Red sediment in urine. White sediment in urine

Microscopy of the urine sediment is essential and important part general clinical trial. Specialists distinguish between elements of unorganized and organized sediment. The main elements of organized sediment are leukocytes, erythrocytes, cylinders, epithelium; unorganized - amorphous or crystalline salts.

Sediment in the urine healthy people may contain single cells squamous epithelium contained in the urethra and transitional epithelium, which is located in the renal pelvis, ureter and renal epithelium in the urine of healthy people is completely absent.

With urethritis or prostatitis in men, a precipitate may form in the urine, consisting of In female urine, these cells are present in significant quantities. Often in urine, layers of such an epithelium and horny scales are found. This sediment is evidence of metaplasia of the mucous membranes. urinary tract.

The presence of transitional epithelium is manifested during acute inflammatory processes in the bladder, intoxications, neoplasms in the urinary tract, urolithiasis.

Cells of the epithelium of the urinary tubules appear with intoxication, nephritis, insufficient blood circulation in the kidneys. Renal amyloidosis at the albuminuric stage is practically not accompanied by the appearance of renal epithelium, but in the azothemic and edematous-hypertonic stages this occurs quite often. The epithelium, which has signs of fatty degeneration that occurs with amyloidosis, is an indicator of the addition of a lipoid component. The same epithelium is often detected in the event of lipoid nephrosis. The appearance of kidney in a significant amount is observed with necrotic nephrosis.

A white sediment in the urine may also be due to the presence of leukocytes in the urine. Normally, they are absent in it, or single copies come across. Leukocyturia, characterized by the presence of more than 5 leukocytes in the sample of the analysis, can be infectious and aseptic. The concept of pyuria refers to the detection of 10 leukocytes by microscopic analysis with a resolution (x400) in the sediment obtained by centrifuging urine. Active leukocytes are absent in the norm. The detection of active leukocytes in urine is a confirmation of the presence of an inflammatory process, although it does not indicate the place of its localization.

A sediment in the urine, consisting of erythrocytes, is a signal for further research, since they are normally absent in urine. Most common causes their appearance (hematuria) is chronic or acute glomerulonephritis, pyelocystitis, pyelitis, chronic renal failure, kidney injury or Bladder, papillomas, urolithiasis, tuberculosis of the urinary tract and kidneys, overdose medicines(anticoagulants, urotropine, sulfonamides), tumors.

Sediment in the urine various types cylinders indicates infections, intoxications, changes in the kidneys.

Precipitation of salts and various mineral elements depends on various properties urine, especially on pH. Hippuric and uric acid salts, calcium phosphate, calcium sulfate precipitate in the urine, which has an acidic reaction. Tripelphosphates, magnesium phosphate, amorphous phosphates, calcium carbonate, sulfanilamide crystals are found in urine, which has an alkaline reaction.

Uric acid is found in kidney failure, fever, leukemia, massive decaying tumors, resolving pneumonia, heavy physical exertion, consumption of large amounts of meat products.

Amorphous urates give the urinary sediment a brick or pink color. In large numbers, they appear in urine in chronic and acute glomerulonephritis, congestion in the kidney, febrile conditions.

Salts of oxalic acid (oxalates) are found in large quantities in urine with pyelonephritis, calcium metabolism disorders, diabetes, epilepsy, with excessive consumption of vegetables and fruits.

Precipitate in the urine formed by ammonium urate appears with cystitis, kidney infarction. Other elements that are not normally present in urine also indicate the occurrence various diseases. In case of any deviations from the norm of urinalysis, it is necessary to consult a specialist.

Urinalysis is a routine research method used in the diagnosis and control of a number of diseases, as well as screening examinations. Urinalysis is one of the most effective methods diagnosing abnormalities in the work of the kidneys.

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

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

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

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

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

Rules for collecting urine

Mayonnaise jars for urinalysis and other "classic" containers of polyclinics and folklore are irrevocably gone. To collect the material, it is worth using special sterile containers and preservatives. Thus, the chances of getting foreign substances into the sample are minimized, and the period of transportation of the sample from the patient to the diagnostic equipment, acceptable for high-quality urinalysis, is also significantly increased.

