If there is pyelonephritis, what will a blood test show? General urine test and culture for sterility. Main indicators when examining pyelonephritis: norms and rules for collection

Pyelonephritis is one of the most difficult to diagnose kidney diseases. Its symptoms are similar to some infectious processes (for example, blood poisoning or influenza). Pyelonephritis can sometimes be mistaken for cholecystitis, pancreatitis or other acute inflammatory processes of organs abdominal cavity. Its timely and correct identification will allow you not to make a mistake in diagnosis and begin treatment at the earliest stages of this disease.

Figures and facts about pyelonephritis

The word “pyelonephritis” comes to us from the Greek language. It contains three terms:

• pyelos – “pelvis”;
• nephros – “kidney”;
• it is a word-forming part meaning “inflammation”.

That is, pyelonephritis is inflammatory disease infectious origin, which involves the renal cups, its pelvis, and renal tissue.

Pyelonephritis - inflammation of the cups, pelvis and kidney tissue

To understand the scale, seriousness and danger of this process, you need to know some numbers regarding it, namely:

1. Every year, approximately 1% of the world's population falls ill with pyelonephritis, which is 70–80 million people.
2. Women of reproductive age suffer from kidney inflammation 6 times more often than their male counterparts.
3. In all age groups pyelonephritis is the most common disease of the urinary system.
4. Today, this pathology ranks second in frequency among all infectious processes, second only to respiratory diseases.
5. Pyelonephritis occurs in 2–12% of pregnant women, and the incidence of such patients has increased fivefold over the past 25 years.
6. Life-threatening purulent complications (kidney carbuncle, apostematous nephritis) occur in every third patient with acute pyelonephritis.
7. Of all patients in urological hospitals, about half are sick chronic inflammation renal collecting system.
8. From sepsis, which often complicates purulent pyelonephritis, 50–80% of patients die.
9. In almost every second patient, this disease results in impaired renal function, steadily leading to chronic renal failure.

Unfortunately, pyelonephritis in many cases is not recognized in time. The frequency of errors in diagnosis reaches 50%. The reason for this is the predominance of signs general intoxication above local symptoms on early stage acute illness. As a result, treatment often begins too late, so the course of pyelonephritis is significantly worsened.

Pyelonephritis is discovered during a pathological autopsy in every tenth person who died for unspecified reasons, and during his lifetime this disease was not even suspected. In people who died in old age, inflammatory changes in the kidneys are detected even more often - in 20%.

It is in connection with all this information timely diagnosis pyelonephritis is of paramount importance in urological practice.

Video: what is pyelonephritis

Initial examination and interview of the patient

First of all, a urologist or nephrologist examines the patient, listens to his complaints, studies the anamnesis and focuses his attention on external manifestations diseases that play an important role in diagnosis. The main clinical symptoms characteristic of pyelonephritis are:

• high temperature with fever and shaking chills;
• unilateral or bilateral pain over the lumbar region;
• pyuria (cloudy urine mixed with pus);
• bacteriuria (presence of pathogenic bacteria in urine).

The doctor relies on these signs in the process of searching for the correct diagnosis.

Sometimes pyelonephritis occurs according to the type gastrointestinal disorders, in these cases, patients complain of diarrhea, vomiting and nausea. Dysuric phenomena, expressed by frequent painful urination and imperative calls to him. Constant and strong headache in the forehead is also a common complaint of patients with pyelonephritis. During development septic complications Possible loss of consciousness leading to coma.

At acute inflammation kidney condition of the patient is usually serious. His body temperature reaches 40 °C or more, and this is the main diagnostic sign, allowing to distinguish pyelonephritis from cystitis or urethritis.

When studying the anamnesis, the doctor pays attention to previous urinary tract diseases, especially recurrent cystitis and attacks of pyelonephritis that the person has ever had. The patient’s indications of purulent processes of any localization that existed in the recent past or the presence of currently chronic inflammatory processes in the body (gynecological, rheumatic and others.).

It has been noticed that women who have been ill many times infectious inflammations genitourinary organs, with an accuracy of 80%, they make the correct diagnosis for themselves.

