Testing urine for the presence of certain groups of organic substances in it makes it possible to become familiar with the functioning of the body. This kind of analysis is prescribed not only when the patient complains of certain changes, but also as a means of prevention after/during treatment. Timely identification of harmful substances will help get rid of errors in the functioning of the kidneys, other internal organs, eliminate inflammatory processes.

Protein in a general urine test - characteristics and norms

The presence of protein in the urine is one of the symptoms that indicates a malfunction of the kidneys. In some cases, even in absolutely healthy people, under the influence of certain factors, urine testing can show the presence of protein.

What is the normal level of protein in urine for adults and children?

The level of this substance in urine at the time of morning collection should not exceed 0.033 g/l. However, this indicator may vary depending on lifestyle:

• For people who are engaged in heavy physical work, for athletes - 0.250 g/day.
• For people who do not lead an active lifestyle – no more than 0.080 g/day.

Causes of increased and decreased protein in urine in children and adults

There may be several factors that provoke the appearance of protein in the urine:

Bilirubin in a general urine test - characteristics and norms

During normal functioning of the body, the substance in question is excreted through the liver. When there is an excess of bilirubin in the blood, the function of its extraction is partially performed by the kidneys, which ensures the presence of this component in the urine.

Should there be bilirubin in the urine in children and adults?

In the absence of any pathologies in the functioning of the body, urine testing in children and adults should not show the presence of bilirubin in it.

Causes of bilirubin in urine in children and adults

The presence of the substance in question in the urine indicates a malfunction of the liver/kidneys.

The most common causes of bilirubin in urine are:

Glucose in a general urine test - characteristics and norms

Often, the increase (occurrence) of glucose in the urine occurs due to the inability of the kidneys to reabsorb glucose.

How much glucose should there be in the urine of children and adults according to the norms?

The substance in question may normally be present in urine, but its permissible concentration is limited: no more than 0.8 mmol/l. If, when testing urine, the glucose level exceeds the specified norm, a blood glucose test is prescribed at the same time.

Reasons for the increase (occurrence) of urine glucose in children and adults

The detection of this substance in the urine requires further, more thorough research, which will help establish the exact cause of this pathological phenomenon.

The most likely factors that cause the appearance of glucose in the urine in children and adults are the following:

Urobilinogen in general urine analysis - characteristics and norms

This substance is formed in the intestines from bilirubin. The main role in removing urobilinogen is assigned to the liver, but the kidneys also partially participate in this.

What should be the normal level of urobilinogen in urine in children and adults?

When testing morning urine, the substance in question is not detected in it. In general, no more than 6 mg may be present in the urine of adults and children throughout the day. urobilinogen. Some time after urine collection, urobilinogen is converted to urobilin.

Reasons for the presence (increase) of urobilinogen in urine in children and adults

The reasons that cause this pathological phenomenon when testing urine can be of a different nature:

Bile acids (pigments) in general urine analysis - characteristics and norms

The most common representatives of this group of substances are bilirubin and urobilinogen. Excretion of the components in question occurs through feces, less often through urine.

A distinctive feature of bile pigments when present in urine is its non-standard color: dark yellow, with a green tint.

What should be the normal level of bile pigment in urine in children and adults?

Bile pigments are regularly formed in the body under the influence of enzymes in the intestines. Often the main share of such substances (more than 97%) is excreted along with feces, in other cases through urine.

The permissible norm of the pigments in question in the urine of adults and children cannot exceed 17 µmol/l. An increase in this indicator is associated with serious diseases.

Causes of occurrence (increase) of bile pigment in urine in children and adults

The reasons causing an increase in the concentration of bile pigments when testing urine can be of a different nature:

Indican in general urine analysis - characteristics and norms

The substance in question is formed as a result of protein decay in the cavity of the small intestine. An increase in the level of indican concentration in the urine does not always indicate pathological conditions: this may be associated with poor nutrition (the predominance of meat foods in the diet).

What should be the normal content of indican in urine in children and adults?

This substance may be present in the urine of healthy people and children, but its amount is limited: 0.005-0.02 g/day. If there is an excess of indigan, the urine will have a blue tint, and the patient will complain of abdominal pain and diarrhea.

Reasons for increased urine indican levels in children and adults

Factors that provoke an increase in the level of indican concentration in the urine are often associated with errors in the functioning of the gastrointestinal tract:

• Inflammatory, purulent phenomena in the intestines: colitis, peritonitis, intestinal obstruction, chronic constipation, abscesses/abscesses in the intestines.
• Malignant formations in the stomach, intestines, liver.
• Diabetes mellitus.
• Gout.

Ketone bodies in general urine analysis - characteristics and norms

The formation of these substances occurs due to the decomposition of fatty acids. There are several types of ketone bodies: acetone, acetoacetic acid, hydroxybutyric acid.

Detection of the substances in question in urine has important for timely diagnosis and treatment of diabetes.

With inadequate drug treatment diabetes mellitus, the level of ketone bodies in the urine will increase, which will indicate a deterioration in the functioning of the central nervous system.

How many ketone bodies should be in the urine of children and adults according to standards?

The presence of these substances in the urine of adults and children, even in small doses, is a sign of pathology.