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

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.

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

If the urine turns red, it most likely contains blood. If it resembles milk diluted with water, it contains an excess of fat. The pus contained in it gives a grayish tint. Green or Blue colour- one of the signs of the processes of decay in the intestines. Foamy urine occurs only in men. There is nothing to worry about: this 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 the harmless aspirin large doses can turn urine pink. It is especially undesirable to take antibacterial drugs and uroseptics on the eve of the urine test. It is necessary to consult a doctor about a pause in their use. Except in cases where the main subject of the study is just the concentration of drugs in the urine.

Alcohol greatly distorts the results of a urine test.

Try to drink no more and no less liquid than usual on the eve of the urine test.

12 hours before taking the analysis, do not live sexually.

We also note 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 making a diagnosis (for example, " inflammatory process in the genitourinary system") is played not by the presence / absence of bacteria in the urine, but by their increased amount: the characteristic growth compared to the norm (2 thousand bacteria in 1 ml) is 50 times (up to 100 thousand bacteria in 1 ml of urine).

Urinalysis is prescribed for:

Diseases of the urinary system;
- screening examinations during professional examinations;
- to assess the course of the disease, control the development of complications and the effectiveness of the treatment.
- Persons who have undergone streptococcal infection(tonsillitis, scarlet fever) it is recommended to take a urine test 1-2 weeks after recovery. For healthy people, we recommend taking 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 are required hygiene procedures so that the 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 urine collection 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 instructions for collection, 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 professional examinations.
• Assessment of the course of the disease, monitoring the development of complications and the effectiveness of the treatment.
• Persons who have had a streptococcal infection (tonsillitis, scarlet fever) are advised to take a urine test 1 to 2 weeks after recovery.

Interpretation of 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 saturation of the urine with it. Sometimes only the color of the precipitate may change: for example, with an excess of urates, the precipitate has a brownish color, uric acid- yellow, phosphates - whitish.

Increasing color intensity- a consequence of the loss of body fluids: swelling, vomiting, diarrhea.
Urine color change 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 clarity

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

Relative density (specific gravity) of urine

The relative density (specific gravity) of urine depends on the amount of excreted organic compounds (urea, uric acid, salts) and electrolytes - Cl, Na and K, as well as on the amount of water released. The higher the diuresis, 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 specific gravity (hypostenuria). total loss concentration function leads to equalization osmotic pressure plasma and urine, this condition is called isostenuria.

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

Raise relative density(hyperstenuria):

1. glucose in the urine in uncontrolled diabetes mellitus;
2. protein in the urine (proteinuria) with glomerulonephritis, nephrotic syndrome;
3. drugs and (or) their metabolites in the urine;
4. intravenous infusion of mannitol, dextran, or radiopaque agents;
5. low fluid intake;
6. large fluid loss (vomiting, diarrhea);
7. toxicosis of pregnant women;
8. oliguria.

Decrease in relative density:

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

urine pH.

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

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

Reference values:

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

Boost:

1. metabolic and respiratory alkalosis;
2. chronic renal failure;
3. renal tubular acidosis (type I and II);
4. hyperkalemia;
5. primary and secondary hyperfunction of the parathyroid gland;
6. carbonic anhydrase inhibitors;
7. diet with great content fruits and vegetables;
8. prolonged vomiting;
9. infections of the urinary system caused by microorganisms that break down urea;
10. the introduction of certain drugs (adrenaline, nicotinamide, bicarbonates);
11. neoplasms of the genitourinary system.

Reduction:

1. metabolic and respiratory acidosis;
2. hypokalemia;
3. dehydration;
4. starvation;
5. diabetes;
6. tuberculosis;
7. fever;
8. severe diarrhea;
9. taking medications: ascorbic acid, corticotropin, methionine;
10. diet with high content meat protein, cranberries.

Protein in the urine (proteinuria).

Protein in the urine is one of the most diagnostically important laboratory signs kidney pathology. A small amount of protein in the urine (physiological proteinuria) may also occur 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 exertion, after a long walk (march proteinuria). Protein in the urine can also be found in healthy people with strong emotional experiences, hypothermia. Adolescents have orthostatic proteinuria (upright).

