What are the indications for this laboratory test? Under what conditions will a clinical urine test in children be reliable? The norm and deviations from the indicators are assessed by a pediatrician, a specialist or a laboratory assistant. But parents also want to know what is behind the mysterious numbers and symbols on the form.
Urine is a biological fluid that helps remove toxins, waste, salts, hormones, metabolic products, and excess water. In medical practice, urine samples and interpretation of test results have been used since ancient times. The most important purpose of studying urine parameters is diagnostic. Based on the results of the analysis, the doctor can evaluate the functioning of the urinary system, liver, gallbladder, intestines, heart, and endocrine system.
What may be the indications?
Under what conditions is a clinical urine test prescribed?
- Preventive routine examination. In children under one year old, it is done three times: at one month, three months and a year. In children after one year of age, it is recommended to take the test twice a year. A medical certificate for kindergarten and school cannot be completed without a clinical analysis of urine and blood. The doctor may also prescribe a test before vaccination if the baby has any chronic diseases or allergies.
- Diagnosis of diseases of the genitourinary system. At the slightest suspicion of problems with the kidneys and bladder, the child complains of painful urination, pain in the kidneys, the doctor prescribes a general urine test.
- Monitoring the effectiveness of treatment and monitoring the course of the disease. After a course of drug therapy, repeat urine tests are prescribed. The doctor may also recommend donating urine for various complications and protracted illnesses, such as acute respiratory viral infections.
- Bacterial infections. After suffering bacterial infections (sore throat, scarlet fever), it is mandatory to take a urine test a week after recovery. This is due to the fact that streptococcal infection can cause complications in the urinary system.
How to properly collect urine
The results of a clinical urine test are often false. And this is explained not only by the human factor and errors in calculations or accidental substitution of the studied material. Often a bad urine test in a child occurs when the rules for collecting material for research are violated. How to properly collect urine for clinical analysis?
- In the evening, eliminate foods that may distort the results: spicy, fatty, sour, sweets, carbonated drinks with dyes, vegetables and fruits that affect the color of urine. You should also not take diuretic medications or herbs.
- Hygiene procedures. It is recommended to wash the genitals of girls and boys under running water without soap. If hygiene standards are violated, bacteria that are present on the skin and genitals can be found in the urine.
- Morning portion. In the morning, urine is most concentrated and therefore gives the most reliable results. It is also important to remember that collected urine can only be stored for 1.5 hours in a cool place. Stale urine is not suitable for clinical studies.
- Temperature. Urine should not be overheated, but it should also not be frozen or transported in the cold. Otherwise, salts may precipitate, which the laboratory technician will classify as pathological disorders.
- Only on an empty stomach. After eating, there may be a distortion of indicators.
- Capacity It is best to buy a special sterile container for urine at a pharmacy. But if urine is collected in a glass jar, you must thoroughly wash, rinse, and dry the container and lid. If particles of dust, dirt, or detergent remain on the walls of the jar, the norm for urine analysis in children may be violated.
- How to collect. It is recommended to take an average portion of urine during one urination, that is, the first and last parts should be flushed into a potty or toilet. An older child who has good urinary control can complete this task.
Features of collection in infants
Many mothers of infants ask the question: how to collect urine from a baby? They come up with all sorts of clever ways: for example, they lay the child on an oilcloth, wait for him to urinate, then pour the liquid into a container or wring out the filled diaper. These methods are not suitable because a lot of bacteria and chemical compounds are collected along with urine, which amaze laboratory technicians. How can you solve the problem?
- Ambush the baby. Mothers know approximately the time when the child should pee. Remove the diaper, place a clean container and wait. Sometimes, however, you have to wait a long time. Yes, and the baby may find this procedure tedious.
- Buy a urinal. This simple and inexpensive device will help mom save time. The urine bag is a sterile 100 ml plastic bag with a hole for the genitals. The urine bag is attached to the body using an adhesive hypoallergenic layer. Before using it, you need to wash your baby and dry the skin thoroughly. The collected urine must be poured into a sterile container for transportation to the laboratory.
In infants, the entire portion of urine is usually taken for examination, since the total volume is small, and it is difficult to obtain an average portion. Read more about this and babies in our other article.
Sample form for clinical urine analysis
The form must indicate the child’s last name, first name, and age. The study can be carried out by a laboratory assistant or a urine analyzer. If the test results are provided by a machine, the form will contain abbreviations in Latin or parameters in English. Sometimes the laboratory technician enters some data by hand that the analyzer does not produce. It is believed that a more accurate analysis can be obtained by examining urine under a microscope, which is carried out by a laboratory assistant.
Table - Normal indicators of general urine analysis in children
| Options | Abbreviation for electronic analysis | Norms |
|---|---|---|
| Color | Color | Light yellow (s/w), straw, yellow |
| Transparency | Clarity | Transparent |
| Volume | V | For diagnosis it is not of fundamental importance, 20–30 ml is enough |
| Specific gravity | S.G. | Children under 4 years old: 1007–1016; from 5 to 10 years: 1011–1021; teenagers:1013-1024 |
| Glucose | G.L.U. | No/Negative/Negative |
| Bilirubin | BIL | No/Negative/Negative |
| Acetone | KET | No/Negative/Negative |
| Acid-base reaction | pH | From 4.5 to 8 |
| Protein | PRO | No/Negative/Negative |
| Urobilinogen | UBG | Up to 17 µmol |
| Leukocytes | LEU | No/Negative/Negative or in boys 0-1-2 in the p/z; in girls from 0-1-2 to 8–10 in p/z |
| Red blood cells | BLD | No/Negative/Negative or 0–1 in p/z |
| Cylinders | Fit in manually | No/Negative/Negative |
| Epithelium | Ep. or pl. ep. (entered manually) | Up to 10 in p/z |
| Salts | Fit in manually | No/Negative/Negative |
| Bacteria | NIT | No/Negative/Negative |
| Slime | Fit in manually | No/Negative/Negative |
Decoding: norms and deviations
A laboratory technician or attending physician is responsible for deciphering the norms and abnormalities of a child’s urine test. If parents see any “scary” numbers or reductions, do not panic. Only a specialist, taking into account the child’s condition and his age, can objectively evaluate the results of the study.
