Isolated urinary syndrome. Characteristic signs of urinary syndrome and treatment recommendations

In the global understanding, changes in urine characteristic of certain pathologies are called “urinary syndrome.” Moreover, this term denotes both a violation of urination and the manifestation of qualitative and quantitative changes in urine analysis.

But in a narrower sense, urinary syndrome refers to the manifestation of urinary syndrome in the urine - the appearance of protein in the urine (proteinuria), the appearance of blood in the urine (hematuria), the appearance of leukocytes in the urine (leukocyturia), and the manifestation in the urine of special casts, bacteria and manifestations of pathological salt sediment. If urination is impaired, changes in urine volume, rhythm or frequency of urination, as well as dysuria, may be detected.

Urine volume abnormalities

Daily urine volumes healthy babies may vary depending on age, diet, salt intake, volume of fluid drunk, physical activity, body temperature and environment, as well as air humidity or dryness. In addition, the rhythms of urination may depend on the time of day - the maximum urine is released in the daytime from 15 to 19 hours, the least urine is released at night from three in the morning to six in the morning. On average, the ratio of daytime to nighttime urine volume is approximately three to one. If babies are premature and are on artificial nutrition, their urine volumes may be slightly larger than that of full-term infants. Among the pathologies, several typical disorders can be identified that require detailed discussion.

Nocturia, or the predominance of the volume of nighttime diuresis over the daytime, can form in many of the pathological conditions and diseases of the urinary system; this is one of the manifestations of tubular abnormalities (defects in the renal tubes). Often, such changes occur during the development of acute or exacerbation of chronic pyelonephritis (inflammation renal pelvis), may occur as a result of eliminating edema, especially if it is nephrotic syndrome, which is treated with glucocorticoids. There may also be a persistent and long-term predominance of nocturnal diuresis over daytime diuresis, which can occur with progressive damage to the collecting ducts of the kidney, which as a result progress to the development of chronic kidney failure.

A decrease in daily urine volume, or oliguria, is a state of reduction in daily urine output by less than a quarter or a third of age-related norms. A physiological decrease in the volume of urine can be observed in children aged two to three days, when the mother begins lactation and the child loses a large amount of moisture from the surface of the skin. The manifestation of oliguria may be one of the most important symptoms acute renal failure or at the final stage of development of chronic renal failure, this is observed with congenital pathology, hereditary pathology or with severe acquired kidney pathologies.

Polyuria- this is a sharp increase in the amount of urine excreted per day, which exceeds the daily norm by two times or more, amounting to more than one and a half liters of liquid for every square meter of body area. The increase in urine volume may be due to increased water or salt diuresis, that is, excess fluid in the body or excess salts. With polyuria, there may be a parallel condition of pollakiuria - frequent urination. But this symptom can also be a manifestation of hypothermia, cystitis, neurotic disorders, in this case, a lot of urine or just a little drops of urine may be released, there may be pain, burning, and a false urge to urinate. There may also be frequent attacks of urination when the urethra is irritated by salts dissolved in the urine or by inflammatory processes.

A separate variant of frequent urination is dysuria - frequent and very painful urination - it can occur during an acute inflammatory process in the lower urinary tract (urethritis and cystitis), as well as in the external genital area with balanoposthitis (inflammation of the foreskin) or vulvitis (inflammation of the genitalia). girl's organs). In addition, pain can occur as a result of blood clots or large salt crystals passing through the urinary tract.

Changes in general urine analysis

Changes in urine tests are one of the most important signs of kidney pathology, and therefore, based on the results of urine tests, a preliminary diagnosis can be made, which is then only confirmed by additional studies. Changes in urinalysis may include changes in color and clarity, urine reaction and density, and glucose and protein levels, and microscopy examination of urine sediment is also used.

A general urine test is usually recommended to be carried out immediately after the child urinates, this will be the ideal test to strive for. But it is necessary to take into account the possibility of taking the analysis within two hours from the moment the analysis is collected. In the future, the information content of urine analysis becomes less indicative.

Changes in urine color and clarity

The color of normal urine can be from light yellow to amber; it is due to the presence in the urine of coloring pigments of bile metabolism and bilirubin metabolism - urochromes, urobilin and its other analogues. In children in the neonatal period, up to the third to fifth day of age, and in rare cases up to two weeks of age, a slightly reddish tint of urine may be observed due to high content salts uric acid. This is called a state of uric acid diathesis, and in some conditions it has the character of a uric acid infarction. These salts can easily crystallize on the diaper, leaving brick-red colored salts on the diaper.

In more late dates in children who are on breastfeeding, the urine may have a very pale yellowish color because the kidneys have a low concentration ability. Some foods can color your urine, such as beets, rhubarb, pumpkin or kiwi. Many medications also change the color of urine, some dyes, antibiotics and sulfonamides. Urine may darken when standing, especially when treated with nitrofurans.

With pathologies, the color of urine in children can change dramatically, especially the color of urine can change in the presence of salts when standing. Fresh urine in healthy children is transparent, salts can be white, red, and the color of urine can change in the presence of blood, leukocytes, fats and casts, and mucus.

Turbidity of urine from salts is considered conditionally pathological, since the amount of salts strongly depends on the type of diet and the volume of fluid consumed, the reaction of urine and the volume of urine excretion. But if the urine becomes cloudy constant sign or the child’s salts are deposited on the walls of the pot - examination and treatment of nephropathy is necessary.

Acidity or pH of urine

Urine reaction in normal conditions can vary significantly depending on the type of diet and fluid intake, the range of urine fluctuations can be from 4.0 to 8.0 - that is, from acidic to alkaline, the average acidity of urine is from 6.4 to 6.4 - approximately neutral. When consumed predominantly plant food the urine reaction will be alkaline, night urine may be the most acidic, dropping to 5.0 or even lower. When protein foods predominate, the reaction is mainly slightly acidic.

The release of acid and alkali ions by the age of the newborn is already quite mature, and on the first day of life the acidity of urine is about 5.6, but in premature infants the acidity is lower, which is associated with the birth crisis and stress. Gradually, by the end of the first week of life, acidity decreases, urine becomes slightly acidic or neutral while the baby eats mostly breast milk.