Through the membrane of the renal glomeruli is normal most of proteins do not pass, which is explained big size protein molecules, as well as their charge and structure. With minimal damage in the glomeruli of the kidneys, first of all, the loss of low molecular weight proteins (mainly albumin) is observed, 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 tubules of the kidneys physiologically secretes a certain amount of protein (Tamm-Horsfall protein). Some of the proteins in the urine may come from urinary tract(ureter, bladder, urethra) - the content of these proteins in the urine rises sharply with 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 pathological proteins in the plasma), renal (due to kidney pathology) and postrenal (associated with urinary tract pathology). The appearance of protein in the urine is frequent nonspecific symptom kidney pathology. In renal proteinuria, the 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 pathological change barrier function of glomerular membranes. Massive loss of protein in the urine (> 3 g/l) is always associated with glomerular proteinuria. Tubular proteinuria is caused by a violation of protein reabsorption in the pathology of the proximal tubules.

Reference values: < 0,140 г/л.

The presence of protein in the urine (proteinuria):

1. nephrotic syndrome;
2. diabetic nephropathy;
3. glomerulonephritis;
4. nephrosclerosis;
5. impaired absorption in renal tubules(Fanconi syndrome, heavy metal poisoning, sarcoidosis, sickle cell disease);
6. multiple myeloma (Bence-Jones protein in the urine) and other paraproteinemias;
7. violation of renal hemodynamics in heart failure, fever;
8. malignant tumors urinary tract;
9. cystitis, urethritis and other urinary tract infections.

Glucose in the urine.

Glucose in the urine is normally absent or found in minimum quantities, up to 0.8 mmol / l, because in healthy people, all blood glucose, after filtering 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 suction 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 the urine is important for the diagnosis of diabetes mellitus, as well as monitoring (and self-monitoring) of antidiabetic therapy.

Note: the most accurate method is research general analysis urine with Multistix diagnostic strips (+ sediment microscopy). The result is read automatically by 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 urinalysis for glucose is as follows: first comes the “negative” result, the next step is "5.5" (traces). If the true glucose value is between these values, then due to this step of the test strip, the device outputs it as the minimum positive value - 5.5.

Since the questions of doctors and patients about this threshold value of glucose concentration have recently become more frequent, the laboratory decided, when receiving such a result, not to issue a figure, but to write “traces”. With such a response to glucose in the urine, we recommend additional research, in particular, this is the determination of fasting blood glucose, the study of daily urinary 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 - significant increase concentration of glucose in the urine.

Level increase (glucosuria):

1. diabetes;
2. acute pancreatitis;
3. hyperthyroidism;
4. renal diabetes;
5. steroid diabetes (taking anabolics in diabetics);
6. poisoning with morphine, strychnine, phosphorus;
7. dumping syndrome;
8. Cushing's syndrome;
9. myocardial infarction;
10. pheochromocytoma;
11. major trauma;
12. burns;
13. tubulointerstitial lesions of the kidneys;
14. pregnancy;
15. intake of large amounts of carbohydrates.

Bilirubin in the urine.

Bilirubin is the main end metabolite of porphyrins excreted from the body. In the blood, free (unconjugated) bilirubin in 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 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. At hemolytic jaundice urine test for bilirubin is negative.

Reference values: negative.

Detection of bilirubin in urine:

1. mechanical jaundice;
2. viral hepatitis;
3. cirrhosis of the liver;
4. metastases of neoplasms in the liver.

Urobilinogen in urine.

Urobilinogen and stercobilinogen are formed in the intestine from bilirubin excreted in the bile. Urobilinogen is reabsorbed in the colon and through the system portal vein again enters the liver, and then again, along with bile, is excreted. A small part of this fraction enters the peripheral circulation 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 stands, urobilinogen passes into urobilin.

Reference values: 0 - 17.

Increased selection urobilinogen in urine:

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

Ketone bodies in the urine (ketonuria).

