Urine analysis according to Zimnitsky: what does it show?
A urine sample according to Zimnitsky is an additional laboratory test, with the help of which it is possible to assess the functional abilities of the kidneys and in time to suspect pathologies manifested by malfunctions of the urinary system. The technique was developed by the doctor S. S. Zimnitsky at the beginning of the twentieth century - in 1924, and is still actively used in clinical practice. Its essence is to collect all the urine excreted by the patient per day into separate containers marked by the hour. This allows us to draw conclusions about the quality of glomerular filtration of the kidneys "in real time", that is, to track how the organs cope with their responsibilities throughout the day.
Content:
- What does the urine analysis according to Zimnitsky show?
- Indications for the study
- How to prepare for the Zimnitsky urine collection?
- How to collect urine for analysis according to Zimnitsky?
- Norm in the table and interpretation of results
The indisputable advantages of the method include its simplicity and availability - no complicated equipment is required for the analysis, all the necessary instruments and reagents are at the disposal of any laboratory. Since urine collection according to Zimnitsky is carried out at regular intervals throughout the day, and the accumulated biomaterial has a rather large volume and takes up a lot of space, this study is usually carried out in a hospital. But it is possible to collect urine correctly at home - we will tell you how to do this, as well as give the norms for the results of urine analysis according to Zimnitsky, explain in an accessible language what this sample shows, what it is for, what deviations may be and what is their probable cause …
What does the urine analysis according to Zimnitsky show?
During the study, the following indicators are determined:
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The volume of liquid, the use of the patient per day - it is necessary to keep a food diary, which is fixed while drinking or making soups, as well as the amount of servings per milliliter;
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Daily urine output is the total volume of urine excreted during the control period. To calculate it, the technician adds up the contents of all containers;
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The ratio of fluid to diuresis - normally 65-80% of the incoming water is excreted from the body with urine, the rest goes to current needs, and also comes out with sweating;
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The ratio of nighttime diuresis to daytime - a healthy person does not wake up during sleep to go to the toilet, and the volume of the morning urine portion accumulated by the body during the night does not exceed one third of the daily urine output;
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The rate of urine formation after taking large volumes of fluid - well-functioning kidneys quickly filter the water coming from the digestive tract and evacuate everything unnecessary from the body with it;
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Fluctuation of urine density in different portions - it should not differ in too large an amplitude;
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The density of urine in the control container and its average density in all containers must comply with the established standards.
The main thing that the analysis of urine according to Zimnitsky shows is precisely its density or, in other words, the specific gravity, that is, the ratio of the solid part of the solution to water. This solid part is formed by nitrogenous compounds, various organic substances, acids and salts. Serious deviations of urine density from the norm in one direction or the other, as well as strong fluctuations in specific gravity during the day, are unfavorable diagnostic signs and can indicate a number of serious diseases.
Indications for the study
Urine analysis according to Zimnitsky is prescribed for both adults and young children, and especially often for expectant mothers. During pregnancy, the fluid balance in a woman's body changes according to the needs of the growing fetus, and her kidneys are forced to temporarily work for two. The alarming results of a general urine analysis, the presence of glucose, protein, an increased level of leukocytes in it, as well as edema, severe toxicosis and surges in blood pressure - all this is a reason for conducting a urine sample according to Zimnitsky in pregnant women.
As for other categories of patients, the indications for them are as follows:
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Violation of the urination regimen - frequent urge, prolonged absence of urine, its abnormally small or large volumes;
- Painful sensations during or after urination, pain in the lower abdomen or back;
- Changes in the color, consistency or odor of urine, the presence of pathological impurities in it (foam, flakes, blood, pus);
- Constant thirst;
- Hyperhidrosis (excessive sweating);
- Systematic occurrence of edema;
- Dizziness, weakness, headaches, fainting;
- Rapid or rare heartbeat, chest pain;
- Cold limbs, clammy sweat, fits of fear;
- Poor results of other tests (general or biochemical blood test, general urine test);
- Already existing diagnoses - diabetes mellitus, glomerulonephritis, amyloidosis, liver cirrhosis, renal or heart failure, hypertension or hypotension, heavy metal poisoning, and so on - to determine the severity of the disease or control the course of treatment.
How to prepare for the Zimnitsky urine collection?
This study does not require any special preliminary preparation; it is also not necessary to follow a diet or any special drinking regimen. The test should show how your kidneys work under normal conditions. It is recommended only to refrain from eating very salty and spicy foods that provoke strong thirst. It is not worthwhile to somehow artificially load the body by drinking a lot of water just like that.
The main preparatory activities are the purchase of sterile medical containers for the collection and transportation of urine. Their standard capacity is 200-250 ml, the minimum quantity is 8 pieces, but it is better to take 2-3 spare ones. If you do not have the opportunity to acquire such containers, glass jars of the same volume (like those in which mayonnaise is sold) can be easily adapted for collecting urine for analysis according to Zimnitsky. The container must be sterilized over steam for 2-3 minutes, and the lids must be boiled.