Kidney palpation data

The next stage of diagnosis is palpation of the patient’s kidneys. In this case, important signs of pyelonephritis are:

• positive Pasternatsky sign (pain with light tapping of the lumbar region);
• the occurrence of a muscular protective reaction on the affected side;
• soreness in the area of ​​the costovertebral angle - the point of intersection of the lateral edge of the erector spinae muscle and the lower edge of the 12th rib.

Laboratory tests to diagnose pyelonephritis

In the presence of typical symptoms the diagnosis of pyelonephritis is beyond doubt if it is confirmed by the results laboratory research. The main role here belongs to general clinical tests of urine and blood, the study of blood biochemistry, bacterial culture to determine the type of microflora that caused the disease, as well as specialized tests (according to Zimnitsky and Nechiporenko).

Blood tests

During a general (clinical) blood test, standard indicators are studied. The study is easy to conduct and provides a lot of information. With pyelonephritis in the blood there are typical signs inflammatory process - pronounced leukocytosis, increased speed erythrocyte sedimentation ().

In addition, patients with clinical signs In case of sepsis, blood culture is performed to detect microflora in it (bacteremia) and determine its sensitivity to antibiotics.

Bacteria in the blood are detected in approximately every fifth patient with acute pyelonephritis.

A biochemical blood test includes the study of many indicators. On the eve of this test, the patient is advised to avoid physical activity, limit meat foods in the diet, do not drink alcohol, coffee and strong tea.

The most significant biochemical indicators in the diagnosis of pyelonephritis:

• C-reactive protein, which is a marker of the presence of inflammation. It is detected in blood plasma shortly after the onset of the infectious process in the body. With the development of acute pyelonephritis, the content of this protein in the first hours of the disease sharply increases by 20-90 times compared to its normal level.
• Creatinine and urea. The level of these substances is the most important value characterizing the degree of impairment of the excretory capacity of the kidneys. Creatinine and urea are products of protein metabolism that circulate in the general bloodstream and are excreted in urine. Knowing these indicators, you can assess the performance of the urinary organs. In patients with pyelonephritis, the level of creatinine and urea in the blood serum is increased, which is a sign of renal failure.

The value characterizing the usefulness of renal blood flow is called creatinine clearance in medicine.

Table: main biochemical indicators of the blood of a healthy person

General urine analysis

For general analysis, prepare an average portion of the first morning urine obtained during the natural act of urination. If the patient is unable to void on his own bladder(if unconscious or in serious condition), its urine is obtained by catheterization of this organ.

It is not recommended to take this test for women during menstruation or if there are any other vaginal discharge. If this is absolutely necessary, then you need to thoroughly toilet the external genitalia and close the entrance to the vagina. cotton swab so that extraneous secrets do not get into the material.

An increase in the number of leukocytes (pyuria), erythrocytes and leukocyte casts in the urine sediment compared to the norm indicates pyelonephritis. Often when microscopic examination chains and colonies of bacteria (bacteriuria) are visible in the material.

Table: normal indicators of general analysis of urine sediment

Bacterial culture of urine and determination of microflora sensitivity to drugs

Urine culture to determine the number of microorganisms in it, the type of causative agent of pyelonephritis and its sensitivity to antibacterial drugs executed 3 times:

• before starting treatment;
• during it;
• after finishing.

Following all preventive measures to avoid contamination of the material, urine for culture is collected in sterile containers and immediately taken to the laboratory.

In an uncomplicated form of kidney inflammation, urine culture to monitor the correctness of the prescribed treatment is done 3 days after the start of antibiotic therapy and on the 11th day after its completion. In case of complicated pyelonephritis, such a study is carried out after a week and a month, respectively.

Urine culture at such a time is necessary to detect microorganisms that are insensitive to the drugs used and change treatment tactics, if necessary. In addition, this test helps detect a new attack of the disease after completing a course of antibiotic therapy.

Result indicator bacterial culture are the so-called colony-forming units (CFU), which are contained in 1 ml of urine. If their number significantly exceeds the norm (1000 CFU/ml or less), then this indicates the presence of an infectious-inflammatory disease in the urinary system.

At the first test for bacteria, more than 100 thousand CFU are detected in 1 ml of urine in 80% of patients with pyelonephritis.