Ketone bodies (acetone, acetoacetic and beta-hydroxybutyric acids) are formed as a result of increased catabolism of fatty acids. Definition ketone bodies important in recognizing 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, ketoacidosis. These changes cause CNS dysfunction 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 the urine (ketonuria):

1. diabetes mellitus (decompensated - diabetic ketoacidosis);
2. precomatose state, cerebral (hyperglycemic) coma;
3. long-term fasting complete failure from food or a diet aimed at reducing body weight);
4. severe fever;
5. alcohol intoxication;
6. hyperinsulinism;
7. hypercatecholaminemia;
8. isopropranolol poisoning;
9. eclampsia;
10. glycogenoses I, II, IV types;
11. lack of carbohydrates in the diet.

Nitrites in the urine.

Nitrites are absent in normal urine. In the urine, they are formed from nitrates of food origin under the influence of bacteria, if the urine has been in the bladder for at least 4 hours. Detection of nitrites in the urine (positive test result) indicates 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 sex.

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

Reference values: negative.

Hemoglobin in the urine.

Hemoglobin is absent in normal urine. Positive result The test 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: negative.

The presence of hemoglobin in the urine:

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

The presence of myoglobin in the urine:

1. muscle damage;
2. heavy physical activity, including sports training;
3. myocardial infarction;
4. progressive myopathies;
5. rhabdomyolysis.

Microscopy of urine sediment.

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 the urine: cells, protein casts (with or without inclusions), crystals or amorphous deposits of chemicals.

Erythrocytes in the urine.

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

Reference values: < 2 в поле зрения.

Erythrocytes in the urine - exceeding the reference values:

1. urinary tract stones;
2. tumors of the genitourinary system;
3. glomerulonephritis;
4. pyelonephritis;
5. hemorrhagic diathesis (with intolerance to anticoagulant therapy, hemophilia, coagulation disorders, thrombocytopenia, thrombocytopathies);
6. urinary tract infections (cystitis, urogenital tuberculosis);
7. kidney injury;
8. arterial hypertension with involvement of renal vessels;
9. systemic lupus erythematosus (lupus nephritis);
10. poisoning with derivatives of benzene, aniline, snake venom, poisonous mushrooms;
11. inadequate anticoagulant therapy.

Leukocytes in the urine.

An increased number of white blood cells in the urine (leukocyturia) is a symptom of inflammation of the kidneys and/or lower urinary tract. At chronic inflammation leukocyturia is a more reliable test than bacteriuria, which is often not detected. 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 the urine may be due to the admixture of secretions from the external genital organs with vulvovaginitis, insufficiently thorough toilet of the external genital organs when collecting urine for analysis.

Reference values:

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

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

1. sharp and chronic pyelonephritis, glomerulonephritis;
2. cystitis, urethritis, prostatitis;
3. stones in the ureter;
4. tubulointerstitial nephritis;
5. lupus nephritis;
6. rejection of a kidney transplant.

epithelial cells in the urine.

Epithelial cells are almost always present in the urine sediment. epithelial cells derived from different departments genitourinary system, differ (usually isolated flat, transitional and renal epithelium). Squamous epithelial cells characteristic of the lower genitourinary system are found in the urine of healthy individuals and their presence is usually small. diagnostic value. The amount of squamous epithelium in the urine increases with urinary tract infection. An increased number of transitional epithelial cells can be observed with cystitis, pyelonephritis, nephrolithiasis. The presence of renal epithelium in the urine indicates damage to the kidney parenchyma (observed with 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 early sign risk of allograft rejection.

Reference values:

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

Detection of renal epithelial cells:

1. pyelonephritis;
2. intoxication (taking salicylates, cortisone, phenacetin, bismuth preparations, salt poisoning heavy metals, ethylene glycol);
3. tubular necrosis;
4. kidney transplant rejection;
5. nephrosclerosis.

Cylinders in urine.

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

Granular casts are formed as a result of the destruction of tubular epithelium cells. Their detection in a patient at rest and without fever indicates renal pathology. Waxy casts are formed from compacted hyaline and granular casts. Erythrocyte cylinders are formed when erythrocytes are layered on hyaline cylinders, leukocyte - leukocytes. Epithelial casts are (rarely) derived from renal tubular cells. Their presence in the urine test a few days after the operation is a sign of rejection of the transplanted kidney. Pigment casts are formed when pigments are incorporated into the cast and are observed in myoglobinuria and hemoglobinuria.

