Normal urinalysis: deciphering the indicators. The norm of protein, erythrocytes, leukocytes, glucose, epithelium, bilirubin in the urine

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

Clinical or urinalysis is prescribed for the diagnosis and monitoring of therapy for most diseases. The biological fluid secreted by the kidneys contains a large number of metabolic products, the characteristics of which are used to judge the work of the genitourinary, cardiovascular, endocrine, digestive, and immune systems. What does a normal urine test mean and what indicators correspond to it, we will consider in this article.

General information

Urine formation begins in the kidneys. Further, waste products enter the renal pelvis, where they accumulate and eventually enter the bladder. Together with urine, various substances of a toxic nature, organic particles, epithelium, s alts and more are excreted from the body of an individual. In total, this biological fluid contains about one hundred and fifty chemical compounds. Reasons for changemicrobiological, chemical or physical composition are both pathological and physiological. Therefore, a detailed study of its composition helps to understand this. The final indicators obtained during the study are compared with the norm. Deciphering the urine test in adults, as in children, is handled by medical professionals. All parameters are evaluated as a whole. It is important to remember that a diagnosis cannot be made based on a single OAM result. Despite the availability and simplicity, this method of laboratory research makes it possible to obtain important information about the work of all organs and systems of the body. In addition, it detects disorders in the functioning of the kidneys, which initially occur without symptoms.

How do I get a complete urinalysis (OAM)?

This study is included in the mandatory list of diagnostic tests that are carried out not only when signs of illness appear, but also for preventive purposes. The reliability of the result depends on the correct preparation and collection of biomaterial. Below are the rules that doctors recommend to follow:

1. Purchase in advance at the pharmacy or take a sterile container from the clinic.
2. On the eve you should not drink alcohol, drugs (in agreement with the doctor), products with a coloring pigment (carrots, beets, chocolate), refrain from sexual intercourse.
3. It is undesirable for the female sex during menstruation to take an analysis, it is better to postpone it to another day.
4. Urine is collected in the morning, on an empty stomach, immediately after sleep,having previously carried out a hygienic procedure for the genitals using a conventional soap product.
5. The container collects an average portion of urine in a volume of fifty to one hundred milliliters.
6. The biomaterial must be delivered to the laboratory within two hours.

It is impossible to allow contamination of the biomaterial with foreign elements.

Indications for OAM prescription

This analysis is recommended by doctors:

1. When managing pregnancy.
2. Before hospitalization.
3. For diseases of the genitourinary system.
4. If there are signs of endocrine disorders.
5. For differential diagnosis.
6. In case of first failures in the work of the cardiovascular and other systems, gastrointestinal tract.
7. When examining an individual to identify infectious and inflammatory pathologies.
8. To monitor the work of the body during therapy. The effectiveness of ongoing activities is evaluated.
9. Before and after surgery or transfusion of blood substitutes and blood.
10. During various examinations and medical examinations.
11. For preventive purposes annually.

If the interpretation of the results showed a significant deviation of the indicators from the permissible values, then the individual is shown additional instrumental and laboratory examinations.

What are the tests?

The study of urine is an important step in the diagnosis. When the urinalysis values are normal, then the individual is he althy. In cases other thangeneral, more research needed:

1. According to Nechiporenko - allows you to study the change in the characteristics of the biomaterial depending on the state of he alth, as well as evaluate the effectiveness of therapy, and clarify the diagnosis. The study is carried out in a special device (Goryachev's chamber). During its execution, the number of blood cells is counted. Urinalysis is normal if the amount in one milliliter is within two thousand leukocytes, no more than five hundred erythrocytes, and there are no cylinders at all. Otherwise, there are he alth problems.
2. According to Zimnitsky - the specific gravity of urine and the amount of various substances in it are determined, that is, the concentration function of the kidneys is analyzed. The purpose of this method is to study some features of the functioning of the cardiovascular system or kidneys.



3. According to Kakovsky-Addis - rarely used, since the process is very laborious. With its help, the number of shaped elements is examined.
4. Ambourger method - used, as in the previous case, to determine the formed elements in the urine.
5. Rehberg test - used to determine the concentration of creatinine. The analysis is necessary for nephritis, glomerulosclerosis, renal failure or wrinkled kidney syndrome.
6. Sulkovich's test - detects the presence of calcium in urine, the lack of which indicates he alth problems.

Deciphering urine analysis in adults: the norm

During a laboratory study, physico-chemicalindicators of urine: color, transparency, smell, specific gravity, erythrocytes, protein, leukocytes, nitrites, glucose. They also conduct microscopy of the sediment in order to detect fungi, mucus, bacteria, crystals, and more. During the analysis with the help of instruments and visually, doctors evaluate:

1. Transparency – normal biomaterial is always transparent. The presence of turbidity indicates inclusions that are in urine - s alts, protein, mucus and more.
2. Color - depends on the presence of pigments and can change depending on the food consumed and the amount of liquid drunk. In addition, with some diseases, urine acquires a different shade - red, black, white and others.
3. Smell - in a normal urine test, it is always present. However, foul-smelling, putrid, or reminiscent of ammonia, indicates pathological processes occurring in the body.
4. Protein - to detect it, a special reagent is added to the urine. Turbidity indicates its presence.
5. Acidity - litmus paper is used to determine it. Normally, the environment is acidic, and alkaline is found in vegetarians.
6. Density - this indicator is influenced by the composition and amount of urine components.
7. Glucose - test strips are used to determine. Normally, it should not be.
8. Research of sediment - urine is defended for two hours, and then centrifuged.

