Quantitative changes in urine. Urine formation: primary, secondary phase, composition

A healthy person excretes 1200-1500 ml of urine during the day. The amount of urine excreted depends on the amount of liquid taken, temperature environment when, for example, in a hot climate, part of it is actively excreted from the body with exhaled air and sweat glands, as well as the state of the kidneys. In this regard, the amount of fluid taken and the amount of urine excreted per day are taken into account, and their ratio determines the positive or negative daily diuresis. Quantitative changes in urine are characterized by an increase (polyuria) or a decrease (oliguria) in the daily volume, cessation of its entry into bladder(anuria).

This sub-process is called glomerular filtration, and it occurs when the second phase of urine production enters: tubular reabsorption. The filtered glomerular fluid moves to the renal tubules, and there useful material are reabsorbed and reincorporated into the blood, which must be carried to the organs that need them.

The renal tubules are divided into: proximal coiled tubule, distal coiled tubule and collecting duct. During filtration, organic waste is removed by expelling it from the blood plasma into the so-called urine space. But waste also moves throughout the renal tubule, starting in tubular capillaries and ending in the lumen of the tubule.

Polyuria- an increase in the amount of urine excreted is observed with plentiful drink, elimination of edema and ascites, when taking diuretics, chronic pyelonephritis, wrinkled kidney, polycystic kidney disease, hyperplasia prostate, diabetes insipidus, diabetes mellitus, various forms chronic renal failure. characteristic feature polyuria is low density urine (1001-1012). This is due to the retention of toxins in the body due to a violation of the concentration ability of the kidneys and a corresponding compensated increase in the amount of urine. The exception is patients diabetes, which, along with large quantity urine, its density remains high (1030 or more), which is due to the presence of sugar in it (glucosuria).

Most of these elements expelled in the urine are formed during the renal glomerulum process and also belong to that part of the fluids that have not been reabsorbed into the blood. Another part of the waste was created and carried by the cells of the renal tubules.

After passing through the tubes, the liquid enters the collecting tube, and even there water can be integrated. But it is at this time and in this place that the liquid can be called urine. These collection tubes culminate in the renal calyces, which in turn reach the renal pelvis, ureters, and bladder, where urine accumulates and waits for the desire and reflex to urinate. Urine is expelled through the urethra.

Oliguria- a decrease in the amount of urine excreted can be observed in healthy individuals with a small amount of fluid consumed, in urological patients with severe destructive changes in the renal parenchyma. It can also be with non-urological diseases accompanied by fever, profuse sweating, vomiting, diarrhea, falling blood pressure, bleeding, as well as in cardiovascular insufficiency and acute nephritis flowing with edema, ascites. In the pathogenesis of oliguria lie severe changes in renal dynamics.

A common question people have is: Why does urine seem more concentrated or yellow than usual at certain times? As urine moves through the various ducts formed by the renal tubule, glomerular filtration changes in its composition. As already mentioned, in the latter, all those substances that can affect the body and are harmful to it are removed from the blood.

However, from this process there is an amount of water and solutes that are reabsorbed into the peritubular capillaries, and this is how more concentrated hypotonic urine is more dilute in water or hypertonic urine. This happens when a person is in a state of dehydration. The body prefers to reserve water, and renal tubules at this time, they again absorb more water than is done in normal conditions. This is why urine is produced and expelled more concentrated.

Anuria- Absence of urine in the bladder. In this regard, there is no urge to urinate, with percussion of the bladder area above the pubis, tympanitis is determined, with ultrasound, there is no urine in the bladder. There are three main types of anuria: prerenal (prerenal), renal (renal), postrenal (postrenal). With the first two, the kidneys do not excrete urine, that is, there is no urination (secretory anuria), with the third, the kidneys excrete urine, but its flow from the kidneys to the bladder is impaired (excretory anuria).

Change in urine volume

On the other hand, when there is good, the renal tubules reabsorb less water and the urine produced is excreted in a more diluted way. It is assumed that in the conditions of a normal, good and healthy person, your urine level is more or less always the same, you can say that it remains in the same range.

However, there is no doubt that there are daily factors that can affect this range, and it is there that the body reacts instantly, causing a process called hydrosaline homeostasis, which basically helps to maintain this range of urine at the same volume and level.

Prerenal anuria due to extrarenal causes: common - a drop in blood pressure below 50 mm Hg. Art., shock, collapse, bleeding and local - thrombosis, embolism of vessels of both or single kidney.