Reference values: missing.

Hyaline casts in urine:

1. renal pathology (acute and chronic glomerulonephritis, pyelonephritis, nephrolithiasis, kidney tuberculosis, tumors);
2. congestive heart failure;
3. hyperthermic conditions;
4. high blood pressure;
5. taking diuretics.

Granular casts (nonspecific pathological symptom):

1. glomeruloneforitis, pyelonephritis;
2. diabetic nephropathy;
3. viral infections;
4. lead poisoning;
5. fever.

Waxy cylinders:

1. chronic renal failure;
2. amyloidosis of the kidneys;
3. nephrotic syndrome.

Erythrocyte casts (hematuria of renal origin):

1. acute glomerulonephritis;
2. kidney infarction;
3. thrombosis of the renal veins;
4. malignant hypertension.

Leukocyte casts (leukocyturia of renal origin):

1. pyelonephritis;
2. lupus nephritis in systemic lupus erythematosus.

Epithelial casts (the most rare):

1. acute tubular necrosis;
2. viral infection (for example, cytomegalovirus);
3. poisoning with salts of heavy metals, ethylene glycol;
4. overdose of salicylates;
5. amyloidosis;
6. renal transplant rejection.

bacteria in urine

Isolation 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 portion of urine is preferable for research. To determine the type of bacteria and assess the level of bacteriuria, as well as to identify the sensitivity of microorganisms to antibiotics, you can use bacteriological culture urine.

Reference values: negative.

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

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

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

Urine is a solution various salts, which can precipitate (form crystals) when standing urine. The formation of crystals is facilitated by low temperature. The presence of certain salt crystals in urinary sediment indicates a change in the reaction to the acidic or alkaline side. Excessive salt content in the urine contributes to the formation of stones and the development of urolithiasis. At the same time, the diagnostic value of the presence of salt crystals in the urine is usually small. lead to the formation of crystals higher doses ampicillin, sulfonamides.

Reference values missing.

Uric acid and its salts (urates):

1. highly concentrated urine;
2. acid reaction of urine (after physical activity, meat diet, fever, leukemia);
3. uric acid diathesis, gout;
4. chronic renal failure;
5. acute and chronic nephritis;
6. dehydration (vomiting, diarrhea);
7. in newborns.

Tripelphosphates, amorphous phosphates:

1. alkaline urine reaction in healthy people;
2. vomiting, gastric lavage;
3. cystitis;
4. Fanconi syndrome, hyperparathyroidism.

Calcium oxalate (oxaluria occurs with any urine reaction):

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

Mucus in urine.

Mucus is secreted by the epithelium of the mucous membranes. It is normally present in the 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 proper preparation to take a urine sample.

Reference values: insignificant amount.

Clinical analysis of urine, which is called general, is established according to the results of physical and chemical studies. Urine color, transparency, presence of inclusions, specific gravity, odor are evaluated visually.

Only then various chemical components are added to the urine in order to determine it by reactions. chemical composition. If a white sediment in the urine is visible without using a microscope or its color differs from the normal one - yellow, of different saturation - we can conclude that there are health problems.

What does the presence of sediment mean?

Normally, fresh urine is completely transparent. Transparency decreases depending on the content of salts, mucus, desquamated epithelium, bacteria, and fat in the analysis.

White flakes

They can appear in the presence of a protein that a healthy person should not have.

Proteinuria - the so-called protein excretion - is extrarenal and renal. With extrarenal protein, the amount is about 1%.

It is not protein that is released, but protein exudate, which may indicate both inflammation of the ureters and a change in the composition of the secreted fluid due to external factors. In healthy people, this condition occurs with increased physical exertion, under the influence of stress, with hypothermia.

Lesions of the parenchyma of the kidneys and an increase in the capillaries of the renal tangles occur in infectious-toxic conditions. In this case, large white flakes can be seen in the urine, the amount of protein reaches from 10 to 20%.

White flakes in urine baby, which appeared once, should not alarm parents. This happens when changing nutrition, introducing a new feed. If the baby is cheerful, eats well, you should not worry.

