What is a urine test according to Nechiporenko?
An analysis according to Nechiporenko is usually called a type of laboratory study of urine, in which microscopy of its sediment is performed with the determination of the number of leukocytes, erythrocytes and cylinders per unit volume (1 ml). Such an analysis differs from a general clinical study of urine in greater specificity. It is prescribed in case of detection of pathological changes in the general analysis to exclude or confirm renal pathology.
How to collect a urine test according to Nechiporenko?
A urine sample according to Nechiporenko is considered a specific study, on the basis of which serious conclusions are made about the state of kidney health.
Preparation for its conduct must be appropriate:
- Heavy physical activity on the day before the study should be excluded. The same applies to spicy and fried foods, psychoemotional overstrain, food and dyes that affect the color of urine, medicines. The body must be in a state of relative functional rest;
- Do not do research before, during, and immediately after your period. This can lead to false results. The same applies to diagnostic manipulations with the bladder (cystoscopy, catheterization);
- Direct urine collection should be preceded by hygienic procedures with thorough washing of the genitals with warm water;
- Requires preparation of a clean plastic container or other container. The main thing is that it is closed with a lid;
- Direct sampling of material is carried out by collecting only the urine that is released in the middle of the urination process. This means that the initial portions of urine are released into the toilet, and immediately after that a collection container is placed under the stream. The act of urination is also completed not in a container, but in a toilet bowl. Only 20-25 ml is enough for analysis.
What is the rate of urine analysis according to Nechiporenko?
Normal indicators are as follows:
- Leukocyte cells - up to 2000 pcs. in 1 ml;
- Erythrocyte cells - up to 1000 pcs. in 1 ml;
- Cylindrical elements - up to 20 hyaline cylinders.
Decoding of urine analysis according to Nechiporenko
An important aspect of any diagnostic study is not only the correctness of its conduct, but also a competent assessment of the indicators obtained. The reliability of the diagnosis and the effectiveness of treatment tactics in relation to each patient depend on this.
The performed diagnostic procedure determines the cellular composition of urine. Its deviations from the normative indicators in a larger direction arise only with serious pathology of the excretory system.
- Leukocytes. These cells are immune and must be present in the blood and urine in a certain concentration, which indicates the normal protective properties of the body. If an excess of these cells is recorded in the urine, this indicates their increased migration to the kidneys, which is direct evidence of the presence of infection and inflammation;
- Erythrocytes. These blood cells must not be allowed to enter the urine. But since a person is in constant motion, and not all cells are the same size, occasionally single red blood cells seep through the renal barrier or the vascular wall of the inner surface of the urinary tract. An increase in the number of red blood cells in the urine is evidence of either damage to the glomerular apparatus of the kidneys, or mechanical irritation of their mucous membrane. The state of erythrocytes - fresh or leached cells - is necessarily assessed. This says a lot;
Cylinders. They are a kind of protein casts of the renal tubules. They are based on protein, which does not have time to be reabsorbed into the blood from the primary urine. The deposition of leukocytes, salts and other cellular elements of urine on it leads to the formation of microscopic plugs in the renal tubules. As they are washed out, they are excreted in the urine. Cylinders can be hyaline, granular, epithelial, erythrocytic, and waxy. It all depends on their appearance and structure, which is determined by the nature of the pathological processes in the renal tissue. Normally, cylinders can be detected in the urine, but only of the hyaline row.
If deviations from the norm of indicators of the general analysis of urine were not confirmed by its microscopic examination according to Nechiporenko, this indicates errors in the sampling and is an indication for re-diagnosis, but after more thorough preparation. In cases where the indices obtained during the Nechiporenko urine sample are significantly higher than the established norms, the patient probably has kidney or urinary tract pathologies. Indicators corresponding to normal values, especially those confirmed by repeated studies, exclude any renal pathology.
This concept means significant deviations from the norm of any of the indicators of urine analysis according to Nechiporenko. What it can be, and what diseases are caused, is displayed in the table.
Leukocyturia above 2000 / ml
Hematuria above 1000 / ml
Hyaline cylindruria above 20 / ml
Granular cylinders in any quantity
Wax cylinders in any quantity
Epithelial casts in any quantity
Erythrocyte casts in any quantity
Video: urine analysis according to Nechiporenko and Zimnitsky in normal and pathological conditions:
Leukocytes and erythrocytes according to Nechiporenko
If the presence of an excessive number of cylinders in the urine analysis according to Nechiporenko indicates only kidney damage, then changes in leukocytes and erythrocytes may indicate diseases of other organs of the genitourinary system.
- Inflammation of the renal pelvis;
- Damage to the ureters;
- Bladder disease;
- Pathology of the internal genital organs in men (prostate, seminal vesicles).
Diseases of the urethra are not included in the list of those that can be determined by the analysis of urine according to Nechiporenko, since the first portion of urine, which carries out all the cellular elements from the urethra, is not collected.
The value of the study of leukocytes is also very great. Leukocyturia (when the number of leukocytes in 1 ml of urine exceeds 2000 cells) can have varying degrees of severity. If there are so many leukocytes that they cannot be counted, they speak of pyuria (pus in the urine). Such changes indicate a pathological process of an inflammatory nature in the kidneys or urinary tract. The more leukocytes are determined, the more active the inflammatory process.
This could be:
- Pyelonephritis - inflammation of the renal pelvis complex;
- Inflammatory processes in the ureters, bladder and renal pelvis in the presence of calculi in them;
- Cystitis is an inflammatory lesion of the bladder mucosa;
- Sluggish glomerulonephritis - inflammation of the renal parenchyma of non-infectious origin;
- Kidney abscess and paranephritis are purulent diseases of the kidneys and perirenal tissue.
As for erythrocytes, an increase in their content in the urine is called hematuria (when the number of erythrocytes in 1 ml of urine exceeds 1000 cells).
It can be presented:
- Microhematuria - a slight increase in the number of erythrocyte cells relative to the normal rate. The urine does not visually change its color;
- Macrohematuria - there are so many erythrocytes that it is very difficult to count them. This urine is red in color;
- Fresh erythrocytes. This means that they retain their structure and are similar to those seen with blood microscopy;
- Leached erythrocytes are destroyed blood cells, which can be represented by separate fragments of erythrocytes;
It is extremely important to determine the specific type of red blood cells. After all, fresh erythrocytes in urine always speak of either their active sweating through the renal barrier, or damage to the mucous membrane of the urinary tract. This is possible with toxic lesions of the kidneys, glomerulonephritis, kidney stones, ureters and bladder, decaying tumors of these organs.
Leached erythrocytes indicate that their source is the kidney or long-term bleeding from the mucous membranes of the urinary tract. In the second case, not only leached erythrocytes will be recorded, but also fresh ones.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".