Determining the acidity of urine is necessary for diagnosing many pathological conditions, although it does not provide an accurate diagnosis and level of lesions, nor does it reflect general changes in acidity in the body. Constantly acidic urine is usually observed with acidosis during the period of rickets at the height of the stage, with acute fevers, with the formation of cardiac, renal and respiratory failure, with diabetes mellitus. Neutral and alkaline reactions of urine can occur during vomiting, during the passage of edema, and during infections of the urinary system due to the breakdown of ammonia by microbes and alkalization of urine.

Often, urine acidity indicators can reflect general trends in the acid-base state of the body; acidosis is especially acute in urine. But with some kidney damage, with damage to the tubules, the urine is usually persistently alkaline or neutral, and can also be when taking diuretics.

Urine density and osmolality

Density or specific gravity urine reflects the degree of dissolution of various substances in it, the ability to concentrate primarily urea and salt sediment in it. The normal density of urine can vary depending on the food and volume of fluid the child drinks, as well as the degree of fluid loss from the skin and intestines. The density of urine can quite clearly characterize the ability of the kidneys, their ability to dilute or concentrate urine, and this depends on the needs of the children’s body. The density of children's urine can range from 1007 to 1025, although the range of fluctuations can generally be from 1001 to 1039. early age, in the first weeks of life, the specific gravity of urine is usually small, averaging about 1016-1019.

The main reason that sharply increases the density of urine may be the appearance of glucose in the urine; every one percent of glucose increases the density of urine by 0004. Also, the specific gravity of urine increases every three grams of protein by 0001. Some kidney diseases can sharply increase the density of urine - so density high with oliguria stage acute glomerulonephritis, then the density of urine reaches 1030. But with most kidney diseases The density of urine decreases depending on the degree of damage to the kidney tubules.

Urine may have a monotonous rhythm of urine density, with little or no fluctuation in density during the day and night. This condition may be called isthenuria - constant density of urine. If fluctuations in the density of urine have a range of less than 1010, this is called a violation of the concentration function of urine, which is called the state of hyposthenuria.

Physiological hypotenuria can be observed in young children, especially those who are breastfeeding, this happens in children throughout the first year of life. Also similar condition may occur with various types of chronic kidney diseases - with acute glomerulonephritis at the stage of polyuria, as well as with symptoms of acute or chronic interstitial nephritis, in a condition of renal or pituitary diabetes mellitus.

Abnormalities in urinalysis are far from limited to this, and in addition to physicochemical factors, the urinary sediment may also change the indicators of blood cells - both typical for a normal urine analysis and normal analysis and not dating. If there are any changes in the urine test, it is necessary to conduct a repeat, control urine test - perhaps the changes were temporary.

If the changes are persistent, a detailed examination by a nephrologist and treatment are necessary. At early diagnosis and the beginning of treatment, many of the kidney diseases are quite easily curable and are put into a stage of long-term remission.

The urinary syndrome is based on physical, chemical and microscopic changes in urine. Microscopic changes in urine are assessed by centrifuging urine and examining the urinary sediment under a microscope. In the sediment, typical and atypical changes can be distinguished, changes that are more or less pronounced. Based on microscopic sediment data and its changes, a preliminary diagnosis can often be made quite accurately.

Sediment microscopy study

There is a distinction between the organic part of the sediment and the inorganic components in the urinary sediment. Organic parts in the sediment can be represented by casts, erythrocytes, leukocytes and epithelial cells.

Epithelial cells in the urinary sediment can be of different nature - they can enter the urine as it passes through the urinary tract, starting from the renal pelvis, then the ureters, Bladder and urethra. Flat, round and cylindrical epithelial cells can be distinguished. As a result of the change physical and chemical properties urine may have a significant impact on appearance epithelial cells and this can make it very difficult to distinguish them from each other, and by the type of epithelium one can quite accurately determine the level of damage to the urinary tract by the inflammatory process.

Tubular epithelium or urinary tract epithelium may be detected. It is worth remembering that a small amount of squamous or columnar epithelium in a urine test is quite normal, a certain number of cells are exfoliated and are constantly renewed. A definitive pathology is the appearance of renal epithelium in a urine test (these are cells renal tubules, which means there is kidney damage). In appearance, tubular epithelial cells are difficult to distinguish from the epithelium in the deep layers of the bladder, but the presence of epithelium should be given importance when protein, blood elements and casts appear, if there are signs of fatty or protein degeneration. If epithelial cells are present in the urine in very large quantities, which indicates desquamation of the mucous membranes in the urinary tract area, when they are injured or inflamed due to salt crystals or infection.

Cylinders- these are a kind of casts from the kidney tubules, which are based on protein. In combination, protein with other elements in the urine can be visualized as hyaline, granular or erythrocytic. The protein that forms the basis of the cylinders can be folded into cylinders only when special conditions. One of the conditions for protein coagulation inside the renal tubules is a change in the reaction of urine in the acidic direction. If the urine reaction changes to alkaline, under such conditions protein coagulation does not occur and cylinders are not formed, or they are in this alkaline environment They quickly collapse and can only be detected in a stream of freshly released urine.

The casts may be true or false, and true casts may be granular, hyaline, or waxy. Hyaline cylinders may have a delicate and uniform structure; elements from urinary sediment may adhere to the surface of these cylinders. If epithelial cells stick together, epithelial casts can form, but if formed elements stick together, these will be erythrocyte or leukocyte casts. Such casts can occur with any kidney problems that result in renal proteinuria (protein in the urine) or the appearance of protein of extrarenal origin.

Granular casts can be a protein base that is saturated with degenerated or destroyed cells and from the kidney tubules, which always speaks in favor of severe kidney damage. They can occur with all types of glomerulonephritis, especially with chronic form or rapidly progressing, may indicate damage to the inrestitium and renal tubules.

Wax casts are rough formations from wide-lumen renal tubules, which are formed as a result of flattening of epithelial cells during chronic inflammation. They can occur with severe kidney damage with damage and serious degeneration of the epithelium of the kidney tubules. This indicates dystrophic processes and degeneration of kidney tissue, especially in the area of the tubules. This happens with renal amyloidosis, with mixed form glomerulonephritis with the formation of renal failure.
False cylinders are the formation of cylinders from organic or Not organic matter, which are areas of accumulation of ammonium urate salts, drops of fat, leukocytes, fibrin or mucus; such formations do not indicate kidney damage, but may be evidence of damage to any part of the urinary tract.