When this type of urine is periodically excreted, but the behavior does not change, it is worth checking the blood sugar level. AT rare cases in children, fatty degeneration of the liver occurs, and the beginning of the process may suggest an analysis.

With inflammatory processes in the urine excretory system additional symptoms appear:

• a change in the behavior of the child - he becomes capricious, refuses to eat;
• the temperature rises;
• seizures may occur.

The appearance of white flakes in the urine during pregnancy is caused by the following reasons:

• inflammatory processes in the kidneys and renal pelvis;
• incorrect collection of tests - the number of exfoliating epithelial cells during pregnancy is increased, and the violation hygiene requirements evokes such a picture;
• in the 3rd trimester, mucus clots that begin to stand out from the vagina when the mucous plug leaves, connecting with the epithelium, visually look exactly like this;
• manifestation of diseases of the genital organs, purulent discharge from the birth canal.

The cause of the formation of white flakes in the urine in women is often gynecological infections. Even with thorough washing, it is impossible to get rid of them. In addition, during any inflammatory processes, the number of desquamated epithelial cells increases.

In the urine, white clots in men also appear due to inflammatory processes in the genitourinary system.

Urine sediment studies

A small amount of microscopic sediment in the urine is only visible under a microscope. If salt and cellular elements increased amount, urine becomes cloudy, clots form in it.

AT acidic environment meet:

• uric acid;
• urates - uric acid salts;
• oxalates.

AT alkaline environment- Tripelphosphates, ammonium urate, phosphates.

All these inclusions are called unorganized sediment. It also includes: bilirubin, cholesterol, xanthine, hippuronic acid, fatty acid and other elements.

Organized urine sediment - cellular elements - includes epithelial cells of squamous, cylindrical, renal and transitional epithelium, leukocytes, erythrocytes, cylinders.

The state of the urinary system is assessed by the number of leukocytes. Normally, they should not be more than 3-5 units in the field of view.

During inflammatory processes in internal organs, not related to the excretory system, the number of leukocytes is also increased. The largest number leukocytes is found in analyzes when the patient's condition requires urgent surgical intervention on the abdominal organs.

Normally, there should be no erythrocytes in the urine, but 1-2 in the field of view can occur with increased physical activity. Hematuria, as this condition is called, can also be of renal and extrarenal origin.

In order to determine where the blood comes from, a special test is carried out, which is called a three-cup test. During urination, portions of urine are collected sequentially in 3 cups. If the red blood cells are only in the first glass - the inflammatory process concerns the urethra, in the second - the problem area - the bladder, in the third - bleeding from the kidneys.

In women, the number of red blood cells in the urine may be increased not due to diseases of the urinary system, but with various problems in gynecological organs.

Sometimes a woman does not even suspect that a few days before menstruation or after or in the middle of the cycle, she has some detachment of the endometrium. And only by urinalysis can you find out about existing problems or individual characteristics organism.

Special samples

Quantitative microscopic tests to examine urine sediment establish the reasons why the quality of urine changes.

1. A study according to Nechiporenko - with pyelonephritis, the number of leukocytes in the blood test increases, with glomerulonephritis - cylinders and erythrocytes;
2. Orthostatic test - the appearance of hematuria after exercise. Thus, it is possible to identify increased mobility kidneys;
3. Kakhovskiy-Addis test. Serves for the diagnosis of inflammatory processes of the kidneys and renal pelvis.

Any inflammatory process in the body affects the performance of urine tests. White discharge may be in the form of flakes, acquire a thread-like form, be deposited in the form of a precipitate.

Thus, the body signals the beginning infectious diseases and availability oncological processes before the onset of the main symptoms - pain and fever. Gray-white clots in the urine can appear with fatty degeneration of the kidneys, coagulated blood clots - after injuries.

If changes in the urine are visually noticeable, you should consult a doctor. Self-medication can aggravate the condition and lead to irreversible changes in the urinary system.

For more full use data of microscopic examination of urine sediment for diagnostic purposes, it is advisable to distinguish seven types of sediment.

