell.
Normally, the density of urine in women and men is 1.012-1.22 g / l. If the indicators are elevated, this is a sign of pyelonephritis. A decrease in its density indicates renal failure.

More than a change in color, the smell speaks about pyelonephritis - it becomes unpleasant, and appears even before the onset of other symptoms. This is due to reproduction pathogenic bacteria and their vital activity - putrefactive processes are always accompanied by an unpleasant odor.

Analysis according to Nechiporenko

This analysis shows the number of leukocytes, erythrocytes, protein, cylinders, bacteria and other inclusions.

Normal urine values ​​in adults should be as follows:

• leukocytes up to 2000/ml;
• erythrocytes - up to 1000 / ml (higher - hematuria or blood in the urine);
• cylinders - up to 20 / ml.

In addition to these inclusions, acute pyelonephritis may reveal pus (pyuria), protein, bacteria, casts.

Cylinders are the same proteins, but compressed when passing through the tubules of the kidneys. If the analysis shows them high content, this indicates proteinuria, which develops with glomerulonephritis or nephrotic syndrome.

The presence of protein indicates damage, expansion of the tubules and glomeruli of the kidneys, since normally large protein molecules do not pass through them. But the protein in the urine does not always indicate pathology - a small amount, up to 0.033 g / l, is detected in healthy people, and also after infectious disease, intense physical activity and consumption of protein foods.

Bacteria are detected at any infectious pathologies bodies urinary system. Pus in the urine occurs with a developed inflammatory process.

Analysis according to Zimnitsky

With pyelonephritis, tests are also prescribed to determine the degree of impaired renal function. For this, a Zimnitsky test is carried out - it shows how the organs cope with the concentration of urine. The same analysis allows you to determine the density of urine and daily diuresis.

Normally, both men and women should have the following indicators:

• daily diuresis - from 1.5 to 2 thousand ml;
• the ratio of drunk and excreted liquid - from 65 to 80%;
• daily diuresis - 2/3 of the total;
• night - 1/3 of the total;
• the density of the liquid is not less than 1.020 (it decreases with inflammation of the renal pelvis).

Other indicators in the analysis of urine, if they deviate from the norm, then not much.

Gram study

It is carried out to determine the type of pathogen. Everything in medicine pathogenic microorganisms divided into two large groups: gram-positive and gram-negative. The type of bacteria is determined by staining with aniline dyes. Gram-positive bacteria stain for Blue colour, gram-negative do not stain.

This division is justified by different properties their cell walls, which affect drug sensitivity. Depending on the results of staining, antibiotics are selected. Gram-negative bacteria are sensitive to some groups of drugs, and gram-positive to others.

As a rule, a part of urine collected for Nechiporenko analysis is used for Gram staining.

Blood analysis

In fact, a blood test for pyelonephritis is also necessary - in order to determine the presence and level of the inflammatory process in the body. For this, a general analysis (KLA) is carried out, that is, “blood from a finger”. Two indicators of blood speak about inflammation in the kidneys: the number of leukocytes and the erythrocyte sedimentation rate (ESR). The higher these parameters, the more serious the inflammatory process. Indirectly, a decrease in the number of red blood cells and hemoglobin also speaks of pyelonephritis.

To assess the work of the kidneys, a biochemical blood test is also prescribed, the main parameters of which will be the content of creatinine, urea, uric acid and residual nitrogen, elevated level which indicates a deterioration in kidney function.

How to take tests correctly

First of all, passing any tests, you need to remember about intimate hygiene, which is performed before each collection of urine, about the ban on products that change its color or smell. The same applies to antiviral or antifungal, antibacterial substances. Women are not recommended to give urine during menstruation - blood particles can get into the container and distort the results of the study. However, it happens that the tests need to be carried out urgently, in this case, more thorough hygiene of the external genital organs is needed, a woman is recommended to use a tampon.

Analyzes are given according to certain rules. Urine for general analysis is collected in the morning, on an empty stomach, at the first urination, in a sterile container. After collection, it is immediately sent to the laboratory so that bacteria do not develop in the liquid, which, of course, are present in it - this can distort the results.

For research according to Nechiporenko, an average portion of the first morning urine is collected, according to the same rules.