Manifestations of hematuria

Hematuria- this is the manifestation of blood in the urine (in the morning portion or in all daily portions) in various quantities - from microscopic to visible to the eye. Microscopic manifestations of red blood cells in the urine are called microhematuria, changes that are visible to the eye in the form of meat slop are macrohematuria.

With hematuria, the number of red blood cells in the field of view does not exceed more than 100 in the field of view, and when the number of red blood cells increases above one hundred or the field of view is completely covered with red blood cells, it is called macrohematuria.

In this case, the color of urine may become reddish or brownish, the color of meat slop. In addition, a brownish tint to the urine may indicate the presence of free hemoglobin in the urine. This is possible with manifestations of intravascular breakdown of red blood cells (hemolysis), but usually red blood cells are destroyed within the urine itself. Gross hematuria can occur with acute streptococcal glomerulonephritis, with immunoglobulin nephropathy and with some urological diseases.

Microhematuria with a small number of red blood cells in the urine occurs with less severe and serious kidney pathologies and urinary tract.

Hematuria is classified as true or false. True hematuria occurs as a result of blood entering the urine from the kidneys or from the urinary tract; with false hematuria, blood enters the urine from the genitals. In true hematuria, the cause of the blood is severe inflammation or tumor processes; it can also be caused by structural changes in the area of the glomeruli of the kidneys, with congenital or hereditary kidney pathology. This is typical for hereditary nephritis and renal dysplasia. In addition, blood in the urine can occur when there is significant excretion of crystals in the urine or when stones damage the urinary tract.

Hematuria is a common manifestation of pathology of the kidneys and urinary tract; it is the most common symptom of disease. It may be short-lived when passing small pebbles or salts. Blood in the urine can be recurrent with immunoglobulin lesions and persistent if there is permanent damage to the kidney tissue ( hereditary pathologies, renal dysplasia or glomerulonephritis).

The assessment of hematuria is carried out taking into account what symptoms are accompanied by blood in the urine. The presence of pain is especially important, since severe pain can occur with renal colic, with urolithiasis, with the release of blood clots or pus through the urinary tract - this can happen with kidney tuberculosis, with tumor processes, with papillary necrosis or thrombosis of the renal vessels. If blood appears in the urine without pain syndrome, this may indicate congenital or acquired nephropathy.

Hematuria is often manifested by the release of protein, the release of urates or oxalate salts. In a third of children, blood in the urine manifests itself in dysmetabolic nephropathy, when salts are excreted in the urine, which subsequently flow into urolithiasis. Most often, difficulties in the manifestation of hematuria with diagnosis arise if the hematuria occurs without any other symptoms. Sometimes hematuria can occur with fevers, during heavy physical exertion, or as a reaction to the toxic effects of drugs.

Why does blood appear in urine?

Early hematuria childhood manifests itself as a result of infectious pathology, sepsis, intrauterine infections, polycystic lesions of the kidneys, Wilms tumor, thrombus formation in the vessels of the kidneys, nephropathy, toxic damage kidneys during treatment, metabolic disorders congenital and acquired. At an early age, the manifestation of hematuria, especially massive and visible to the eye, can be a very unfavorable sign for health and life.

The preschool and school periods change the causes of hematuria - mainly secondary and primary phenomena of glomerulonephritis, nephritis, dysmetabolic nephropathies. Congenital or hereditary pathologies are also relevant, especially in combination with developmental disorders. Urolithiasis has also become relevant for children.

How is hematuria determined?

The presence of blood in the urine itself can be determined using special test strips. The technique is based on determining urine hemoglobin, but the test can react to other components in the urine. If the test is positive, further research is necessary, which is carried out quantitatively - by counting the number of red blood cells. This is done by microscopying a morning urine sample. Hematuria is understood as an increase in the number of red blood cells of more than 2-4 in the field of view, although other doctors say that there should be no red blood cells in the analysis at all.

With a single urine test, it is not always possible to identify pathology and detect the presence of red blood cells in the urine. The disease may be hidden for some time, and therefore changes in urine analysis may not be observed in every analysis. In addition, testing your urine for the presence of red blood cells can help evaluate the effectiveness of treatment. It is difficult to assess the presence and amount of blood in the urine in single tests, so it is necessary to estimate the daily number of red blood cells in the urine. Quantitative method research is the Amburger or Addis-Kakovsky method, but they are very labor-intensive and complex. The Nechiporenko method and the study of 24-hour urine will also be used. Urine analysis is calculated per 1 milliliter of urine.

If there are no red blood cell casts in the urine, there are no signs of kidney disease or damage to the kidney tissue, there is a manifestation of dysuria (pain when urinating), and blood is released in clots from the urethra, then doctors can assume the sources of bleeding are not in the kidneys, but in the lower parts of the urinary system - in the bladder or urethra.

In severe cases, with serious kidney damage, urine may take on an unpleasant appearance and the color of meat slop, and this indicates heavy loss of blood from the urinary system. In such cases, you must immediately consult a doctor or call an ambulance. It is necessary to note the presence of concomitant manifestations - pain in the lumbar region or abdomen, pain in the projection of the bladder, nausea and vomiting, fever and profuse sweating, tachycardia and pressure fluctuations (this can be like sharp decline pressure, up to shock, or a sharp increase - arterial renal hypertension).

Usually, the first thing that is done when blood appears in the urine is to be hospitalized in the nephrology or urology department of a children's hospital. A detailed examination is carried out there - repeated blood and urine tests, ultrasound and x-ray examinations, and, if necessary, magnetic resonance scanning. This will help identify the causes of blood in the urine and plan treatment.

Changes in urine tests in a child

Urinalysis is one of the main studies carried out from a very early age of the child. Despite the seeming primitiveness of the analysis, the methodology of which has been known for decades, a general urine test remains the “gold standard” in examining children with diseases not only of the kidneys, urinary system and problems of the genital organs, but also with many other diseases. Along with a general blood test, a general urine test is taken during almost any examination and during any medical examination. In a urine test, almost any indicator can change, but most often, a urine test looks at the presence of inflammation in the body, both inside the kidneys and in the body as a whole. What can changing indicators say? general analysis urine, especially changes in white blood cell count, salt or protein in the urine.

