The reaction to the blood is weakly positive. Hematuria in children

In the presence of red blood cells in urine, hematuria is diagnosed. Blood in the urine of a child, pink blotches on a diaper cause serious concern to parents.

Not always the appearance of red blood cells in the urine can be seen visually. At a low concentration, microhematuria is diagnosed only according to the results of laboratory tests. In the presence of blood cells, it is required to pass additional tests, to find out the reasons for such changes in the child's body.

Blood in the urine does not always indicate the presence of diseases. The reason may be physiological process, for example, heavy loads during sports.

When is blood in urine considered normal?

After the birth of a child, the body is restructured and adapted to new conditions. In this case, the erythrocytes accumulated during prenatal development are destroyed and others are formed. With this process, the appearance of red blood cells in the amount of up to 7 cells per field of view is possible. How long this process will last depends on the immunity of the child.

Given the underdevelopment paired organ in children under two years of age, red blood cells may appear in the urine due to insufficient filtration. In this case, the presence of erythrocytes up to 5 cells in the field of view is the norm.

In children older than two years, if there is no history of diseases of the urinary system, the content of erythrocytes in urine should be as follows:

• for boys up to 1;
• for girls up to 3.

An increased concentration indicates a deviation from the norm.

The appearance of blood in the urine of a child is considered safe in such cases:

• after using a catheter in the urethra, possible bloody issues after 2-3 days;
• when the child experienced severe physical exercise;
• when using an endoscope to diagnose a disease, there may be blood blotches in the urine for two days;
• after removal or crushing of stones.

The reasons

In the absence of pathologies, hematuria in children develops as a result of the inability of the body to environmental factors and stress. Often, children with blood in the urine need restorative therapy.

Reasons for the development of hematuria:

• prolonged exposure to the sun during the hot season;
• visiting the bath;
• use spicy foods and spices;
• excessive intake of citrus fruits and chocolate;
• transferred stresses;
• the body's response to medication.

In newborns

If a change in the color of urine occurred in an infant in the first days of life, do not panic. Most likely, this is a physiological process - uric acid infarction, which, despite the seriousness of the name, is not a disease and does not require treatment.

But the presence of blood in the urine of a newborn may be the result of infection of the tract, developmental anomalies, trauma during delivery. Therefore, the formation of blood in the urine of a baby requires testing and additional examination.

At the baby

The development of hematuria in children under one year is most often the result of vascular fragility. May occur with severe colds, as a result of an exorbitant load for the baby. Blood in the urine may appear if hygiene is not observed, which contributes to the development of infectious processes. The appearance of erythrocytes in the urine is possible and in the presence of congenital pathologies The child has.

Teenagers

In older children, diseases of the organs become the cause of the development of hematuria urinary system inflammatory nature. In this case, along with the blood, mucus and pus may be discharged. Education blood impurities may be a consequence of the ICD, the calculus goes through the urinary ducts, damaging them.

Cause classification

The provoking factors for the appearance of blood in the urine are divided as follows:

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1. Prerenal - intoxication, sepsis, infections.
2. Renal - diseases that affect the kidneys.
3. Postrenal - pathologies lower organs urinary system.

Erroneous analyzes

It is very important to properly collect urine for research. If you do not observe hygiene before delivery biological fluid, the result may be false. In the presence of an inflammatory process in the intestine, the contained erythrocytes fall into a container for collecting urine.

Girls should not give urine before the start of menstruation and a week after the end. Blood cells may appear hormonal disorders, as well as in pathologies of the appendages.

Hematuria in pathologies

Traces of blood in the urine of a child can be the result of injury. With a fall, blows to the abdomen, bruises of the lower back, with sports injuries, blood flow in the parenchyma is disturbed, which leads to gross hematuria. With rupture of the kidneys and ureters, there is a copious internal bleeding requiring immediate hospitalization.

Hematuria in children most often develops as a result of violations of the urinary organs:

1. Inflammatory. Diseases of the pelvis, parenchyma, cystitis and urethritis.
2. Non-inflammatory. ICD, oncology, developmental anomalies, hydronephrosis.

In children, blood in the urine may be due to diseases:

• infectious (flu, meningitis, scarlet fever, typhoid);
• formations of suppuration with phlegmon;
• pneumonia and sepsis;
• congenital pathologies associated with impaired hematopoietic function, modification of blood cells, insufficient coagulability, hemophilia;
• heart defects.

Symptoms of hematuria

In addition to staining urine, pathological processes other signs may appear in the organs of the urinary system.

When glomerulonephritis occurs a sharp decline volume of excreted urine, there are also such symptoms:

• malaise;
• headache;
• increase in body temperature;
• the presence of mucus and impurities in the urine;
• puffiness of the face.

With pyelonephritis, the following manifestations are present:

• lower back pain;
• temperature fluctuations accompanied by chills;
• the presence of mucus and pus in the urine;
• cramps during deurination;
• sudden urinary incontinence;
• frequent urge to void Bladder.

Cystitis most often occurs in girls, characterized by the following symptoms:

• when emptying the bladder, constant pain;
• discharge of urine with mucus and pus;
• malaise;
• discomfort in the pubic area;
• incontinence.

KSD is quite rare in children. At this age, there is more often a violation metabolic processes, that leads to high content salts, which in the future may provoke the formation of stones.

Diagnostics

When red blood cells appear in the urine in children, first of all, you need to take a blood test. Relatively additional methods, which may need to be paid, the attending physician will inform. The following studies may be needed:

• blood test (general, clinical, according to the method of Nechiporenko and Ambourzhe);
• establishment of an indicator of coagulability;
• tests regarding the content of nitrogenous substances;
• ultrasound examination of the genitourinary system and abdominal organs;
• excretory uropyelography.

