The body’s vital product is urine. Its composition, as well as the quantity, physical and chemical properties, even in a healthy person are unstable and depend on many innocuous causes that are not dangerous and do not cause any ailments. But there are a number of indicators determined by laboratory tests when passing tests that indicate various diseases. The assumption that not everything is in order in the body can be done independently, you just need to pay attention to some characteristics of your urine.
How is urine
The formation and composition of urine in a healthy person depends primarily on the work of the kidneys and stresses (nervous, food, physical and others) that the body receives. Every day, the kidneys pass through themselves up to 1,500 liters of blood. Why so much, because a person has on average only 5 liters? The fact is that this liquid tissue or liquid organ (also called blood) passes through the kidneys about 300 times a day.
With each such passage through the capillaries of the renal corpuscles, it is cleansed of unnecessary waste products, proteins, and other things. How is this done? The aforementioned capillaries have very thin walls. The cells that form them work as a kind of living filter. They trap large particles and allow water, some salts, and amino acids to leak into a special capsule. This fluid is called primary urine. Blood enters the tubules of the kidneys, where some filtered substances are returned to it from the capsules, and the remaining ones are excreted through the ureters and urethra. This is all familiar to us secondary urine. The composition (physico-chemical and biological, as well as pH) is determined in the laboratory, but some preliminary hints can be done at home. To do this, you should carefully study some characteristics of your urine.
Quantitative indicators
Of the one and a half thousand liters of blood passed through, the kidneys are discarded about 180. When re-filtered, this volume decreases to 1.5-2 liters, which is an indicator of the norm, in the amount of which urine should be excreted in a healthy person per day. Its composition and volume may vary, depending on:
- season and weather (in summer and in hot weather the norm is less);
- physical activity;
- age
- the amount of fluid drunk per day (on average, the amount of urine is 80% of the fluids that are ingested);
- some products.
Deviation of the quantitative norm in one direction or another can be a symptom of the following diseases:
- polyuria (more than 2 liters of urine per day) can be a sign of nervous disorders, diabetes, edema, exudates, that is, discharge of fluid into organs;
- oliguria (0.5 l of urine or less) occurs in heart and kidney failure, other kidney diseases, dyspepsia, nephrosclerosis;
- anuria (0.2 L or less) is a symptom of nephritis, meningitis, acute renal failure, tumors, urolithiasis, and urinary tract cramps.
In this case, urination may be too rare or, conversely, frequent, painful, increase at night. All these deviations should be consulted by a doctor.
Color
The composition of human urine is directly related to its color. The latter is determined by special substances, urochromes, secreted by bile pigments. The more of them, the yellower and richer (higher in density) urine. It is considered to be the norm color from straw to yellow. Some products (beets, carrots) and medicines (Amidopyrine, Aspirin, Furadonin and others) change the color of urine to pink or orange, which is also the norm. The figure shows a test for the color of urine.
Existing diseases determine the following color changes:
- red, sometimes in the form of meat slops (glomerulonephritis, porphyria, hemolytic crisis) ;
- darkening of collected urine in air up to black (alkaptonuria);
- dark brown (hepatitis, jaundice);
- gray-white (pyuria, that is, the presence of pus);
- greenish, bluish (rotting in the intestines).
Smell
This parameter can also indicate a changed composition of human urine. So, the presence of diseases can be assumed if the following odors dominate:
- acetone (a symptom of ketonuria);
- feces (E. coli infection);
- ammonia (means cystitis);
- very unpleasant, fetid (in the urinary tract there is a fistula in the purulent cavity);
- cabbage, hops (the presence of methionine malabsorption);
- sweat (glutaric or isovalerian acidemia);
- decaying fish (trimethylaminuria disease);
- "Mouse" (phenylketonuria).
Normally, urine does not have a pungent odor and is transparent. Also at home, you can examine urine for foaminess. To do this, it must be collected in a container and shaken. The appearance of abundant, non-settling foam for a long time means the presence of protein in it. Further, more detailed analyzes should be carried out by specialists.
Turbidity, Density, Acidity
In the laboratory, urine is examined for color and smell. Attention is also drawn to its transparency. If the patient has turbid urine, the composition may include bacteria, salts, mucus, fats, cellular elements, red blood cells.
The density of human urine should be in the range of 1010-1024 g / liter. If it is higher, this indicates dehydration; if lower, it indicates acute renal failure.
Acidity (pH) should be in the range of 5 to 7. This indicator can vary depending on the person’s food and medicine. If these reasons are excluded, a pH below 5 (acidic urine) may indicate that the patient has ketoacidosis, hypokalemia, diarrhea, and lactic acidosis. At a pH above 7, the patient may have pyelonephritis, cystitis, hyperkalemia, chronic renal failure, hyperthyroidism and some other diseases.
Protein in the urine
The most undesirable substance that affects the composition and properties of urine is protein. Normally, it should be in an adult up to 0.033 g / liter, that is 33 mg per liter. In infants, this indicator can be 30-50 mg / l. In pregnant women, protein in the urine almost always means some complications. It was previously believed that the presence of this component in the range from 30 to 300 mg means microalbuminuria, and above 300 mg - macroalbuminuria (kidney damage). Now they determine the presence of protein in daily urine, and not in a single one, and its amount up to 300 mg in pregnant women is not considered a pathology.