- Color . Color changes may be associated with food, volume of fluid, taking medications, vitamins, or indicate pathological abnormalities. Redness of urine may indicate red blood cells contained in it (occurs with cystitis, kidney stones, bladder diseases, intoxications). White color indicates the presence of fats, lymph, phosphates (occurs in diseases of the genitourinary system, cancer, kidney tuberculosis). A dark yellow tint indicates dehydration, heart disease, and liver disease. Urine with a greenish and brownish color can show bilirubin, which happens with stagnation of bile, diseases of the liver, gall bladder, and purulent inflammatory processes.
- Transparency. A healthy child's urine should be clear and clean. If any visible impurities are found in it, if it is cloudy, this may indicate the presence of: protein, leukocytes, erythrocytes, salts, epithelium, bacteria. There are situations when the urine is cloudy, but no dangerous substances are found in it. Then a wise doctor will suggest leaving the baby, who is feeling well, alone and not looking for illness in him. You also need to remember that urine becomes cloudy upon contact with oxygen, violation of the collection rules and timing of delivery of the material to the laboratory.
- Volume . For a general analysis, the volume of urine is not so important. Even 10 ml of liquid is enough. Volume is important for other research methods when urine is collected over a 24-hour period (daily diuresis). What are the normal daily amounts for children of different ages? Newborns - 330 ml, babies from 1 to 2 years old - 470 ml, children from 2 to 5 - 560 ml, from 5 to 8 - 680 ml, from 8 to 12 - 850 ml, from 12 to 14 - 1000 ml.
- Specific gravity. In other words, this is the density of urine. It shows the degree of filtration of the kidneys. The density of urine changes throughout the day. This is influenced by climate, fluid consumed, quality and type of nutrition, and the child’s age. A decrease in specific gravity occurs with excess fluid in the body, nephritis, and during therapy with diuretic drugs. High density (or specific gravity) may indicate renal failure, endocrine system disorders, or fluid deficiency.
- Glucose. A normal urine test in children excludes the presence of glucose (sugar). Its presence may indicate the following diseases: diabetes, pancreatitis, sepsis. But the appearance of sugar can also be triggered by excessive consumption of sweets on the eve of the test, stress, and physical activity. Read more about it in our other article.
- Bilirubin. Bilirubin is excreted from the body through the intestines. The presence of bile pigment in urine, even in small doses, cannot be ignored. Violation of the functions of excreting bilirubin and its entry into the kidneys indicates diseases of the liver and gall bladder.
- Acetone or ketone bodies. As a result of the breakdown of proteins and fats, not only the glucose necessary for the body is formed, but also toxic ketone bodies. Acetone in the urine can appear during prolonged fasting or, conversely, overeating, unbalanced nutrition, poisoning, physical and emotional fatigue, and intellectual stress. Acetone can also be associated with serious diseases, for example: diabetes, intestinal infection, hormonal disorders. If acetone is detected in a child’s test, most often this indicates a temporary disorder. But this deviation cannot be left without the doctor’s attention.
- Acid-base reaction. Normally, urine should have a neutral or slightly acidic reaction. hH depends on the type of diet and food combination. For example, meat oxidizes the body, and vegetables leach. But an acid reaction also occurs in a number of diseases: heart failure, acute nephritis, gout, diabetes. An alkaline reaction is possible with renal failure, vomiting, acute infections of the bladder, kidneys, and hyperventilation.
- Protein . Low protein in the urine can be associated with physical, psycho-emotional stress, stress, and hypothermia. The substance may not be detected in repeated tests. The degree of protein in the urine can be mild, moderate, or high. Typically, the presence of protein is associated with urinary tract diseases. Read more about it in our other article.
- Urobilinogen. This is a product of bilirubin processed in the intestines, which enters the blood and liver. The main part of urobilinogen in a healthy body is bound by the liver. Some portion enters the kidneys and is excreted in the urine. If abnormalities are found in a child’s urine, this may indicate intestinal and liver diseases.
- Leukocytes. The abbreviation “in p/z” or “in p/zr”, which can be seen on the form, stands for “in sight”. It indicates the number of cells that fall into the field of view when examining the material under a microscope. Exceeding normal levels of leukocytes indicates acute or chronic inflammation of the urinary tract. Most often it occurs with cystitis, pyelonephritis. A very high content may indicate a purulent process. Read about the reasons for their increase and deciphering the results in our other article.
- Red blood cells. Normally they should be absent from the analysis. Sometimes a small amount of blood in the urine can be the result of intense physical activity. Red blood cells are contained in urine in case of kidney injuries, cystitis, kidney disease and other diseases. Read about it in our other article.
- Cylinders. These are various protein and other cylindrical cellular structures. They are usually found in urine along with protein. There are granular, erythrocyte, leukocyte, epithelial, pigment and other types of cylinders. The detection of these structures may indicate impaired renal function. The doctor can differentiate the diagnosis based on the type of cylinders and their volume.
- Epithelium. Epithelial cells enter the urine from the urinary tract mucosa. Exceeding the norm may indicate inflammation of the urinary tract. There are three types of epithelial cells: flat, transitional, renal. A small amount of total epithelial cells in the urine is acceptable. Exceeding the norm indicates infection, inflammation in the organs of the urinary system.