Renal anuria more often develops in diseases of the kidney parenchyma, leading to acute and chronic renal failure: necrosis of the renal papillae, transfusion of incompatible blood, long-term chronic pyelonephritis, sepsis, acute glomerulonephritis accompanied by large edema, shriveled kidneys, crush syndrome (crash syndrome). With renal anuria, necrosis of the tubules or their obstruction by products mainly occurs. pathological process. This group of anuria should include congenital aplasia of the kidneys, accidental or deliberate removal of both (or the only functioning) kidney

It should be noted and noted that higher or lower urine levels will occur depending on the needs of the body, as well as with the concentration of the same fluid. That is why various elements intervene in this process of homeostasis, which guarantee an increase or decrease in water reabsorption, depending on the environment and context.

For example, these mechanisms should help increase water reabsorption when vital fluid intake has decreased or when water loss has been increased by sweating. In this process nervous system and endocrine system interfere in some way. They help form more concentrated or more dilute urine, not to mention that it occurs at a higher or lower level. It all depends on the requirements of the body to maintain homeostasis or balance.

Postrenal anuria(obstructive) is usually caused by a mechanical obstruction to the outflow of urine from the kidneys - blockage of the ureters or ureter of a single kidney with stones, compression of the ureter by a tumor emanating from the uterus, prostate, bladder, enlarged lymph nodes, retroperitoneal fibrosis after radiotherapy, accidental ligatures on the ureters during pelvic gynecological operations.

Management of urinary tract infections. . Written by Heidi Wiesenfelder. At any given time, about 20% of the blood passes through the kidneys to be filtered so the body can eliminate waste and maintain hydration, blood pH and correct levels substances in the blood. The first part of the process of urine formation occurs in the glomeruli, which are small groups blood vessels. The glomeruli act as a filter, allowing water, glucose, salt, and waste to pass through the Bowman's capsule, which surrounds each glomerulus and prevents the passage of red blood cells.

Quantitative changes in urine output should also include nocturia and opsiuria.

nocturia(nocturnal polyuria) is characterized by the excretion of most of the daily amount of urine at night and is usually observed with latent cardiovascular insufficiency. The fluid retained in the tissues during the day is released at night, when the heart is working with less stress.

The fluid in Bowman's capsule is known as nephrite filtration and resembles blood plasma. It also includes ammonia-derived urea, which builds up as the liver processes amino acids and filters through the glomerulus. About 43 gallons of fluid pass through the filtration process, but most of it is then reabsorbed rather than eliminated. Reabsorption occurs in the proximal tubules of the nephron, which is absorption behind the capsule, in the loop of Henle, and in the distal and collecting tubules, which are further along the loop of Henle.

Water, glucose, amino acids, sodium and others nutrients reabsorbed into the bloodstream into the capillaries around the tubules. Water goes through the process of osmosis: moving water out of the area high concentration to an area of ​​low concentration. Sodium and other ions are not completely reabsorbed, while most of remains in the filtrate when more is consumed in the diet, resulting in higher blood concentrations.

Opsiuria- delayed excretion of fluid in the urine is observed with circulatory failure, kidney and liver disease, often when taking large doses alcohol.

Polyuria- an increase in the amount of urine excreted is observed with the following diseases and states:

Hormones regulate an active transport process in which ions such as sodium and phosphorus are reabsorbed. Secretion is final stage during the formation of urine. Some substances move directly from the blood into the capillaries around the distal and collecting tubules within these tubules. The secretion of hydrogen ions in this process is part of the body's mechanism to maintain the correct pH or base acid balance. More ions are secreted when the blood is acidic and less when it is alkaline.

Potassium, calcium, and ammonium ions, as well as some drugs, are also released at this stage. This is done in part by increasing the secretion of substances such as potassium and calcium when concentrations are high and increase reabsorption and decrease secretion when low levels. The urine created by this process then passes into central part kidney, called the pelvis, where it flows into the ureters and then through the bladder.

  • plentiful drink;
  • elimination of edema and ascites;
  • when taking diuretics;
  • wrinkled kidney;
  • polycystic kidney;
  • prostatic hyperplasia;
  • various forms of chronic.

A characteristic sign of polyuria is the low density of urine (1001-1012). This is due to the retention of toxins in the body due to a violation of the concentration ability of the kidneys and a corresponding compensated increase in the amount of urine. The exception is patients with diabetes mellitus, in whom, along with a large amount of urine, its density remains high (1030 or more), which is due to the presence of sugar in it (glucosuria).

Excretion is the process by which the body removes metabolic waste from the body

In humans, this function is responsible for various organs. However, the kidney plays important role in the allocation of waste products of food metabolism. After food products digested into digestive system and are absorbed and transported to the circulatory system to be used by the cells, waste products are formed that are removed from the body through the renal system.

These substances are eliminated by the formation of urine, the main components of which are water, electrolytes, urea, uric acid and end products of hemoglobin metabolism and hormone metabolites. To perform an excretory function, the renal system has a number of structures that perform certain functions.