If there are leukocytes in the urine

Leukocytes– these are special blood and tissue cells that are responsible for the body’s antimicrobial defense and fight against inflammation. They are found in large quantities in the blood, transported to organs and tissues where foci of inflammation occur. With the development of inflammation, leukocytes are able to leave blood vessels and directed to the area of inflammation to fight infection and restore tissue. Under normal conditions, there may be very few leukocytes in the urine; they are acceptable as single in the field of view in boys (0-2 in the visual field), and up to 6-8 leukocytes in the field of view in girls due to the peculiarities of the structure and functioning of the reproductive tract. In cases of allergies or exudative-catarrhal constitutional abnormalities in children, the number of leukocytes may be slightly increased, and leukocytes are always higher in children at an early age due to difficulties in the procedure for collecting urine and treating the genitals. The permissible maximum when we can talk about normal values urine is up to 4-6 in the field of vision in boys, and up to 8-10 in the field of vision in girls. During the phenomena inflammatory processes in the genitals of children, the number of leukocytes may increase not due to a urinary infection, but due to the entry of leukocytes from the area of inflammation into the area of the head of the penis of boys or the labia of girls. An increase in the number of white blood cells is usually accompanied by an increase in the number of epithelial cells.

Pathologies associated with the number of leukocytes

An increase in the number of leukocytes in the urine is called the condition of leukocyturia - the presence of leukocytes in the urine, and when the number of leukocytes increases to the point where they cover the entire field of view when examining urinary sediment under a microscope, this is called pyuria - pus in the urine. Leukocyturia may be the result of inflammation in the kidneys and urinary system of a microbial (bacterial) nature, but it may also be a sign viral infection, as well as leukocytes in the urine can also be a sign of non-microbial damage to the kidneys and urinary organs. This is the so-called true leukocyturia, that is, leukocytes are released directly from the urinary system. There may also be a condition of false leukocyturia, which occurs not due to the presence of inflammation in the urinary system, but in the presence of inflammatory or allergic processes in the area of the external genitalia of children of both sexes.

Types of leukocyturia, causes

An increase in the number of leukocytes in the urine can occur with various nephrological and urological diseases - with acute pyelonephritis or exacerbation of a chronic process, leukocyturia occurs, which is accompanied by the presence of moderate proteinuria (the appearance of protein in the urine in small quantities).

In this case, manifestations of pyelonephritis will occur against the background of a violation of the child’s condition, general intoxication with high fever and pain in the abdomen. But pyelonephritis is not the only pathology that occurs with symptoms of leukocyturia. Leukocyturia can cause urological diseases such as cystitis (inflammation of the bladder) and urethritis (inflammation of the urethra).

At the same time, one of the leading symptoms of cystitis and urethritis are symptoms of dysuria - urination disorders with symptoms of pain, disturbances in the volume of urine output and the rhythm of urination.

If a child experiences manifestations of non-microbial nephritis (inflammation caused not by infection, but by other factors), then leukocyturia is accompanied by microhematuria (excretion of blood in the urine in a small amount) and moderate symptoms of proteinuria.

Moderate excretion of leukocytes in the urine is characteristic of the initial stages of the development of acute glomerulonephritis, or during the period of primary exacerbation of the chronic process, which will reflect the body’s reaction to the fact that antigen-antibody complexes are deposited in the glomeruli of the kidneys, which causes acute or chronic inflammation. If the course of the disease is favorable, after a week of illness, leukocytes from the urine gradually disappear. If leukocytes in the urine remain unchanged, or their level increases, these symptoms of glomerulonephritis should be regarded as an extremely unfavorable factor in the development of this disease.

Sometimes, in various types of acute processes, the mere presence of leukocytes in the urine is not enough; it is necessary to identify leukocytes using a urocytogram, examining the urine sediment after staining it with special dyes. With infectious lesions of the kidneys or urinary tract, neutrophil types of leukocytruria can be observed, these are those blood cells that form pus in the urine. Under such conditions, up to 95% of leukocytes in the urine will be neutrophils, and only about 5% will be lymphocytes. IN initial stage glomerulonephritis - be it acute or chronic, in the acute stage, in the urocytogram the neutrophilic component of leukocytes will also predominate over the lymphocytic one, but this difference will be less pronounced. In the dynamics of the development of the disease, changes in the urine may be different - lymphocytes in the urine can be equal to neutrophils, and even exceed their number. Another typical change in the urocytogram during glomerulonephritis is the presence of mononuclear cells, special cells, in the urine. With non-microbial (abacterial) glomerulonephritis, leukocyturia can be eosinophilic in nature, which indirectly indicates the allergic nature of kidney damage and the involvement of immune mechanisms. The number of lymphocytes in urine sediment changes with hereditary nephritis, disorders of salt metabolism and nephropathies, as well as dysplastic processes in the renal tissue.

Bacteria in urine

U healthy child urine must be sterile, that is, there should be no microbes in it, but periodically, non-pathogenic or opportunistic flora from the genital tract can be sown from the urine in an analysis in such an amount that cannot be called diagnostically significant. All this occurs due to the fact that microbes from the genital tract or perineal skin can enter the urine due to defects in urine collection, especially in very young children. Also, pathogenic microbes can penetrate into the urine during some general infectious processes in the body. But they cannot exist for a long time in the aggressive environment of a child’s urine and are quickly eliminated from it; this condition is called transient bacteriuria.

The appearance of bacteria in urine often indicates infectious lesion urinary tract and may indicate a causative agent of infections of the urinary and reproductive system. Therefore, urine culture is called the gold standard in the diagnosis of genitourinary diseases in children. But the only difficulty in carrying out this analysis is the difficulty in collecting urine correctly - the ideal collection is bladder catheterization, but it is used extremely rarely in children and only in a hospital.

In general conditions, urine is collected in the morning, after a thorough toilet of the genitals with free urination from the middle portion of urine, the analysis is collected in a special sterile container, which is given to the parents by the laboratory that will conduct the analysis. The morning urine sample will be the most indicative, since it will have the highest concentration of microbes.

