Part II. Urine Examination Not all waste is removed from the body by the kidneys, but the kidneys are the only organs in the body primarily concerned with removing waste materials. All other organs that also act as "waste collectors" are located in other

Chapter 9. Physico-chemical characteristics of urine Amount of urine The amount of urine excreted per day by an adult healthy person (diuresis) ranges from 1000 to 2000 ml - this is approximately 50-80% of the fluid taken during this time. Daily diuresis is influenced not only by the condition

Urine examination according to Zimnitsky This method of urine examination was proposed by the Russian therapist, Professor S. S. Zimnitsky (1873–1927). Indications Assessing the functional state of the kidneys. The essence of the method The amount of urine excreted per day (daily diuresis) is studied in

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Urine analysis according to Zimnitsky Concluding the conversation about the types of urine tests, I’ll tell you about one more analysis. When the doctor really wants to assess how the patient’s kidneys are working in general, he prescribes a Zimnitsky test, in other words, “24-hour urine.” Then the nurse, like

Chapter 2 Urine examination The urine of a healthy person is sterile, but can become contaminated during the process of passing through the urinary tract and collecting material. Due to the fact that the patient usually carries out urine collection independently (with the exception of children and seriously ill patients), it is of utmost importance

Urinalysis according to Nechiporenko Urinalysis according to Nechiporenko - quantitative determination of the content of leukocytes, erythrocytes and casts in the urine. Indications for the analysis: diagnosis of hidden pathological processes - inflammation, hematuria,

Urine examination for the determination of psychoactive substances 1. Urine should be collected in a clean container. Impurities of detergents and other substances may distort the result.1. Immediately after collecting urine, the container should be closed with a tight lid to prevent evaporation and

Perhaps this is one of the most capricious types of urine tests that are difficult to collect and diagnose. Based on its results, it is impossible to make a final diagnosis and the availability of other more detailed diagnostic sources is required.

Although it is believed that the technique is quite easy, since interpreting the results does not require any complex equipment, its complexity lies in the many “side” factors that dramatically affect the final results. One of these “side” factors can be called the quality of urine collection, which the patient collects independently. And this is the basis of the entire test.

In other words, the test will fail if the collection technology is violated. And it’s easy to break it; even just choosing the wrong container is enough. False-positive results for nocturia can be obtained in many patients in winter, when the temperature in the apartment is relatively low and we sleep under a warm blanket. This contrast can increase blood flow, which also speeds up all metabolic processes, including kidney function. Consequently, there will be a more frequent urge to urinate at night.

It is for this reason that we didn’t really want to tell our readers about it, but due to numerous requests, we still decided to do it. Perhaps over time it will be canceled due to low information content.

It determines the quality of the basic functional ability of the kidneys, namely how they perform their main role - they secrete, concentrate or dilute urine excreted naturally.

During the day, the kidneys are able to “filter” a huge volume of fluid, thereby purifying the blood. To do this, they can osmotically concentrate and dilute the urine, excreting all that is unnecessary and leaving in the blood a maximum of the necessary components that are involved in the metabolic process. If an organ begins to act up, this will certainly affect the excretory quality of the fluid, which can be seen in the daily diuresis.

This test can also be prescribed for diabetics if they suspect renal failure or any inflammatory process progressing in the genitourinary system.

Indications for the use of the technique may also include:

• suspected diabetes mellitus
• signs of kidney failure
• chronic form of glomerulonephritis and pyelonephritis
• hypertonic disease

The test is carried out according to three main indicators:

• specific gravity of urine (relative density) of each portion taken
• total amount of urine excreted
• quality of urine distribution during the day (in other words, how much of it is released over several hours at night and during the day)

Preparation

There are no special requirements for the test. Preliminary adherence to a diet, such as, for example, is not required, however, it is worth considering the fact that

Excessive fluid intake distorts the result.

Also, you should not use any diuretics on the day of the study, even if they were prescribed by your doctor.

In addition, you will need to prepare the following in advance:

• 8 empty urine containers
• alarm
• pen and notepad (diary) for notes

Bottles come in volumes: 25, 30, 60, 120, 250 ml. It is best to buy the maximum volume to collect all the liquid. Buy containers with a reserve of 2 - 3 sterile jars. Even if they are not needed, they will still come in handy someday in the future, because their shelf life is practically unlimited.

How to collect urine for analysis

The most important thing is to correctly collect urine for the Zimnitsky test. Collection duration is 1 day.

The final result depends on how to collect urine correctly.

Moreover, it is important to collect only all the urine, without pouring excess into the toilet (what does not fit in 1 container is placed in another additional one and numbered with all the necessary notes).

To do this, we prepare 8 containers, each of which must indicate the last name, first name, patronymic (or just with initials) of the patient, the serial number and the time interval during which the urine was collected in a specific jar.