Type of erythrocytes

Not only the quantitative level allows you to establish the degree of development of hematuria, the type of red blood cells indicates the cause of the appearance of blood in the urine.

In the presence of erythrocytes of a standard structure, the presence of inflammation of the lower organs of the urinary system is possible. If a there is blood at the end of urination, this indicates damage to the neck of the urethra, the development of a tumor in it, in boys - inflammation of the urethral canal.

With the modification of red blood cells, diseases of a congestive nature are possible, which is often found in the development of KSD. This occurs as a result of urinary retention when overlapping with a calculus. urinary tract, while the bodies change shape, is converted into rings.

To determine the cause of hematuria in children, an examination by a gynecologist and urologist is required.

Treatment

Therapy of hematuria is carried out after diagnosis and depends on the type of disease:

• in case of injury, surgical intervention may be required;
• if glomerulonephritis is established, it is necessary special diet and reception medications(hormonal and cytostatics);
• in the presence of cystitis or pyelonephritis, antibiotics are used for treatment;
• if tuberculosis is the cause of hematuria, hospitalization is required in a specialized dispensary.

Oncological diseases in children are rare, more often such processes are diagnosed in older people. As symptomatic therapy hemostatic agents are used.

At timely detection pathologies and complex treatment you can get rid of the disease and such a manifestation as blood in the urine.

General analysis urine
Urinalysis is a simple test that allows you to evaluate the function of the kidneys and other internal organs, as well as to identify the inflammatory process in the urinary tract and changes in other organs. Determine the transparency of urine, density, color, the presence of protein, sugar, salts.

Microscopy of urine sediment after centrifugation reveals inflammatory cells and other pathological inclusions.

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. The more concentrated the urine, the darker it is. Therefore, when intense heat or intense physical activity profuse sweating urine is less, and it is more intensely colored. Sometimes only the color of the precipitate may change (for example, with an excess of urates, the precipitate has a brownish color, uric acid is yellow, phosphates is whitish). A change in the color of urine may be the result of the release of coloring compounds formed during organic changes or under the influence of food components, medications, contrast agents. In pathological cases, the intensity of urine color increases with an increase in edema associated with kidney and heart diseases, with loss of fluid associated with vomiting, diarrhea, or extensive burns.

Urine becomes dark yellow (dark beer color) sometimes with greenish tint with an increase in urinary excretion of bile pigments, which is observed with parenchymal (hepatitis, cirrhosis of the liver) or mechanical (blockage of the bile duct with cholelithiasis) jaundice. Red or reddish urine may be due to a large number beets, strawberries, carrots, as well as some antipyretic drugs (antipyrine, amidopyrine). Large doses can give urine a pink color. A more serious cause of red urine is hematuria, blood in the urine, which may be associated with kidney or extrarenal disease. The greenish-yellow color of urine may be due to the admixture of pus, which occurs when a kidney abscess is opened, as well as with purulent urethritis and. The presence of pus in the urine alkaline reaction results in a dirty brown or gray color urine.

Urine is normally clear. Turbidity of urine may be the result of the presence of erythrocytes, leukocytes, epithelium, bacteria in the urine, precipitation of salts (urates, phosphates, oxalates) and depends on the concentration of salts, acidity and storage temperature 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.

Relative density(specific gravity) of urine depends on the concentration of substances dissolved in urine (uric acid, urea, creatinine, salts and other substances), as well as on the amount of water excreted. 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. Decreased concentration function of the kidneys with kidney failure leads to a decrease in the specific gravity of less than 1010 g/l (normally 1010-1025 g/l).

The urine of healthy people may have different reactions - pH from 4.5 to 8. Usually the reaction of urine is slightly acidic (pH between 5 and 6). Fluctuations in the pH of urine are due to the composition of nutrition: a meat diet causes an acidic reaction of urine, the predominance of vegetable and dairy foods leads to alkalization of urine. (proteinuria) is one of the most important laboratory signs kidney pathology. A small amount of protein in the urine (physiological proteinuria - the amount of protein not exceeding 0.002 g / l or 0.003 g / l in daily urine) can also be in healthy people when consuming a large amount of protein that has not passed heat treatment(unboiled milk, raw eggs), intense physical activity, strong emotional stress, after a long walk, for soldiers - after a forced march. Pathological appearance protein in the urine may be associated with kidney disease (glomerulonephritis, nephrosis, tuberculosis, toxic damage kidneys), with pathology of the urinary tract (ureters, bladder, urethra), and also occurs with nephropathy in pregnant women, fever during various diseases, hemorrhagic vasculitis, severe anemia, arterial hypertension, severe heart failure, hemorrhagic fever etc. Proteinuria associated with lesions of the urinary tract is characterized by a relatively low level of protein (usually less than 1 g / l) in combination with a large number of leukocytes or erythrocytes in the urine, as well as the absence of casts in the urine. The protein content is estimated in the urine collected by the patient per day. The following degrees of proteinuria are distinguished by severity: mild proteinuria - 0.1-0.3 g / l, moderate proteinuria - less than 1 g / day, severe - 3 g / day or more. Glucose in the urine is normally absent. The detection of glucose in the urine (glucosuria) is important for the diagnosis of diabetes mellitus, as well as monitoring (and self-monitoring) of antidiabetic therapy.

Video about urinalysis and symptoms of diseases associated with the results of the tests.

Microscopy of urine carried out in the sediment formed after centrifugation of 10 ml of urine. The sediment consists of solid particles - cells, cylinders, crystals, etc. Erythrocytes (shaped elements of the blood) enter the urine from the blood. In any urine, there are necessarily erythrocytes, but if, upon microscopic examination of the sediment, they come across in every or almost every field of view, this is a pathology. The appearance of red blood cells in the urine (hematuria) may be due to bleeding at any point urinary system, urological diseases and hemorrhagic diathesis. The norm is 0-2 in the field of view.