Urine analysis according to Zimnitsky

A urine test according to Zimnitsky is performed to assess kidney function. During the study, the volume of fluid excreted by the kidneys per day, per night, per day and every 3 hours is measured.

The analysis technique does not imply any preparatory measures or changes in the patient’s diet and drinking regimen. Urine collection begins at 6 a.m. in the usual way, every 3 hours in a separate jar. There should be a total of 8 containers with material; They all have the portion number and collection time written on them, then the material is taken to the laboratory.

During the analysis according to Zimnitsky, they find out:

1. Daily diuresis. Normally - approximately 1.5 liters.
2. The ratio of daytime (from 6 to 18) and night (from 18 to 6) diuresis. The first must prevail over the second.
3. Three-hour urine volume and the difference between portions. Normally, the amplitude does not exceed 50–300 ml.
4. Changes in urine density in different portions. This value should not differ in any two containers by more than 16 g/l.

Healthy kidneys with normal concentrating and diluting abilities produce urine, the specific gravity of which within 24 hours increases to a maximum (more than 1020 g/l) and decreases to a minimum (less than 1010 g/l). A significant decrease in urine density throughout the day is a sign of impaired renal concentration function, characteristic of pyelonephritis.

Table: numbers of urine portions and time of collection for the sample according to Zimnitsky

Test according to Nechiporenko

For this analysis, only an average portion of urine is used. It counts the number of leukocytes, erythrocytes and cylinders in 1 ml of this biological fluid.

The test allows you to differentiate pyelonephritis from glomerulonephritis. With the first disease, the number of leukocytes in the urine is increased compared to the norm, and with the second, the number of red blood cells is increased. This study also monitors the effectiveness of the therapy.

Table: normal urine values ​​using the Nechiporenko test

Video: what urine tests tell you

Instrumental examinations for the diagnosis of pyelonephritis

As instrumental diagnostic studies Ultrasound, radiographic and other methods are widely used for kidney inflammation.

Kidney ultrasound

Ultrasound examination of the kidneys (synonyms: ultrasound scanning, echography, ultrasonography) consists of recording, using a special apparatus, impulses reflected by these organs. Along with ultrasound scanning, Doppler sonography, based on the Doppler effect, is used to assess the condition of blood vessels and blood circulation in the kidneys.

The Doppler effect is a physical phenomenon consisting of a change in the frequency of waves depending on the movement of the source of these waves relative to the observer. As the source approaches, the frequency of the waves it emits increases and the length decreases. As the source of waves moves away from the observer, their frequency decreases and the wavelength increases.

Kidney examination with ultrasound machine is performed with a person lying on his stomach, on his back or on the side opposite to the side being examined. A series of photographs are taken in longitudinal, transverse and oblique projections, and the size and location of the kidneys, the condition of their cups, pelvis and parenchyma are established.

The procedure is the safest, most accessible and patient-favorite method for diagnosing pyelonephritis. Ultrasound is particularly accurate in detecting dilation of the pelvis and cups and detecting abscesses in the perinephric tissues.

An enlarged kidney, combined with a decrease in its mobility, is the most important sign of pyelonephritis, clearly visible during this examination. The expansion of the hollow organ system indicates the obstructive nature of the disease; it means that somewhere in the urinary tract there is an obstruction to the outflow of urine.

Ultrasound comes to the rescue where it is necessary to identify focal purulent changes in the renal parenchyma (carbuncle or abscess) or in the tissue surrounding the organ. Often, a halo of irritation is detected around the affected kidney, caused by edema of the perinephric fat base.

X-ray studies for pyelonephritis

There are 3 types of x-ray examinations of the kidneys: plain x-ray, intravenous excretory urography and CT scan.

Survey radiography

Simple plain radiography involves taking an image of the abdominal cavity at the level of the kidneys. If there is a noticeable decrease (wrinkling) of these organs on one or both sides, then this indicates a state of chronic pyelonephritis.

When idle plain radiography The kidneys in the image are visualized in only 2/3 of people, and this is the main disadvantage of the method.

