Nocturia increased its causes

Nocturia, increased nighttime urination and urine output increased significantly, nocturia more than all day (24h) half of the total urine output by. Normal, nighttime urination 0-2, urine output was 300-400ml, about all day 24h urine output of 1/4 to 1/3. With increasing age, daytime urine and nocturia than the value gradually decreases to 1:1, the ratio of the age of 60. Less drinking water, usually after dinner, not eating, coupled with in vivo metabolic rate is low after sleep onset, slow blood flow, the original urine by tubular reabsorption, nocturia was significantly less than during the day urine. Clinical nocturia increased with kidney disease, drainage, and spiritual points. Nephropathy sexual nocturia increased, a variety of causes kidney damage, renal dysfunction, the kidneys can not during the day and in vivo metabolites completely discharged excretion resulting in increased nocturia, the need to continue in the night. Common in chronic tubulointerstitial nephropathy, chronic pyelonephritis, hypertensive renal arteriosclerosis, chronic renal insufficiency.

The diagnostic significance of urine general traits check nephropathy

The urine of the general traits inspection is part of the routine urine examination, the kidneys and urinary tract diseases have a certain diagnostic value. Including urine output, urine color, transparency, foam, odor, pH, specific gravity, infiltration volume (pressure), as described below.


(A) urine


(2) urine color is normal discharge of fresh urine, mostly pale yellow. The depth of the urine, in addition to the value of the level of enrichment depends on the urine and urine acidity (pH), is also affected by certain foods and drugs, so the larger changes. Occurrence of abnormal urine of kidney disease, caused by visible renal tuberculosis, kidney stones caused by a light red or reddish brown hematuria, tuberculosis oppression of the perirenal lymphatic white Chyluria, renal abscess caused by light green pyuria, etc..


(3) the transparency of normal urine is transparent, place may be a slight turbidity. Discharge of fresh urine was cloudy, mostly pathological, can be found in. Renal hematuria, pyuria, bacteriuria, fat, urine, chyluria.


(4) bubble normal urine shake of a small amount of white or light yellow foam. Severe nephrotic urine proteinuria, can produce a large number of white foam, which is due to protein changes the surface tension of the urine.


(5) normal smell of fresh urine, with special faint aroma. Place too long the urine, due to the contamination of bacterial decomposition of urea, ammonia odor; eating garlic or chili, urine with a garlic odor, and so on. The urine of the diabetic nephropathy ketoacidosis was apple-like odor, urine in the urinary system when the abscess and kidney abscess showing a corrupt and foul smell.


Under normal diet conditions (6) urine acidity (pH), urine pH of 4.6 to 8.0, an average of 6.0, normal urine showing a weak acid. Nephritis, renal tuberculosis common acidic urine, type I renal tubular alkalosis visible alkaline urine.


(7) the relative density of urine relative density of urine, the weight ratio of urine and pure water. Normal adults, in the ordinary diet, the relative density of urine more than fluctuations in the range of 1.015 ~ 1.025, the maximum fluctuation range of the 24h day of urine relative density of 1.003 ~ 1.035; relative density of the morning urine is often about 1.020. Urine relative density increased with acute nephritis, diabetes crazy Majesty kidney; urine relative density decreases, the common stage of chronic nephritis and diabetes insipidus.


(8) of urine 's penetration of the volume (pressure) urinary infiltration capacity of all means urine solute particles the total number. The amount of urine penetration only with the number of solute particles are less vulnerable to the impact of protein, glucose and other macromolecules, more realistic reflection of the renal concentration and dilution function. The normal adult urinary infiltration is generally 600 ~ 1000mmol / L, the average for the 800mmol / L, the maximum range of 40 of ~ 1400mmol / L. Reduce seen in obstructive nephropathy, uric acid nephropathy, increased seen in diabetic kidney disease.

The diagnostic significance of the chemical examination of urine for kidney disease

The chemical examination of urine, is an important item in the urine routine examination. It consists of a urine protein, urine glucose, urine ketone bodies, chyluria, as described below.


(1) normal urine within the urinary protein (Pro) contains only a small amount of protein a day 24h urine within 20 ~ 80mg conventional qualitative test was negative (a). When the urine protein content exceed 100mg/24h the conventional qualitative test is positive (+), known as proteinuria. Proteinuria, clinical common in acute and chronic nephritis, kidney disease, urinary tract infection and other diseases.


(2) urine (GLU), normal urine contains only trace of glucose, called physiological urine, the urine qualitative test is negative (a); urine quantitative test 0.56 ~~ 5.0mmol/24h. Renal glucosuria and diabetes, the urine increased.


(3) urine ketone (KET) ketone intermediate product of fat metabolism, including acetoacetate, beta-hydroxy butyric acid and acetone. Normal urine ketone content is minimal, qualitative test is negative (a); quantitative test: acetoacetate normal for 9mg/24h to the beta-hydroxybutyric acid 25mg/24h acetone 3mg/24h. Ketone body abnormalities seen in diabetic ketoacidosis, and diabetic nephropathy.


