MEDICAL BIOLOGY, HUMAN ANATOMY, PHYSIOLOGY AND PATHOLOGY - Ya.I. Fedonyuk 2010

ANATOMY, PHYSIOLOGY, PATHOLOGY

CHAPTER 8. URINATION PROCESS AND ITS PATHOLOGY

ANATOMY AND PHYSIOLOGY OF THE URINARY ORGANS

PATHOLOGY OF THE KIDNEYS AND URINARY BLADDER

COMPOSITION OF PATHOLOGICAL URINE

2. QUALITATIVE CHANGES IN URINE

During the day, a healthy person excretes about 60 g of solid matter with urine, consisting of organic and inorganic salts. They are dissolved in urine and determine its specific gravity. At different times of the day, it ranges from 1.010 to 1.025 at pH 6-7. An increase in specific gravity to 1.030 or more is called hypersthenuria, a decrease to 1.005 or less is called hyposthenuria, and a monotonous specific gravity is termed isosthenuria. The cause of hypersthenuria (in all urine portions, the specific gravity exceeds 1.025) should be sought outside the Kidneys. These may include Diabetes Mellitus, hyperparathyroidism, or prolonged fluid loss by the body. Hyposthenuria is observed in excessive fluid intake and renal insufficiency. Isosthenuria (the specific gravity of urine is 1.013-1.015) indicates the onset of renal insufficiency, as it demonstrates the kidneys' inability to adapt to varying conditions throughout the day. Hypoisosthenuria (specific gravity 1.002-1.004) is a sign of terminal renal insufficiency.

The normal urine reaction is slightly acidic. The degree of acidity depends on the level of H-ions in it. Normally, urine pH ranges from 5 to 7. A basic (alkaline) urine reaction is observed in inflammatory processes.

Odor. Urine that has stood in the air for some time has the smell of ammonia. In the presence of putrefactive processes and a vesico-intestinal fistula, urine has a fecal odor.

The color of urine (transparency, turbidity) depends on the presence of pus, salts, and Bacteria. Turbidity indicates the presence of pathological elements in the urine.

A red color of urine indicates the presence of Blood (Hematuria). Sometimes urine acquires a red tint due to the intake of certain medications (antipyrine, phenolphthalein, etc.), or a large amount of beets and carrots.

The red color of urine can also be the result of myoglobinuria—the accumulation of a red-brown pigment, which is observed in traumatic toxicosis (Crush syndrome).

When blood impurities are visible to the naked eye, it is referred to as macrohematuria, whereas if blood is detected only under a Microscope, it is called microhematuria (erythrocyturia).

Hemoglobinuria is caused by the presence of free blood pigment Hemoglobin in the urine. As in hematuria, the urine has a red color, but remains transparent.

Proteinuria is an increase in The amount of protein in the urine exceeding 0.033 g/L. In urological diseases, proteinuria is categorized as false, since it results from blood and pus impurities. In case of nephron damage, true proteinuria is observed, which is the result of impaired filtration and reabsorption of Plasma Proteins.

Leukocyturia (the presence of leukocytes in the urine) is a sign of an inflammatory process in the kidneys or Urinary Tract. Isolated leukocytes are also found in the urine of healthy individuals.

Leukocytes capable of Brownian motion in a native smear are called active, while those that have changed their properties due to a decrease in the osmotic density of urine are called Sternheimer-Malbin Cells.

When urine becomes turbid due to A large number of leukocytes, it is referred to as pyuria (pus in the urine).

"Turbidity of urine may be caused by the presence of a large number of bacteria—bacteriuria. To determine The Role of bacteria, they are counted in 1 ml of urine. If more than 10 bacteria are cultured, it is considered true bacteriuria, and if less than this amount, false bacteriuria.

Turbidity of urine is often caused by the presence of dissolved salts in it. A high content of uric acid salts (urates) is called uraturia. A white color of urine is observed at a high concentration of carbonates—carbonaturia.

Urine may have the color and consistency of milk. This phenomenon is called chyluria. It is caused by Lymph impurities.

Urine can be turbid during inflammatory processes in the lower urinary tract due to the presence of fibrin threads or films—fibrinuria.

Pneumaturia is the discharge of air or gas with urine, caused by the accidental penetration of gas into the urinary tract during cystoscopy, ureteral catheterization, or the presence of an external urinary fistula. Gas is formed during the Fermentation and decomposition of urine in the Urinary Bladder, as well as during putrefactive processes caused by The breakdown of a malignant bladder tumor, etc.

The presence of casts in the urine—cylindruria—is a symptom of nephron tubular damage, although a certain number of them are also found in urine in other diseases.

Lipiduria (lipuria) is the appearance of fatty substances in the urine; it is observed in fat embolism of the renal capillaries due to fractures of tubular bones, diabetes mellitus, and Nephrotic Syndrome.

Hydatiduria (echinococcuria) is the appearance of small echinococcal cysts in the urine. They enter the urinary tract from a Kidney affected by echinococcosis.

Enzymuria is characterized by the appearance of Enzymes in the urine.

Spermatorrhea (spermaturia) is the presence of sperm elements in the urinary sediment. It is observed in cases of deformation of the posterior Urethra and the seminal colliculus, as well as atony of the internal genital Organs.