Excretory urography

Methodology excretory urography is based on the ability of the kidneys to excrete a contrast agent, previously administered intravenously to the patient, with urine. The study allows you to find the level of obstruction urinary tract and its reason.

However, at the beginning of the pathological process, such a diagnosis of kidney inflammation can present certain difficulties, since this disease sometimes develops in patients without disturbances in the outflow of urine (primary non-obstructive pyelonephritis), and there may not yet be any deviations from the norm in test results.

In this category of patients, urographic images on the same film at the time of inhalation and at the time of exhalation have diagnostic value. This makes it possible to detect restrictions in the movement of the affected kidney while the patient is breathing.

At chronic pyelonephritis The urogram shows deformations of the pyelocaliceal system of the kidney.

Video: how excretory urography is done

Kidney CT

Compared with the methods described above, computed tomography of the kidneys with intravenous administration contrast agent is more informative in identifying both urinary tract obstruction and purulent complications pyelonephritis - apostematous nephritis, renal carbuncle or perinephric abscess.

The extreme accuracy of this method is due to the ability to clearly distinguish pathological tissues from healthy ones. Great importance It also has a high resolution of the diagnostic equipment used. If necessary surgical intervention the results of the procedure help the doctor decide on the type of surgical access to the kidney: percutaneous (percutaneous) or open.

The only disadvantage of CT is the high cost of the study.

Video: what is computed x-ray tomography

Kidney MRI

Magnetic resonance imaging is used in the diagnosis of pyelonephritis mainly to detect its complication - paranephritis (inflammation of the perinephric tissues). The principle of this research is quite complex and is based on recording with a special sensor the electromagnetic response generated by hydrogen atoms. The latter are found in all living tissues, including the kidneys.

Video: what is a kidney MRI and how is it done?

Other methods

When the main diagnostic methods turns out to be insufficient, the patient may be prescribed additional research.

Vaccine cystography

Cystography is a type of excretory urography. At the same time, X-ray examination bladder filled with contrast agent. The latter enters the organ either from the kidneys through the ureters (descending route) or through the urethra (ascending route).

Victory cystography is called cystography, performed during the act of urination. The study is prescribed to a patient if vesicoureteral reflux is suspected - the phenomenon of the backflow of urine from the bladder into the ureter. This diagnosis is carried out a month after the acute symptoms of pyelonephritis have stopped.

Thermography (or thermal imaging)

Thermography is a method of obtaining information about an organ by studying its thermal radiation. Helps identify pathological changes in tissues even before they appear radiological signs and even in the absence of complaints from the patient.

Combination of thermography with other instrumental and laboratory methods allows you to determine the side of the lesion and the stage of the inflammatory process in the kidneys, as well as monitor the effectiveness of treatment. Such research will be especially helpful in purulent forms pyelonephritis.

Differential diagnosis

In all cases of suspected pyelonephritis, the doctor is faced with the task of distinguishing it from diseases with similar symptoms. Inflammation of the kidneys must be differentiated from the following diseases:

• appendicitis;
• glomerulonephritis;
• cholecystitis;
• acute pancreatitis;
• intestinal diverticulitis;
• cystitis;
• sepsis (blood poisoning).

The need for differential diagnosis arises when local hidden symptoms pyelonephritis. In this case it the most important signs- presence of bacteria and high leukocytosis in urine. Urine tests need to be repeated several times, since at the onset of the disease changes in this biological fluid may not be visible.

At acute cholecystitis There are symptoms of peritoneal irritation and pain localized in the right hypochondrium and radiating to the shoulder and scapula.

Unlike acute pyelonephritis, with appendicitis pain first appears in the upper part of the abdominal cavity, and later moves to the lower right region. Symptoms of peritoneal irritation occur. With acute inflammation of the kidneys, the body temperature suddenly rises to 38–39 °C, lasts all night, accompanied by chills and heavy sweat, and by morning drops sharply to 36–37 °C. Appendicitis is characterized by a gradual increase in temperature and its stable maintenance at high levels.

Very often, pyelonephritis is mistaken for glomerulonephritis or cystitis. Here the decisive role in diagnosis belongs to laboratory tests and clinical symptoms.