In small children, it is permissible to collect urine for analysis from a free stream when the baby urinates, and if it is not possible to collect urine strictly in the morning after waking up, take any convenient portion from morning urination. Before taking the analysis, you need to thoroughly wash the child according to all the rules with soap, girls - from front to back under running water, boys - as you prefer. Collect the urine sample immediately into a container and immediately close the lid; it must be delivered to the laboratory within an hour after collection, otherwise the urine will lose its diagnostic value. If it is not possible to immediately transport the urine, you must place it in a tightly screwed container on the bottom shelf of the refrigerator.

The results of the analysis can be considered positive if more than 10 to the fifth degree of microbial bodies per 1 ml of urine were sown in the urine test, and for newborns - 10 to the 4th degree. To control the analysis, it is necessary to repeat the analysis once or twice in order to determine the causative flora and eliminate defects in the collection of the analysis.

When assessing the degree of bacteriuria (the presence of bacteria in the urine), it is necessary to study the specific type of microflora. Typically, microbial lesions of the kidneys or urinary tract are caused by special gram-negative microbes living in the intestines or on the skin - Escherichia coli, Proteus, Klebsiella, Enterobacter or Pseudomonas. Enterococci and staphylococci, streptococci are less often sown. For each microbe, its diagnostic titer per milliliter of urine is diagnostic. The detection of some of the microbes in the urine is in itself a reason for treatment, regardless of their titer.

If there is salt in the urine

There is always a certain amount of dissolved salts in urine; sometimes, in a certain environment, they can precipitate. The amount and type of salts precipitated in a urine sample depends on many factors - the type of diet and type of food, the acidity of urine, the condition of the epithelium of the urinary tract itself and even the time of year and drinking regime. In the urinary sediment of children, oxalate, urate or phosphate salts are usually found; they can precipitate with calcium, ammonium, this depends on the characteristics of metabolism.

The most common precipitated salts are oxalates - they can precipitate even in newborns. In some conditions, in the first days after birth, uric acid salts, urates, may precipitate; this condition is called uric acid infarction of the kidneys; these salts color the urine brick-red.

The occasional appearance of oxalate and urate salts in the urine does not pose a danger, but if these salts appear in every or almost every urine test, they are excreted in large quantities or have large crystals, this is most likely a state of dismetabolic nephropathy - a special functional disorder in the functioning of the kidneys, leading to disruption of the filtration processes of inorganic and organic substances. This condition is dangerous in terms of further development of urolithiasis. Sometimes salts appear in children during fever, after taking certain medications, after excessive intake of special foods - chocolate, sorrel, meat.

But the detection of tripelphosphates and phosphates in the urine should always alert the doctor - they are usually formed in conditions of urine infection. Phosphate salts settle on microbial bodies and form crystals. Usually, when phosphates are detected in the urine, a large number of microbes, leukocytes and even red blood cells are also detected in parallel with them.

Selection large quantity salts- this is a reason to conduct a detailed examination of the kidneys for abnormalities, since urolithiasis today is very young and can occur even in children at an early age. Kidney stones cause serious disturbances in well-being and disrupt the child’s life processes.

Urinary syndrome is a combination of pathological processes of the urinary system of various kinds and changes in the composition and structure of urine: the presence of foreign bacteria, salts and other various elements. It can occur latently (excluding cases of gross hematuria and massive leukocyturia) and can only be detected using laboratory methods. Urinary syndrome is the only sign of kidney and urinary tract diseases in children and adults. It also shows the presence of other pathologies in the body.

Common types of urinary syndrome are isolated hematuria, isolated proteinuria and isolated leukocyturia.

The main symptoms of isolated hematuria are bloody discharge in the urine. Urine may appear reddish or bloody (gross hematuria) or completely unchanged (microhematuria). Hematuria can be isolated (without cylindruria and proteinuria), this indicates the presence of diseases such as:

stones in the bladder and ureters;
infectious processes in the genitourinary system, the most common example is kidney tuberculosis;
inflammation of the renal papillae, for example in nephropathy;
genetic kidney diseases.

With this form, pronounced painful sensations When urinating, pathologies are determined:

urolithiasis disease;
necrosis and thrombosis of renal vessels;
renal colic;
kidney tuberculosis.

But if pain during urination is not observed, most likely the patient has congenital or acquired nephropathy.

To blood factors in urine infants relate:

plasma damage;
infections occurring during intrauterine development;
formations in the kidneys;
high platelet concentration;
kidney injury from toxins during drug therapy.

Naturally, in any case, the detection of urinary syndrome in infants is a negative sign. The appearance of bloody discharge in urine in older children indicates the presence of stones in the urine. urinary tract and jades. Most often, urine collected in the morning is used for analysis. If bloody discharge is detected in the urine of children, urgent hospitalization is required. If a urine test reveals cylindruria in addition to bloody discharge, benign familial hematuria or Berger's disease can be suspected. Establishing the presence of both hematuria and proteinuria is a sign of various ailments and predetermines chronic failure kidney

Isolated proteinuria

The main manifestation of isolated proteinuria is protein in the urine.

If only protein is detected, this does not always indicate renal pathologies. Isolated proteinuria exists as both benign and malignant.

Benign can be:

transient idiopathic, determined, as a rule, in urine once and is no longer determined during a secondary study;
orthostatic, with long-term standing;
functional, the protein can be detected due to high temperature body, hypothermia, nervous strain, heart problems.

With this form of the disease, the patient will hear a positive prognosis from the doctor.

Persistent isolated proteinuria can be a consequence of pathologies such as:

heavy metal poisoning;
diabetes;
cystinosis;
amyloid dystrophy;
glomerulonephritis.

Of course, with all these diagnoses, the doctor’s prognosis will be negative.

Isolated leukocyturia

The main manifestation of isolated leukocyturia is the presence of casts in the urine. Cylinders are microelements of protein origin. Depending on the processes occurring in the body, the protein has a different cylindrical shape.

Cylinders are divided into:

hyaline and are found in almost all pathologies; protein is detected in urine tests;
waxy ones appear in severe renal pathologies and inflammatory processes;
granular can be found in cases of damage to the kidney tubules and glomerulonephritis;
false ones are detected when various pathologies urinary tract.

The difference between this form of leukocyturia is that it is characteristic of inflammation of the urinary tract, and not of the kidney parenchyma. Severe leukocyturia, especially together with slight hematuria or proteinuria, indicates inflammatory processes in the kidneys, and also with various types of nephritis.