Leukocytes in urine are normally 0-6 in the field of view. An increased number of leukocytes in the urine () is a symptom of the lower sections. A very large number of leukocytes in the urine (pus) is the so-called pyuria, for the detection of which a three-glass test is performed. The patient is offered to urinate in turn into three vessels, and most of urine should fall into the middle. Such a test makes it possible to approximately establish the localization of the inflammatory process. If most of the pus is in the first portion of urine, then infectious process goes in the urethra, in the middle portion - in the bladder, and in the last portion, pus occurs during the process in the kidneys or prostate gland. If the kidneys are affected, there will be pus in all three vessels.

Epithelial cells are almost always present in the urine sediment. These are cells derived from different departments urinary system. The squamous epithelium that lines the urethra, bladder, and ureters diagnostic value does not have. It is always present in the urine. The appearance of cells of the renal epithelium indicates renal pathology.

Normally, epithelial cells in the field of view are observed in single copies.

- elements of urine sediment of a cylindrical shape (a kind of casts of the renal tubules), consisting of protein or cells. The process of formation of cylinders is affected by the acidity of urine. In terms of composition and appearance there are several types of cylinders (hyaline, granular, erythrocyte, leukocyte, waxy, etc.). Normally, only hyaline casts are present in the urine in the amount of 20 pieces / ml. It is important to remember that casts are not made of plasma protein, but of a special kidney protein. Therefore, situations are possible when there are cylinders in the urine, but there is no soluble protein, and vice versa. Hyaline cylinders can be found in healthy people in cases of prolonged stay in an upright position, with hypothermia or overheating, after heavy physical exertion.

No bacteria in urine. For research, the first morning portion of urine is preferable. The detection of bacteria in the urine is not always a sign of an inflammatory process in genitourinary system. Important for the diagnosis is increased amount bacteria. So, in healthy people, no more than 2 thousand microbes are found in 1 ml of urine, while for patients with inflammation in urinary organs characteristically 100 thousand bacteria in 1 ml. If an inflammatory process in the urinary tract is suspected, bacteria in the urine are determined bacteriological examination, in which urine is sown under sterile conditions on special nutrient media and, according to various signs of a grown colony of microorganisms, their type is determined, as well as sensitivity to, in order to choose the right treatment. Bacteria are detected in infections of the urinary system (pyelonephritis, cystitis). Detection of yeast fungi indicates candidiasis resulting from irrational antibiotic treatment.

Salts in the urine. Urine is a solution various salts, which can precipitate (form crystals) when standing urine. The precipitation of various inorganic deposits depends on the acidity of the urine, which is characterized by pH. With an acid reaction of urine (pH less than 5), salts of uric and hippuric acids, calcium phosphate, etc. are determined in the sediment. With an alkaline reaction of urine (pH more than 7), amorphous phosphates, trippelphosphates, calcium carbonate, etc. Oxalates (salts of oxalic acid) appear with the abuse of foods containing oxalic acid (such as tomatoes, sorrel, spinach, lingonberries, apples, etc.). If a person did not use these products, then the presence of oxalates in the urinary sediment indicates a metabolic disorder in the form of oxalo-acetic diathesis. In some cases of poisoning, the appearance of oxalates in the urine makes it possible to confirm the use by the victims with high accuracy. toxic substance- ethylene glycol. By the nature of this or that urine sediment, one can also say about the possible disease of the person being examined. So, uric acid crystals appear in large quantities in the urine in case of kidney failure, dehydration, in conditions accompanied by a large breakdown of tissues (these can be malignant diseases blood, massive, decaying tumors, resolving). Excessive salt content in the urine contributes to the formation of stones and the development of urolithiasis.

The day before the analysis, you can not eat vegetables and fruits that can change the color of urine, take diuretics. Before collecting urine, it is necessary to make a toilet of the genital organs so that bacteria of sebaceous and sweat glands. Women are not recommended to take a urine test during menstruation. Morning urine is taken for the study, immediately after sleep, preferably an average portion of at least 100 ml, which is collected in a clean, dry glass dish. The sample must be delivered to the laboratory within 1 hour after collection. Prolonged storage of urine leads to changes in its physical properties, bacterial growth and destruction of sediment elements. For Quantification cellular elements found in urine, special units of measurement are used, for example, “1-2 erythrocytes in the field of view”, “single epithelial cells in the field of view, “leukocytes cover the entire field of view”.

Biochemical analysis of urine

bilirubin in urine healthy people is contained in minimal, undetectable amounts. Bilirubinuria is observed mainly with liver damage or mechanical obstruction of the outflow of bile. But the first pigment that appears in the urine with liver damage is not bilirubin, but urobilin. Normally, the test for urobilin is negative.

Ketone bodies in urine(ketonuria) are formed as a result of increased breakdown fatty acids(acetone, acetoacetic and beta-hydroxybutyric acids). Determination of ketone bodies is important in diabetes mellitus. Normally, the reaction is negative.

hemoglobin in urine normally absent. Positive result observed with intravascular, intrarenal breakdown of erythrocytes with the release of hemoglobin. For research, the entire portion of morning urine is collected after a thorough toilet. Urine must be collected in a completely clean, dry container; store before the study can be no more than 1.5 hours in a cold place.

Bile acids appear in the urine with liver pathology in varying degrees severity: weakly positive (+), positive (++) or sharply positive (+++). Their presence indicates a gross lesion of the hepatic tissue, in which bile formed in the liver cells, along with entry into bile ducts and the intestine directly enters the bloodstream. The reasons are acute and chronic hepatitis cirrhosis of the liver, obstructive jaundice caused by blockage of the bile ducts. This indicator is used as an important indicator differential diagnosis jaundice. Bile acids in the urine can also be found in people with liver damage without external signs jaundice, so this analysis is important for those who suspect liver disease, but do not have jaundice of the skin.