Why do ketone bodies appear in urine in children and adults - reasons

The detection of these substances in urine may indicate the following pathologies:

Hemoglobin in a general urine test - characteristics and norms

This substance is formed during the destruction of the structure of red blood cells, after which the blood masses are replenished with a considerable amount of hemoglobin. The liver is responsible for removing the main part of hemoglobin; the kidneys take part in this process partially.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

General indicators urine test can fluctuate over a fairly wide range, and these fluctuations can be physiological or pathological. Physiological fluctuations are a variant of the norm, while pathological fluctuations reflect a disease.

An increase or decrease relative to the norm of any indicator cannot be assessed unambiguously and a conclusion can be drawn about the presence of a disease. Test results can help clarify the possible cause of disorders, which may only be at the stage of a syndrome and not a mature disease. Therefore, timely detection of abnormalities in tests will help begin treatment and prevent the progression of the disease. Also, test indicators can be used to monitor the effectiveness of treatment.

Let's consider probable reasons changes in various indicators of general urine analysis.

Causes of urine color change

In the presence of pathology, urine may change its color, which indicates a certain syndrome and disease.

The correspondence of urine colors to various pathological conditions of the body is shown in the table:

Pathological color urine	Possible disease (cause of urine color change)
Brown, black	Hemolytic anemias (sickle cell, thalassemia, Minkowski-Choffard anemia, Marchiafava-Michelli disease, march anemia, syphilitic, hemolytic disease of the newborn) Malignant neoplasms (melanosarcoma) Alkaptonuria Poisoning with alcohol, salts of heavy metals, phenol, cresol, etc.
Red (meat color) slop)	Kidney damage due to injury (impact, bruise, rupture, etc.) Renal colic Kidney infarction Acute kidney inflammation (glomerulonephritis, pyelonephritis)
Dark brown foamy (urine color beer)	Botkin's disease Obstructive jaundice (blockage of bile ducts by stones)
Orange, rose red	Hemolytic jaundice (hemolytic disease of the newborn) Porphyria (impaired hemoglobin synthesis)
Brown (the color of strong tea)	Hemolytic jaundice Some types of hemolytic anemias
Colorless or white-yellow	Diabetes mellitus types 1 and 2 Diabetes insipidus
Milky (color of milk, cream)	High concentration of fats in urine (lipuria) Pus in the urine (pyuria) High concentration of phosphate salts

These color variations will help you navigate, but to make an accurate diagnosis you should take into account data from other examination methods and clinical symptoms.

Causes of cloudy urine

Impaired urine clarity is the appearance of turbidity of varying severity. Cloudy urine may be present a large number salts, epithelial cells, pus, bacterial agents or mucus. The degree of turbidity depends on the concentration of the above impurities.

From time to time, every person experiences cloudy urine, which is formed by salts. If you cannot donate this urine for analysis to the laboratory, then you can conduct a test to determine the nature of the turbidity.

To distinguish salts in urine from other types of turbidity at home, you can slightly warm the liquid. If the turbidity is formed by salts, then it can either increase or decrease until it disappears. Turbidity formed by epithelial cells, pus, bacterial agents or mucus does not change its concentration at all when urine is heated.

Reasons for changes in urine odor

The smell of fresh urine is normal - not pungent or irritating.

The following pathological odors of urine are most often observed:
1. The smell of ammonia in urine is characteristic of the development of inflammation of the mucous membrane of the urinary tract (cystitis, pyelitis, nephritis).
2. The smell of fruits (apples) in the urine develops in the presence of ketone bodies in people suffering from type 1 or 2 diabetes.

Reasons for changes in urine acidity

Urine acidity (pH) can change to alkaline and acidic, depending on the type of pathological process.

The reasons for the formation of acidic and alkaline urine are reflected in the table:

Reasons for changes in urine density

The relative density of urine depends on kidney function, so a violation of this indicator develops with various diseases of this organ.

Today, the following options for changing the density of urine are distinguished:
1. Hypersthenuria – urine with high density, more than 1030-1035.
2. Hyposthenuria is urine with low density, in the range of 1007-1015.
3. Isosthenuria – low density of primary urine, 1010 or less.

A single excretion of urine with high or low density does not provide grounds for identifying hyposthenuria or hypersthenuria syndrome. These syndromes are characterized by prolonged urine production during the day and night, with high or low density.

Pathological conditions causing disturbances in urine density are reflected in the table:

Hypersthenuria	Hyposthenuria	Isosthenuria
Diabetes mellitus type 1 or 2 (urine density can reach 1040 and higher)	Diabetes insipidus	Chronic renal failure severe degrees
Acute glomerulonephritis	Resorption of swelling and inflammation infiltrates (period after the inflammatory process)	Subacute and chronic jades severe
Stagnant kidney	Nutritional dystrophy (partial starvation, deficiency nutrients etc.)	Nephrosclerosis
Nephrotic syndrome	Chronic pyelonephritis
Edema formation	Chronic nephritis
Convergence of edema	Chronic renal failure
Diarrhea	Nephrosclerosis (degeneration of the kidney connective tissue)
	Glomerulonephritis
	Interstitial nephritis

Determination of chemicals in urine in various diseases

As we see, the physical properties of urine in the presence of any diseases can change quite significantly. In addition to changes in physical properties, various chemicals, which are normally absent or present in trace quantities. Let's consider what diseases cause an increase in the concentration or appearance of the following substances in the urine:

• protein;
• bile acids (pigments);
• indican;
• ketone bodies.