Doctors evaluate the results of this analysis in combination with other laboratory tests.

Diuresis

This is a processformation and excretion of urine. For diagnosis, daily, daytime and nighttime diuresis matters. The volume of daily urine is approximately 1.5–2 liters for a he althy individual. Deviations from the norm are observed in certain diseases or other conditions:

1. Meningitis, nephritis, acute renal failure, intoxication, spasm of the urinary tract - anuria (lack of urine during the day).
2. Neuro-reflex failure - olakisuria, that is, a small amount of urination.
3. Nervous excitement - pollakiuria or frequent urination.
4. Acute liver failure, dyspepsia, kidney and heart problems - oliguria or a decrease in the daily urine output.
5. Nervous excitement, diabetes insipidus and diabetes - polyuria (increased daily urine output). In addition, this condition occurs with a large intake of fluids or foods that provoke the formation and excretion of urine.



6. Inflammatory processes of the urinary tract - painful separation of urine (dysuria).
7. Fever, pathology of the nervous system, inflammation of the urinary tract contributes to urinary incontinence, that is, enuresis. Nocturia or physiological enuresis is typical only for babies under two years of age.
8. The initial stage of heart failure in the stage of decompensation, cystitis - nocturia, that is, more urine is excreted at night than during the day. This condition is not considered abnormal in children under two years of age.

Evaluation of organoleptic propertiesurine

These include the following indicators:

1. Transparency - normally, urine is absolutely clean and does not contain any impurities. In the presence of pyelonephritis, inflammation of the bladder in the acute or chronic stage, the urine becomes cloudy. In addition, turbidity is provoked by epithelial cells, microorganisms, s alts and red blood cells.
2. Smell - unsharp and specific. In some abnormal conditions, urine acquires various unpleasant odors: murine (phenylketonuria), feces (infections caused by E. coli), fetid (intestinal problems, the presence of pus), acetone (ketone bodies were detected in urine).
3. Color - in a normal urine test, the shade is straw yellow. Color change is characteristic of some pathologies: dark yellow - heart failure, burns, swelling, diarrhea, vomiting; dark brown - hepatitis, jaundice; greenish-blue - during the processes of putrefaction in the intestines.



And there are also other shades that are different from the norm.

4. Foaming - Urine foams slightly. When agitated, the foam spreads evenly over the entire surface, it is unstable and transparent. If there is protein in the urine, then the foam is abundant.

Biochemical characteristics of urine

During its implementation, they examine:

1. Protein - a small amount found in urine, most often associated with excessive physical activity, cold showers, severe emotional stress. A significant excess of the permissible norm of protein in the urine indicates seriouspathologies. The condition in which an individual has abnormally high levels of protein is called proteinuria. It comes in varying degrees. High - characteristic of amyloid degeneration of the kidneys, exacerbation of glomerular nephritis. Medium - acute and chronic stage of glomerular nephritis. Mild - interstitial nephritis, urolithiasis, diseases in which the tubular transport of organic elements and electrolytes is impaired.
2. What is the norm of glucose in the urine? There should be no sugar, but a small amount, namely, no more than 0.05 g / l is allowed. A condition in which a high concentration of glucose in urine is detected is called glycosuria. The main causes are: diabetes mellitus, neoplasms of the brain, intoxication of the body with phosphorus, chloroform, morphine or strychnine, Basedow's disease, exacerbation of pancreatitis, blood poisoning, hypercortisolism, chromaffinoma. In addition, a slight increase in sugar in urine is observed in pregnant women and with the abuse of confectionery.
3. Ketone bodies in urine - what is the norm? They shouldn't be. These include acetone, acetoacetic and beta-hydroxybutyric acid, which are formed in the liver. Their appearance in urine indicates a violation of the pancreas, the presence of diabetes, tumors, anemia. Prolonged fasting and a carbohydrate-free diet also contribute to their appearance.
4. Diastase is alpha-amylase, a pancreatic enzyme that breaks down carbohydrates. It is excreted in urine. Normally, its allowable limits are from 1 to 17 units / h.
5. Urobilinogen in urine is norm althere must be traces of it. It is formed in the intestine from bilirubin. Being exposed to bacteria and enzymes, it is oxidized and converted into urobilin and again enters the bloodstream. Further, it penetrates the kidneys and is excreted from the body along with urine. If its concentration is too high, then the urine becomes a rich yellow color.