Determining an accurate diagnosis is quite difficult, especially when negative analysis urine culture.

Sterile leukocyturia can occur due to factors such as:

pregnancy;
acute fever;
treatment with glucocorticoids and cyclophosphamide;
pathologies of the ureters infectious nature curable with antibiotics;
mechanical damage to the genitourinary organs;

inflammation of the urethra, bladder, prostate;
all types of tubulointerstitial nephritis;
tuberculosis;
infections caused by microorganisms.

There is also a minor urinary syndrome, but it is expressed not in a qualitative change, but in a quantitative one. That is, the amount of urine decreases significantly.

Helpful information

Urinary syndrome is a fact of many different ailments that must be identified and treated.

If therapy is impossible, the doctor should prescribe procedures that will help the patient feel much better. It is worth emphasizing that urinary syndrome is a fact that pathological processes occur in the body. Numerous additional examinations are required to make the most accurate diagnosis.

Elimination of the pathological process depends on the factor that provoked it. In any situation, you cannot ignore the first manifestations of urinary syndrome; you must immediately contact a qualified doctor for comprehensive examination and effective treatment.

Urinary syndrome is a disturbance in the functioning of the urinary system, which is manifested by changes in the composition of urine, its quality and quantity. In such a situation, problems with urinary frequency as well as other symptoms may also appear. At the initial stage of development of the syndrome, a person does not show any symptoms, which makes the pathology dangerous.

Urinary syndrome can be caused by many reasons. The main ones include the following:

systematic nervous overstrain;
various infectious diseases;
benign neoplasms of the urinary system and neighboring organs;
urolithiasis disease;
oncological tumors;
various types of injury or overextension;
multiple sclerosis;
depression;
Parkinson's and Alzheimer's diseases;
congenital developmental pathologies;
encephalitis;
exposure to bad habits;
diabetes.

Urinary syndrome is a disorder of the urinary system.

These are not all the pathologies that can provoke urinary syndrome. In order to find out exact reason It is necessary to seek help from a doctor as soon as possible and undergo a series of examinations. Treatment should begin immediately, since even the slightest delay can lead to the development of complications. As for treatment, it should be selected only by the attending physician. Self-medication is strictly prohibited. In order to get rid of the pathology, among other things, you should follow all the recommendations of your doctor.

What abnormalities does urinary syndrome indicate?

From medical practice it follows that urinary syndrome may indicate various renal abnormalities and pathologies of the urinary tract. Such pathologies include:

Hematuria – this pathology consists in the presence of blood in the urine. Such impurities may have varying degrees severity from presence noticeable to the naked eye to detection only by microscopic analysis. In this case, the urine may have a brownish or reddish tint. If a person is diagnosed with hematuria, this may indicate the development tumor formations in the urinary tract, as well as about urolithiasis or any infection.
Cylindruria - in this case, the human body experiences various processes, which lead to increased acidity of urine. This pathology indicates inflammation of the kidneys, their damage, as well as damage to the urinary tract or glomerulonephritis.
Leukocyturia - this pathology indicates viral inflammation of the urinary tract or kidneys. With such a deviation in urine analysis, the number of leukocytes increases and this may indicate pathologies such as pyelonephritis in acute or chronic stage. In addition, an increase in white blood cells may indicate diseases such as urethritis. In addition to an increase in leukocytes, with all the pathologies listed above, the patient may experience symptoms such as pain when urinating, as well as possible deviations in progress. Among other things, leukocyturia may indicate that inflammation occurs in the glomeruli of the kidneys in the human body.
Bacteria - their detection in urine indicates the presence of infections in the urinary tract.
Salts - in small quantities, some types of salts are present in the body of even a completely healthy person, but despite this, sometimes they settle, this can happen due to poor nutrition, changes in drinking habits, as well as urine acidity. If salts are not systematically found in urine analysis, then there is nothing to worry about, otherwise this may indicate serious abnormalities in kidney function, and may also indicate the presence of stones in the kidneys.

The most common forms of urinary syndrome, which provoke various disorders in the body, are the following deviations:

Blood in the urine, which can be present in varying amounts and affect the color of the urine. If such a symptom appears, you must immediately seek help from a medical facility. Since the appearance of blood discharge indicates diseases such as stones in the ureter and bladder, infections of the genitourinary system, damage to the renal papillae or hereditary diseases kidney If a person has bloody impurities in his urine, then in order to make an accurate diagnosis and prescription additional research Additional symptoms are of great importance. For example, if such deviations are accompanied by pain when urinating, then a person may develop diseases such as tuberculosis, renal colic, necrosis or thrombosis of the renal vessels. If even minor pain does not appear, then the situation may indicate congenital or acquired nephropathy.
Protein in the urine - this pathology is also called isolated proteinuria. This manifestation does not always indicate kidney disease, but must be fully diagnosed, since deviations can have both benign and malignant forms. Protein appears in the urine in situations where a person develops diseases such as glomerulonephritis, Balkan endemic nephropathy, diabetes mellitus, cystinosis or amyloid dystrophy. If one of the listed diseases occurs, treatment should be started immediately, as otherwise the pathology can lead to the development of serious complications.

In addition to everything else, there is also small urinary syndrome, let’s try to find out what it is right now. Small urinary syndrome is a quantitative decrease in urine output.

Changes in urine indicate the development of pathology

IN medical practice There are also situations where blood in the urine is found in children, especially infants. In this case, immediate hospitalization is required. This is explained by the fact that pathology indicates dangerous diseases at this age, such as sepsis, thrombosis or various shapes neoplasms.

Another manifestation of the bladder is such a deviation as shy bladder syndrome. The peculiarity of this deviation is that a person suffering from such a deviation cannot go to the toilet in an unfamiliar environment, and even more so if strangers are present. Such a deviation from medical point vision is not a disease, but most likely refers to psychological deviations and disorders.

Shy Bladder Syndrome is a Psychological Problem

Many doctors believe that the cause of the development of bladder syndrome is the use of certain medications, and nervous overstrain can also provoke its development. As a therapy in such a situation, patients are recommended to take a course psychological correction. During treatment, the patient is not prescribed any medications, since in this case they cannot have the desired effect and help get rid of the syndrome.

