There is a large number of innovative technologies that are actively used in the diagnosis of diseases. However, one should not forget about the simple methods of laboratory research, without which no doctor can do. These include various research methods using human biological material, for example, urine. What are urine tests? They are classified as specific and non-specific.
The first methods of urine analysis are used to detect specific substances, for example, narcotics. The second ones reveal general disorders of the body in various pathological conditions.
The group of non-specific analyzes includes:
General urine analysis is a basic analysis and is prescribed not only for diseases of the urinary system, but also to assess the general condition of the patient and the dynamics of the treatment.
Determines color, density, transparency, pH, content of protein, glucose, blood corpuscles, salts. In addition, the presence of mucus, bacteria, sediment. Results will be reliable if you follow these guidelines:
- Collect urine in the morning. Before this, it is necessary to carry out hygienic processing of the external genital organs. The container used must be clean and dry. Dedicated containers are best, as residual detergent on the dishes can distort the results.
- You need to collect an average portion of urine in the amount of 30-50 ml.
- The material must be delivered within 2 hours after collecting the analysis.
- The day before, you should not eat foods that stain urine, for example, beets, as well as drugs (warfarin, etc.).
- Do not collect during the menstrual cycle.
Any deviations from the norm are of high diagnostic value. For example, glucose content. Normally, the level of glucose in the urine is so low that it cannot be detected. However, with physical activity, eating food rich in carbohydrates, a physiological increase in glucose is revealed. The threshold level in a single volume is 0,8 mmol/l. With its increase, glucosuria is diagnosed, which occurs in diabetes mellitus, renal failure, endocrine diseases – Itsenko-Cushing’s disease.
Analyzes assessing the state of certain functional indicators of the kidneys
Analysis of urine according to Zimnitsky reflects the ability of the kidneys to concentrate. For this purpose, the relative density of urine is calculated.
Methodology: Every three hours, urine is collected, and the very first portion is not used. The result is 8 cans, each of which is numbered. If for some period there was no urge to urinate, then the jar remains empty.
Next, the volume and relative density of each portion is determined, the daily diuresis is compared with the amount of fluid drunk and the volume of daytime and nighttime diuresis is calculated (cans collected before 18.00 refer to daytime diuresis, and after 18.00 – to nighttime). Normally, daytime diuresis prevails, and volume fluctuations are on average 50-250 ml, the relative density amplitude is 0,012-0,016.
With a number of chronic conquests (glomerulonephritis, nephritis, etc.), this indicator decreases. An increase in this indicator is typical for diabetes mellitus, increasing edema.
Urine analysis according to Nechiporenko. The method calculates the number of leukocytes, erythrocytes, as well as the number of cylinders. A medium portion of urine is used, from which 1 ml is taken. After centrifugation, the number of cells is counted.
The main indications for the purpose of this analysis is the diagnosis of inflammatory diseases of the urinary system, hematuria (as a result of damage to the ureteral mucosa, for example). Normally, the number of erythrocytes should not exceed 1000 (if the indicator is higher, then this condition is called hematuria), and 2000 leukocytes in 1 ml of urine (leukocyturia). The number of cylinders must not exceed 20 (cylinders). Leukocyturia indicates inflammatory diseases such as cystitis or pyelonephritis. Hematuria is characteristic of nephrotic syndrome or heart attack. An increase in the number of cylinders may indicate the presence of pyelonephritis or hypertension.
The analysis of urine according to Addis-Kakovsky calculates the indicators as in the analysis according to Nechiporenko, only in this method the daily volume of urine is used. And accordingly, the normative indicators will be multiplied by 1000. For example, if according to Nechiporenko leukocytes should not exceed 2000, then according to Addisukhovsku – 2.
Microbiological examination of urine reveals microflora, as well as its sensitivity to antibiotics. Periodic monitoring of the results allows you to assess the effectiveness of therapy. An average portion of morning urine is collected in a volume of up to 20 ml. Collection containers must be sterile and tightly closed. Further, the isolation and determination of the pathogen in the urine is performed. To do this, use universal media such as blood agar.
There are three degrees of pathogenicity of cultures:
- Primary – capable of independently causing damage to the organs of the urinary system. It can be saprophytic staphylococcus or E. coli, enterococcus faecalis.
- Secondary – infect organs against the background of an existing infection. More often it is Staphylococcus aureus, representatives of the genus Enterobacter, Klebsiella, etc.
- Doubtful cause damage rarely. For example, representatives of the genus Pseudomonas.
Bacteriuria is the presence of bacteria in the urine. It is considered reliable if the number of bacteria exceeds 100 thousand in 1 ml of urine. If bacteria are detected, and especially, with a significant number, it is necessary to conduct a study to identify sensitivity to antibiotics. For this, inoculation is carried out on culture media with antibiotics. Sensitivity is confirmed if the growth of the colony on this medium stops.
Methods using microscopy
Urine cytological examination is performed to detect atypical cells. Urine is used after morning urination, as long-term presence of urine in the bladder during sleep leads to changes in cells, their destruction. If the histologist detects atypical cells, then this is an indication for cystoscopy, while the bladder and urethra are examined. Cytology is mainly used for the differential diagnosis of tumor diseases.
At the moment, there are express methods that can detect drugs in urine.
One of them is immunochromatographic analysis (ICA) – based on the reaction of an antigen with an antibody. A positive reaction is the staining of two stripes. This method is very easy to implement. It allows you to quickly get the result, it is most often used in forensic science when it is necessary to analyze a large amount of material. Identifies 14 types of drugs.
The chemical-toxic method is carried out for the same purpose, but it is longer (up to 4 days), since it allows detecting all narcotic and psychotropic substances.
The variety of types of urine analysis, as well as the simplicity and cost-effectiveness of methods, explain their mandatory inclusion in the practice of a doctor of any specialty. Since laboratory tests of urine include a large number of indicators, this allows you to choose a further direction in the differential diagnosis of diseases and in the conclusion of the diagnosis.
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