- Salts. Sometimes salts of phosphoric, uric, and oxalic acid are found. Their content in urine is most often associated with urolithiasis, viral hepatitis, cystitis, gout, and diabetes mellitus. Also, the appearance of oxalic acid salts can be explained by excessive consumption of fruits and vegetables.
- Bacteria. Normally, bacteria, like fungi, should be absent in the urine. If they are detected, the doctor gives a referral for urine culture. If Candida fungi are detected in the analysis, this may indicate a weakened immune system after antibiotic therapy or candidiasis.
- Slime . Normally, it does not appear in urine at all. Increased mucus indicates inflammation in the urinary tract.
If deviations from the norm are detected in the analysis, do not panic in advance. A single sample of material does not confirm any diagnosis. It often happens that a repeated clinical analysis, observing all the rules for collecting urine, turns out to be normal. If protein, leukocytes, acetone, glucose, bilirubin, and red blood cells are found in the baby’s urine, it is necessary to consult a specialist and retake the test so that the doctor can see the dynamics of the process.
Types of urine tests
There are several types of urine tests that are prescribed to differentiate diagnoses. This primarily concerns urinary tract diseases.
- Urinalysis according to Nechiporenko. This analysis is also called cumulative samples. Laboratory testing is prescribed during a routine examination of patients with chronic diseases of the urinary system, if protein, casts, leukocytes, and red blood cells are detected in a general urine analysis. Cumulative tests allow you to see pathological structures in urine and detect chronic, hidden inflammation. The norms of red blood cells in 1 ml of urine are up to 1000, leukocytes - up to 2000, hyaline casts - up to 20, the content of any other casts, even in small quantities, is considered a violation of the norm.
- Urine analysis according to Zimnitsky. Prescribed for testing kidney function. It is carried out according to three parameters: daily urine volume (diuresis), specific gravity, balance between day and night norms. If a child has polyuria (too much daily urine), this may be due to excessive fluid intake and a number of diseases of the urinary system, kidney failure, and metabolic disorders. Oliguria (small amount of daily urine) and nocturia (nighttime diuresis predominates over daytime) can also indicate urinary tract diseases.
- Bacterial culture of urine. This test is also called urine sterility culture. An average portion of urine is taken for collection. Normal test parameters: 1.0 × 10 2 CFU in 1 ml of urine. Exceeding the norm may indicate bacterial urinary tract infections.
- Biochemical urine analysis in children. This study is prescribed if urinary tract diseases are diagnosed. Usually a daily sampling of material is required. Based on the biochemical composition of urine, one can evaluate not only the functioning of the kidneys, but also other organs and systems of the body. Potassium, sodium, chlorine, urea, calcium, phosphorus are released as a result of cleansing the body with the help of the kidneys. Pathological disorders are always indicated by the following substances: glucose, protein, acetone, cylinders and other structures.
- Test strips. Indicator tests allow you to conduct a urine test at home in a short time. This is necessary if there is acute pain in the abdomen, in the kidney area, suspected diabetic coma, or inflammation of the urinary tract. The level of confidence is quite high. Using express tests, you can determine in urine: glucose, acetone, bilirubin, leukocytes, protein, blood, acidity, specific gravity, etc. Tests can be with one or two sensors, that is, urine can be examined only according to one or two parameters at a time.
A general urine test in children helps the doctor clarify the diagnosis as soon as possible. There are diseases of the urinary tract, which an experienced doctor can accurately determine using a clinical urine test. But in most cases, additional laboratory tests of urine are prescribed: biochemical, bacterial, microbiological analysis, tests according to Nechiporenko, Zimnitsky, Sulkovich and other tests.
In this article:
Urinalysis is the simplest method of diagnosing a child’s body, which is used by pediatricians.
Children's urine tests and interpretation of their results can quickly detect various diseases, and not only of the genitourinary tract.
This method is used quite often because babies cannot talk about their feelings. The following studies are included in the general analysis:
- physical properties of urine - color, density, quantity, acidity;
- chemical - glucose, proteins, bile pigments and ketone bodies;
- microscopy of sediment - red blood cells, leukocytes, hemoglobin and epithelial cells.
The process of urine formation begins in the kidneys. Primary urine is formed from blood plasma in nephrons (glomeruli of thin capillaries) during the filtration process. The final urine is formed in the renal tubules, where all the necessary nutritional components are absorbed from the urine into the blood, and the end products of metabolism come back from the blood. They must be removed from the body through urine. Further, through the collecting duct system, urine enters the pelvis, ureter and accumulates in the bladder. Therefore, the composition of urine is influenced by all processes along the path of its transformation. If there is a malfunction somewhere in it, substances that should not be there get into the urine. Therefore, analysis can tell about many changes in organs and systems.
The normal indicators for children and adults are different; deciphering a urine test in newborns will show completely different results compared to an adult. Structurally and functionally, the nephrons in children are still immature. Urine in the first year of life has a relatively low density due to the reduced concentrating ability of the kidneys.
The permeability of nephron vessels is increased, so proteins, glucose, erythrocytes and leukocytes appear in children’s urine much more often than in adults. Since the formation of the genitourinary system occurs gradually, clinical urine analysis in children requires checking and rechecking.
Types of tests in children
Most often, in childhood, urine is given for a general analysis. Other methods are prescribed as additional methods to obtain more accurate indicators of blood elements:
- If a genitourinary system infection is suspected, an analysis is performed using the Amburge or Addis-Kakovsky method. To do this, the entire volume is collected in a container within a certain time, for example, 3-4 hours or 12-24 hours. Then comes the counting of the release of red blood cells and white blood cells over a certain period of time.
- The collection method according to Nechiporenko is an average amount of urine. This method is simpler, but no less accurately allows you to identify cystitis, pyelonephritis or gromerulonephritis.