If a person consumes an excessive amount of liquid, then he may be mistakenly diagnosed with, say, diarrhea.

To avoid such false positive results, it is important to record everything in a diary.

Clearly record exactly how much liquid and water-containing food you consumed during a given time (how much water, drinks, fruit, soup, etc.).

For example, an entry might look like this: in the period from 09:00 to 12:00 in the morning I drank 250 ml of milk tea, ate 2 apples; from 12:00 to 15:00 in the afternoon I drank 2 cups of coffee (the total volume of coffee consumed was 200 ml) and 0.5 liters of plain water; from 15:00 to 18:00 - ate mushroom soup (300ml), a glass of kefir (250ml), etc.

Don't forget also that tea is a diuretic. It is not recommended to drink a lot of it during collection.

Collection time

On the very first day of collection, you need to empty your bladder in the morning (around 06:00). The resulting portion does not need to be collected. This night urine is poured into the toilet. After this, all the liquid is collected from 09:00 to nine in the morning the next day.

After each of the eight three-hour periods of time, the patient urinates in a separate jar.

If during this time he has no urge to urinate, then the jar is still numbered, the time period is recorded and it is left empty.

If the container is full, then you need to urinate in an additional container, and not flush it down the toilet!

The collection ends at nine o'clock in the morning the next day. After this, all jars are sent to the laboratory for testing on the same day. You cannot store urine for a long time!

Store what you collect only in the refrigerator. At room temperature, urine quickly deteriorates.

Decoding

Normal for men and women

• It is advisable that the total daily volume of urine does not exceed 1 - 1.5 liters
• Normally, the specific gravity ranges from 1012 to 1025 g/l
• The range of individual can servings can be from 50 to 250 ml
• A twofold predominance of daytime diuresis over nighttime (approximately 2/3 during the day, and 1/3 at night of the total amount of fluid)
• The difference between the maximum and minimum relative density of urine should be at least 0.012 - 0.016 g/l (for example, 1006 - 1020)
• The ratio between the fluid entering the body and the urine excreted should not exceed 65 - 80%
• After consuming liquids or water-containing foods, the volume of urine excreted increases

In children, normal values ​​will be slightly lower. They largely depend primarily on age. The older the child, the closer his indicators are to adult values. Any doctor takes this feature into account when interpreting the results.

Deviations

Since the main diagnostic indicators are the volume and density of urine, any deviations from the norm may indicate the presence of some kind of problem. This gives every reason to conduct other detailed studies that will help make a more accurate diagnosis. No conclusions can be drawn based on this analysis alone.

Thus, the following deviations from the norm are distinguished, which are characterized by:

• Polyuria

The excretion of the total volume of urine per day increases with a low specific gravity, at which the formation of primary urine increases as a result of renal filtration of biological fluid.

It is determined when the daily volume of urine exceeds normal values ​​in the amount of 1500 to 2000 ml or if the total amount of urine exceeds 80% of the fluid consumed during the day.

May indicate: renal failure, diabetes mellitus.

• Oliguria

When the volume of daily urine, which has a high specific gravity, decreases. If the kidneys do not cleanse the blood well, the weight of urine increases and the volume decreases.

If, after the urge to urinate, less than 1000 ml is released per day and the total amount of urine in relation to the amount of fluid drunk is less than 65%.

Diagnosis: renal, heart failure, arterial hypotension, massive destruction of red blood cells, poisoning.

• Nocturia

Night diuresis prevails over daytime (exceeds 1/3 of the total daily volume).

The night volume of urine can increase in a number of cases with: impaired renal concentration function, diabetes mellitus, heart failure.

• Hyposthenuria

As the name implies, this is a condition in which there is insufficient reabsorption of primary urine. As a result, urine is released whose density is less than 1012 - 1013 g/l. in each of the jars.

What this may indicate: exacerbation of the chronic form of poelonephritis, pronounced heart failure, renal failure with chronic complications (amyloidosis, hydronephrosis, diabetes insipidus, glomerulonephritis and pyelonephritis, leptospirosis, long-term effects of heavy metals on the kidneys).

This figure can be reduced by taking diuretics or large amounts of tea.

• Hypersthenuria

The opposite effect occurs when urine density increases. It is noted when the density in at least 1 jar exceeds 1035 g/l. This is possible when reabsorption is higher than glomerular renal filtration.

It is regarded as one of the signs for the following diseases: exacerbation of chronic glomerulonephritis, anemia,.

A similar condition is possible with: toxicosis of pregnancy, accelerated breakdown of red blood cells, blood transfusion.