(4) chyluria extensive abdominal lymphatic duct obstruction and thoracic duct obstruction can occur chyluria, the vast majority of filariasis caused by the spot's. The chyluria occasionally in the pyelonephritis, renal tuberculosis, and other normal person does not appear chyluria.

The diagnostic significance of urinary sediment microscopic examination of kidney disease

Urine sediment microscopic examination of the abnormal results are often seen with the renal biopsy consistent with structural changes, in particular, abnormal results of urine protein analysis, the diagnosis of kidney disease have a greater practical value. Its contents, including red blood cells, white blood cells and pus cells, epithelial cells, tubular, salt crystallization, addition to the tube, its contents are as follows.


(1) red blood cell (RBC) in normal urine, usually red blood cells, or only individual red blood cells. After centrifugation, the urine, such as the microscope for each high power field, the average visible 1 to 2 red blood cells is abnormal; such as each high power field, erythrocyte, urine appearance pale skin, called microscopic hematuria in more than three; such as urinary appearance was to wash the meat in water samples or red ocher, compared with gross hematuria. Hematuria is common in acute nephritis, chronic nephritis, renal tuberculosis, kidney stones, kidney tumors.


(2) white blood cell (WBC) and pus cells in the normal urine can be a small amount of white blood cells, white blood cells per high-power field (HP) generally centrifuged urine for 1 to 2, it is still normal. Such as per high power field of more than 5 white blood cells, called microscopic pyuria. Microscope the pyuria prompt urinary tract suppurative inflammation, such as pyelonephritis, bladder, or urethritis, renal tuberculosis; glomerulonephritis, urine white blood cells can also be slightly increased.


(3) the epithelial cells of normal urine, showing that a small number of epithelial cells, centrifuged urine per high power field shows the epithelial cells remain normal. Epithelial cells have a flat, transitional, small round epithelial cells. Flat epithelial cells, generally little clinical significance. Transitional epithelial cells from different sources, surface, middle, and the underlying transitional epithelial cells, in which the middle transitional epithelial cells increased common in pyelonephritis. Small round epithelial cells from kidney, normal urine in rare, large numbers of tubular lesions, the diagnosis of renal parenchymal disease. When chronic renal congestion, renal infarction and hemoglobin calm, showing that the cytoplasm of round cells contain brown granules (hemosiderin).


(4) precipitation of salts Results goods urine salt crystals, mainly due to the influence of urine pH. Alkaline urine, a common trivalent phosphate crystals, the crystallization of urinary ammonium, non-product form of phosphate, calcium phosphate, calcium carbonate, calcium phosphate is more common in chronic pyelonephritis, the rest of little clinical significance. Acidic urine, common uric acid crystals, calcium oxalate Results goods, non-crystalline urate associated with hematuria appear, suggesting the possibility of uric acid stones. Cystine crystallization in normal urine is rare, the large number of cystinosis and the formation of stones. Normal urine, cholesterol is rare, but seen in renal amyloidosis or steatosis, pyelonephritis, cystitis, pyuria.


(5) other tangible components of lipid droplets appear separately in the urine is common in the nephrotic syndrome. Mucus filaments appeared in large numbers in the urine, can be found in the urinary tract irritation or mucosal inflammation. Microorganisms, such as urine, bacteria found in the fresh centrifuged urine, can be the initial diagnosis of urinary tract infection.


(6) two kinds of urinary sediment and quantitative examination 3h urinary cell excretion rate, normal male, red blood cells <3 x 104 / h, the white blood cells <7 × 104 / h; normal female, red blood cells <4 × 104 / h, white blood cells < 14 × 104 / h.

Glomerular functions check the significance of Nephropathy

Clinical clearance rate often through the determination of various substances to reflect glomerular function. Clear rate measurement, we can find the glomerular filtration rate, renal blood flow, tubular reabsorption and secretion of various substances in order to grasp the kidney function of the degree of impairment. Glomerular function tests include inulin clearance, myogenic hepatic clearance rate, serum creatinine, blood urea nitrogen, glomerular radionuclide clearance, etc..


(1) inulin clearance of inulin as a lower molecular weight polysaccharides composed of fructose-all by glomerular filtration, tubular its absorption, excretion, and therefore inulin clearance (Cin, ) can accurately reflect glomerular filtration rate. Acute glomerulonephritis, chronic renal insufficiency, Cin significantly reduced; chronic glomerulonephritis, renal arteriosclerosis, may have varying degrees of reduction; pyelonephritis, a little lower.


(2) endogenous creatinine clearance rate of endogenous creatinine is primarily through glomerular filtration, tubular almost its absorption and excretion. Therefore, within the creatinine clearance rate (Ccr) measurement, to more accurately reflect the glomerular filtration rate, is a commonly used method of kidney function is good or bad. Acute and chronic glomerulonephritis, Ccr can be reduced; late chronic glomerulonephritis, Ccr decreased significantly; chronic renal insufficiency, and poor prognosis.


(3) serum creatinine concentration of serum creatinine (Scr), depending on the body of nitrogen catabolism and renal excretion; In the case of relatively stable intake of food and in vivo catabolism, blood concentration depends on the ability of renal excretion. Therefore, Scr concentration, to some extent, can understand the degree of impairment of glomerular filtration, can more accurately reflect the kidney function. Renal failure, uremia, Scr increased.