- The condition of the pancreas allows us to evaluate tests for alpha-amylase.
- If rickets is suspected, Sulkovich tests are prescribed.
- A daily urine test in a child allows you to assess the ability of the kidneys to concentrate (Zimnitsky method), conduct biochemical studies for calcium, potassium, sodium, phosphorus, urea, creatinine, lead and hormones.
General urine test in children
All parents have to undergo a general urine test in their children. This procedure is carried out when a disease is suspected, to identify complications after an illness, and also for prevention. Therefore, it is advisable to know what urine test is normal in children. The main indicators that are revealed during a general urine test:
- Color. Normally, urine should be light yellow, dark urine may indicate liver disease or toxic damage to the body, and cloudy color may indicate an inflammatory process in the kidneys. A reddish color occurs when taking certain medications.
- Transparency. In a healthy child, the urine is transparent, its cloudiness, the presence of sediment or flakes indicate inflammatory processes in the genitourinary system.
- Acidity level. Normally, urine should be slightly acidic (pH 5-7); if the analysis reveals a neutral or predominant alkaline environment, this may indicate inflammatory processes in the urinary tract.
- Density. Normal indicators are considered to be 1001-1005 g/l for newborns, 1005-1015 g/l at six months, reaching adult levels of 1018-1025 g/l when switching to mixed feeding. If they are elevated, the body is dehydrated and there is a lot of sugar in the blood. But low density indicates renal failure.
- Protein. For normal indicators, its presence is considered to be 0.033%. Exceeding the norm indicates inflammatory processes and infection of the body.
- Red blood cells. Normally, they should be absent or present in very small quantities (no more than 3 in the field of view), urine analysis during teething should also not record them more than normal. Elevated levels may indicate decreased immunity, kidney disease or oncology.
- Leukocytes. Normally they are not detected or are detected in rather small quantities (no more than 2-3 in the field of view). In large quantities they serve as an indicator of cystitis and kidney disease.
Thus, the interpretation of a clinical urine test may indicate a dysfunction in the child’s body. If its general indicators are normal, and only an increased number of red and white blood cells is present, an analysis is prescribed using the Nechiporenko method.
Causes of poor urine analysis in children
Indicators of a poor urine test in a child indicate the presence of serious inflammatory or infectious diseases.
However, there may be other reasons:
- non-sterile container for collecting material;
- ingress of feces together with urine;
- drinking plenty of fluids on the eve of tests, which affects density indicators;
- eating brightly colored vegetables and fruits, which affects the color of urine;
- intake of medications or herbal preparations;
- insufficiently thorough morning toilet;
- pouring urine from one container to another;
- collecting urine in a pot;
- extracting urine from a diaper, cotton wool or diaper;
- leaving the container in a warm room for too long.
Rules for collecting urine in older children
For older children who go to the toilet on their own, the rules for collecting urine are the same as for adults:
- Prepare sterile containers in advance (it is better to purchase them at a pharmacy).
- In the morning, before urinating, wash your genitals with warm water.
- Wipe off the moisture well with a clean towel.
- Sit over the toilet, bathtub or basin, holding the container with your hand.
- Release about a quarter of the urine and, with an effort of will, stop the process.
- Place the container near the urethra, release some of the urine and forcefully stop the process again.
- Remove the container and release the remaining urine into the toilet or potty.
Rules for collecting urine in young children
In the case of small children, parents need to be patient and be very careful.
- Do not collect urine from a diaper or potty. It is advisable to purchase a children's urinal, which is available separately for boys and girls. The urine is drained from it into a sterile, sealed container.
- To collect urine, you need to guess the time when the child wants to urinate. As a rule, this desire arises reflexively after being undressed or at the sound of pouring water.
- Do not squeeze urine out of cotton wool, diapers or diapers.
For the convenience of parents, there are Internet resources that offer online transcripts for children’s urine tests. The results of this transcript are for informational purposes and do not constitute a diagnosis. Moreover, they cannot replace consultation with a doctor. They are useful in terms of additional information about the condition of the body, but do not serve as a reason to independently identify diseases and prescribe treatment for the child.
Useful video about urine analysis
Urinalysis is a unique, fast and effective diagnostic method for diseases of the urinary system. It is taken from both adults and children. The level of certain substances in the urine of an adult and a child is different. Therefore, when you see deviations from the norm, you should not panic.
Firstly, the functioning of the body is different in an adult and a small child. And secondly, in medicine there is only one standard of forms in which the results of the research are entered (there are no special forms for children).
Therefore, every parent should know how to correctly decipher their child’s urine test on their own in order to promptly seek help from a doctor.
Urine is 90% water. More than 1000 substances dissolve in it, including electrolytes and organic substances.
Every day, about a hundred dry substances are removed from the human body. It should be noted that even in completely healthy children, the composition of urine changes throughout the day.
The amount of daily urine excreted and the substances it contains may vary depending on several factors. In particular, this is influenced by the degree of tubular reabsorption and the intensity of urine filtration.
In what cases is a general urine test prescribed?
This laboratory test is prescribed for children aged 0 to 16 years under the following circumstances:
- suspected diseases of the urinary system;
- screening examination;
- development of streptococcal infections (surrendered a few weeks after recovery);
- development of inflammatory diseases.
In addition, a urine test is periodically taken when undergoing special treatment to ensure its effectiveness. For healthy children, a sample is taken for preventive purposes every 5-8 months, and for infants every 3-4 months.
Urine collection rules
In some situations, improper collection of biological material for research leads to poor analysis results. However, the child is completely healthy at this moment. The results are unreliable. Therefore, in order to avoid errors in the study, the parent must correctly collect urine from his child.