Table: distinctive features of pyelonephritis, glomerulonephritis and cystitis

In pyelonephritis infectious nature. He has acute or chronic course. A person's renal pelvis becomes inflamed. Urinalysis for pyelonephritis is the main method of diagnosis. With its help, they monitor and make adjustments to the prescribed therapy, assess whether the patient has been cured or not. If necessary, other treatment is prescribed to people at risk: children under 7 years of age, 18-30 year old women and older men diagnosed with prostate adenoma.

Causes

Obstruction of the urinary tract, adenoma, urolithiasis, and colic in the kidneys contribute to the disease. It develops due to pathogenic bacteria. Infection occurs via ascending/urogenic and hematogenous/lymphogenous routes.

Symptoms

There are two forms of the disease: chronic and acute. The differences between them are based on the nature of the inflammation. During development acute form changes occur in the kidneys, resulting in the development of a cellular infiltrate. When a person becomes ill, functionally active epithelial cells, which are structural and functional elements of the internal parenchymal organ.

Symptoms of acute pyelonephritis

• Chills, high temperature;
• Frequent urge to urinate;
• Profuse sweating;
• Vomiting/nausea;
• Lumbar, joint pain;
• Weakness and migraines;
• Dryness and pallor of the skin.

Taking a blood test for pyelonephritis, pus is detected. The content of red blood cells, protein and bacteria in this case is high. It is difficult to identify the disease in children, as the clinical data and picture are blurred.

If acute illness is not treated in time, a chronic illness will develop. Sometimes it is caused by past infections, viral diseases and hypothermia of the body. According to statistics, the disease is more often diagnosed in women due to the structural features of the organs. Symptoms appear constantly or there is a lull, followed by a protracted phase of exacerbation. Therefore, phases are distinguished: active inflammation, latent form and remission.

How is it diagnosed?

When making a diagnosis, methods for obtaining results play a primary role. Without research, it is difficult to find out the type of disease and its accompanying ailments. With their help, the composition, smell of urine, color, density, transparency, amount of sugar and protein in it are determined. If microorganisms are present, their sensitivity to antibiotics will be determined. The therapist prescribes a general urine and blood test for the patient, a blood test for sugar, and an ultrasound scan of the kidneys.

What rules are followed when collecting urine?

The indicators are worsened by non-compliance with urine collection rules. Before the procedure, doctors recommend toileting the external genitourinary organs using soap or weak antiseptics. Men take 2-3 samples to determine the source of leukocytes (prostate, urethra, bladder).

Tests for pyelonephritis are of two types. The first is general, and the second is expanded, for example, according to Nechiporenko.

Since the fluid collection system varies, preparations are made for the procedure in advance. IN otherwise the condition of the kidneys will be distorted.

2 days before collection, do not eat foods that change the color of urine. Avoid taking diuretics one week before the procedure. Women do not take it until their period ends. Urination should be free. When taking a general urine test for pyelonephritis, buy a special disposable jar at the pharmacy. It is prohibited to pour the collected liquid from one container to another to prevent cases of distortion of processes in the patient’s body.

The following parameters are assessed:

• Leukocytes;
• Bacteria;
• pH indicators;
• Consistency;
• Coloring.

There are no universal parameter values, because in medical practice minor deviations due to chronic or previous diseases of the patient were identified.

General indicators

When taking a general urine test for pyelonephritis, the laboratory assistant’s task is to carefully check all indicators.

Urine with pyelonephritis has a different color, smell, density and transparency. It is important to determine its acidity, composition, presence/absence of yellow pigment and a number of elements.

Today, doctors prescribe extensive studies to the patient to study the stage of the disease in detail. They take a urine test according to Nechiporenko and the Addis-Kakovsky test.

Patients with kidney problems or urinary system registered at the clinic will be sent for such a laboratory test. It involves establishing the concentration of cylinders, erythrocytes, and leukocytes. The diagnostician’s task is to identify the sediment and the percentage of content of each of the above elements.

Before collecting urine, the patient prepares thoroughly. When washing he does not use cosmetical tools. Bacteria remain on the genitals during urination. It will be possible to determine from them whether the disease is developing or not. The smell of urine changes if you use deodorant, gel intimate hygiene. Use only clean containers purchased at the pharmacy. The structure, density and color of urine during pyelonephritis change in women if they donate it during menstruation. You can't do that.