Urinary syndrome is not classified as a disease and is just an indicator that a pathological disease is developing in the human body.

Such a deviation in the human body as urinary syndrome is diagnosed during a urine test. In the event that after the laboratory research If any deviations from the norm are detected in the urine, then the patient is given exactly this diagnosis and a number of additional studies are prescribed, which also take into account associated symptoms. Only everything taken together allows the doctor to make a correct and accurate diagnosis, as well as prescribe effective treatment.

Testing is mandatory for diagnosis.

After the diagnosis is made, a course of therapy is prescribed and if it does not bring any results, then the patient is prescribed procedures that will ensure the patient feels better.

Note! Urinary syndrome indicates pathological processes occurring in the human body, and in order to find out which ones, a number of numerous additional examinations are required.

After the pathology is diagnosed, treatment is prescribed, which should be aimed at eliminating the factors that provoked the development of this disease. In no case should such changes be left without diagnosis and treatment, as they can provoke very serious complications.

Conclusion

The occurrence of urinary syndrome can be provoked completely for various reasons, which can be the most elementary and indicate minor deviations in the human body, and, conversely, in some situations arise as a result of serious pathologies internal organs. Regardless of the reason that triggered the development of urinary syndrome, you should immediately undergo a number of additional examinations and accurately determine the diagnosis. After this you need to start immediate treatment and strictly follow all recommendations of the attending physician.

Any inflammation in the urinary system and kidneys is dangerous manifestations, and can lead to serious consequences. The treatment method is chosen individually in each case.

Urinary syndrome/irritable bladder syndrome, including cases of pain when urinating that are not caused by a urinary infection or bladder stones. There are no exceptional symptoms, so the clinical diagnosis can be quite difficult.

Other names: Hypersensitive Bladder Syndrome, Sick Bladder (PBS)

Interstitial cystitis (IC) or urinary syndrome is a condition characterized by chronic or recurring pelvic pain and frequent urination.

The disease is usually diagnosed in people over 18 years of age, although no scientific basis, why IC may not be present in children.

There was a time when doctors did not believe that the disease existed, the patient had to constantly jump from one doctor to another to find relief.

The term interstitial cystitis was first coined in 1878. The urologist first looked for “elusive ulcers” on the wall of the bladder as he stretched it for examination with a cystoscope. The ulcer was called a "Hanner's ulcer" and was a classic type of urinary syndrome.

However, many patients who did not have ulcers had irritable bladder symptoms and were considered psychiatric cases until 1978. In 1978, a non-ulcer type was described. It is now known that most patients with urinary syndrome are of the non-ulcer type.

Symptoms range from mild discomfort to severe pain, and some patients feel pressure in the pelvic area. General signs include incomplete emptying, urinary frequency, or a combination of both.

There are no symptoms for urinary syndrome, so the clinical diagnosis is quite difficult.

The change in symptoms and their severity prompt a person to think that the problem is a combination of diseases.

The cause of urinary syndrome is little understood, and research is being done to better understand it. However, despite two decades of research, little progress has been made in understanding.

Epithelial dysfunction

Epithelial dysfunction is observed in patients with urinary syndrome. In this case, the bladder urothelium (outer layer) fails in its function, which increases the abnormal permeability of solutes (such as potassium) found in the urine.

This causes an inflammatory reaction in the lower layer of the mucosa. Soluses can depolarize sensory nerves, causing localized pain.

Mast cell activation

Activation of mast cells is involved in the disorder. It initiates the release of histamine, which releases substance P (the disease neurotransmitter) and induces the proliferation of pain-sensitive demyelinated C-fibers. C-fibers are observed in large quantities on late stage urinary syndrome, this explains bladder hypersensitivity in patients.

The symptoms are very similar to those of tuberculosis of the genitourinary system, so more early methods treatments were aimed at eliminating this disease. But patients do not respond to TB treatment. Today there is a significant increase in awareness of the disease.

Progress in knowledge of causes, diagnosis, and treatment gives hope for a better treatment option.

There is no evidence that irritable bladder syndrome is associated with great risk cancer development. It does not affect fertility and does not affect fetal growth in pregnant women.

It is much more common in women compared to men.

Symptoms

Pain

Intermittent pain or discomfort, including throbbing, burning, or pressure. Pain occurs when the bladder fills with urine or empties.

Men also have pain when they ejaculate or when they have an orgasm. Women feel pain during menstruation or during vaginal intercourse.
The location of the pain can be anywhere in the lower abdomen, pelvic area, urinary passage (urethra), anus, rectum.

Frequency and emptying

They usually exist together, although urgency can exist on its own without frequency. The frequency of urination increases significantly, mainly because the bladder cannot hold much urine, even if its size is normal.

If a person urinates more than 8 times, it is considered abnormal. Night urination disturbs the sleep of the affected person. Some may go to the toilet every 10 to 15 minutes, 40 to 60 times a day.

Urinary syndrome is a complex of various disorders of urination and changes in the composition and structure of urine: the presence of bacteria and salts, microhematuria, leukocyturia, cylindruria and proteinuria. Also, characteristics of urinary syndrome may include dysuria, disturbances in the amount of urine and frequency of urination. In cases where it is the only sign of kidney disease, it is called isolated urinary syndrome.

Deviations in the composition of urine

Urinary syndrome in children and adults is a sign of kidney disease and diseases of the urinary tract. It can signal the presence of various pathologies.

Hematuria

Hematuria is the presence of a certain amount of blood in a urine test: from microscopic to noticeable to the naked eye. The color of the urine becomes reddish or brown.

Hematuria indicates a tumor in the urinary tract, the presence of stones or infection. It may accompany disease of the renal papillae (nephropathy caused by sickle cell anemia). It is also typical for hereditary nephritis and renal dysplasia. The nature of hematuria is assessed by what symptoms accompany it. Great importance The diagnosis depends on whether urination is accompanied by pain. Pain indicates renal colic, urolithiasis, renal tuberculosis, necrosis and thrombosis of renal vessels. If urination is painless, then most likely the patient suffers from nephropathy, congenital or acquired.