The prepared containers or jars should be labeled with time intervals:
- 09: 00-12: 00
- 12: 00-15: 00
- 15: 00-18: 00
- 18: 00-21: 00
- 21: 00-00: 00
- 00: 00-03: 00
- 03: 00-06: 00
- 06: 00-09: 00
How to collect urine for analysis according to Zimnitsky?
So, the container is ready, you woke up at 6: 00-7: 00 o'clock - go to the toilet as usual and urinate in the toilet. Sample collection will begin at 9 am. It is best to set up a series of alarms in your phone or smartphone every three hours until 6 am the next day - a total of 8 rings. There is no need to take special hygienic measures, it is enough to wash with ordinary soap. But this procedure should be repeated before each next session of urine collection.
When the alarm goes off, you need to take a container with the appropriate marking and urinate there, and absolutely all the excreted urine should be in the container. If you don't feel like writing at this point, put the container aside. There will be an urge until the next alarm clock rings - urinate in the right container. The urge was repeated, the container is not full yet, and the time for the next collection has not come - continue to urinate there. There was not enough container volume - take a spare one and label it in the same way. Cap the filled containers and store in the refrigerator. They will need to be delivered to the laboratory the next morning.
You do not need to specifically endure until the designated time - urinate when there is a need. Keep in mind that the collection of biomaterial is carried out not only during the control hours, but also in the intervals between them, and all the urine excreted during the next period should enter the containers!
During the day, keep a food diary - write down the volumes of all the liquids you drink and eat (water, tea, coffee, juices, soups, fermented milk drinks, juicy fruits and raw vegetables in significant quantities).
To make it very clear how to collect urine for analysis according to Zimnitsky, let's consider this process using the example of a table with the data of one patient:
|
Time |
Fluid intake diary |
Number of urine emissions |
Excreted urine volume |
|
09: 00-12: 00 |
Cup of tea (300 ml) |
|
|
|
12: 00-15: 00 |
Soup portion (350 ml) Cup of coffee (180 ml) |
|
|
|
15: 00-18: 00 |
A glass of juice (250 ml) Watermelon (300 g) |
|
|
|
18: 00-21: 00 |
Cup of tea (300 ml) |
|
|
|
21: 00-00: 00 |
A glass of kefir (200 ml) |
|
|
|
00: 00-03: 00 |
- |
|
|
|
03: 00-06: 00 |
A glass of water (200 ml) |
|
|
|
06: 00-09: 00 |
Cup of coffee (180 ml) |
|
|
|
Liquids drunk: |
2260 ml |
||
|
Daily diuresis: |
1610 ml |
||
|
Diuresis to fluid ratio: |
71.23% |
||
|
The ratio of nocturnal diuresis to daytime: |
29.19% |
||
Video: urine analysis according to Nechiporenko and Zimnitsky in normal and pathological conditions:
Norm in the table and interpretation of results
The results of urine analysis according to Zimnitsky will be ready in 1-3 working days - it depends on the internal routine of a particular laboratory. There is very little data in the final form, let's look at each indicator and find out what deviations from the normal values may indicate.
Important: the diuresis of children over 10 years old is close to the values typical for an adult. You can calculate the norm for a younger child using the formula: 600 + 100 x (n - 1), where n is the age in years. For example, the diuresis of a three-year-old baby will be approximately 800 ml.
Urine analysis rate according to Zimnitsky:
|
Daily diuresis |
1500-2000 ml |
|
The ratio of urine output to fluid intake |
65% -80% |
|
The ratio of nocturnal diuresis to daytime |
1/3 |
|
Urine production rate |
high |
|
Fluctuation in urine density |
1 003-1 035 g / l |
|
Density of urine in one container |
> 1020 g / l |
|
Average density of urine |
<1035 g / l |
Possible pathologies:
|
Name |
What is the violation |
The reasons |
|
Hypersthenuria |
Density of urine over 1035 g / l |
|
|
Hypostenuria |
Urine density below 1003 g / l |
|
|
Polyuria |
Daily urine output over 2000 ml Decreased urine density The ratio of urine output to the volume of fluid consumed is more than 80% |
|
|
Oliguria |
Daily urine output below 1500 ml Increased urine density The ratio of urine output to the volume of fluid consumed is less than 65% |
|
|
Anuria |
Daily urine output below 50 ml or absent |
|
|
Nocturia |
Nocturnal urine output exceeds 1/3 of daytime or even prevails over it |
|
So, we found out how to collect urine for analysis according to Zimnitsky, what this study shows and what the reasons for the deviations in the indicators may be. But we emphasize that it is better to entrust the decoding of the test results to the doctor, since this can be done objectively only taking into account the medical history of a particular patient and the data obtained in the course of other diagnostic measures. Take care of yourself and be healthy!
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".