Salt sludge type characterized large quantity amorphous and (or) crystalline salts. An amorphous volumetric pinkish precipitate is given by urates, a whitish one by phosphates, a crystalline brick-red one by uric acid crystals, a crystalline whitish one by tripelphosphate crystals, etc.

Crystals of oxalates, acidic ammonium urate and neutral phosphates can occur alone and together with other salts of acidic or alkaline urine. Perhaps detection among crystalline salts and their intergrowths (phosphate, oxalate, uric acid), which indicates the presence of conditions for the formation of stones.

The content of cellular elements(leukocytes, erythrocytes, epitheliocytes, etc.) depends on the type of salts (amorphous, crystalline). The number of leukocytes is most often within the normal range, erythrocytes can be detected in the presence of salt crystals due to trauma to the mucous membrane of the urinary tract. In those cases where the sediment is crystalline, especially with agglomerations of salts, there are epithelial cells from various parts of the urinary tract (renal pelvis, ureters, bladder). In the amorphous sediment, only a small number of bladder epithelial cells are found. In the urine of women, in addition, non-keratinized and keratinized stratified squamous epithelium of the external genital organs is found. Protein - traces or absent.

Desquamative type. In the sediment, cells of the stratified squamous epithelium of the external genital organs in women or epithelial cells of the bladder are detected with increased desquamation without elements of inflammation (there is no protein, the number of leukocytes is within the normal range). Pronounced desquamation of epithelial cells from various parts of the urinary tract is observed during the passage of crystalline salts. Many epitheliocytes with signs of malignancy can occur in bladder cancer.

catarrhal type of sediment observed most frequently. Characterized by the presence a small amount protein and catarrhal inflammation elements: mucus, leukocytes - separately, in clusters and groups, often together with vaginal epithelial cells, urethra, prostate, renal pelvis, etc. Single erythrocytes can also be observed. By the nature of the epithelium in the sediment, one can judge the localization pathological process(pyelitis, urethritis, prostatitis, cystitis, etc.).

Purulent type. The sediment is voluminous, microscopic examination come to light neutrophilic granulocytes densely covering the entire field of view of the microscope. Protein content - up to 1 g/l. Occurs in acute purulent cystitis and exacerbation chronic cystitis, acute purulent pyelonephritis and exacerbation of chronic, purulent pyelocystitis, acute kidney failure. For all these diseases (with the exception of SNP), preparations must be stained according to Ziehl-Nelsen.

Hemorrhagic type. Sediment brown, red, friable. Microscopic examination reveals erythrocytes that completely cover all fields of view. Observed in acute and subacute glomerulonephritis, hematuric form chronic glomerulonephritis, tuberculosis and neoplasms of the kidneys and bladder, nephrolithiasis, acute kidney failure.

renal type. Microscopic examination of this type of sediment reveals kidney epithelial cells and casts. Both of them can occur in different numbers, from single specimens in the preparation to several in each field of view. Depending on the severity of the pathological process, the cells of the epithelium of the kidneys may be unchanged or be in a state of protein, granular, fatty, hyaline-drop and vacuolar dystrophy. Cylinders observed various kinds, the presence of all ten of their varieties is possible. The sediment usually contains erythrocytes. With pathology of the kidneys, accompanied by microhematuria, with the exception of nephrotic and often mixed forms of chronic glomerulonephritis, nephrotic syndrome and chronic insufficiency kidneys, erythrocytes leached and fragmented.

Gross hematuria due to acute insufficiency kidneys, erythrocytes are unchanged, in all other cases of kidney pathology - unchanged leached. Protein - from traces to several grams per 1 liter.

Necrotic type. In the sediment, necrotic patches are found, which may contain:

1. elastic fibers (tuberculosis, abscess, neoplasm);
2. cheesy necrosis, sometimes with epithelioid cells or giant multinucleated cells Pirogov - Langhans (disintegration of tuberculous granuloma);
3. fibrous base and accumulations of bacteria, hematoidin and hemosiderin crystals, tumor cells (not always).

In practice, a combination of different types of urine sediment is most often encountered, but the above classification allows not only to navigate the features of the sediment, but also to some extent determine the localization and nature of the pathological process.