Rules for conducting a test according to Zimnitsky. Analysis results and their interpretation

Any medical examination begins with laboratory tests, and urinalysis is one of the first. Indicators of the biological fluid allow you to assess the general condition of the patient. The first thing that deviations from the norm will tell about is a violation of the kidneys. If it is, a number of additional studies are carried out, in particular, a Zimnitsky test. Why and in what cases is it prescribed and how to collect urine for analysis?

What will the functional test according to Zimnitsky show

The main function of the kidneys is to remove unnecessary toxins from the body - metabolic waste, poisons, foreign elements. By filtering the blood, secondary urine is formed, where, together with water, protein breakdown products, nitrogenous compounds, enter. And useful substances - minerals, protein and glucose - come back into the blood. The concentration of nitrogenous compounds in the urine indicates how well the kidneys are doing their job.

The concentration indicator is called relative density, it is it that is evaluated when analyzing samples according to Zimnitsky.

The process of formation of the final urine occurs in the renal glomeruli, tubules and interstitial tissue. Samples according to Zimnitsky allow you to control their functional viability and timely detect pathology.

The Zimnitsky test is designed to diagnose abnormalities in kidney function

The presence in the urine of organic substances that should not normally be present (glucose, epithelium, bacteria, protein) allows, in addition to kidney diseases, to suspect pathologies of other organs in the patient.

Urine for the sample is collected during the day. The amount of fluid released during this time, its density and distribution during the day (day and night diuresis) are analyzed.

When is a study ordered?

Urinalysis according to Zimnitsky is prescribed for adults and children in the following cases:

• with suspicion of an inflammatory process in the kidneys;
• to exclude (or confirm) renal failure;
• with constant patient complaints of high blood pressure;
• if there was a history of pyelonephritis or glomerulonephritis;
• with suspected diabetes insipidus.

Pregnant women are prescribed tests in case of severe edema and impaired protein metabolism. In a planned manner, urine should not be collected by women during menstruation. In emergency cases, the sampling is performed using a catheter. There are no other contraindications for testing.

Preparation and collection of material for analysis

The algorithm for collecting urine for samples according to Zimnitsky is the same for children and adults. Pregnant women should adhere to the following rules:

• do not eat vegetables that color urine and change its smell (beets, horseradish carrots, onions, garlic);
• do not violate the recommended drinking regimen;
• do not take diuretics.

During the day, urine is collected at certain hours in 8 separate containers. Just in case, 1-2 spares should be prepared. The first morning portion at 6 o'clock in the morning merges into the toilet. Further, starting from 9.00, with an interval of three hours, the samples are collected in jars. The last container is filled at 6:00 the next morning.

Urine is collected every three hours

Each jar is signed - the name, surname and time of collection are put on it. If at this time there was no urge to urinate, an empty container is handed over to the laboratory (also with an indication of the time).

If the one-time volume of urine excreted exceeds the size of the container, an additional jar is taken, and the same time is marked on them.

The mode of drinking and eating should be normal. During the day, a diary is kept, in which the amount of fluid taken is noted. Everything is taken into account - water, tea, coffee, juices, juicy fruits, soups and the like. Records are handed over to the laboratory assistant along with biological material.

Tightly sealed jars of collected urine should be stored in the refrigerator. Pharmaceutical containers or sterile glass jars can be used to collect material. Do not use plastic utensils.

Deviations from the norm give rise to further examination of the patient

Table: normal sample values ​​according to Zimnitsky

Normally, morning urine is more concentrated than evening urine. It is diluted with liquid drunk during the day. In all portions, the biological fluid may have a different color and smell. The physiological norm of density can vary from 1001 to 1040 g / l. With a normal drinking regimen, it is 1012–1025.

Deciphering the analysis

The interpretation of the results of the analysis is carried out only by a specialist. Deviation from the norm of any indicator requires close attention of the doctor.