To take the OAM, a morning urine sample is collected. It must be collected only in a dry, sterile container (can be purchased at a pharmacy). If urine is collected from infants, then urinal bags are used, which are secured with Velcro. The external genitalia must be clean. After the biological material is collected, it is poured into a sterile container.
Urine for laboratory testing is not allowed:
- pour into a sterile container from the pot;
- squeeze out of a diaper or nappy.
Otherwise, the analysis results will be poor and inconsistent with reality. In children aged 1.5–2 years, biological material for research is collected in the same way as in an adult.
Decoding for children
There are indicators that are the main ones when studying the composition of biological material. Deviation from the norm of any of them in children may indicate the development of diseases of the urinary system, heart, thyroid gland and other internal organs.
- The level of transparency of biological material is determined by examining it in transmitted light. The cause of cloudy urine is some inflammatory diseases of the urinary tract, as well as the presence of impurities and bacteria in it. In the absence of inflammation and infections in children aged 0 to 16 years, urine is completely transparent and does not contain any impurities.
- According to regulatory standards, urine in children aged 0 to 2 years is straw-yellow. In older children it takes on an amber-yellow hue. The cause of a change in the color of the excretory fluid can be pyelonephritis, taking certain medications and foods. Darkening of biological material can be caused by prolonged standing or taking nitrofuran drugs.
- In a child, in the absence of any diseases, the urine reaction is slightly acidic. It tends to change under the influence of nutritional factors. An alkaline environment can be formed when eating foods of plant origin, while an acidic environment can form when eating food of animal origin. If a child’s urine is acidic in one test and alkaline in another, then the functioning of his urinary system is normal. The cause of acidic urine (the pH level of which is more than 5.5) is acute diseases of the kidneys and ureteric tubules. In case of infectious diseases of the urinary tract, a neutral or alkaline environment is fixed.
- Normally, in children under 16 years of age, the specific gravity is 1008–1025. Density may vary throughout the day. This depends on the food the child eats, the amount of liquid he drinks, as well as his age. If there is a low urine density throughout the day, this indicates various dysfunctions of the kidneys and urinary system.
- In the absence of inflammation and infections, protein is not detected in the child’s urine. Its presence may indicate kidney pathologies in which tissue damage occurs. It is worth noting that in infants and older children, protein can enter the urine from the mucous membranes of the urinary tract and vagina. This condition is referred to as extrarenal proteinuria.
- Leukocytes are “guardians” of health that “eat” pathogenic microorganisms that enter the body. Normally, they are present in the urine of every child, including infants, in single “copies”. An increased number of leukocytes in the urine (8–10 in girls, 5–7 in boys) indicates the development of various inflammatory diseases in the kidneys and urinary system. But here, too, it should be taken into account that leukocytes can penetrate into the urine from the outside, that is, from the external genitalia. Most often, this phenomenon is observed in boys with phimosis, in girls with vulvovaginitis. These diseases are detected at the age of 1-2 years during a preventive examination.
- This term refers to casts of renal tubules, which are folded proteins. Their appearance indicates the predominance of an acidic reaction in the urine and the development of corresponding diseases. Indeed, in an alkaline environment, the cylinders quickly dissolve and are removed from the body.
- The exact amount of salts is determined only in daily urine. Its presence can be caused by eating meat, prolonged fasting, taking hormonal drugs or intense physical activity. If we talk about pathologies, a high salt content in infants and children from 2 to 16 years old can be caused by stagnation of urine, pyelonephritis and cystitis.
If there are no pathological processes, there are no red blood cells in the urine. In rare cases, they are found in single quantities (1-2 per field of view). An increased number of red blood cells in biological material is a deviation from the norm, which indicates the development of hematuria (blood in the urine).
In medicine, there are two concepts - macrohematuria and microhematuria. In the first case, the urine turns dark red due to a significant admixture of blood. Microhematuria cannot be detected with the naked eye; red blood cells are detected only by microscopic examination. Such conditions are caused by the development of many congenital or acquired diseases.
It is worth noting that children over 2 years of age eat many foods that can color their urine. When deciphering the analysis, it is very important to tell the doctor what the child ate the day before.
OAM decoding table
There is a specific table that describes the norms for urine test results in children of various age categories. Therefore, only a doctor can give an accurate interpretation of the study.
| Index | Norm |
|---|---|
| Color | Straw yellow |
| Transparency | Completely transparent |
| Density | Up to 2 years - 1002–1005 Up to 5 years - 1012–1020 Up to 12 years - 1011–1025 |
| Urine reaction | Slightly acidic |
| Glucose | - |
| Protein | - |
| Epithelium | 1-2 |
| Cylinders | 0-2 |
| Leukocytes | 0–6 |
| Red blood cells | 0-2 |
| Slime | - |
| Salts | - |
| Bacteria and fungi | - |
Any deviations from these standards indicate the presence of inflammatory or infectious diseases. Additional examination is required to make an accurate diagnosis.
A general urine test is one of the most frequently prescribed tests. It is taken at almost every visit to a therapist or pediatrician. In addition, there are other types of urine tests for children and adults. Let's look at what urine tests there are, how the general analysis is interpreted, and why a child may have a bad urine test.
Types of urine tests in children
A general urine test is performed more often in children than in adults. With its help, the doctor determines the condition of many organs and systems of the child, their functioning, and the presence of pathological processes in the body.
If the doctor suspects that the baby has a disease such as pyelonephritis, glomerulonephritis or cystitis, he prescribes a urine test according to the Nechiporenko method, and in the diagnosis of kidney and urinary tract diseases they use a urine test according to Kakovsky-Addis.
Some urine characteristics that are necessary to clarify the diagnosis are not included in standard tests. Then they are made separately. Such studies include, first of all, the Sulkovich test (determination of calcium salts), the alpha-amylase test (assessment of the condition of the pancreas), and the Zimnitsky test (assessment of the condition of the kidneys).