Causes of protein in urine (proteinuria)

The appearance of protein in the urine can be caused by various reasons, which are classified into several groups, depending on the origin. A pathological increase in the concentration of protein in the urine above 0.03 g is called proteinuria. Depending on the protein concentration, moderate, moderate and severe degrees of proteinuria are distinguished. Moderate proteinuria is characterized by protein loss of up to 1 g/day, moderate – 1-3 g/day, severe – more than 3 g/day.

Types of proteinuria

Depending on the origin, the following types of proteinuria are distinguished:

• renal (renal);
• stagnant;
• toxic;
• febrile;
• extrarenal (extrarenal);
• neurogenic.

The reasons for the development of various types of proteinuria are presented in the table:

Type of proteinuria	Reasons for the development of proteinuria
Renal (renal)	pyelonephritis renal amyloidosis kidney stones kidney abscess kidney tuberculosis tumor or metastases in the kidney nephritis (acute and chronic) nephrosis nephrotic syndrome eclampsia in pregnancy nephropathy in pregnancy paraproteinemic hemoblastoses (multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, immunoglobulin diseases, secreting lymphomas)
Stagnant	chronic heart failure neoplasms localized in the abdominal cavity
Toxic	Use of the following medications in very high doses: salicylates, isoniazid, painkillers and gold compounds
Feverish	Severe increase in body temperature caused by any disease
Extrarenal (extrarenal)	cystitis urethritis pyelitis prostatitis vulvovaginitis chronic constipation long diarrhea
Neurogenic	skull injury meningeal hemorrhage myocardial infarction renal colic

Causes of glucose (sugar) in urine

The appearance of glucose in the urine is called glycosuria. The most common cause of glycosuria is diabetes mellitus, but there are other pathologies that lead to this symptom.

So, glucosuria is divided into the following types:
1. Pancreatic.
2. Renal.
3. Hepatic.
4. Symptomatic.
Pancreatic glucosuria develops against the background of diabetes mellitus. Renal glycosuria is a reflection of metabolic pathology, and occurs with early age. Hepatic glycosuria can develop with hepatitis, traumatic damage to the organ, or as a result of poisoning with toxic substances.

Symptomatic glycosuria is caused by the following pathological conditions:

• concussions;
• hyperthyroidism (increased concentration of thyroid hormones in the blood);
• acromegaly;
• Itsenko-Cushing syndrome;
• pheochromocytoma (adrenal tumor).

IN childhood In addition to glucose, other types of monosaccharides can be detected in the urine - lactose, levulose or galactose.

Reasons for the appearance of bilirubin in urine

Bilirubin in the urine appears with parenchymal or obstructive jaundice. Parenchymal jaundice includes acute hepatitis and cirrhosis. Obstructive jaundice includes various options blockage of the bile ducts with an obstruction to the normal outflow of bile (for example, cholelithiasis, calculous cholecystitis).

Reasons for the appearance of urobilinogen in urine

Urobilinogen in a concentration exceeding 10 µmol/day is determined in the urine in the following pathologies:

• infectious hepatitis;
• chronic hepatitis;
• liver cirrhosis;
• tumors or metastases in the liver;
• hemoglobinuria (hemoglobin or blood in the urine);
• hemolytic jaundice (hemolytic disease of newborns, hemolytic anemia);
• infectious diseases (malaria, scarlet fever);
• fever of any cause;
• the process of resorption of foci of hemorrhage;
• volvulus;
• bile acids (pigments);
• indican.

Reasons for the appearance of bile acids and indican in the urine

Bile acids (pigments) appear in the urine when the concentration of direct bilirubin in the blood increases above 17-34 mmol/l.

Reasons for the appearance of bile acids in urine:

• Botkin's disease;
• hepatitis;
• obstructive jaundice (calculous cholecystitis, cholelithiasis);
• cirrhosis.

Indican is a product of decay of protein structures in the small intestine. This substance appears in the urine with gangrene, chronic constipation, all kinds of abscesses, ulcers and abscesses of the intestine, malignant tumors or obstruction. Also, the appearance of indican in the urine can be caused by metabolic diseases - diabetes mellitus or gout.

Reasons for the appearance of ketone bodies in urine

Ketone bodies include acetone, hydroxybutyric acid and acetoacetic acid.

Reasons for the appearance of ketone bodies in urine:

• diabetes mellitus of moderate and severe severity;
• fever;
• severe vomiting;
• therapy with large doses of insulin over a long period of time;
• eclampsia in pregnancy;
• cerebral hemorrhages;
• traumatic brain injuries;
• poisoning with lead, carbon monoxide, atropine, etc.

IN postoperative period, after a long stay under anesthesia, ketone bodies can also be detected in the urine.

Interpretation of urinary sediment microscopy

One of the most informative parts of a general urine analysis is sediment microscopy, in which the number of different elements located in one field of view is counted.

Leukocytes, pus in the urine - possible causes

An increase in the number of leukocytes more than 5 in the field of view indicates a pathological process of an inflammatory nature. An excess of white blood cells is called pyuria - pus in the urine.