Urinalysis for sugar
Special training is not required. Urine is collected during the day: the first morning portion of urine is removed, all subsequent portions of urine allocated during the day, night and morning portion next day are collected in one container, which is stored in the refrigerator during the entire collection time (this necessary condition, because at room temperature significantly reduced glucose levels.

After completing the collection of urine, accurately measure the contents of the container, be sure to mix and immediately pour into a clean container and bring it to the laboratory for research. You don't have to bring all the urine.

On the referral form, you need to indicate the daily volume of urine (diuresis) in milliliters (for example, “Diuresis - 1250 ml”), also write the height and weight of the patient. For express analysis of urine for glucose, indicator strips are used.

Urine amylase(pancreatic enzyme): Urine is collected in a similar way to a glucose test. The urine must still be warm to determine amylase activity.

Analysis according to Zimnitsky
An analysis according to Zimnitsky is carried out to study the concentration function of the kidneys. For analysis, it is necessary to collect all the urine released during the day. special dietary restrictions and physical activity not required. All urine is collected in eight containers in portions, for 3 hours each, in the 1st - from 9.00 to 12.00, in the 2nd - from 12.00 to 15.00, and so on throughout the day and all night. During these 3 hours, it is necessary to urinate at least 1 time in each of the containers (the amount of urine does not matter). The amount of day and night urine and the amount of fluid drunk are determined. The daily volume of urine is obtained by adding the volumes of the first four portions of urine collected from 9.00 to 21.00 h, and the nocturnal diuresis is obtained by summing from the 5th to the 8th portions of urine (from 21.00 to 9.00). In healthy people, 65-80% of the liquid drunk per day is excreted during the day. In addition, daytime diuresis should be approximately 2 times higher than nighttime. The density of urine is measured in eight 3-hour portions taken during the day. An increase in the daily amount of urine excreted compared to the liquid drunk can be observed with the convergence of edema, and a decrease, on the contrary, with an increase in edema (renal or cardiac). An increase in the ratio between nocturnal and daytime urine output is characteristic of patients with heart failure. The concentration function of the kidneys is disturbed earlier than other functions, so the Zimnitsky test allows you to identify pathological changes in the kidneys on early stages, until signs of severe renal failure appear, which, as a rule, is irreversible. A low relative density of urine with small fluctuations during the day (no more than 1003-1004) is characteristic of a disease such as diabetes insipidus, in which the production of the hormone vasopressin (antidiuretic hormone) in the human body decreases. This disease is characterized by increased urination and an increase in the volume of urine excreted several times, sometimes up to 12-16 liters per day.

Analysis according to Nechiporenko
Analysis according to Nechiporenko is laboratory research urine, with which the doctor can assess the condition, function of the kidneys and urinary tract. Blood cells (erythrocytes and leukocytes) are counted in 1 ml of urine using a Goryaev counting chamber. The analysis makes sense if pathology is not detected in the general urine test, and when clinical examination there are symptoms of damage to the urinary system. It allows you to identify hidden inflammation. It is carried out to identify in more detail violations found in the general analysis of urine, it is often used to monitor the effectiveness of treatment, so it can be performed several times. To the analysis of urine according to Nechiporenko special training not required. For analysis, it is necessary to collect the first morning portion of urine.

Rehberg-Tareev test
The Rehberg-Tareev test is used to determine the ability of the renal tubules to secrete or absorb back (reabsorb) certain substances. The patient in the morning on an empty stomach in lying position collect urine for 1 hour and in the middle of this period of time take to determine the level of creatinine. Using a simple formula, calculate the value glomerular filtration(characterizes the excretory function of the kidneys) and tubular reabsorption. At healthy men and women of young and middle age, the glomerular filtration rate (CF), calculated in this way, is 130-140 ml / min. A decrease in CF is observed in acute and chronic nephritis, kidney damage in hypertension and diabetes - glomerulosclerosis. The development of renal failure and the increase in nitrogenous wastes in the blood occur with a decrease in CF to about 10% of the norm. At chronic pyelonephritis a decrease in CF occurs later, and with glomerulonephritis, on the contrary, before violations concentration ability of the kidneys. Persistent drop in CF to 40 ml/min at chronic disease kidney indicates severe renal failure, and a decrease in this indicator to 15-10 ml / min indicates the development of the final (terminal) stage of renal failure, requiring the patient to be connected to the apparatus. artificial kidney or a kidney transplant. Tubular reabsorption normally ranges from 95 to 99% and can drop to 90% or less in people without kidney disease when drinking or drinking large amounts of fluid. The most pronounced decrease in this indicator is observed in diabetes insipidus. A persistent decrease in water reabsorption below 95% is noted, for example, in primary wrinkled (against the background of chronic glomerulonephritis, pyelonephritis) or secondary wrinkled kidney observed in hypertension or diabetic nephropathy.

Vanyukov Dmitry Anatolievich
Head of Therapeutic Department. Military sanatorium SibVO "Yeltsovka"

"The doctor must observe
Is the patient's urine the same
like a healthy one, and the less similarity,
the more severe the disease

Hippocrates "Aphorisms" (460-377 BC).

Along with KLA, feces for worm eggs, Wasserman reaction, blood test for HIV, blood pressure measurement and ECG recording, R-graphy of organs chest a general urinalysis is included in the list of mandatory studies, which should be carried out by all initially applied patients, regardless of the alleged diagnosis.

For research, the entire portion of morning urine is collected in a completely clean and dry dish after a thorough toilet of the genitals. Without changing its cellular composition, urine can stand in a cold place no more than 1.5 hours!