Analysis according to Zimnitsky involves the collection of 8 portions of urine, with an interval of 3 hours between urination. The first urination is performed at 6 am, this urine is not collected. The following portions are collected in separate sterile containers, which are stored until morning in the refrigerator, tightly closed.

As for the general blood test, it can be taken on any day, but always in the morning, on an empty stomach. No other preparation is required.

Based on the results of the described studies, it is possible to put accurate diagnosis. Of course, in our time, ultrasound is mandatory, other hardware and instrumental types of examinations may be shown, but they are necessary for exact definition kidney function, the state of their tissues. And for the diagnosis, the patient's history, examination and test results are quite enough.

Urinalysis indicators for pyelonephritis play a big role, since this disease often occurs without severe symptoms. And to determine the severity of the process, as well as to find out how severe the pathology is, it is possible only by obtaining the results of urine.

Research types

When a doctor suspects a patient has pyelonephritis, blood and urine tests should be taken on the same day. But single studies are usually not enough, and it is necessary to consider all the results only in dynamics.

As a rule, several types of analysis are used:

1. General. Helps to determine the presence of an active inflammatory process.
2. According to Nechiporenko. Carried out in the absence pronounced changes in urine, and allows you to determine the predominance of leukocytes over other elements.
3. According to Zimnitsky. The collection is carried out for differential diagnosis in kidney pathology. Allows you to see the volume daily diuresis, find out the specific gravity of urine. Often performed with suspicion of.
4. For sterility. Helps in the treatment of disease. It is used to determine the type pathogenic flora and its sensitivity to antibacterial agents.
5. For the presence of a urogenital infection. This allows you to confirm or exclude the presence of a specific flora.

Which type of urinalysis for pyelonephritis is the most important. To answer it, one should consider in more detail what each of the methods consists of, and the degree of its information content in this disease.

General study

General analysis is carried out in almost all diseases. During pyelonephritis, it should be checked as often as possible. Without fail, it should be done on the first day of visiting a doctor, then a week later, and then two weeks later. Depending on the characteristics of the course of the disease, the doctor may recommend taking it on other days.

A general urine test in acute pyelonephritis will show a large number of leukocytes (from 15 in the field of view), with severe inflammation, they can be observed throughout the field. There are traces of protein (about 2%). The presence of hyaline casts helps confirm the diagnosis. Grainy cylinders indicate serious condition. Micro- (and less often macrohematuria) may be noted. Urine becomes cloudy in appearance, acquires an unpleasant odor.

A general urine test in the chronic form of the disease in remission may be within the normal range. Therefore, additional studies are being used to identify it.

Indicators in the study of urine

The main indicators that allow us to talk about the inflammatory process in the kidneys are:

1. The presence of leukocytes. Leukocyturia can reach up to 100 million/day in acute period, some decrease is observed after the start of treatment up to 10 million / day. Among women normal amount leukocytes - 0-6, and in men - 0-3.
2. . Refers to pathognomonic signs of manifestation of pyelonephritis. True bacteriuria is considered when 100,000 microbes are found in ml of urine or more. If between 50,000 and 100,000 are found, it is considered a possibility. With a score below 10,000, the disease can be ruled out.
3. Hematuria. Has no special clinical significance, and is not a sign of kidney inflammation, especially if we are talking about gross hematuria. But the combination a large number leukocytes in combination with leukocytes is. The number of red blood cells in men is normally from 0 to 1, and in women - 1-3. An increase in these indicators most often indicates the presence of sand and stones.
4. Albuminuria is not always detected in this disease. Availability elevated protein in urine can help with differential diagnosis between pyelonephritis and glomerulonephritis.
5. The density of urine in this pathology is usually reduced, and the acidity is high.

Blood indicators

A blood test can only be additional method confirming the correctness of the diagnosis, provided that there are no other infectious or inflammatory processes in the body.

In the acute form of the disease, leukocytosis occurs, the white blood formula shifts to the left. ESR is accelerating. chronic changes in the kidneys can cause a decrease in hemoglobin.

In the case of a urine test for pyelonephritis in children, the indicators are approximately the same as in adults. With inflammation, its specific gravity decreases, leukocyturia occurs (normally no more than 7-10 per field of view), cylinders and bacteria are determined.

The result of the study indicates the severity and severity pathological process. In addition, it allows you to determine the degree of effectiveness of antibiotic treatment.