Reasons that cause the appearance of leukocytes in the urine:

• acute pyelonephritis;
• acute pyelitis;
• acute pyelocystitis;
• acute glomerulonephritis;
• treatment with aspirin, ampicillin;
• heroin use.

Sometimes, to clarify the diagnosis, urine is stained: the presence of neutrophilic leukocytes is characteristic of pyelonephritis, and lymphocytes - of glomerulonephritis.

Red blood cells, blood in urine - possible causes

Red blood cells in the urine can be present in varying quantities, and when their concentration is high, they speak of blood in the urine. By the number of red blood cells in the urinary sediment, one can judge the development of the disease and the effectiveness of the treatment used.

Reasons for the appearance of red blood cells in the urine:

• glomerulonephritis (acute and chronic);
• pyelitis;
• pyelocystitis;
• chronic The reasons for detecting different types of casts in urine are presented in the table:
  

  Type of cylinders urinary sediment	Causes of casts in urine
  Hyaline	nephritis (acute and chronic) nephropathy in pregnancy pyelonephritis kidney tuberculosis kidney tumors kidney stones diarrhea epileptic seizure fever poisoning with sublimate and salts of heavy metals
  Grainy	glomerulonephritis pyelonephritis severe lead poisoning viral infections
  Waxy	chronic renal failure kidney amyloidosis
  Erythrocyte	acute glomerulonephritis kidney infarction thrombosis of the veins of the lower extremities high blood pressure
  Epithelial	renal tubular necrosis poisoning with salts of heavy metals, sublimate taking substances toxic to the kidneys (phenols, salicylates, some antibiotics, etc.)

  Epithelial cells in urine - possible causes

  Epithelial cells are not just counted, but also divided into three types - squamous epithelium, transitional and renal.

  Cells squamous epithelium in urinary sediment are detected in various inflammatory pathologies of the urethra - urethritis. In women, a slight increase in squamous epithelial cells in the urine may not be a sign of pathology. The appearance of squamous epithelial cells in the urine of men undoubtedly indicates the presence of urethritis.

  Transitional epithelial cells in urinary sediment are detected in cystitis, pyelitis or pyelonephritis. Distinctive signs of pyelonephritis in this situation are the appearance of transitional epithelial cells in the urine, in combination with protein and a shift in the reaction to the acidic side.

  Renal epithelial cells appear in the urine when the organ is seriously and deeply damaged. Thus, most often renal epithelial cells are detected in nephritis, amyloid or lipoid nephrosis, or poisoning.

  Pathologies leading to the release of salts into the urine

  Crystals of various salts can appear in urine normally, for example, due to dietary patterns. However, in some diseases there is also the release of salts in the urine.

  Various diseases that cause the appearance of salts in the urine are presented in the table:
  
  The table shows the most common salts that have diagnostic value.

  Mucus and bacteria in urine are possible causes

  Mucus in the urine is detected in case of urolithiasis or long-term chronic inflammation of the urinary tract (cystitis, urethritis, etc.). In men, mucus may appear in the urine due to prostatic hyperplasia.

  The appearance of bacteria in the urine is called bacteriuria. It is caused by an acute infectious-inflammatory process occurring in the organs of the urinary system (for example, pyelonephritis, cystitis, urethritis, etc.).
  A general urine test provides a fairly large amount of information that can be used to make an accurate diagnosis in combination with other techniques. However, remember that even the most accurate analysis does not allow you to diagnose any disease, since this requires taking into account clinical symptoms and objective examination data.

The composition and concentration of substances dissolved in urine reflect the course of all types of metabolism. Unnecessary metabolic products are excreted from the body in the urine if the size of their molecules allows them to pass through the kidney filter. The rest are sent to the intestines.

Bile pigments are present in urine in very small quantities. They are the ones that color urine yellowish. It is impossible to identify this minimum using conventional laboratory methods, and is not considered necessary.

If the color of urine darkens to a “beer shade,” a suspicion arises of an increase in the concentration of bile pigments caused by their increased content in the blood. Conducting a urine test with qualitative and quantitative reactions allows you to make a correct diagnosis.

What bile pigments end up in urine?

There are 2 types of bile pigments found in urine:

• bilirubin;
• urobilinogen.

Accordingly, such conditions can be called bilirubinuria and urobilinogenuria.

What is bilirubin?

The breakdown of red blood cells causes an increased release of hemoglobin. It is from this that bilirubin is formed in the liver. The substance can be present in the blood in two states:

• free bilirubin (unconjugated) – does not pass through the barrier of the renal membrane, which means it is not normally found in urine, despite the increased level;
• bound (conjugated) - reacts with glucuronic acid, becomes a soluble compound and is excreted into urine, bile, and with it into the intestines.

Transformations occur in liver cells. Bilirubinuria is caused by an increased level of conjugated bilirubin in the blood.

The formation of bilirubin is associated with the process of breakdown of red blood cells

How is urobilinogen formed?

Urobilinogen is a product of the subsequent processing of bilirubin in the intestine by:

• mucosal enzymes;
• bacteria.

More modern data indicate the presence of urobilinogen bodies, which include derivatives:

• mesobilirubinogen,
• i-ypobilinogen,
• urobilinogen IX a,
• d-urobilinogen,
• "third" urobilinogen.