A. Physical properties

1. Quantity

Amount of morning urine (usually 150–200 ml) gives no idea about daily diuresis. Measure the volume of morning urine to interpret its relative density.

2. Color

Normally, the color of urine is yellow and depends on the concentration of substances dissolved in the urine. With polyuria, the dilution is greater, so the urine is lighter in color, with a decrease in diuresis - a rich yellow hue.

Color changes upon admission medicines(salicylates, etc.) or the use of certain food products(beets, blueberries).

Pathologically altered urine color occurs with hematuria (a type of meat slop), bilirubinemia (the color of beer), with hemoglobin- or myoglobinuria (black), with leukocyturia (milky white).

3. Transparency

Normally, fresh urine is completely transparent. If at the time of excretion the urine turns out to be cloudy, then this is due to the presence in it of a large number of cell formations, salts, mucus, bacteria, and fat.

Cloudy urine may indicate microhematuria, but in most cases it is a sign of infection (i.e., bacteriuria). An imaging test may serve as a preliminary test in asymptomatic patients. In the course of the studies, it turned out that the sensitivity of the visual examination of urine samples is 73% (that is, only in? cases in cloudy urine there were no bacteria).

4. Smell

Normally, the smell of urine is unsharp, nonspecific. When urine is decomposed by bacteria in the air or inside the bladder (in the case of cystitis, bladder cancer), ammonia smell. As a result of putrefaction of urine containing protein, blood or pus, for example, with bladder cancer, the urine acquires the smell of rotten meat. In the presence of ketone bodies in the urine, the urine acquires a fruity odor, reminiscent of the smell of rotting apples.

5. Urine reaction

Fluctuations in the pH of urine are due to the composition of the diet: a meat diet causes an acidic reaction of urine, a vegetable one - alkaline. With a mixed diet, mainly acidic metabolic products are formed, therefore Normally, urine is acidic.

When standing, urine decomposes, ammonia is released and the pH shifts to the alkaline side. Therefore, the reaction of urine is approximately determined with a litmus test immediately upon delivery to the laboratory, because. when standing, it can change. The alkaline reaction of urine underestimates the indicators of specific gravity; leukocytes are quickly destroyed in alkaline urine.

alkaline urine reaction is typical for chronic infection urinary tract and observed with diarrhea, vomiting. Acidity urine increases in febrile conditions, diabetes mellitus, kidney tuberculosis, kidney failure.

6. Relative density of urine (specific gravity)

The density of urine is compared to the density of water. The determination of relative density reflects the functional ability of the kidneys to concentrate and dilute and is often used as a screening test for mass examinations of the population.

Normally, the morning portion of urine should have a relative density of 1.020-1.024.

How to evaluate specific gravity figures

The concentration function of the kidneys when assessing the Zimnitsky test is considered moderately reduced if the values maximum densities do not rise above 1.020. A decrease maximum relative density of urine up to 1.015-1.016 regarded as significant.

Figures of relative density of morning urine equal to or greater than 1.018 indicate the preservation of the concentration ability of the kidneys and eliminate the need for its study using special methods. High or low numbers of morning urine density require clarification of the reasons for these changes.

The state in which maximum relative density of urine in the Zimnitsky sample less than 1.010 characterized as hypostenuria. Complete violation of the osmoregulatory function of the kidneys, osmotic concentration urine is lower than the osmotic concentration of blood plasma, severe damage to the tubules of the kidneys. Hypostenuria is detected in severe tubulointerstitial nephropathies, CRF, diabetes insipidus.

The relative density of urine is less than 1.005 in a patient with polyuria means the actual absence secretion of ADH, which is observed in neurogenic diabetes insipidus or in children with congenital nephrogenic non-diabetes diabetes.

The relative density of urine depends on molecular weight particles dissolved in it. Protein, glucose increase the specific gravity of urine. For example, diabetes mellitus can be suspected with relative density figures of 1.030 and above against the background of polyuria.

The main reasons for the decrease in the specific gravity of urine

The process of urine formation is regulated by the renal concentration mechanism and antidiuretic hormone (ADH) produced by the pituitary gland. In the presence of ADH, more water is absorbed and the result is a small volume of concentrated urine. Accordingly, in the absence of ADH, water absorption does not occur and large volumes of dilute urine are excreted.

Three main groups of reasons for a decrease in the specific gravity of urine:

• excess water consumption
• neurogenic diabetes insipidus
• nephrogenic diabetes insipidus

1. Excess water intake(polydipsia) threatens to reduce the concentration of salts in the blood plasma. To protect itself, the body excretes large volumes of diluted urine. There is a disease called involuntary polydipsia, which, as a rule, affects women with an unstable psyche. The leading signs of the disease are polyuria and polydipsia, low relative density of urine.

2. Neurogenic diabetes insipidus- insufficient secretion of an adequate amount of ADH. The mechanism of the disease is the inability of the kidneys to retain water through the concentration of urine. If the patient is deprived of water, diuresis almost does not decrease and severe dehydration develops.

The main causes leading to neurogenic diabetes insipidus:

• The most common is damage to the hypothalamic-pituitary region due to head trauma, neurosurgical intervention in the pituitary gland or hypothalamus. Or damage as a result of a brain tumor, thrombosis, leukemia, amyloidosis, sarcoidosis, encephalitis after acute infection and etc.
• Reception ethyl alcohol accompanied by reversible suppression of ADH secretion and short-term polyuria. Diuresis occurs 30-60 minutes after taking 25 g of alcohol. The volume of urine depends on the amount of alcohol taken in single dose. Continuous use does not lead to sustained urination despite the existence of a constant blood alcohol concentration.
• The most common cause is idiopathic neurogenic diabetes insipidus, most often found in adults at a young age.

