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Urine test mind map
This is a mind map about urine tests, including urine physical tests, urine odor, urine color and transparency, urine density, etc. I hope it will be helpful to you!
Edited at 2023-11-03 22:03:15
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Urine test mind map
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- Outline
Urine test
urinalysis test
Urine volume: Generally refers to the total volume of urine excreted from the body within 24 hours (changes in urine volume mainly depend on the glomerular filtration rate, renal tubular reabsorption, and concentration and dilution functions)
Reference interval: Adults: 1~2L/24h, approximately 1mL/(h.kg); Children: The urine output calculated per kilogram of body weight is 3 to 4 times that of adults.
clinical significance
Polyuria: When the urine output in 24 hours in adults is greater than 2.5L, and in children, the urine output in 24 hours is greater than 3L, it is called polyuria.
Physiological polyuria: polyuria caused by physiological or exogenous factors due to normal kidney function. (Can be seen in: drinking too much water; less sweating in cold weather; mental stress; too much intravenous fluid infusion; application of caffeine, dehydrating agents, diuretics, etc.)
Pathological polyuria: often caused by decreased glomerular reabsorption and concentrating functions.
Oliguria: Adult urine output in 24 hours is less than 0.4L or hourly urine output is continuously less than 17mL (less than 0.8mL/kg in children) is called oliguria.
Physiological oliguria: seen when the body is dehydrated or sweats excessively.
Pathology Oliguria:
Anuria: In adults, the urine output in 24 hours is less than 0.1L or there is no urine excretion within 12 hours; in children, the urine output in 24 hours is less than 50 mL, which is called anuria, and further development to the inability to discharge urine is called anuria. (Acute renal tubular necrosis caused by nephrotoxic substances such as mercury, carbon tetrachloride, diethylene glycol and other nephrotoxic substances can often suddenly cause oliguria and anuria.)
Urine smell
Reference interval: Fresh urine has a faint aromatic odor.
Clinical significance: The smell of fresh urine in healthy people is composed of esters produced by the kidneys and volatile acids contained in urine, and is significantly affected by food or drugs.
Abnormal odor in fresh urine and its causes
Ammonia smell - chronic cystitis, chronic urinary retention
Putrid smell - urinary tract infection, advanced bladder cancer
Rotten apple smell - diabetic ketoacidosis
Garlic smell - organophosphorus pesticide poisoning
Rat odor - phenylketonuria
Sweet maple syrup smell - maple syrup urine disease
Urine color and clarity
Normal fresh urine: mostly light yellow to yellow, clear and transparent.
Urine transparency is divided into
Clear and transparent - no particulate matter visible to the naked eye
Slightly turbid (foggy) - there is a small amount of visible particulate matter, but the words on the newspaper can be read clearly through the urine
Turbidity (cloudy) - there are visible particulate matter, and the words on the newspaper are blurred through the urine
Noticeable turbidity - you cannot see the words on the newspaper through the urine
clinical significance
Physiological changes
1) The color of urine is related to the amount of urine volume: if the urine volume is large, the urine color will be light; if the urine volume is small, the urine color will be darker.
2) Urine color is related to food: For example, eating a large amount of carrots, papaya, etc. can make the urine dark yellow, and eating a large amount of aloe vera can make the urine red.
3) Menstrual blood pollution can make female urine appear light red or red.
4) The effects of various drugs on urine color.
Pathological changes
red
1) Hematuria: When the urine contains a certain amount of red blood cells, it is called hematuria.
Due to the different blood content in urine, it can appear light red, blood red, or like meat washing water;
If the blood content per liter of urine exceeds 1 mL, the urine will appear light red or red, which is called gross hematuria;
If there is no obvious change in the appearance of the urine, and the average number of red blood cells per high-power field of view during centrifugal urine sediment microscopy is no less than 3 red blood cells, it is called microscopic hematuria.
After excluding the contamination of women’s menstrual blood, the causes of hematuria are found in:
① Urinary system diseases, such as renal tuberculosis, renal or urethral stones, congenital malformations, renal tumors, etc.
② Reproductive system diseases, such as prostatitis, fallopian tube inflammation, cervical cancer, etc.
③Bleeding diseases, such as hemophilia, etc.
④The influence of drugs. For example, taking anti-tuberculosis drugs rifamycins can cause urine to turn brick red, which should be distinguished from naked hematuria.
⑤Others, such as cardiovascular disease; strenuous exercise in healthy people can occasionally cause transient hematuria.
2) Hemoglobinuria: urine is dark red, brownish red or even soy sauce color
Reason: During intravascular hemolysis, broken red blood cells release hemoglobin, which exceeds the binding capacity of globin, resulting in an increase in plasma free hemoglobin. And because the relative molecular weight of hemoglobin is small, it can be filtered into the original urine through the glomerulus and exceed the renal tubule. The reabsorption threshold causes hemoglobinuria.
Found in: favismosis, paroxysmal nocturnal hemoglobinuria, paroxysmal cold hemoglobinuria, immune hemolytic anemia, etc.
3) Myoglobinuria: urine is pink or dark red
Reason: Due to muscle cell damage and rupture, myoglobin is released. Its relative molecular mass is only 17,000, and it is easily filtered from the glomerulus, causing myoglobinuria.
Seen in: extensive damage and degeneration of muscle tissue, such as acute myocardial infarction, large area burns, trauma, etc. (Occasionally seen in healthy people after strenuous exercise)
4) Porphyria: urine is red wine color
Seen in: Congenital abnormalities of porphyrin metabolism. (It is also found in drugs, food, etc. that can also make urine appear red) Porphyrins, drugs, food, etc. cause urine to appear red, which is called pseudohematuria.