The last two types and stercobilinogen are synthesized in fairly small quantities and are of no diagnostic value.

The formation of urobilinogen from conjugated bilirubin occurs in the upper part of the small intestine and the beginning of the large intestine. Some researchers believe that it is synthesized by cellular dehydrogenase enzymes in the gallbladder with the participation of bacteria.

A small part of urobilinogen is absorbed through the intestinal wall into the portal vein and returns to the liver, where it is completely broken down. The other is processed into stercobilinogen.

Further, through the hemorrhoidal veins, these substances can enter the general bloodstream and are excreted into the urine by the kidneys. Most of the stercobilinogen in the lower intestine is transformed into stercobilin and excreted in the feces. This is the main pigment that provides color to feces.

The normal level in urine is considered to be no more than 17 µmol/l. If urine is briefly exposed to air, urobilinogen is oxidized by oxygen and converted into urobilin. This can be seen by color:

• urobilinogen is a colorless substance, fresh urine has a straw-yellow tint;
• after some time, due to the formation of urobilin, it darkens.

Jaundice in newborns is associated with increased breakdown of red blood cells and the transition to their own hematopoiesis

What do urine pigments “tell”?

Taking into account the biochemical transformations and properties of bile pigments, their determination can be considered a reliable sign of liver damage and the inability to cope with the disposal of red blood cell breakdown products.

When bilirubinuria is detected, 2 pathology options should be assumed:

• disruption of the functioning of liver cells (inflammation, loss of number due to replacement by scar tissue, compression by edema, dilated and overcrowded bile ducts), this process is confirmed by checking the content of aspartic and alanine transaminases, alkaline phosphatase, and total protein in the blood;
• accumulation in the blood of an increased content of hemoglobin from destroyed erythrocyte cells; for clarification, a study of the hematopoiesis process and analysis of bone marrow punctate will be required.

When is the level of bilirubin in urine impaired?

Unconjugated bilirubin appears in the blood in liver diseases:

• viral hepatitis;
• toxic hepatitis due to poisoning with toxic substances (medicines);
• severe consequences of allergies;
• cirrhosis;
• oxygen hypoxia of liver tissue in heart failure;
• metastatic damage to cancer cells from other organs.

But it does not pass into urine due to the impossibility of filtration. Only in the case of renal and hepatic failure with destruction of the nephron membrane can it be detected in urine.

These same diseases are accompanied by the accumulation of conjugated bilirubin. Its level in the blood determines the degree of damage to the liver tissue. The “renal threshold” for bilirubin is considered to be a level of 0.01-0.02 g/l.

If the liver function is not impaired, but the outflow of bile into the intestines is hampered, then a significant amount of conjugated bilirubin enters the blood and its excretion in the urine increases accordingly. This variant of pathology develops when:

• cholelithiasis;
• compression of the bile duct by a tumor of the head of the pancreas or swelling in acute pancreatitis.

Impaired bile outflow leads to high levels of bilirubin in urine

Bilirubinuria appears as a result of a slow flow of bile in the interlobular ducts (cholestasis), leakage of bile into blood vessels. The patient is expressed in yellowness of the skin and sclera. The type of jaundice (mechanical or parenchymal, subhepatic or hepatic) is determined by the ratio of free - bound bilirubin in the blood and urine.

Important hallmark Hemolytic conditions are determined by the absence of bilirubinuria.

What is judged by the content of urobilinogen?

In diagnosis, both increased and decreased levels of pigment in the urine are important. The growth of the upper normal level is possible due to:

1. Damage to the liver parenchyma, but maintaining the flow of the bulk of bile into the intestine. The part of the pigment returned through the portal vein is not processed by hepatocytes due to their functional inferiority. Therefore, urobilinogen is excreted into the urine.
2. Activation of hemolysis (destruction of red blood cells) - increased synthesis of urobilinogen bodies and stercobilin occurs in the intestine. In this case, the returning part of urobilinogen is broken down by the working liver into the final product (pentediopente), and stercobilin goes through the hemorrhoidal veins into the general bloodstream, the kidneys and is excreted in the urine.
3. Intestinal diseases - which are accompanied by increased reabsorption of stercobilinogen through the affected wall (prolonged constipation, enterocolitis, chronic intestinal obstruction, cholangitis).

The mechanism of hemolysis is characteristic of diseases such as:

• malaria;
• Addison-Beermer anemia;
• lobar pneumonia;
• infectious mononucleosis;
• Werlhof's disease;
• some types of hemorrhagic diathesis;
• sepsis.

Massive hemolysis is caused by:

• complication of massive internal bleeding;
• transfusion of incompatible blood group;
• resorption of large hematomas.

Parenchymal failure is secondary to circulatory disorders after myocardial infarction and the development of cardiac weakness. Treatment of liver cirrhosis by applying a shunt to eliminate portal hypertension can be complicated by renal vein thrombosis.

A decrease in urobilinogen concentration indicates:

• blockage of the biliary tract due to stones or compression by a tumor;
• inhibition of bile formation up to complete cessation in severe hepatitis and toxic liver damage.