General urine analysis in children: explanation
When parents receive the results of their child’s analysis, they see the values of the indicators. But what do they mean? Of course, only a doctor can correctly interpret the study. But you can at least approximately try to determine whether the obtained values differ from established standards and why such deviations may occur.
Let's give an example of deciphering a urine test in children based on the main indicators.
Urine color. Normal urine should be straw-yellow in color. Dark yellow urine occurs with dehydration (in case of diarrhea, vomiting), heart failure. Almost black color is characteristic of liver diseases and some infections. Colorless or pale urine is a common sign of diabetes mellitus, diabetes insipidus, and kidney pathology. Urine that resembles meat slop in color may indicate glomerulonephritis or kidney tuberculosis. Saturated red color of urine occurs with urolithiasis, pyelonephritis, glomerulonephritis. At the same time, some foods (beets, blueberries) and medications (sulfonamide drugs, metronidazole) give a reddish color to urine.
Transparency of urine. Normally, urine should be clear. Turbidity can be caused by pyelonephritis, cystitis, glomerulenphritis, amyloidosis.
Specific gravity of urine. In urine analysis in children, the norm for this indicator is for a newborn up to 10 days 1.008 -1.017 g/l, up to 2-3 years - 1.010-1.016 g/l, from 4 to 12 years - 1.012-1.020 g/l, over 12 years – 1.010-1.023 g/l. An increase in urine density is possible with diabetes, glomerulonephritis, and fluid loss. A decrease in density occurs with diabetes insipidus, the development of renal failure, and the use of certain diuretics.
Acidity of urine. The normal urine acidity (pH) is 4-7. A decrease in acidity develops with metabolic or respiratory alkalosis, chronic renal failure, ureaplasmosis, renal tubular acidosis. An increase in urine acidity is observed in the case of metabolic or respiratory alkalosis, diabetes mellitus, and dehydration.
Protein. Normally, there is no protein in the urine or its concentration does not exceed 0.033 g/l. This substance can be detected in the urine of physically poorly developed children aged 7 to 16 years. An increase in this indicator is almost always observed in diseases of the kidneys and urinary tract.
Glucose (sugar). In a urine test in children, glucose should be absent or not exceed a concentration of 0.8 mmol/l. Higher glucose levels occur in diabetes mellitus, nephrotic syndrome, acute pancreatitis, and pheochromocytoma.
Ketone bodies (acetone, hydroxybutyric and acetoacetic acids). According to the norm, ketone bodies should not be detected in urine. The reasons for the detection of these substances are diabetes mellitus, acetemic vomiting, acute pancreatitis.
Bilirubin. Normally, it should not be detected in urine. If it is found, one can assume the development of renal failure, liver cirrhosis, hepatitis, hemolytic disease, cholelithiasis.
Urobilinogen. According to standards, this substance should be absent in urine. Urobilinogen is determined in hemolytic anemia, some infections, colitis, enterocolitis, liver cirrhosis, hepatitis.
Hemoglobin. Urinalysis in children should not show hemoglobin. The causes of its appearance include hemolytic disease, phenol and mushroom poisoning, and malaria.
Leukocytes. The norm is 0-6 leukocytes in the field of view of the microscope. An increase in the level of leukocytes in the urine is observed in diseases of the kidneys, ureter, bladder, urethra, prostate, and infections of the external genitalia.
Red blood cells. In a general urine test in children, the norm of red blood cells is 0-3 in the field of view of the microscope. The reasons for the increase in the level of these substances are nephrotic syndrome, urolithiasis, acute glomerulonephritis.
Epithelium. The norm is 1-2 cells in the field of view of the microscope. Depending on the type of epithelial cells in the urine, the doctor may suspect the development of diseases of the kidneys, ureter, and bladder.
Cylinders. Normally, casts should not be detected in urine; no more than one hyaline cast can be detected. If these substances are found in the analysis, the development of glomerulonephritis, pyelonephritis, cystitis, chronic renal failure, renal amyloidosis, and viral infections can be assumed.
Salt. Normally they should be absent. The appearance of salts in the urine, depending on their type, may indicate dehydration, gout, pyelonephritis, diabetes mellitus, and intestinal dysbiosis.
There should be no bacteria or fungi in the urine. Their presence is a sign of the development of a bacterial (cystitis, urethritis, prostatitis, pyelonephritis) or fungal infection.
Diastase (amylase). The norm of diastase in urine analysis in children is 1-16 U/l. A significant increase in this indicator indicates the development of acute or exacerbation of chronic pancreatitis.
Why is there a bad urine test in children?
Doctors talk about a bad urine test in a child if the main indicators differ from their normal values. If necessary, the doctor will refer the baby for additional tests to determine the exact cause of the deviations.
But in some cases, a poor urine test in a child may be the result of improperly collected material. Usually, when writing a referral for testing, the doctor tells you how to take it correctly. There are well-known rules for collecting urine:
- Before taking the test, the child undergoes a thorough toileting of the external genitalia;
- The container for collecting urine must be clean. It is convenient to use special containers for collecting urine, which can be purchased at the pharmacy;
- When collecting material, the first portion of urine is released into the toilet;
- Typically, urine is collected in the morning on an empty stomach. If the collection conditions are different, the child’s parents should notify the doctor.
Text: Galina Goncharuk
4.64 4.6 out of 5 (55 votes)
Urine tests are routine tests, and when contacting a pediatrician for any reason (including a preventive examination or examination to obtain a certificate for a swimming pool, music, sports school, etc.), at least a general urine test is mandatory. If changes are detected in the analysis, additional studies are prescribed. But what exactly do the results of urine tests mean, what is their norm and what do deviations indicate?