(4) the concentration of blood urea nitrogen blood urea nitrogen (BUN), depends on the decomposition of the body nitrogen metabolism and renal excretion, to some extent, reflect the glomerular filtration rate is good or bad. Determination of serum BUN can be used as indicators of renal function of the extent of damage and therapeutic. Increased seen in acute glomerulonephritis, chronic glomerulonephritis.


(5) clear the rate of glomerular radionuclide glomerular radionuclide clearance with inulin clearance accurately reflect glomerular filtration rate, and has the advantage of no need to collect urine and continuous intravenous infusion of the drug; subject to radioactive substances into the body, so the pregnancy and lactating women should not be applied.

Diagnostic significance of the determination of renal tubular function in kidney disease

Determination of renal tubular function, including phenol red excretion test, kidney concentrated dilution test, urine osmotic pressure, urine concentration dilution test, free water clearance rate measurement, renal tubular glucose absorption determination of tubular Determination of ammonia hippuric acid excretion bicarbonate reabsorption excretion (alkali load) test, now commonly used tests are described below.


(1) of phenol red excretion test phenol red, also known as phenol sulfur peptide (PSP), is harmless to human body's pigment. Phenol red injected into the body, about 94% from the urine. Determination of phenol red excretion in the urine, can be used as a rough indicator to determine the excretion of proximal tubule function. 15min after the phenol red injection of the normal adult, the excretion of 28% to 51%, an average of 35%; the 2h excreted a total of 63% to 84%, an average of 70%. Low excretion of the elderly. Clinical practice, often for 15 min excretion <25%, the 2h excretion of <55%, row tubular secretion function to reduce the boundaries. Phenol red excretion rate, seen in glomerular, tubular or renal interstitial lesions.


(2) renal concentrated dilution test kidney (urine) enrichment experiments, the ability to observe the body's water shortage situation, the distal tubules to concentrate urine. 3 times normal urine specimens, at least a relative density of> 1.026 (the elderly in more than 1.020); urine relative density <1.020, indicating poor renal concentration. The extreme damage of the renal function, urinary maximum relative density of 1.010; uremia, urine relative density of 1.010 ~ 1.012; glomerulonephritis, pyelonephritis, hypokalemia and hyperkalemia, kidney disease, but also showed relative density of urine abnormalities .


(3) free water clearance rate of free water clearance (CH2O) per minute cleared from plasma to urine and pure water, to better reflect the kidney to regulate fluid balance in the body dry and too much water than urine osmolality the ability, it can more accurately determine the severity of the renal concentration and dilution function and renal disease. Normal CH2O 25 ~ 100ml / h. CH2O positive on behalf of the renal diluting capacity, a negative value on behalf of renal concentration capacity equal to or close to zero indicates that the kidney can not concentrate and dilute urine in the function of serious injury.


(4) determination of renal tubular glucose reabsorption With the constant increase in plasma glucose concentration, renal tubular reabsorption of glucose values ​​also increased when the blood glucose concentration exceeds a certain limit, renal tubular reabsorption capacity of saturated can not be too much sugar reabsorption to the urine. At this point, the amount of filtrate reabsorption of glucose, known as renal tubular glucose reabsorption (TMG). TMG significantly reduced, seen in severe acute glomerulonephritis and chronic glomerulonephritis; renal arteriosclerosis, chronic pyelonephritis, caused by the occlusion of part of the glomerular or tubular ischemia, TMG can be reduced.

The diagnostic significance of urine bacterial culture nephropathy

Urine bacterial culture, ordinary bacterial culture and a special bacterial culture of two kinds. Regardless of the bacterial culture before check-ups should be strict compliance with aseptic technique, proper collection of pollution-free urine specimens, available catheterization France, the middle of urination France, suprapubic bladder puncture.


Urine ordinary bacterial culture, clear urinary tract infection diagnosis and treatment of special significance, under normal circumstances, urine since the formation of the whole process of storage to the bladder, there should be no bacterial growth. Urinary tract infection pathogens in the urine to the large population growth, a common urinary tract pathogens E. coli, deformation, Pseudomonas aeruginosa, Aerobacter aerogenes, Staphylococcus aureus and other. By the common bacteria of the urine culture, what can be diagnosed bacterial infection, and susceptibility testing, the choice of antibiotics for clinicians to provide an objective basis.


Urine acid-fast bacilli (Mtb) to check is the key to the diagnosis of urinary structure. Urine acid-fast bacilli examination, direct smear method, urine Mycobacterium tuberculosis culture, fluorescence spectrometry and enzyme amplification method. Urinary sediment smear-positive detection rate of 50% to 70% detection rate is the highest positive first morning urine. The urine Mycobacterium tuberculosis culture positive detection rate of the method was higher, reaching 90%. Mycobacterium tuberculosis culture further confirmed the general sedimentation smear-positive, to be urine. Renal tuberculosis, Mycobacterium tuberculosis, often intermittent, a small amount of discharge, so check the continuous three times as well.