An increase in relative density indicates that it contains many substances such as protein, glucose, urea, sodium (salt). The more there are, the higher the density. Just 3g of protein increases the relative density level by 0.001g/l, and every 10g of glucose increases it by 0.004. Ideally, there should be no protein in the urine at all, just like a large amount of glucose. As blood passes through the kidneys, it is filtered. After this, primary urine is formed, which is similar in composition to blood plasma. There is still some protein present in it. But after processing is completed (this process is called reabsorption), the output is secondary urine, which should not contain any protein components.

This condition is typical for glucosuria, when a lot of protein appears in diuresis, and this may already indicate nephrotic syndrome or an uncompensated form of diabetes.

Urinalysis according to Zimnitsky is also prescribed during pregnancy, but the frequency of urination in women in the position will be higher. Don't be afraid of this, this is the norm. The most important thing to pay special attention to is the relative density of urine. The higher it is, the higher the risk of developing kidney problems. If this type of examination is suspected, pregnant women will not be prescribed.

The cost of the study is not high, from 300 rubles and above.

To diagnose a number of diseases, it is necessary to know how the patient's kidneys work. Thanks to urine testing using an effective method developed at the beginning of the 20th century by Dr. S.S. Zimnitsky, it is possible to determine deviations in their functions. However, it is important to correctly collect biomaterial.

What does a urine test according to Zimnitsky show?

The doctor needs to find out what is the ability of the patient’s kidneys to concentrate urine and excrete it from the body. This is especially important if there is a suspicion of inflammatory processes in the organs of the genitourinary system. During pregnancy, renal pathologies are fraught with defects in fetal development and serious consequences for the mother. Analysis according to Zimnitsky helps to detect dangerous violations in time.

Based on the volume of urine excreted, one can judge what the patient’s morning, afternoon, night and daily diuresis is. Deviations are easy to determine if you know the normal sample values ​​according to Zimnitsky:

• the total volume of urine per day is 1.5-2 liters;
• daytime diuresis - two thirds, nighttime - one third of the daily amount;
• the ratio of the volumes of liquids drunk and urine is 65-80%;
• the density of the biomaterial in one or two or three jars is more than 1020 g/l, and in all containers it is less than 1035 g/l.

Density

This indicator is necessary to identify the concentration of organic substances. This is mainly uric acid, urates, urea. The more there are, the higher the relative density of the fluid secreted by the kidneys and bladder. Urine should not contain protein or glucose. When the Zimnitsky analysis shows their presence, this is a clear sign of pathology.

If in each of the containers the density of daily biomaterial is less than 1012 g/l, such a low indicator signals the inability of the kidneys to fully concentrate and excrete urine. This is a good reason to suspect renal failure, which can be observed with pyelonephritis. This can also be the case for heart failure.

The density of urine increases, as a rule, in patients with glomerulonephritis and diabetes mellitus. As these pathologies develop, proteins, dead cells and other large blood elements and glucose enter the kidneys. High results of the relative density of biological fluid in the Zimnitsky sample are observed during pregnancy complicated by toxicosis.

Specific gravity is normal

This is also an important diagnostic parameter, characterizing the function of the kidneys’ accumulation of metabolic “waste” in a liquid state for their subsequent removal from the body. The specific gravity of urine is the ratio of its weight to the weight of water, which is denoted by one. Laboratory technicians determine this indicator with a urometer. Fluctuations in the norm vary in the range of 1012-1035 g/l.

How to properly collect urine for analysis

You can count on the reliability of the results provided that all the rules for conducting the study are followed. Collection in Zimnitsky is carried out according to strictly defined hours throughout the day. The day before you need to select 8 clean glass containers. Since the collection must be carried out precisely on time, you cannot do without an alarm clock.

The algorithm for accumulating biomaterial for analysis according to Zimnitsky is as follows:

• at 6:00 you need to urinate using the toilet;
• starting from 9:00, you should perform this procedure in jars every 3 hours;
• control time: 12:00, 15:00, 18:00, 21:00, 24:00, 03:00, 06:00.
• filled containers must be closed and stored in the refrigerator;
• They should be handed in with records of liquids drunk.

In the intervals between the indicated hours, several urges to urinate may appear. You need to collect all the biomaterial without spilling anything. When there is a lot of urine and the prepared container is not enough, use additional one. If it’s time to collect the next portion, but there is no desire to urinate, the jar is left empty.

Preparation for the Zimnitsky test

To avoid consuming too much liquid and to avoid unreliable results, you should:

• drink and eat throughout the day, as always, except for salty and spicy foods, beets, carrots;
• stop taking diuretics 24 hours before the study;
• Wash the external genitalia before collecting biomaterial.

Daily fee

This diagnostic method checks kidney function under increased stress, controls the composition and amount of substances that are removed from the body in urine within 24 hours. Daily analysis is indicated during pregnancy, suspicion of a number of renal pathologies, and diabetes mellitus. For this purpose, it is better to use a large measuring container with graduated divisions.