Methods for qualitative and quantitative determination of pigments in urine

Qualitative samples can identify a substance, but do not indicate its mass. Tests for bilirubin are based on the ability to form a green compound (biliverdin) when oxidized with iodine or nitric acid. An iodine-containing solution (Lugol's, potassium iodide, alcohol tincture) is added layer by layer into a test tube with 5 ml of urine.

Bilirubinuria is indicated by the formation of a green ring at the border

To detect urobilin, bilirubin, which interferes with the reaction, is removed from urine with a solution of calcium chloride and ammonia, then various tests are carried out:

• with copper sulfate - urine is combined with copper sulfate, then with a chloroform solution, after shaking, an intense pink color appears;
• using a spectroscope – the blue-green part of the spectrum remains.

Depending on the intensity of the color, the following may be marked in conclusion:

• (+) – the reaction is weakly positive;
• (++++) – sharply positive.

A detailed determination of the amount of bile pigments in urine is carried out using biochemical reagents in special clinics. The fact is that the study of bile pigments is more indicative of the results of blood tests rather than urine tests.

When is it necessary to check a urine test for bile pigments?

Qualitative tests for bile pigments are included in the mandatory list of standard urine tests. Therefore, if the patient complains of:

• dyspeptic disorders;
• vague pain in the hypochondrium on the right;
• yellowness of the sclera, skin;
• darkening of urine and light-colored stool;
• It is necessary to exclude diseases of the liver and gall bladder.

When choosing a method of treating a patient, the doctor must not harm the human organs and systems, so the analysis is needed to exclude the toxic effect of the drug on the liver.

The appearance of jaundice requires examination for bile pigments

Poisoning with various toxic substances is accompanied by damage to kidney and liver function. By identifying bile pigments, the degree of disorder can be tentatively assumed.

In severe myocardial diseases, a positive test indicates the involvement of liver tissue in the formation of general hypoxia.

Are there any specific features of collecting urine for analysis?

When collecting urine, general requirements should be met:

• mandatory hygiene of the external genitalia;
• Only the average portion of morning urine is suitable for research;
• the container with urine should not be stored for more than two hours, there is no need to leave the transparent jar in the light;
• 50 ml is enough for analysis.

Bile pigments in urine are involved in the metabolism of important organs and the hematopoietic system. Their determination in urine plays a significant role in diagnosis.

Urine contains mainly water, electrolytes, organic matter, and is a product of material metabolism and filtration of blood in the kidneys. The composition of urine is constantly changing and depends on the intensity of glomerular filtration, the level of reverse absorption of water and biologically active substances from primary urine and/or renal excretion. Assessing the composition of urine allows one to judge the functional capabilities of the kidneys, the stability of metabolic processes in the body, the presence of pathologies, and the effectiveness of the treatment tactics used. Normally, bilirubin metabolic products should not be present in urine. Bile pigments are quantified by special tests.

Pigments are formed from hemoglobin, which contains red blood cells.

What are bile pigments?

Bile pigments are products that are formed from hemoglobin, which contains red blood cells. The cells are destroyed to produce bilirubin in a free, unbound state. Once in the liver, this substance reacts with glucuronic acid and a bound pigment is formed. In this form, it enters the bile, and with it into the intestines.

When reacting with intestinal microflora and enzymes, urobilinogen is obtained. This compound is partially absorbed into the blood and then excreted in the urine. With pathologies of the bile-forming system, such as a removed gallbladder, an inflamed liver, bilirubinuria and urobilinogenelia develop.

Types of pigments

Urine may contain 2 types of bile substances: bilirubin, urobilinogen, which are formed during the division of red blood cells. If there are no pathologies in the body, urine should normally not contain bilirubin pigment. The concentration of urobilinogen throughout the day can vary within different limits, without exceeding the norm. Over time from the moment of collection of the material, urobilinogen in the urine is converted into urobilin.

Bilirubin pigment

When bilirubin increases, the urine turns dark brown.

The substance should not be detected in urine by classical laboratory tests, such as general and biochemical analysis. Normally, this metabolic product should be removed from the body. When its limit in urine is increased, bilirubinuria develops. Urine turns dark brown. The phenomenon often occurs when the gallbladder has been removed.

The free substance is insoluble in water, so it is not found in urine. The property of solubility is endowed with a compound bound by hepatic glucuronic acid. When the pigment is elevated in the blood, the excess is excreted from the kidneys into the urine. Increased bilirubin is observed against the background of progression of liver and biliary tract diseases. As a result of stagnation, rapid formation of cholesterol and bilirubin pigment occurs. They form a sediment in the bile with gradual crystallization, which becomes overgrown with calcium salts and other components, which leads to the formation of stones.

If yellowness of the skin appears, but there is no pigment in the urine, hemolytic jaundice is diagnosed. In this case, increased bilirubin is detected in the blood. As a result of such hemolysis, indirect bilirubin pigment is not filtered by the kidneys, which means it is not excreted in the urine. The causes of bilirubinuria are:

• stone formation in the kidneys and urinary tract;
• failures in the diet with a large amount of carbohydrates;
• pathologies that cause rapid destruction of red blood cells, for example, blood diseases, malaria, sickle cell anemia, chemical intoxication.

The formation of urobilinogen is provoked by various diseases.