Doctors strongly recommend not taking antibiotics and limiting your diet! First you need to urinate past, and then into the container itself. After that, they take her to the hospital without delay. The longer the patient travels, the more distorted the result. In no case should the test be done in the evening, since not only the smell of urine changes, but also the proliferation of pathogenic bacteria begins.

How are the results of the Nechiporenko study deciphered?

• Leukocytes - ≤2000/1 ml;
• Red blood cells - ≤1000/1ml;
• Hyaline casts - ≤20.

Deviations help in determining concomitant illness. Because of high leukocytes Suspect cystitis, prostatitis, stones or kidney infarction. At elevated level The patient's erythrocytes develop nephrotic syndrome or acute glomerulonephritis. Renal pathology manifests itself high content hyaline casts. An excess indicates that the protein has not been converted from primary urine and has returned to the blood.

Hidden pathologies are a dangerous phenomenon. Granular casts appear from a layer of destroyed cells covering the kidney tubules. Deviations of this nature cause glomerudonephritis, lead poisoning of the body and viral infection.

Waxy casts indicate inflammation due to nephrotic symptom, dysfunction syndrome, and renal amyloidosis.

Erythrocyte casts cause kidney dysfunction, destructive phenomena in the walls of blood vessels in the renal tubule. When red blood cells are blocked in the renal tubule, these casts form. Delayed detection of the disease leads to renal vein thrombosis, hypertension, and renal infarction. Violation provokes infections viral in nature, drug overdose, necrosis.

Conclusion

To avoid being tested and not being treated for nonspecific inflammation kidneys of a bacterial nature, characterized by damage to the cups, renal pelvis and parenchyma, prevent it. Women drink plenty of fluids to help remove bacteria from the body when they urinate. They cleanse the urinary tract with cranberry juice. Urination is done after sexual intercourse and the urge to do so is not suppressed during the day. They wash in the shower, and thoroughly dry their genitals after defecation/urination. They don't let me through hygiene procedures morning, evening, after sex and bowel movements.

Kidney diseases. Pyelonephritis Pavel Aleksandrovich Fadeev

Blood chemistry

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If the development of kidney or urinary tract disease is suspected, patients are prescribed certain tests. In case of pyelonephritis, the patient must submit urine for research. If necessary, the doctor additionally prescribes tests for and.

Features and definition of pyelonephritis

The disease is an inflammation of an infectious nature. The causative agents of pathological processes are pathogenic microorganisms. They disrupt the outflow of urine and contribute to the development of infection in the urinary system.

The pathology is accompanied by characteristic signs:

• high body temperature;
• chills and fever;
• disturbance of the urination process;
• increased blood pressure.

Doctors make an accurate diagnosis based on urine examination. Tests will require morning urine. At the acute stage, patients with severe disease are prescribed. Patients also need to have their blood tested.

With pyelonephritis, the functioning of the kidneys is impaired. Inflammatory processes affect the characteristics of urine. Its density, color, transparency and smell change. The same applies to microbiological properties. During studies, doctors pay attention to the amount of fluid released. An indicator by which it is easy to determine impaired kidney function.

Deviations in kidney inflammation

U healthy person the normal concentration of leukocytes in urine is up to 2000/mg. The red blood cell level should not exceed 1000 units. Laboratory tests allow you to determine the development of pathological processes and confirm the doctor’s preliminary diagnosis.

Acute changes

Pathological processes appear due to infection of the urinary tract. Kidneys in acute form of pyelonephritis can be completely healthy. But the level of bacteria and leukocytes will show the development of pathological processes. There are certain indicators that determine the density of urine, as well as the level of protein.

The inflammatory process affects one or two kidneys at once. There are numerous reasons for its development and degree of progression. Considering the peculiarities of the occurrence and course of acute pyelonephritis, it is difficult to say clearly what deviations there are. Doctors pay attention to the general results of urine tests, which are far from normal.

Laboratory research allows specialists to study many factors:

• shade of urine;
• contents of the material being studied;
• presence of protein and sugar.