Protein in human urine can temporarily (one-time) increase for the following reasons:
- postural (body position in space);
- physical exercises;
- febrile (fever and other febrile conditions);
- for obscure reasons in healthy people.
Protein in urine is called proteinuria in repeated tests. It happens:
- mild (protein from 150 to 500 mg / day.) - these are symptoms that occur with nephritis, obstructive uropathy, acute post-streptococcal and chronic glomerulonephritis, tubulopathy;
- moderate (from 500 to 2000 mg / day. protein in the urine) - these are symptoms of acute post-streptococcal glomerulonephritis; hereditary nephritis and chronic glomerulonephritis;
- pronounced (more than 2000 mg / day. protein in the urine), indicating that the patient has amyloidosis, nephrotic syndrome.
Red blood cells and white blood cells
Secondary urine may include so-called organized (organic) sediment. It includes the presence of red blood cells, white blood cells, particles of a squamous, cylindrical, or cubic cell epithelium. Each of them has its own norms.
1. Red blood cells. Normally, men do not have them, and women contain 1-3 in the sample. A small excess is called microhematuria, and a significant excess is called macrohematuria. This is a symptom:
- kidney disease
- bladder pathology;
- discharge of blood into the genitourinary system.
2. White blood cells. The norm in women is up to 10, in men - up to 7 in the sample. Excess amounts are called leukoceturia. It always indicates the current inflammatory process (a disease of an organ). Moreover, if the white blood cells in the sample are 60 or more, the urine acquires a yellow-green color, a putrefactive odor and becomes cloudy. Having discovered white blood cells, the laboratory assistant determines their nature. If it is bacterial, then the patient has an infectious disease, and if not bacterial, the cause of leukoceturia is in problems with the kidney tissue.
3. squamous cells. Normally, men and women either do not have them, or there are 1-3 in the sample. Excess speaks of cystitis, drug or dysmetabolic nephropathy.
4. Epithelial particles are cylindrical or cubic. Normally absent. Excessive evidence of inflammatory diseases (cystitis, urethritis and others).
Salt
In addition to organized, the composition of the urine analysis determines the unorganized (inorganic) sediment. Various salts leave it, which normally should not be. At pH less than 5, salts may be as follows.
- Urate (causes - malnutrition, gout). They look like a dense brick-pink sediment.
- Oxalates (products with oxalic acid or diseases - diabetes, pyelonephritis, colitis, inflammation in the peritoneum). These salts are not colored; they look like octagons.
- Uric acid. This indicator is considered normal at values from 3 to 9 mmol / l. Excess indicates kidney failure and gastrointestinal problems. It can also be exceeded under stress. Uric acid crystals are diverse in form. In sediment, they acquire the color of golden sand.
- Sulphate of lime. Rarely precipitated white precipitate.
At pH above 7, salts are as follows:
- phosphates (the cause is products containing a lot of calcium, phosphorus, vitamin D, or diseases - cystitis, hyperparathyroidism, fever, vomiting, Fanconi syndrome); the precipitate of these salts in the urine is white;
- tripelfosphates (the same reasons as with phosphates);
- ammonium urate.
The presence of a large amount of salts leads to the formation of kidney stones.
Cylinders
Changes in the composition of urine are significantly affected by diseases associated with the kidneys. Then, cylindrical bodies are observed in the collected samples. They are formed by coagulated protein, epithelial cells from the renal tubules, blood cells and others. This phenomenon is called celindruria. The following cylinders are distinguished.
- Hyaline (coagulated protein molecules or Tamm-Horsfall mucoproteins). Normally 1-2 per sample. Excess occurs with large physical exertion, fever, nephrotic syndrome, kidney problems.
- Granular (glued destroyed cells from the walls of the renal tubules). The reason is severe lesions of these renal structures.
- Wax (curled protein). Appear with nephrotic syndrome and with the destruction of the epithelium in the tubules.
- Epithelial. Their presence in the urine indicates pathological changes in the tubules of the kidneys.
- Red blood cells (these are red blood cells clinging to hyaline cylinders). Appear with hematuria.
- White blood cells (these are stratified or blotted white blood cells). Often found together with pus and protein fibrin.
Sugar
The chemical composition of urine also indicates the presence of sugar (glucose). Normally he is not. To obtain the correct data, only daily fees are examined, starting with the second deurination (urination). Detection of sugar up to 2.8-3 mmol / day. not considered a pathology. Excess may be caused by:
- diabetes mellitus;
- endocrinological diseases of nature;
- problems with the pancreas and liver;
- kidney disease.
During pregnancy, the sugar norm in urine is slightly higher and equal to 6 mmol / day. If glucose is detected in the urine, a blood test for sugar is also mandatory.
Bilirubin and urobilinogen
Bilirubin is not part of normal urine. Rather, it is not found due to scanty amounts. Detection indicates such diseases:
- hepatitis;
- jaundice;
- cirrhosis of the liver;
- gall bladder problems.
Urine with bilirubin has an intense color, from dark yellow to brown, and when shaken, a yellowish foam is obtained.
Urobilinogen, a derivative of conjugated bilirubin, is always present in the urine as urobilin (yellow pigment). The norm in the urine of men is 0.3-2.1 units. Erlich, and women 0.1 - 1.1 units. Ehrlich (Ehrlich's unit is 1 mg of urobilinogen per 1 deciliter of a urine sample). An amount below the norm is a sign of jaundice or is caused by a side effect of certain medications. Exceeding the norm means liver problems or hemolytic anemia.