Identification of red urine caused by different reasons:
dark yellow
It is most common in bilirubinuria, which is urine containing a large amount of conjugated bilirubin. The foam in the urine also turns yellow after shaking. (This point can be distinguished from drug-induced dark yellow urine. The foam of drug-induced dark yellow urine turns milky white after shaking, and the qualitative test of bilirubin is negative)
Bilirubinuria is common in obstructive jaundice and hepatocellular jaundice. (After prolonged exposure, bilirubin in urine is oxidized to biliverdin, making urine brown-green)
White
1) Chyluria and fatty urine
Chyluria: Due to the rupture of lymphatic vessels in the urinary system or the obstruction of deep lymphatic vessels, lymph fluid enters the urine, resulting in milky white and turbid urine.
Lipouria: Fat droplets in the urine. (Fat droplets appear in blood and urine due to damage to lipid cells)
Chyluria: Found in filariasis, but also in abdominal lymphatic tuberculosis, tumor compression of the thoracic duct and abdominal lymphatic vessels, nephrotic syndrome, renal tubular degeneration, thoracoabdominal trauma, or other reasons causing obstruction of lymphatic circulation around the kidneys. Faturia: Found in adipose tissue extrusion injury, fractures, nephrotic syndrome, renal tubular degeneration and necrosis, etc.
2) Pyuria and bacteriuria
Commonly seen in purulent infections of the genitourinary system, prostatitis, seminal vesiculitis, etc.
The appearance of pyuria is yellow-white or white turbidity, which is caused by the urine containing a large number of pus cells and inflammatory exudates.
Pus cells and inflammatory exudates in pyuria can sink and form a white cloud-like precipitate after standing. Bacteriuria contains There are a lot of bacteria, it is cloudy and turbid, and it does not sink after standing.
3) Crystalluria
Yellowish-white, off-white or light pink turbid
Reason: Mainly because the urine contains a high concentration of salts, the urine is transparent when it is first excreted from the body. When the external environment drops, the solubility of the salts decreases, and the salt crystals precipitate quickly, making the urine turbid. (If the patient excretes salt crystals in urine for a long time, it may easily lead to infection or stone formation)
In inflammatory diseases, the three-cup urine test can be used to initially understand the site of inflammation and assist in clinical differential diagnosis.
Dark brown: Common in severe hematuria and denatured hemoglobinuria, it can also be seen in tyrosinosis, phenol poisoning, alkuric acidemia, or melanoma.
Blue color: Mainly seen in diaper cyanide syndrome, often caused by too much urinary blue derivative blue in urine. (It can also be seen in some gastrointestinal diseases caused by excessive green urine and green production, as well as the influence of certain drugs or foods)
Light green: Commonly seen in Pseudomonas aeruginosa infection, increased biliverdin in urine, and after taking certain drugs, such as indomethacin, methylene blue, amitriptyline, etc.
Nearly colorless: common in diseases with increased urine output such as diabetes insipidus and diabetes.
Dense urine
Refers to the weight ratio of urine to the same volume of pure water at 4°C (commonly known as specific gravity). (Because urine contains 3% to 5% solid matter, the specific density of urine is often greater than that of pure water.)
reference interval
Adult: random urine 1.003-1.030, morning urine >1.020
Newborn: 1.002-1.004
Clinical significance: It can roughly reflect the concentrating and diluting functions of renal tubules
High specific density of urine: Morning urine density is generally higher than 1.025. (Generally, the morning urine density ratio is 1.025 Above, when there is no sugar and protein in the urine, it means that the kidney function is sound. )
Pathological high specific density of urine is seen in: ① Reduced urine output and increased specific density of urine: seen in acute nephritis, liver disease, heart failure, shock, high fever, dehydration or excessive perspiration, etc. ② Increased urine output and increased urine specific density: common in diabetes and the use of radiographic contrast agents.
Low specific density urine (hypotonic urine, refers to morning urine density consistently lower than 1.015)
If the specific density of urine is fixed at 1.010±0.003 (close to the specific density of glomerular filtrate), it is called isotonic urine, indicating that the concentrating and diluting functions of the kidneys are seriously damaged.
Low specific density urine is seen in the polyuria phase of acute renal failure, chronic renal failure, tubulointerstitial disease and acute tubular necrosis.
Diabetes insipidus often presents with severe low specific density (SG <1.003)
The determination of urinary density is helpful in the identification of diabetes with polyuria (high density of urine) and diabetes insipidus with polyuria.
drug effects
Drugs that can increase urine density include dextran, contrast media, sucrose, etc.
Drugs that can reduce urinary density include aminoglycosides, lithium, methoxyflurane, etc.
Urine osmosis volume: Urine osmosis volume refers to the total number of all solute particles (molecules or ions, etc.) with osmotic activity in urine.
Urine osmosis accurately reflects the concentration and dilution functions of the kidneys and is a better indicator for evaluating the concentration function of the kidneys.
Reference interval: 600～1000 mOsm/(kg.H2O). The maximum range within 24 hours is 40~1400 m0sm/(kg.H2O).
clinical significance
Determine the concentrating and diluting functions of the kidneys
Differentiating renal and prerenal oliguria
Methodological evaluation: Both urine specific density and urine osmosis volume can reflect the content of solutes in urine. 1) Urine specific density measurement is simpler and cheaper than urine osmosis measurement, but urine specific density measurement is easily affected by the properties of the solute; while urine osmosis volume is not affected by macromolecules in the specimen and is only related to the number of solute particles. It is better than urine density in evaluating the concentration and dilution functions of the kidneys. 2) Urine leakage detection has complicated steps and is not as simple, fast and economical as urinary specific density. Its current clinical application is not as extensive as urinary specific density.