At the stage of exacerbation of pyelonephritis, all parameters deviate from the norm. Urine becomes light-colored. In some patients it is. The concentration of urine becomes less. Bacteria. According to external signs, urine with pyelonephritis contains blood impurities. If there is pus in the kidneys, the discharge will be cloudy.

The acute form of pyelonephritis is characterized by high concentration SRB. It's about about a protein that is formed in the liver and belongs to the acute phase group. As the inflammatory process develops and progresses, the concentration of CRP increases.

When bacterial infection in the urinary system the protein level is more than 30 mg/l. For a viral disease, these parameters range from 6 to 30 mg/l.

Doctors also examine urinary sediment in acute pyelonephritis. . Doctors note interesting fact that in case of defeat pathological processes This figure is small for one kidney. When the inflammatory process decreases, the results show the presence of pus in the urine.

With the development of acute pyelonephritis in a patient, urine analysis shows the presence of renal and transitional epithelium. The maximum concentration is observed during active development diseases. Against the background of filling with pus, the amount of epithelium decreases. Doctors also diagnose salt and...

Fluctuations in indicators in a chronic form

Pathological processes extend to the calyces and kidney tissue. It is necessary to undergo tests in a timely manner and clarify the diagnosis in order to prevent complications. We are talking about sepsis, when the infection affects the entire human body. Kidney failure also occurs when the organ completely stops producing urine. Without treatment, there is a risk of kidney atrophy.

Urinalysis for chronic form pyelonephritis does not always show changes present in the organ. The indicators worsen against the background of serious damage to the glomeruli and tubules.

Characteristic deviations:

• excreted by the kidney increased amount liquid that has low;
• acidity level increases;
• high transparency;
• V urinary sediment leukocytes, erythrocytes, epithelium, and bacteria are present.

IN general outline analyzes of chronic and acute forms of pyelonephritis are similar. During the patient’s recovery period, the deviations are insignificant, but for the doctor they are great value. It happens that a urine test does not show significant changes in kidney function. But signs of the development of the disease are present. Patients complain about high temperature body, and pain in the lumbar region.

In some situations, research is carried out using the Griess method. Results show presence in urine pathogenic microorganisms and their number. Positive analysis indicates more than 100 thousand harmful bacteria in the urine.

According to external signs, urine becomes pale in color and the protein level is increased. , a large amount of sediment collects. The pH value decreases. In the chronic form of pyelonephritis, urine results show increased content erythrocytes, microorganisms, and leukocytes.

Material for laboratory research must be collected in the morning. Patients are recommended to fast for 10 hours before taking samples. To establish accurate diagnosis Doctors examine urine using various directions. In many situations, the data obtained may be indirect and appear against the background of other pathological changes in the patient's body.

Patients may be prescribed additional studies only to confirm the previous diagnosis. This way the doctor can choose the most effective treatment to warn serious complications and consequences of pathology.

Necessary tests for diagnosis

When the first signs of the disease appear, the doctor carries out medical checkup. Establishes a preliminary diagnosis and prescribes additional tests.

When collecting material throughout the day, the first portions must be stored in a cool place.

Pyelonephritis is a common disease that is difficult to define. The pathology has no obvious signs; occasionally patients have a rise in body temperature. Patients are not able to determine the development of the disease on their own; qualified assistance will be required. Incorrect treatment entails serious complications and consequences.

Typically, pyelonephritis occurs with pronounced symptoms, but a latent course of the disease can also occur. In this case, diagnosing the disease is possible only after urine tests. Also, when the first symptoms of kidney inflammation appear, it is necessary to take a complex additional tests to determine the severity of the disease, its causative agents and assess the condition of the body.

Mandatory studies

The main studies for pyelonephritis are blood and urine tests, they are carried out not only during diagnosis, but also during treatment, and certainly after recovery before discharge.

What examinations are needed:

These are the most important tests for pyelonephritis, but others may be needed for clarification: blood for biochemistry, C-reactive protein, urine according to Zimnitsky, bacteriological blood culture for sterility.

