Peeing is not simple, urine test is not simple!

preface

Peeing is something we have to do every day, who doesn't, what's there to talk about? As everyone knows, peeing is a seemingly ordinary little thing, and the learning is great!

Urine, human urine, is the result of the body's metabolism, the production of urine depends on the filtration of the glomeruli and the reabsorption and secretion function of the renal tubules and collection ducts. Abnormalities such as the color, smell, and density of urine can indicate the health of the body.

Urine hides a lot of codes that are closely related to human health, today the author will talk about urination for everyone first, and then solve the health "code" of urinary routines.

symptoms

Normal people in good health, urination is a smooth thing, but some people pee is not so smooth, there will be urinary frequency, urgency, pain, urinary incontinence, urinary weakness, urinary retention, bifurcation and many other symptoms, these symptoms can correspond to different urinary system diseases.

1. Urinary frequency, urgency, painful urinary and impure urination:

Basically, urinary inflammation caused by bacterial infections, unclean sex and low water intake are the main causes of infection. Women with short urethra are more likely to have urinary tract infections, which are relatively rare in men, but once they occur, they often indicate serious diseases such as abnormal bladder emptying or urinary tract obstruction.

2. Urinary incontinence:

More common in middle-aged and elderly women, the cause of urinary incontinence is closely related to people's lifestyles. Obesity, pregnancy, cough from lung disease are all important factors contributing to urinary incontinence. Improving lifestyle, weight control, avoiding triggers that can lead to increased abdominal pressure, developing normal bowel habits, improving constipation, and avoiding long-term chronic cough are all effective measures to prevent urinary incontinence.

3. Urinary weakness, urinary retention, urine bifurcation:

These symptoms are more common in male patients, many men have such an experience, when young urine is high, urine is far, very cattle X, but after middle age found that the range of urine becomes shorter, and many elderly people simply can not urinate out, urinary weakness, and even urinary retention, which is mostly a prostate problem, may be prostatitis or prostate hypertrophy.

About urine

In addition to these abnormal urination functions, the most common thing in urination is the change in the color, trait, smell, etc. of urine.

Some people's urine will bubble a lot, in this case, first consider whether you have recently eaten more meat, ingest too much protein, is one of the common causes of urine foaming, of course, if the foaming continues, to consider kidney disease.

The smell of urine can also be abnormal. The normal smell of urine is a faint slightly pungent smell of ammonia.

If the ammonia smell is strong and pungent, it means that the urine has been decomposed in the body, which may be a manifestation of cystitis or urinary retention; the urine of diabetics will have a faint honey sweetness, and the urine of patients with diabetic ketoacidosis will have a rotten apple smell; fresh urine, that is, a putrefactive odor is commonly found in urinary tract bacterial infections; of course, when eating garlic, green onions or drugs with special odors, the urine can have the special smell of these substances.

It should be noted that fresh urine should be used to identify the odor of urine. After the urine is left for too long, due to the multiplication of bacteria, the urea is decomposed and produces an ammonia smell, which will affect the observation effect.

The color and traits of the urine have changed, and the first thing we think of is to do a urine routine. Here we will focus on the most common laboratory test in the clinic.

Urine routine test

The general urine routine test includes the color, transparency, specific gravity, urine pH, leukocytes in the urine, nitrite, protein, glucose, urine ketone body, urine biliaryogen, urine heme and so on.

1、Color:

The color of normal people's urine is pale yellow, and it can also change slightly with changes in water intake, activity, and diet. Common abnormal urine colors are as follows:

Dark brown urine: positive for bilirubin, more common in hepatocellular jaundice, obstructive jaundice, etc.

Red urine: hematuria, which can be seen in urinary stones, tumors, infections (including tuberculosis), glomerulonephritis, etc. Some drugs can also cause red urine, such as aminopyrine, phenytoin, rifampicin, metronidazole, etc., so the effects of these drugs must be ruled out first when hematuria is found.

Soy sauce color urine: hemoglobinuria, seen in fava bean disease, etc.

Milky white urine, chylouria, and pyogenia: common in filariasis, or urine containing large amounts of inorganic salt crystals.

2. Transparency

Normal fresh urine, most of which is clear and transparent, except for too long and women's urine can be slightly cloudy, urine turbidity is more common in urate crystals, chylouria, pusuria, hematuria.

3. pH value

The normal range is 4.6-8.0. The pH of urine depends largely on the type of diet, medications taken, and type of disease. Low levels are seen in diabetic acidosis, starvation, severe diarrhea, respiratory acidosis, fever, etc. High altitude is more common in severe vomiting, persistent hyperventilation, urinary tract infections, etc.

4. Specific gravity

Normal range 1.005-1.030. The specific gravity of urine is affected by age, water intake and sweating, and the proportion of urine in infants and young children is low. The specific gravity of urine depends mainly on the concentration function of the kidneys, so it can be used as one of the kidney function tests.

Increased specific gravity: acute nephritis, hyperthermia, cardiac insufficiency when urinary is low; diabetes mellitus when urination is increased; decreased specific gravity: seen in chronic glomerulonephritis, renal insufficiency, diabetes insipidus, and heavy drinking.