Hematuria in children itself younger age is the result of pathologies, sepsis, intrauterine infections, kidney tumors, thrombosis, as well as kidney damage from toxins while taking medications. In infants, manifestations of hematuria are extremely unfavorable symptoms for life and health. In older children, it signals nephritis and urolithiasis.

It is diagnosed by a special test and microscopic examination of a morning urine test. Determination of blood in urine is done using several tests. When such symptoms are detected, the child in most cases requires hospitalization and treatment in urology department children's hospital.

Cylindruria

Cylinders are microelements consisting of protein. It takes a cylindrical shape under certain conditions, thus indicating various processes and changes occurring, e.g. increased acidity urine. The cylinders are divided into hyaline, granular, waxy and false:

hyaline - occur in almost all diseases that cause proteinuria;
waxy - signal serious kidney damage and inflammation;
granular - indicate damage to the kidney tubules, glomerulonephritis;
false - do not indicate kidney damage, but indicate any damage to the urinary tract.

Leukocyturia

Leukocytes are special bodies, blood cells that protect the body from foreign microorganisms and inflammation. They are found in small quantities in any urine, and their levels are increased in children. It is worth noting that girls normally have a higher white blood cell count in the analysis than boys. They can also end up in the urine as a result of inflammation of the external genital organs.

Leukocyturia is one of the symptoms of microbial or viral inflammation of the kidneys and urinary tract. The number of leukocytes in urine analysis increases with acute pyelonephritis and chronic varieties. Other diseases that leukocyturia may indicate are cystitis and urethritis. These diseases will also have other symptoms: painful urination, deviations in the volume of urination. Leukocyturia may be accompanied by microhematuria and proteinuria in the event of nephritis of a non-infectious nature.

Inflammatory reactions in the glomeruli of the kidneys are also indicated by leukocyturia. With a favorable course of glomerulonephritis, after a few days, leukocytes in the urine cease to be detected. Otherwise, such symptoms may signal a negative development of the disease. In case of glomerulonephritis, it is necessary to monitor the absence of blood in the sputum to exclude.

Bacteria

The urine of a healthy person is sterile. Sometimes the analysis reveals no causing diseases microorganisms coming from the external genitalia. During infections that affect the entire body, bacteria also enter the urine. They are unable to survive for a long time in such an aggressive environment, and they quickly hatch. This phenomenon is called transient bacteriuria.

But, mainly, the presence of bacteria in the urine signals the presence of a urinary tract infection. The best way to diagnose diseases of the excretory system is urine culture. The only drawback of this procedure is the difficulty of correctly collecting the analysis. It is necessary to collect urine for analysis in the morning, preferably as soon as the child wakes up, but after hygiene procedures, in a medical sterile container for analysis. The analysis should be in the laboratory no later than an hour after collection. If this is not possible, then it must be placed in the refrigerator, tightly closed. For more exact result It is advisable to take several samples for analysis.

Culture helps identify the causative agent of the disease. Most often, intestinal bacteria and skin- Escherichia coli, Proteus, Enterobacter, Pseudomonas or Klebsiella. Enterococci, staphylococci, and streptococci are found with less frequency.

Salts

Some types of salts are observed in small quantities in tests even in completely healthy people. Sometimes they settle. The type of sediment will be influenced by the most various conditions: nutrition, urine acidity, drinking regimen and even time of year. As a rule, calcium or ammonium oxalates, urates and phosphates are precipitated. If oxalates and urates are periodically found in urine tests, there is nothing wrong with that, however constant loss salts can serve as a sign of dismetabolic nephropathy - a deviation of kidney function in which the filtration of substances is impaired. This, in turn, can cause urolithiasis. Salts may result from the use of certain medications or foods.

However, if phosphates are detected in a urine test, this is a sure sign of infection. When they are detected, bacteriuria is usually also detected.

Changes in urinary habits

Urinary syndrome, in addition to changes in the composition of urine, is also characterized by changes in the volume and regularity of urination. Amount of urine excreted during the day healthy child, varies from the influence of many factors: the amount of water drunk, temperature (both body and environment), stress and others. Urinary rhythms may also vary, but daytime urination predominates, with a ratio of approximately 3 to 1 to nighttime urination. For minor and short-term problems with urination, no treatment is required; you just need to change your daily diet and fluid intake.

However, some symptoms may serve as signs of disease and should be paid special attention to:

Nocturia is the dominance of urine output at night over daytime. Usually the result of pyelonephritis, nephrotic syndrome, and collecting duct diseases.
Oliguria is a reduction in the amount of urine. May indicate renal failure acute or chronic in nature, also manifests itself in various congenital or acquired renal pathologies.
Polyuria is an increase in urine output. Can be caused by hypothermia, cystitis, nephrotic disorders.
Dysuria is a condition in which the periods between urination are greatly reduced, and the urination itself causes severe pain. Indicates acute infections of the urinary ducts or genitals.

Deviations in color and degree of transparency

Urinary syndrome can manifest itself through changes in the color of urine, its consistency, acidity and degree of transparency. Urine normally ranges in color from light yellow to amber.

In newborns and infants, it may have a reddish tint, which is due to the large amount of urates in it. In infants, on the contrary, the urine is pale yellow. The color of urine can change with some medications and foods.

However, regardless of color, healthy children have clear urine. Its cloudiness is a signal to show the child to the doctor so that he can prescribe the necessary treatment. Pathological signs will also include changes in the acidity of urine and its density.

An interesting manifestation of urinary syndrome may also be shy bladder syndrome. This is a condition in which a person cannot relieve himself in an unusual environment, and especially in the presence of strangers. Shy bladder syndrome is not a disease, but rather can be attributed to mental disorders. It seriously complicates life, preventing the patient from leaving home for a long time.

Some researchers believe that shy bladder syndrome is caused by taking certain types medicines. It may also be a sign of diseases of the nervous system. Treatment of the syndrome takes place primarily in the form of psychological correction. Treatment is not carried out with medications, since their use is necessary for a fairly long period of time, which can cause dependence.

Treatment for urinary syndrome

Urinary syndrome is only an indicator that the body requires treatment. It should be aimed at eliminating diseases that cause urinary syndrome. If therapy for these diseases is impossible, then a set of procedures is carried out aimed at alleviating the patient’s condition, in which case the symptoms are eliminated. Symptomatic treatment shown when available chronic diseases causing urinary syndrome.