3. Nephrogenic diabetes insipidus- a decrease in the concentration ability of the kidneys, despite the normal content of ADH in the blood. The main causes of nephrogenic diabetes insipidus can also be divided into three large groups:

• Rare cases of congenital nephrogenic diabetes insipidus.
• metabolic disorders. Conn syndrome(combination of polyuria with arterial hypertension, muscle weakness and hypokalemia). The concentrating ability of the kidneys decreases in Conn's disease early (relative density from 1003 to 1012). Hyperparathyroidism(polyuria, muscle weakness, hypercalcemia and nephrocalcinosis, osteoporosis). The relative density of urine drops to 1002. Due to the significant content of calcium salts, urine often has a white color.
• The most numerous subgroup among patients with nephrogenic diabetes insipidus are those with parenchymal kidney diseases (pyelonephritis, different kinds nephropathy, interstitial nephritis, glomerulonephritis).

B. Chemical examination of urine

Protein

The excretion of protein in the urine is called proteinuria. Previously, the term albuminuria was used, but then it turned out that not only albumin was released. Normal urine does not contain protein. Although in fact there is physiological proteinuria (proteins from the urinary tract, or proteins from prostate in men), but it does not exceed 150 mg / day. Such a small concentration is not detected in single servings. Therefore, normal OAM should not contain protein. The concentration of protein in a single portion of urine, expressed in grams per 1 liter, does not give an idea of ​​the absolute amount of protein lost, protein losses should be measured in daily urine (normally no more than 150 mg / day.)

There are organic proteinuria and functional:

Functional proteinuria is fickle and occurs either with an increase in the permeability of the membranes of the renal filter, or a slowdown in blood flow in the glomeruli with strong external stimuli (stress, fever, exercise). Hence the names of functional intermittent proteinuria - marching, emotional, cold, palpation, orthostatic.

Proteinuria should not be considered as a pathological phenomenon after various vegetative crises, colic, myocardial infarction, epilepsy attack, stroke or mental agitation of individuals with unstable autonomic nervous system. When eating a large amount of protein (for example, egg) with food, alimentary proteinuria may occur, which also cannot be attributed to pathological phenomena.

These functional (benign) proteinuria are not always harmless. Since kidney biopsy has been used, it has become clear that with asymptomatic functional proteinuria, histological changes in the kidneys can be detected, indicating the presence of glomerulonephritis with minimal changes. In some patients, proteinuria spontaneously stops, in other cases, glomerulonephritis develops later.

Persistent proteinuria is always pathological and usually indicates kidney disease.

Depending on the place of occurrence, there are:

• prerenal proteinuria associated with accelerated tissue protein breakdown, severe hemolysis
• renal, due to kidney pathology, which can be divided into glomerular and tubular.
• postrenal, associated with pathology of the urinary tract and most often due to inflammatory exudation. Protein enters the urine from the urinary and genital tract. Such proteinuria does not exceed 1 g / l

Glucose

The appearance of glucose in the urine (glucosuria) depends either on its concentration in the blood or on the processes of filtration and reabsorption of glucose in the nephron:

• An increase in blood sugar above 9.9 mmol / l causes glucosuria.
• At normal sugar in the blood, glucosuria appears in case of violation of reabsorption processes - renal (renal) glucosuria. Renal glucosuria may be primary(congenital) or secondary(occurs in chronic glomerulonephritis, nephrotic syndrome, acute renal failure, etc.) It is observed very rarely.

There are qualitative and quantitative methods for determining sugar in urine. The qualitative reactions are based on the reducing (reduction) properties of glucose. Meanwhile, you should know that not every substance that gives a positive reduction test is a sugar. If there were sugary substances in the container where the urine is collected (a compote jar), then sucrose can be detected in the urine. Simulators can add powdered sugar to urine. At overconsumption fruits can be observed fructosuria, pentosuria; at the end of pregnancy or after the cessation of breastfeeding, lactosuria is noted; after drinking milk, people suffering from fermentopathy have galactosuria and hypoglycemia. These conditions may be mistaken for glucosuria by the laboratory.

There are physiological and pathological renal glucosuria:

• Physiological glucosuria can be observed when a large amount of carbohydrates are taken in with food, when the body temporarily loses the ability to absorb sugar (alimentary), after emotional tension and stress (emotional), taking certain medications (caffeine, corticosteroids).
• Pathological glucosuria are divided into pancreatogenic (the most important of pancreatogenic is diabetic glucosuria) and non-pancreatogenic (observed with CNS irritation, thyrotoxicosis, Itsenko-Cushing's syndrome, acromegaly, pheochromocytoma, kidney pathology, liver).

The variety of causes of glucosuria complicates differentiation. However, in practice, one should proceed from the following. Until appropriate studies rule out the possibility of diabetes mellitus, any case of glucosuria should be considered as a manifestation of this disease. There is glucosuria, the blood sugar content is being examined; if it is elevated, a diagnosis of diabetes mellitus can practically be made. If the blood sugar is normal, then a glucose tolerance test should be performed. Upon receipt normal results TSH should establish the nature of the substance that caused the reduction (glucose or not?). If the detected substance is glucose, then there is renal glucosuria (congenital or secondary).

For correct assessment severity of glucosuria (especially in patients with diabetes mellitus), it is necessary to calculate daily loss of glucose in the urine.

It is possible to use diagnostic strips, for example, heptaPHAN. The test is specific for glucose, other sugars do not interact. The reaction is independent of pH, ascorbic acid and ketone bodies.

Ketone bodies

Ketone bodies - acetone, acetoacetic acid, beta-hydroxybutyric acid, per day 20-50 mg of ketone bodies are excreted in the urine, which are not detected in single portions. Normally, there is no ketonuria in OAM.