5. White blood cells

Normal urinary microscopy does not exceed 5 leukocytes, and the possibility of urinary tract infection should be considered if a large number occurs.

However, it should be noted that there are many factors affecting urine leukocytes, crystallization, small round epithelial cells, yeast, trichomoniasis and other components will lead to increased white blood cells, resulting in false positives; jaundice urine, urine placement time is too long will lead to a decrease in white blood cells, resulting in false negatives.

Therefore, urinary tract infection cannot be judged solely from positive urine leukocytes, and should be judged in conjunction with the following nitrite results.

6. Nitrite

Urinary nitrite is normally negative. Positive urinary nitrite results are common in: pyelonephritis caused by Enterobacteriaceae such as Escherichia coli and symptomatic urinary tract infections, cystitis, and bacteria.

A positive urinary nitrite specificity of up to 80% is of high value for assisting in the diagnosis of urinary tract infections, and a positive nitrite can be preliminarily judged as a urinary tract infection.

If urinary tract infection bacteria (e.g., positive bacteria) do not reduce nitrate to nitrite, or if the urine remains in the bladder for a short time, or if there is a lack of nitrate in the urine, it can also produce negative results, which should be noted.

7. Red blood cells

Normal urine will occasionally show red blood cells, but no more than 3. If there are more red blood cells, it may be red blood cells excreted by bleeding from the kidneys and urinary tract, and it is also considered that blood circulation disorders are caused.

Sometimes there may be a positive urine occult blood and negative urine red blood cells, which are caused by the influence of erythrocytes in the urine due to factors such as osmolality in the urine and finally rupture.

If the patient develops hematuria, another urine red blood cell morphology test is important for determining the source of hematuria. At the same time, combined with the patient's clinical manifestations, urine protein status and imaging test results, it is helpful to comprehensively analyze and judge.

8. Urine protein

Normal people occasionally have small amounts of protein in their urine, including albumin, globulin, and some other small molecular weight proteins secreted by the renal tubules. Urine protein is negative on a normal urine routine, with less than 150 mg of protein in the urine at 24 hours, of which albumin does not exceed 30 mg.

There are many causes of proteinuria, and to diagnose pathological proteinuria, the following factors need to be excluded:

(1) Functional proteinuria: nervousness, strenuous exercise, low temperature stimulation, mostly seen in adolescents.

(2) Orthostatic proteinuria: negative when lying down, standing for too long is positive, more common in adolescents.

(3) Accidental proteinuria: urine mixed with genital system excrement, can appear false positive of urine protein. When a patient has injected a large amount of penicillin, the opposite can lead to a false negative of urine protein.

Urine protein test is an important indication for patients with kidney disease, such as determining that the patient's urine protein is positive and clinically diagnostic, and further 24-hour quantitative urine protein testing can be done.

9. Urine ketones

The qualitative test of the normal human urine ketone body is negative. In starvation, impaired glucose metabolism caused by various reasons, increased lipid breakdown, and diabetic ketoacidosis, ketoemia can occur because the rate of ketone production is greater than the rate of tissue utilization, followed by ketouria.

Urine ketones are positive and are often associated with diabetes, pregnancy, malnutrition, and chronic diseases such as diabetic ketoacidosis. It may also be caused by severe diarrhea, vomiting, starvation, chloroform, ether anesthesia, phosphorus poisoning, and taking biguanide hypoglycemic drugs.

10. Urinary three gallbladders

Urine bilirubin, urine biliaryogen, and urocholin are mainly used as differential diagnosis of jaundice disease, and their results need to be considered in combination with blood bilirubin metabolism indicators and other auxiliary tests.

11. Casturia

There are no casts in normal urine, or occasionally a few transparent casts. The appearance of casts in the urine, especially granular casts and cell casts, are all markers of renal parenchymal lesions and are of great significance for diagnosis.

(1) Transparent cast: when there are mild or temporary functional changes in the kidneys, such as strenuous exercise, high fever and cardiac insufficiency, a small amount of transparent casts can be seen in the urine; when there are substantial lesions in the kidneys, a large amount of transparent casts can be seen.

(2) Red blood cell cast: seen in acute glomerulonephritis, acute tubular necrosis, renal hemorrhage and acute rejection of kidney transplantation.

(3) White blood cell cast: seen in kidney purulent inflammation, such as acute pyelonephritis, interstitial nephritis, etc.

(4) Granular cast type: seen in renal organic lesions, such as chronic nephritis, tubular damage caused by drug poisoning.

(5) Waxy cast: seen in severe glomerulonephritis, chronic nephritis in advanced stages, its appearance suggests that the kidney has long-term and serious lesions.

(6) Fat cast type: it is the product of steatosis of renal epithelial cells, which is found in chronic nephritis and liponephroid nephropathy.

epilogue

Peeing those things are not simple, urine test is not simple, it seems to be a simple and easy test, but it provides us with so much information, it is worth us to use this test well to better serve the health of the public.

Source: Voices of Medicine

Edited by: Ran Reviewer: Rose