The substance is formed from bilirubin pigment when it reacts with intestinal enzymes. A small concentration of colorless urobilinogen should be in the urine. This substance is oxidized to form yellow urobilin. If its content is exceeded, the urine becomes dark.

Urobilinogen is created at a specific rate, so it is regularly excreted in feces and partially in urine. An increase in the rate of its formation is provoked by various diseases. In some cases, the rate drops, then the pigment is not detected in the urine. Exceeding the concentration is usually associated with pathologies that cause intense breakdown of red blood cells, which provokes an increase in the amount of free hemoglobin, which is a source of excess bilirubin, and therefore urobilinogen.

Reasons for excess urobilin in urine:

• malaria;
• bleeding from the gastrointestinal tract, lungs, female genital organs;
• Werlhof's disease;
• Biermer's anemia or hemolytic jaundice;
• lobar pneumonia;
• hemorrhagic diathesis;
• liver diseases;
• severe biliary tract infections;
• cardiac dysfunctions;
• stagnation in the intestines.

If urobilinogen is not present in the urine, then you need to check the bile duct for blockage. For this reason, the passage of bile with bilirubin substance is disrupted.

Even a person who has no health complaints should undergo periodic tests to eliminate the risk of developing various diseases and the formation of pathologies. One of the main tests is to check the urine for the presence of certain types of organic substances. If you promptly diagnose bile pigments in the urine, you can prevent the development of dangerous diseases and eliminate the inflammation that has begun.

Urine changes depending on various factors of the external and internal environments. The appearance and composition of urine can change due to the development of diseases and even the food eaten.

The following must be present in the urine:

• water;
• electrolytes;
• organic.

Urine is a product that is formed as a result of metabolic processes in the kidneys and the filtration of blood in them.

By doing a urine analysis, you can determine:

1. How correctly and well the kidneys work.
2. How do they go metabolic processes in the body.
3. Are there pathological changes that can lead to various diseases.

If a urine test is done during the treatment of existing diseases, the results can be used to draw a conclusion about positive or negative changes in the state of health. One of the main indicators of the analysis is the presence and level of bile pigments.

There may be 2 types of them in urine:

• bilirubin;
• urobilinogen.

Both substances are produced by the division of red blood cells. When unbound bilirubin enters the blood cells, the cells begin to break down and react with a substance such as glucuronic acid as they pass through the liver. As a result, a bound pigment begins to form, entering first the bile and then the intestines.

When the intestinal microflora reacts with enzymes, urobilinogen is formed, which is partially absorbed by the blood and then released along with urine.

If a person has had their gallbladder removed or has various pathologies and diseases of the biliary system, the following are diagnosed:

1. Bilirubinuria.
2. Urobilinogenelia.

In the absence of pathologies and various diseases, bilirubin should not be present in the urine test. But the urobilinogen level can change throughout the day.

Bilirubin is formed by liver cells after the breakdown of red blood cells, which provoke an increase in hemoglobin.

The pigment can be of 2 forms:

1. Unconjugated or free. May be elevated. However, the pigment does not pass beyond the renal membrane. Accordingly, this form of bilirubin is absent in urine.
2. Conjugated or bound bilirubin. It actively interacts with glucuronic acid, transforming into a soluble substance. It easily penetrates into the liver secretions, urine, and intestines.

Urobilinogen is formed after bilirubin enters the intestines.

Here the pigment is modified:

• mucosal enzymes;
• bacteria.

As a result of the presence of urobilinogen, stool becomes colored light color, and urine - in the dark.

Bile pigments in urine such as bilirubin and urobilinogen first enter the liver, after which they are sent to the gallbladder and intestines. In a healthy person, the compounds are absorbed into the blood and are not detected in urine.

Normal indicators are:

• lack of bilirubin;
• 5-10 mg/l urobilinogen.

The urobilinogen level is negligible. The complete absence of bilirubin indicates a normal state of health. This means that the liver and other biliary organs are functioning correctly and fully.

If the pigment bilirubin is still detected in the urine, additional tests and studies must be prescribed.

In this case, the following become mandatory:

1. General blood test.
2. Ultrasound examination of the liver and gall bladder.

Determination of bile pigments in urine in children occurs somewhat differently. Let's assume an increased level of urobilinogen, since the formation of intestinal microflora occurs before the age of 3.

Bile pigments may be present in human urine due to the following reasons:

1. The appearance of stones that began to form in the kidneys and urinary tract.
2. The development of blood diseases in which red blood cells are quickly destroyed. This happens, for example, with malaria.
3. The presence of bleeding in various internal systems and organs. Most often this occurs in the gastrointestinal tract, uterus and lungs.
4. Hemorrhagic diathesis.
5. Congestion in the rectal area.
6. Infections enter the gallbladder, as well as the ducts of the organ.
7. Progression of liver diseases. Among them are cirrhosis and various types of hepatitis.

In addition, deviations from the norm of bile pigments can be caused by poor nutrition, in particular, abuse of saturated carbohydrates. In a healthy person, the level of urobilinogen ranges from 5 to 10 mg/l.

A decrease in the indicator may occur for the following reasons:

• blockage bile ducts;
• liver dysfunction, which occurs due to the development of hepatitis A;
• excessive fluid intake;
• imbalance of bacterial flora;
• lack of the enzyme glucuronyl transferase.