When ketone bodies are detected in the urine, two options are possible:

• in urine along with ketone bodies sugar is detected - one can confidently diagnose diabetic acidosis, precoma or coma, depending on the corresponding symptoms.
• Only acetone is detected in the urine, but there is no sugar - the cause of ketonuria is not diabetes. These can be: fasting-related acidosis (due to reduced sugar burning and fat mobilization); diet, fat rich(ketogenic diet); reflection of acidosis associated with gastrointestinal disorders(vomiting, diarrhea), with severe toxicosis, with poisoning and febrile conditions.

Bile pigments (bilirubin)

From bile pigments in the urine, bilirubin and urobilinogen can appear.

Bilirubin

The urine of healthy people contains minimal amount bilirubin that cannot be detected by conventional quality samples used in practical medicine. Therefore, it is considered that Normally, OAM should not contain bile pigments.

Only excreted in urine straight bilirubin, the concentration of which is normally insignificant in the blood (from 0 to 6 µmol / l), because indirect bilirubin does not pass through the kidney filter. Therefore, bilirubinuria is observed mainly with liver damage (hepatic jaundice) and violations of the outflow of bile (subhepatic jaundice), when direct (bound) bilirubin rises in the blood. For hemolytic jaundice(prehepatic jaundice) bilirubinemia is uncharacteristic.

Urobilinogen

Urobilinogen is formed from direct bilirubin in small intestine from bilirubin excreted in bile.

By her own positive reaction for urobilinogen is not very suitable for the purposes of differential diagnosis, because can be observed in a variety of liver lesions (hepatitis, cirrhosis) and in diseases of organs adjacent to the liver (with an attack of bile or renal colic, cholecystitis, with enteritis, constipation, etc.). But complete absence urobilinogen serves reliable sign stopping the flow of bile into the intestines! Which confirms the diagnosis of subhepatic jaundice in cholelithiasis.

B. Microscopy of urine sediment

The urine sediment is divided into organized (elements of organic origin - erythrocytes, leukocytes, epithelial cells and cylinders) and unorganized (elements of inorganic origin - crystalline and amorphous salts).

Hematuria (blood in the urine)

2 million erythrocytes are excreted in the urine per day, which in the study of urine sediment is normally less than 3 erythrocytes in the field of view for women, and 1 erythrocyte in the field of view for men. Anything above is hematuria.

There are gross hematuria (when the color of urine is changed) and microhematuria (when the color of urine is not changed, and red blood cells are found only under a microscope).

In the urinary sediment, erythrocytes can be unchanged (containing hemoglobin) and changed (deprived of hemoglobin, leached). The appearance of leached erythrocytes in the urine is of great diagnostic value, because they are most often of renal origin and are found in glomerulonephritis, tuberculosis and other kidney diseases. Fresh unchanged erythrocytes are more typical for urinary tract lesions (ICD, cystitis, urethritis).

To determine the source of hematuria, a “three-vessel” test is used: the patient collects urine sequentially into three vessels. With bleeding from the urethra, hematuria is greatest in the first portion (unchanged erythrocytes), from the bladder - in the last portion (unchanged erythrocytes), with other sources of bleeding, erythrocytes are distributed evenly over all three portions.

heptaPHAN test strips distinguish between hematuria and hemoglobinuria.

Hemoglobinuria is due to intravascular hemolysis. It is clinically manifested by black urine, dysuria, and often back pain. In contrast to hematuria, with hemoglobinuria, there are no erythrocytes in the urine sediment; direct bilirubin.

Leukocytes

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

An increase in the number of white blood cells in the urine (leukocyturia) indicates inflammatory processes in the kidneys (pyelonephritis) or urinary tract (cystitis, urethritis). To determine the source of leukocyturia, three glass test: the predominance of leukocytes in the first portion indicates urethritis or prostatitis, in the third - cystitis, a uniform distribution of leukocytes in all portions with highly likely may indicate kidney damage.

Sterile leukocyturia

it the presence of leukocyturia in the absence of bacteriuria and dysuria. For example, during exacerbation chronic glomerulonephritis in the urine sediment, up to 30-40 leukocytes are often found in the field of view. Other causes of sterile leukocyturia: contamination during urine collection, condition after antibiotic treatment, bladder tumors, kidney tuberculosis, interstitial analgesic nephritis.

Antimicrobial therapy is not needed.

urethral syndrome

This is an accelerated painful urination and leukocyturia in the absence of bacteriuria. It occurs predominantly in women. In 30-40% of cases in women with symptoms of infection urinary tract failed to detect bacteriuria. The reasons for the negative result are that the true pathogen given state, as a rule, are anaerobic bacteria, ureaplasma, chlamydia, gonococcus, viruses. And they all require sowing on special environment.

Treatment: if the pathogen is not identified, doxycycline 100 mg 2 times a day for 7 days, azithromycin 1 g once is offered.

epithelial cells

Epithelial cells are almost always found in the urinary sediment. Normally, OAM has no more than 10 pieces in the field of view.

Epithelial cells have a different origin. Cells flat epithelium enter the urine from the vagina, urethra and have no special diagnostic value. Cells 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 this epithelium can be observed with inflammation of these organs, with KSD and neoplasms of the urinary tract. Cells renal epithelium are detected in lesions of the parenchyma of the kidneys, intoxication, febrile, infectious diseases, circulatory disorders.

cylinders

A cylinder is a protein coiled in the lumen of the renal tubules and includes any contents of the lumen of the tubules in its matrix. The cylinders take the shape of the tubules themselves (cylindrical impression).

In the urine of a healthy person per day single cylinders can be detected in the field of view of the microscope. Normally, there are no cylinders in OAM.