In order for a urine test for pyelonephritis to show reliable information, you need to properly prepare for it:

How to collect urine:

1. A general analysis is taken immediately after sleep; only the first morning urine is needed. Required volume 50-100 ml.
2. Nechiporenko method– the average portion of urine is collected during the first morning urination. The collection time must be written on the container.
3. For culture for sterility You can take the test at any time of the day, provided that 2-3 hours have passed since the previous urination. You can only use the vessel that is provided by the laboratory.

Blood is donated in the morning on an empty stomach; the day before you should refuse junk food and notify your doctor if you have taken any medications.

General urine test values

A urine test for pyelonephritis shows a general picture of inflammation. In a completely healthy person, the results will be without deviations, that is, the urine should be completely sterile. At normal operation kidneys produce 1.5-2 liters of urine per day. In most cases, with pyelonephritis, the amount of fluid released decreases, but it may, on the contrary, increase.

The number of leukocytes is important; their level increases during inflammatory processes in the body. The normal amount for women is 0-6, for men 0-3. It should be taken into account that slight deviation is possible when poor nutrition. In acute pyelonephritis, a urine test will show an increase in leukocytes above 15; in chronic pyelonephritis, this figure rarely rises to a critical level.

The acidity of urine during pyelonephritis may fluctuate, the pH level may decrease or increase. An indicator of 5-7 is considered normal; if there are errors in the diet, urine indicators can be in the range of 4.2-8. If the pH is less than 5, then the urine reaction is acidic; at a constant pH level greater than 6, we speak of alkaline environment in the urinary system.

For pyelonephritis high acidity says that the causative agent is Escherichia coli or Mycobacterium tuberculosis.

With other media it is determined low level acidity.

Other meanings of OAM and what they mean:

An important factor in diagnosis is the color and concentration of the secreted fluid.

With pyelonephritis, the urine becomes cloudy and even with the naked eye you can see sediment at the bottom of the container. At purulent formations urine becomes darker in color and more bright color urine with pyelonephritis indicates extensive inflammatory process or related urolithiasis. Also for kidney stones and severe course pyelonephritis may reveal blood in the urine.

Women during menstruation need to use a tampon to avoid unusual impurities in the analysis. In addition, you should warn your doctor about possible blood getting into the container.

The density of urine in a healthy person is 1.010-1.22 g/l. If exceeded permissible value, then with high probability kidney inflammation is diagnosed; a decrease in normal levels occurs with renal failure or as a consequence of taking diuretics.

Transcript of other studies

For more accurate diagnosis A urine test using the Nechiporenko method is necessary. This method is aimed at quantitative calculation of the following indicators:

1. Leukocytes – with pyelonephritis, they increase over 2000 per 1 ml. Also high level leukocyte count may indicate the development of urolithiasis, kidney infarction, cystitis or prostatitis.
2. Red blood cells – normal amount less than 1000 per 1 ml. A high value may indicate the presence of a purulent process in the kidneys, chronic renal failure, glomerulonephritis, nephrotic syndrome.
3. Cylinders - if the number exceeds 20, it occurs with glomerulonephritis, pyelonephritis, renal vein thrombosis, amyloidosis and other pathologies.

A urine sterility test is very important.

It is used to determine which bacteria have become the source of infection, their number, and to which antibiotic they are most sensitive. How this analysis is deciphered:

1. With an amount of up to 103 per 1 ml, the flora is considered normal.
2. Indicator 103-104 – there is a risk of developing inflammation.
3. Over 105 per 1 ml – there is an infection in the urinary system.

A blood test for pyelonephritis can tell about general condition body. But the main importance in case of kidney inflammation is the quantitative indicator of leukocytes. The results indicate all types of these cells and their percentage. The following indicators are considered the norm:

With kidney inflammation, the level of neutrophils is most often exceeded; it is this value that indicates the presence of bacterial inflammation. During the recovery stage, there may be a slight increase in monocytes, but this is considered a normal condition if there are no associated pathologies.

But still, urine tests are considered the most informative. It is from them that any diseases of the urinary system can be accurately diagnosed.

It is impossible to make a diagnosis on your own, even if the results are available. Only doctors will be able to evaluate all the values ​​in complex and understand what kind of disease is developing.