Due to these factors, the following pathologies and diseases may develop:

1. Stones in the gallbladder or its ducts.
2. Tumors of bile-forming organs.
3. Cholangitis.
4. Suprahepatic jaundice.
5. Various poisonings and intoxications.
6. Hepatitis.
7. Cirrhosis.
8. Filatov's disease.
9. Enteritis.
10. Constipation.

If there are no urobilinogen compounds in the urine, this means that the patient suffers from a severe form of hepatitis, which is viral in nature. The second cause of deviations is toxic damage to liver tissue.

When bilirubin enters the urine, it takes on an unusual color. It is dark brown. If you notice changes in your urine, you need to see a doctor and get tested. This will help determine why there is bile in the urine.

Dark-colored urine is often observed in people who have had their gallbladder removed. In addition, changes in the color of urine can be a prerequisite for the development of bilirubinuria.

Bilirubin does not dissolve in water. Therefore, the pigment is present in urine pure. The bound compound of hepatic glucuronic acid enters the urine. If the level of this bile pigment begins to increase in the blood, the excess is excreted through the kidneys into the urine. This usually occurs due to progressive diseases of the liver and bile ducts.

Pathologies of the liver and biliary tract can lead to the formation of congestion. Immobilized bile promotes active formation cholesterol and bilirubin. They precipitate and crystallize. The process is accompanied by the fouling of cholesterol and pigment particles with calcium salts. This becomes the main reason for the formation of stones.

The presence of bilirubin in the blood and its absence in a urine test indicates hemolytic jaundice. The kidneys were unable to properly filter the pigment, so it could not pass into the urine.

The main reasons that lead to the development of bilirubinuria are:

1. Formation of stones in the kidneys and urinary tract.
2. Unhealthy diet, which is dominated by foods enriched with carbohydrates.
3. Blood diseases that lead to its rapid destruction.

If any deviations are found, you should seek advice. This will help to diagnose a developed disease in a timely manner and avoid the development of complications.

The color, consistency, and even smell of urine can indicate the presence of certain health problems. Therefore, you should be attentive to the appearance of unusual signs and immediately consult a doctor. If bile pigments are detected in the urine, the doctor will explain what this all means.

A change in the amount of pigments in urine indicates disturbances in the dissolution of bilirubin, as well as the filtration of urobilinogen. Usually failures occur after removal of the gallbladder or as a result of the development of liver disease. In addition, violations may indicate that the process of removing stones from the biliary system was carried out incorrectly.

Therefore, a urine test for the presence of bile pigments is prescribed for the following patient complaints:

• presence of dyspeptic disorders;
• the appearance of unclear pain from the right hypochondrium;
• the skin and mucous membranes acquire a yellow tint;
• urine becomes dark in color and stool becomes light.

The doctor must ensure that the patient has not been exposed to toxic poisoning, e.g. medicines. Under their influence, the kidneys and liver fail faster than other organs. Conducting a urine test for the presence of bile pigments will help the doctor draw a conclusion about the degree of the disorder and prescribe the correct treatment.

It is important to carry out the most accurate and correct diagnostic measures in order to refute or confirm the pathology. To do this, you need to examine your urine for the presence of pigments. The analysis will help identify substances contained in the urine.

Bilirubin can be detected by oxidation of the starting material with iodine or nitric acid. If a pigment substance is present, the urine turns green during the reaction. For analysis, you need to take a sterile test tube and add 5 milliliters of urine. Then the solution containing iodine is added layer by layer.

As the last one take:

• Lugol;
• potassium iodide;
• alcohol tincture.

To check urobilin levels, you need to remove bilirubin from the urine. The pigment will interfere with the reaction carried out with a solution of calcium chloride and ammonia.

After eliminating bilirubin, you can begin various tests:

1. Copper sulfate. It is combined with urine by adding a chloroform solution. The “cocktail” is shaken. The solution should become intensely colored pink.
2. Spectroscope. The decoding will show the remainder of the blue-green part of the spectrum.

The color intensity of the solution during testing is marked with crosses. One will mean a weakly positive reaction, and 4 plus signs will mean a strongly positive reaction.

Determination of the level of bile pigments can only be carried out in special laboratories and clinics where biochemical reagents are available.

Rules for collecting urine for analysis

The result of a urine test is influenced by the correct collection required material. If the rules are not followed, the result may be inaccurate. Accordingly, the prescribed therapy will also be incorrect.

When collecting urine, it is important to follow several rules.

Among them:

1. The night before collecting material for analysis, it is necessary to perform a thorough external toilet of the genital organs.
2. Collect urine in a special container in the morning. The container may not be sterile, but it must be clean.
3. Remove the collected material to a dark place. Bile pigments are destroyed in light. Therefore, if it is not possible to immediately submit urine to a laboratory, it is better to put the material in the refrigerator. Here urine can be stored for no more than 2 hours.
4. It is enough to collect 30-50 milliliters for research.

It is important to promptly detect the presence of bile pigments. Any violations or deviations from the norm can cause the development of serious diseases and complications.

How long should I wait for the analysis result and what is its cost?

Urine testing for the presence of bile pigments is carried out within one working day. The cost of analysis in many clinics ranges from 150 rubles. If you are served under a policy, the insurance company pays the fee. The analysis is free for the patient.