Cylindruria is a symptom of kidney damage. Type of cylinders special has no diagnostic value.

unorganized sediment

Unorganized urine sediment consists of salts precipitated in the form of crystals and amorphous masses. The nature of the salts depends on the pH of the urine and other properties. For example, with an acid reaction of urine, uric acid, urates, oxalates. With an alkaline reaction of urine - calcium, phosphates. Unorganized sediment has no special diagnostic value. Indirectly, one can judge the propensity for the ICD.

Quantitative methods for studying urine sediment

Quantitative methods for determining urine sediment allow you to more accurately determine the nature urinary sediment which makes it possible to detect latent forms of the disease. AT clinical practice widespread Nechiporenko test- definition shaped elements(leukocytes, erythrocytes, cylinders) in 1 ml of urine taken in the middle of the act of urination from the morning portion.

D. Bacteriuria

Normally, the urine in the bladder is sterile. When urinating, microbes from the lower urethra enter it, but their number is not > 10,000 per 1 ml. Under bacteriuria refers to the detection of more than one bacterium per field of view (qualitative method), which implies the growth of colonies in culture in excess of 100,000 bacteria per 1 ml (quantitative method).

Clearly, urine culture is the gold standard for diagnosing urinary tract infections. The sensitivity of HeptaPHAN diagnostic strips is approximately 70% of all cases of bacteriuria, so a negative result using these strips does not rule out bacteriuria.

Asymptomatic bacteriuria

The presence of bacteria in the urine in the absence of complaints is regarded as asymptomatic bacteriuria. Similar state often occurs with organic changes in the urinary tract; in women who are promiscuous sexual life; in the elderly. Asymptomatic bacteriuria increases the risk of urinary tract infection, especially during pregnancy (infection develops in 40% of cases).

Who should be treated for asymptomatic bacteriuria?

• Men under 60 - exclude chronic prostatitis to carry out antimicrobial treatment.
• Women - single dose antimicrobial drug[trimethoprim 600 mg orally or gentamicin 120 mg IM]. Examination is carried out only with chronic infection.
• Schoolchildren, the elderly (over 60 years old) in the absence of organic changes in the urinary tract are not treated.
• Antimicrobial therapy is carried out during pregnancy, organic changes in the urinary tract, before instrumental research and operations on the urinary tract and genitals, re-catheterization of the bladder.

Why is there blood in the urine of a child? In the language of doctors, the presence in the urine of red blood cells called hematuria. There are many reasons for the appearance of this phenomenon, they can be both serious and safe for the life of the baby. Only a specialized specialist can determine the degree of danger of a pathology, therefore, if the first signs of hematuria are found, either in a boy or in a girl, you should go to a medical facility and undergo the necessary diagnostic examination.

Causes of blood in the urine of a child

If there are traces of blood in the urine of a child, then it is likely that he has kidney problems, but in some cases other reasons can also provoke this phenomenon. Thus, blood in urine can be detected in young children in the following cases:

• kidney dysfunction;
• pathologies of the urinary tract, transmitted by heredity;
• damage to the glomeruli of the kidneys;
• infection in the urinary system;
• malignant formations;
• damage to the urinary tract;
• stone formation and salt in the urea, kidneys;
• blood clotting disorders;
• thrombosis of the renal veins;
• downgrade immune system due to colds and viral infections.

Newborn

If a young mother saw a change in the shade of the urinary fluid in her crumbs, then you should not immediately panic, perhaps her redness is within the normal range and indicates great content urates. However, such a urine reaction when salts penetrate it is not a pathology if it occurs in the first days of a baby's life. This condition is called uric acid infarction and is not considered a disease. But, besides this, urination with blood in newborn boys and girls occurs when the child's urinary tract is infected, congenital renal pathologies and trauma during childbirth. In this case, it is required additional examination and treatment.

At the baby

What can blood in the urine of a baby say? In children up to a year old, the vessels are still quite fragile and therefore all kinds of health disorders can provoke their damage. Hematuria in children of the first year of life can occur even with a cold, which is accompanied by an increase in body temperature, as well as with strong physical activity. Often when urinating one year old baby blood appears in the urine due to improper care behind him. Then a urinary tract infection develops and urethritis and cystitis appear. In addition, hematuria in infancy may indicate congenital pathological changes, diseases of the kidneys, which are characterized by damage to the glomeruli.

For an older child

What does change in urine mean in older children, and is it normal? In most cases, an admixture in the urine of blood in adult children indicates diseases of the urea and kidneys. Blood in the urine of a teenager is often a symptom of urolithiasis, when stones damage the mucous membrane of the bladder and provoke bleeding. In older children, hematuria is also possible with trauma to the urinary tract.

Additional symptoms

A change in the color of urine is a sign various pathologies, which, in addition to hematuria, are also accompanied by such symptoms:

• With inflammation of the bladder (cystitis), in addition to red blood cells in the urinary fluid, the baby may be disturbed by pain sharp pain when emptying through the urethra.
• In infectious and inflammatory kidney disease (pyelonephritis) in little patient possibly a strong increase in body temperature, pain in lumbar and the presence of leukocytes in the urinary fluid.
• If the baby is diagnosed urolithiasis, then in addition to blood in the urine, appears strong pain in the lumbar region.
• In the pathology of the kidneys, characterized by damage to the renal glomeruli, hematuria is accompanied by swelling and increased pressure.

When should you not worry?

urinary fluid with blood secretions considered normal in the following cases:

• If the baby is urethra a catheter was placed, then traces of blood are acceptable for another 2-3 days after its removal.
• If the child before delivery biological material on a laboratory study was engaged in increased physical activity.
• At diagnostic examination with the help of an endoscope, spotting is possible immediately on the day of the procedure and a couple of days after it.
• If the crumbs were crushed calculi or removed from the kidneys.