We have already written about that. Now let's talk about the interpretation of urine tests in children.
General urine analysis
There are a number of indicators that can detect renal dysfunction. They are combined under the name “general urinalysis”.In the table below you can see normal urinalysis values in a child.
| Index | Abbreviation on the form from the electronic analyzer | Normal intervals |
| Color | Color | From light yellow (straw yellow, s/w) to yellow |
| Transparency | Clarity | Transparent |
| Volume | V | Doesn't matter (how many passed) |
| Specific gravity | S.G. | up to 2 years: 1012-10222-3 years: 1010-1017 over 5 years: 1012-1025 teenagers: 1010-1040 |
| Glucose | G.L.U. | Negative |
| Bilirubin | BIL | Negative |
| Acetone | KET | Negative |
| acid-base reaction | pH | 4.5-8.0 |
| Protein | PRO | Negative |
| Urobilinogen | UBG | Up to 17 µmol/l (umo/L) |
| Leukocytes | LEU | Boys: 0-1-2 in PV/NegativeGirls: 0-2 and up to 8-10 in PV/Negative |
| Red blood cells | BLD | 0-1/ Negative |
| Cylinders | Usually attributed by hand (cyl.) | No |
| Epithelium | (Ep. or ep. cl.) | Single, up to 10 in PZ |
| Salts | (the names of the salts are assigned by hand - phosphates, etc.) | No |
| Slime | No | |
| Bacteria | NIT | No |
Deviations from the norm and their meaning
Color Changes:
- Dark yellow color (hyperchromuria) – concentrated urine. Physiological hyperchromuria is observed in the summer and in general with increased sweating, while drinking a small amount of liquid. It is also possible for the urine to become dark colored when eating carrots. Pathological hyperchromuria occurs with dehydration (diarrhea, fever, vomiting) and fasting (including lack of breast milk), with heart problems.
- Very pale, colorless urine (hypochromuria) – observed due to heavy drinking and consumption of foods with a diuretic effect. Pathological hypochromuria occurs with diabetes insipidus, nephrosclerosis and some others.
- Orange color - when eating foods rich in beta-carotene (carrots, persimmons, apricots and other brightly colored orange and yellow-orange fruits and vegetables); while taking riboflavin, multivitamins and vitamin C.
- Pink and red color of urine most often indicates the presence of blood in the urine (cystitis, glomerulonephritis,). In addition, red urine occurs with severe toxicosis, hereditary porphyrinuria, and taking certain medications (sulfazole, red streptocide, amidopyrine).
- The brown color is due to the presence of bilirubin and bile pigments (urobilinogen, urobilinoids, stercobilinogen) or broken down red blood cells in the urine. It is noted in liver diseases (when bile cannot flow from the gallbladder into the intestines), hemolytic anemia.
- Milky white color - in the presence of fats () or lymph (and tumors of the urinary system) in the urine.
- Green, blue color - with severe jaundice, taking methylene blue.
- Brown and black-brown color - with melanosis (excessive accumulation), alkaptonuria (hereditary metabolic disease), naphthol poisoning.
Transparency changes
Turbid urine is observed when there is a high content of leukocytes and mucus in it (inflammatory process of the kidneys or urinary organs). In the presence of salts, the urine does not become cloudy immediately, but after settling.
Specific gravity
The specific gravity will be increased when excreting concentrated urine (dehydration, fever, limited fluid intake) and decreased when excreting dilute urine (excessive drinking, diabetes, polyuria with kidney damage).
Glucose
Sugar in the urine (glucosuria) is detected if a large amount of refined carbohydrates is consumed on the eve of the test; in premature babies - due to the immaturity of the renal tubules. Glucosuria can be a consequence of hyperglycemia (increased blood glucose levels) against the background of diabetes mellitus, hereditary disorders of sugar metabolism (galactosemia). In addition, glucosuria is possible with normal blood glucose levels, for example, it is observed in a number of renal diseases accompanied by impaired renal tubular function (Fanconi syndrome).
Acetone (ketone bodies)
In children, ketone bodies are often found in the urine (in wide circles they are simply called “acetone”). Ketonuria (-acetone, acetoacetic and beta-hydroxybutyric acids) is observed with severe disturbances of carbohydrate, fat and protein metabolism. In children, carbohydrate metabolism is easily disrupted, so ketones are found quite often:
- during fasting (in newborns - during underfeeding);
- with an unbalanced diet (in children with a tendency to acetonemic crises, even small errors in the diet can lead to acetonuria, especially against the background of infectious diseases);
- in case of poisoning;
- against the background of fever;
- for acute infections (, etc.);
- in children with neuro-arthritic diathesis - against a background of stress (even in the case of positive emotions), nervous overexcitation, overwork.
Changes in acid-base reaction
The reaction of urine is very dependent on nutrition: the more protein, the lower the pH. Acidic urine (pH<4) может свидетельствовать о рахите в период разгара, отмечается при сахарном диабете, лихорадке и некоторых других состояниях. Щелочная реакция с pH>8 is often observed with urinary system infections, poisoning with heavy metal salts, and sulfonamides. If the urine reaction is always alkaline, it is necessary to exclude tubular disorders (renal acidosis).
Protein
The appearance of protein in the urine is called proteinuria. Single low amounts of protein can be detected in practically healthy children after physical activity or during fever against the background of an acute infectious disease. But even a single detection of traces of protein requires repeating the analysis or further examination to exclude renal pathology. Constant proteinuria is observed in kidney diseases: from trace amounts of protein in the background to massive proteinuria in nephrotic syndrome.