The first morning portion is flushed down the toilet. All subsequent ones are collected in this container, recording the time of urination. First, the volume of all collected biomaterial is determined. Then the urine is mixed and about 200 ml is poured into a container, which must be handed in with a note about the start and end time of collecting the material, and the total volume.

How to store urine for analysis

The biomaterial does not deteriorate for the longest time, ensuring the accuracy of the research results, in sterile pharmacy containers. In the absence of such containers, you can use a glass jar, which will have to be sterilized over steam for 2-3 minutes. The bottle must be disinfected by dousing it with boiling water several times. Do not use plastic utensils.

Decoding urine analysis according to Zimnitsky

If the biofluid is released in large quantities, the laboratory records hyposthenuria - a condition in which the specific gravity is reduced. For example, when they eat watermelons and melons. The child’s kidneys are weaker, so hyposthenuria is diagnosed when levels are less than 1005-1025 g/l. In sick people, it is often caused by chronic glomerulonephritis, pyelonephritis, nephrosclerosis, and diabetes insipidus.

An increase in the specific gravity of urine - hypersthenuria - is caused by a deficiency of fluids. This happens when a person sweats a lot and the blood thickens. Hypersthenuria in diabetics is explained by high levels of glucose in the urine, and in heart patients - by edema and dropsy. The Zimnitsky test characterizes the patient’s drinking regime. It is important to know this for kidney diseases and urolithiasis.

The volume of daily urine should not exceed 1800-2000 ml, otherwise polyuria is diagnosed. This deviation from the norm is typical for severe kidney damage and diabetes. If the value is less than 1500 ml, oliguria is diagnosed. Pathology develops with renal or heart failure. This is also evidenced by nocturia - the predominance of the volume of urine excreted at night.

An excess of creatinine is characteristic of diabetes, hypothyroidism, acute infections, and a deficiency is characteristic of kidney pathologies and anemia. The amount of urea above normal is observed in hyperthyroidism, pernicious anemia, a diet with a predominance of proteins, and excessive physical activity. In a urine test according to Zimnitsky, all 8 indicators of kidney function should not be the same.

Video

A general urine test sometimes does not show the exact clinical picture of the intended diagnosis. Urinalysis according to Zimnitsky is an additional laboratory examination that allows you to clearly identify disorders in the functioning of the kidneys. You don't know how to prepare for the test and collect fluid? You will need to collect urine throughout the day, even at night, in different jars.

How to collect urine according to Zimnitsky - preparation

Preparation for urine collection is simple:

• Do not change your drinking regime. Drink up to two liters of water a day as usual;
• exclude salty and spicy foods before collecting liquid;
• the day before the test, stop taking diuretics. These medications negatively affect urine characteristics;
• Set an alarm clock and set it every three hours at night. The clock signal will remind you that it is time to urinate. You can use the alarm clock on your mobile phone;
• Prepare a notepad or sheet of paper for notes. Here you will record information about the liquid you drank during the day during the analysis. Record the volume of water that entered the body with soup, compote, etc.

How to collect urine according to Zimnitsky - preparing containers

Prepare 8 jars. Buy a special container for donating urine at a pharmacy. You can also take regular 0.5 liter glass jars. Wash them well and cover with clean lids. Number each container and write on it the time at which you will urinate in that particular jar. Also measure the volume of urine in each container and record it. This is necessary to avoid confusion in the laboratory.

How to collect urine according to Zimnitsky - the collection process

Your actions are as follows:

• at 6-00 in the morning, go to the toilet and urinate in the toilet. Morning urine is not needed for analysis;
• urinate in a jar for the first time in three hours - at 9-00;
• Every three hours after your first trip to the toilet, urinate into a new, labeled container. The last fluid collection ends at 6:00 am the next day;
• place each jar of urine in the refrigerator. Cover tightly.

If there is no urge to urinate at the right time, leave the container empty. If all the urine does not fit into one jar during urination, take an additional container and urinate in it. Do not pour excess urine into the toilet! Liquid collection can be done according to a different scheme - prepare 6 jars and urinate in them every 4 hours, starting from 9-00 in the morning. After your last urination, take all containers filled with urine, along with a record sheet about the liquid you drank during the day, to the laboratory. Also take empty and additional jars to the laboratory assistant, but do not forget to record the time when you did not want to go to the toilet or the volume of urine was large.

Why is urine collection carried out according to Zimnitsky?

The main task of this analysis is to determine the concentration of substances dissolved in urine. Urine may vary throughout the day in color, smell and volume. The laboratory technician measures the density of the liquid, which helps determine the total concentration of substances. Normal density is 1003-1035 g/l. Violation of this indicator may indicate the following diseases:

• renal failure;
• inflammatory processes in the kidneys;
• heart pathologies;
• diabetes mellitus and diabetes insipidus;
• glomerulonephritis;
• blood diseases.