Contribute to this toxic lesions, malabsorption, putrefactive processes in the intestines, hemolytic anemia, kidney failure, liver failure. If there is an excess of the norm of urobilinogen in the urine, then this condition is called urobilinuria. The complete absence of this bile pigment occurs in the following situations. If there is a compression of the duct of the enlarged pancreas by a stone or tumor. The filtration process in the kidneys is disturbed, which is typical for toxic kidney damage, as well as in glomerulonephritis and malignant neoplasms, or due to mechanical blockage of the bile duct, bile is not able to exit the gallbladder.

6. Total bilirubin in the urine - the norm in an adult is a negligible amount. Several forms of this substance are known. Direct or converted enters the excretory system and is excreted from the body. Indirect or unbound is dangerous, as it is very toxic and can easily penetrate cells, disrupting their vital functions. The overall indicator is the sum of the two previous ones and, if it is normal, then further research is not carried out. The appearance of bilirubin in the urine indicates an overestimation of it.blood levels. The reason is diseases of the biliary tract, cirrhosis of the liver, toxic and viral hepatitis.

Physical and chemical characteristics of urine

In this case, evaluate in the general analysis of urine:

1. Density - the norm for an adult is from 1, 015 to 1, 025 g / l. This parameter shows the presence of components dissolved in urine compared to the total amount of its one-time excretion. A decrease in the specific gravity occurs with renal failure, as well as if there is a high temperature in the room where the biomaterial is being studied. An increase beyond the permissible values is characteristic of dehydration.
2. Urine acidity is normally slightly acidic or slightly alkaline, i.e. pH 5–7. Deviation from the allowable indicators is observed with malnutrition, pathological condition, storage of biomaterial for a long time at room temperature. Let's take a closer look at the most common reasons. The acidic environment of urine is observed with: exacerbation of nephritis, nutritional errors (eating a large amount of meat products), gout, taking corticosteroids, ascorbic acid, acidosis, heart or kidney failure, kidney damage with a tubercle bacillus, low potassium in the blood, coma on the background of sugar diabetes. Factors contributing to an increase in urine acidity above the norm (pH more than 7): alkalosis provoked by hyperventilation syndrome, elevated levels of potassium in the blood, chronic renal failure. As well as the use of large amounts of vegetables and mineralalkaline water, taking Aldosterone, Sodium Citrate, Adrenaline, and bicarbonates.

Microscopic analysis of urine

Urinary sediment is examined visually and under a microscope. Pre-biological fluid settles for two or more hours. The deposited precipitate is subjected to centrifugation, then it is placed on a glass slide and examined. At the same time, the laboratory assistant is interested in such indicators that are in sight, such as:

Epithelium - in the general analysis of urine, the norm is no more than ten cells. In addition, its type also matters. Transitional - indicates cystitis, nephrolithiasis and pyelonephritis. Renal - glomerulo- and pyelonephritis, infectious diseases. In infectious processes in the urinary system, squamous epithelium is present in excess

Normally, there should not be cylindrical or cubic, but only flat:

1. Mucus - slight presence is not an abnormality. Its presence in large quantities indicates an inflammatory process in the urinary tract, as well as an improperly performed hygiene procedure in preparation for analysis.
2. Crystals or organic and inorganic s alt acids - in the urine, normally should not be present. In some individuals who do not have he alth problems, due to the characteristics of the diet and physical activity, they are detected in the analysis - oxalates, urates, ammonium urate, phosphates, uric acid, calcium carbonate.
3. Cylinders are the so-called casts, consisting oftubular epithelial cells, red blood cells and proteins. Depending on the presence of certain components in them, they are waxy, hyaline, erythrocyte, granular, epithelial. It is permissible to have only hyaline cylinders in the urine in an amount of not more than two. Exceeding the allowable values or detecting other types of cylinders indicates the presence of a severe pathological process in the body.
4. Erythrocytes - the norm in the urine in women is no more than three, in men - no more than one. Their complete absence is also considered a natural process. For diagnosis, it is important not only to increase the number of red cells, but also their appearance, since fresh cells penetrate into urine from damaged urinary tracts, devoid of hemoglobin and leached from the renal pelvis. The reasons why red cells appear in the urine are kidney injuries, infectious and inflammatory processes of the urinary tract, and malignant tumors. An excess of erythrocytes in urine in women and men is indicated by a change in its color. Urine acquires a reddish-brown color. And this condition is called macrohematuria. In males, blood in the urine often appears due to inflammation of the prostate, especially in the acute phase.
5. Mushrooms, bacteria, parasites, protozoa - they should not be present, that is, urine is normally sterile. When pathogens are detected, bakposev is done to determine the type of microbe and its sensitivity to antibacterial agents.
6. Leukocytes - in the general analysis of urine, the norm: in males, the maximum value is notshould exceed three, and for women - six. An excess amount means that in the body of the individual there is inflammation in the urinary organs, as well as in the kidneys. This is typical for urolithiasis, glomerulo-, pyelo- and nephritis.

Conclusion

Common urinalysis is a comprehensive study conducted in the laboratory, based on the results of which a diagnosis is made. It is an integral part of any survey due to its ease of implementation and high information content. It is used to diagnose various pathologies of the kidneys and bladder, prostate gland, neoplasms and other abnormal conditions in the early stages, when there are no clinical manifestations.