A healthy person excretes 1200-1500 ml of urine during the day. The amount of urine excreted depends on the amount of fluid taken, the ambient temperature, when, for example, in a hot climate, part of it is actively excreted from the body with exhaled air and sweat glands, as well as on the condition of the kidneys.

In this regard, the amount of fluid taken and the amount of urine excreted per day are taken into account, and their ratio determines the positive or negative daily diuresis. Quantitative changes in urine are characterized by an increase (polyuria) or a decrease (oliguria) in the daily volume, the cessation of its entry into the bladder (anuria).

Kidneys: Secretory organs in which urine is produced. Cleaners: Collect the ducts that collect urine as it exits the kidney. Veiga: Organ receptor urine. Urethra: Secretory duct that drains urine out. Figure 11: Diagram of the urinary system.

The organ responsible for the formation of urine is the kidney. In the kidneys, we can distinguish three segments: the cortex, the brain, and the renal pelvis. The cortex and brain are formed by the nephrons, which are the functional unit of the kidneys and which allow the formation of urine. The pelvis corresponds to the dilated segment of the ureter and receives the already formed urine.

Polyuria refers to an increase daily diuresis over 2000 ml. Polyuria can also be a purely physiological phenomenon in completely healthy people: when receiving a large number fluids, after neuropsychic excitement.

However, polyuria is a symptom of many diseases:

  • various tubular nephropathies;
  • pituitary diabetes insipidus;
  • damage to the interstitial lobe of the pituitary gland;
  • various lesions of the adrenal glands;
  • hypokalemia with hypercalcemia.

Polyuria is observed in some patients with chronic kidney failure in the stage of compensation, regardless of the etiology of the disease as a result of a decrease in tubular reabsorption of water and electrolytes. In a number of patients, due to prolonged loss of calcium in the urine and a decrease in its absorption in the intestine, polyurnia with hypostenuria is the most early manifestation kidney failure. The occurrence of polyuria after the elimination of an obstruction in urinary tract associated with the impact of significant osmotic pressure and damage to the tubular apparatus, leading to a temporary decrease in reabsorption.

Since the debris must be removed from the blood, important aspect The function of the kidneys is its connection with the circulatory system. Through renal artery, which flows into small capillaries, the blood enters the kidney, which is cleaned, and then returned to the circulatory system through the renal vein.

Figure 12: Structure of a sectioned kidney to show the main internal structures. We have already mentioned that the functional unit of the kidney is the nephron. This is where the blood is filtered to extract waste. Figure 13: Structure of the nephron. How does the extraction process take place? The kidney performs its functions through several mechanisms: glomerular filtration, tubular reabsorption, secretion, and excretion through the urine.

Polyuria is observed in patients with acute renal failure in the stage of recovery of diuresis. In some patients, the daily amount of urine reaches 5-10 liters due to severe violation tubular functions. In this case, there is a significant loss of potassium, calcium, sodium, chlorides and water. If these losses are moderate, they can be replenished by changing the diet of the litanium.

Recall that it is the vascular element that is responsible for removing waste and other materials to the excretory tubules, returning materials reabsorbed by the kidney or synthesized for the systemic circulation, and delivering oxygen and other metabolic substrates to the nephron.

The excretion process begins in the renal corpuscle, which is formed by blood capillaries and Bowman's capsule. The glamululus, formed by a porous capillary network, acts as a plasma filter. The division is based on molecular structure. Due to this process, plasma filtration of blood is formed, which is formed during the passage of plasma without cellular elements and mostly devoid of proteins from the interior of the glomerular capillaries into the space of Bowman's capsule. This is approximately 180 liters per day.

However, in seriously ill patients, it is necessary to carry out therapy taking into account the loss of electrolytes in the blood serum and erythrocytes. The amount of fluid administered should be determined taking into account the volume of circulating blood (CBV) and the state of the cardiovascular system.

Compensation for fluid loss must be made urgently to avoid the development of hypovolemia. Polyuria is also observed in patients after allotransplantation of the chins. Depending on the level of hyperazotemia, hyperhydration of the patient and the timing of graft ischemia, in some cases, 5-15 liters of urine is excreted during the first day after surgery. In most cases, diuresis is 2-5 liters. The measures taken in these cases are identical to those described above.

Red arrows indicate blood flow and blue arrows indicate ultrafiltrate. If the glomeruli filter 180 liters per day, it follows that there must be resorption, since 180 liters of urine per day does not seem to be ruled out. Resorption occurs throughout the tubular system of the nephron, but is more active in the proximal tubule. Tubular reabsorption allows you to save substances that are important for the body, such as water, glucose, amino acids, vitamins, etc. Which again occur with blood. In addition, reabsorption is able to adapt to the needs of the moment, that is, it participates in the homeostasis of the internal environment.

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