Bilirubin and bile pigments
And an increased content of urobilinogen is observed in liver diseases and hemolytic jaundice. With physiological jaundice of newborns, the concentration of urobilinogen in the urine increases slightly. A complete absence of urobilinogen occurs in young children (up to 3-6 months), and later indicates a mechanical obstruction to the release of bile into the intestines (obstructive jaundice).
Leukocytes
An increased content of leukocytes characterizes an infection of the kidneys or urinary organs and is found in cases of urethritis, pyelonephritis, kidney tuberculosis, and kidney abscess.
Borderline values of leukocytes in girls (from 4-5 to 10) often occur due to errors in collecting tests (the toilet of the external genital organs was not performed, or urine was collected from the first portion).
It should be taken into account that in girls, leukocytes can enter the urine not only from the urinary tract, but also from the vagina in case of other inflammatory gynecological diseases; and in boys - with phimosis.
Red blood cells
An increase in the number of red blood cells – blood in the urine or hematuria. When there are a lot of red blood cells, they change the color of the urine (the color of meat slop, pink, red), and then they talk about gross hematuria. Single red blood cells are not visible to the eye and are determined only microscopically (microhematuria).
Hematuria appears in various kidney diseases:
- glomerulonephritis, interstitial nephritis, pyelonephritis;
- kidney and bladder tumors;
- urolithiasis disease;
- hemorrhagic cystitis;
- urethritis;
- trauma to the urinary organs;
- kidney tuberculosis.
Single red blood cells, up to 5-10 per field of view, are often observed in dysmetabolic nephropathy. Hematuria also occurs with diseases of the blood system in children (hemorrhagic diathesis), and with renal syndrome.
When interpreting the results of urine tests in teenage girls, it is necessary to find out whether the test was taken during menstruation, when blood could get into the urine from the vagina.
Cylinders
Several types of casts are excreted in the urine: hyaline, erythrocyte and leukocyte, epithelial, granular, fatty and waxy.
- Hyaline can occur in healthy children during physical activity and dehydration.
- Red blood cell casts indicate the presence, but are also noted with infarction and kidney injury.
- Leukocyte casts in combination with other signs of a urinary tract infection indicate pyelonephritis.
- Epithelial casts are found when the renal tubules are damaged.
- Granular and fatty casts are released in nephrotic syndrome.
- Waxy ones are found when.
Epithelium
Several types of epithelium can be detected in a child’s urine: squamous, transitional and renal. Flat and transitional epithelium is almost always present in small quantities; its quantity increases with inflammation of the urinary tract or when its mucous membrane is damaged by solid salt crystals. Renal epithelium, if it is occasionally found in the urine in a single quantity, with other normal indicators, is also considered a variant of the norm, but if protein, casts or leukocytes with red blood cells are detected simultaneously with the renal epithelium, this confirms the diagnosis of kidney disease.
Salts
Normally, there should be no salts in the urine, but they can sometimes appear after eating certain foods (uric acid - when there is an excess of meat in the child’s diet, oxalates - after eating cocoa, chocolate, etc.). If salts are found periodically in urine tests, this makes the diagnosis of dysmetabolic nephropathy probable. The constant detection of a large amount of salts requires a detailed examination of the child (to exclude urolithiasis and other kidney pathologies). In cases of kidney and urinary tract infections, tripelphosphates and amorphous phosphates are often present in the urine.
Slime
Mucus in combination with epithelial cells indicates damage to the mucous membrane of the urinary tract due to an inflammatory process or salt crystals.
Bacteria
Urine collected during normal urination is not sterile. But the number of bacteria in it is low and they are not detected during normal testing. If the results indicate the presence of bacteria (from + to ++++), it is recommended to continue examining the child with a urine test for sterility.
Cumulative samples
In case of questionable results of urine tests (traces of protein, borderline values of leukocyturia, etc.) and suspicion of kidney or urinary tract disease, as well as for routine examination of children with existing diseases of the kidneys and urinary organs, cumulative samples are used. Cumulative samples include the Addis-Kakovsky, Amburge and Nechiporenko samples. They make it possible to detect white blood cells and red blood cells in the urine, even if they are not always present, but only periodically during the day.
Norms of cumulative urine samples in children
Exceeding normal values indicates diseases of the kidneys or urinary organs.
Zimnitsky test
A urine test according to Zimnitsky is prescribed to assess kidney function. It examines only 3 indicators: the specific gravity of urine and its fluctuations during the day, daily diuresis (the amount of urine per day) and the ratio between night and daytime diuresis.
Research standards according to Zimnitsky for children
Deviations from the norm:
Hypoisosthenuria - a decrease in the difference between the maximum and minimum specific gravity (range equal to or less than 7 units) - indicates a decrease in the concentrating ability of the kidneys. It is noted in acute and chronic pyelonephritis, renal failure.
An increase in the daily amount of urine (polyuria) is possible against the background of the initial stage of renal failure, as well as with extrarenal diseases (diabetes mellitus and diabetes insipidus, etc.), against the background of copious fluid intake.
A decrease in the daily amount of urine is observed in late stages of renal failure, with glomerulonephritis, HFRS, nephrotic syndrome, heart disease, etc.
The erasure of the difference between daytime and nighttime diuresis occurs with the initial degree of renal failure, and with severe renal impairment, nighttime diuresis predominates over daytime (nocturia).
Three-glass and two-glass samples
These tests are used to roughly determine the location of the inflammatory process or the source of blood in the urine. The normal number of formed elements (erythrocytes and leukocytes) in each portion should be the same as in a general urine test. With a three-glass test, an increase in the level of cells in the first portion indicates the localization of the disease process in the external genitalia or the initial part of the urethra; if the indicators are increased in the second portion, damage to the urethra is assumed; with changes in the third portion, inflammation of the bladder is likely. When pathological changes are found in three portions at once, this may indicate diseases of the kidneys, ureters, and bladder.