Table: what deviations from the norm say

Equally low values ​​in all eight samples (isohyposthenuria) also indicate a deviation in the work of the kidneys. Maximum fluctuations in the specific gravity of urine less than 0.012-0.016 are one of the early signs of renal failure. The alleged diseases are chronic glomerulonephritis, hypertension, development of an amyloid-wrinkled kidney, hydronephrosis, severe polycystic kidney disease.

The low density of urine in samples according to Zimnitsky may have alimentary reasons - long-term adherence to a salt-free or protein-free diet.

Deviations of some indicators from the norm are not necessarily pathological. An increased separation of urine can be observed with the convergence of edema, the intake of diuretics, an excessive amount of fluid drunk. A small amount indicates the formation of edema, insufficient fluid intake, increased sweating.

Urine samples according to Zimnitsky are designed to detect renal pathologies at an early stage. It is impossible to track the development of the disease by this analysis. Even with the progression of the disease and the increase in the content of nitrogenous slags in the blood, the relative density of urine can remain at the same level for a long time.

Video: urinalysis according to Zimnitsky - indications, collection rules, interpretation of the results

The sample is not intended to make an accurate diagnosis. It only indicates the performance of the kidneys. If the analysis reveals deviations from the norm, the doctor prescribes additional clarifying studies.

Update: October 2018

The Zimnitsky test refers to additional, advanced laboratory tests of urine and allows you to evaluate the function of the kidneys, to identify violations in their work. The analysis was developed in 1924 by the general practitioner Zimnitsky S.S. and is still relevant today.

Most often, it is prescribed for suspected acute or chronic inflammatory process, leading to disruption of the kidneys, as well as renal failure against the background of diabetes insipidus and diabetes mellitus, hypertension.

The technique does not require special equipment, therefore it refers to simple, affordable and informative options for urinalysis. Most often it is carried out in a medical institution, when a person is on inpatient treatment or on examination. Patients with chronic kidney disease are prescribed to control organ function.

The study includes the determination of a number of indicators (urine density, daily volume of urine excreted, distribution of the total volume of urine during the day, etc.), the interpretation of which is carried out by the attending physician.

The essence of the technique

The Zimnitsky test allows you to determine the concentration of substances dissolved in urine, i.e. concentration function of the kidneys.

During the day, the kidneys perform the most important work, taking unnecessary substances (metabolic products) from the blood and retaining the necessary components. The renal ability to osmotically concentrate and then dilute urine directly depends on neurohumoral regulation, the effective functioning of nephrons, hemodynamics and rheological properties of blood, renal blood flow, and other factors. Failure in any link leads to kidney dysfunction.

Urinalysis according to Zimnitsky - how to collect?

Urine collection for this study is carried out at certain hours of the day. There are no restrictions on food intake and drinking regimen.

To prepare for the collection of analysis, you need:

• 8 clean jars with a volume of about 200-500 ml. Each jar is labeled accordingly for a separate three-hour period: patient's last name and initials, sample number (from 1 to 8) and time period;
• clock with alarm function (so as not to forget about the time when you need to urinate);
• a sheet of paper to record fluid intake during the day in which urine is collected (including the amount of fluid that comes with the first course, milk, etc.);

Collection of urine

Within 8 three-hour intervals within 24 hours, you need to collect urine in separate jars. Those. each jar must contain urine excreted in a specific three-hour period.

• In the interval between 6.00 and 7.00 am, you should urinate into the toilet, i.e. nighttime urine collection is not necessary.
• Then, at regular intervals of 3 hours, you should urinate in jars (for each urination - a new jar). Urine collection begins after nighttime urination, before 9.00 am (first jar), ends before 6.00 am the next day (last, eighth jar).
• It is not necessary to visit the toilet on an alarm clock (exactly at 9, 12 am, etc.) and endure 3 hours. It is important that all urine excreted in a three-hour period be placed in an appropriate jar.
• You should carefully write down on a piece of paper all the liquid consumed during this day and its amount.
• Each jar immediately after urination is placed in the refrigerator for storage.
• If there is no urge to urinate at the right time, the jar is left empty. And with polyuria, when the jar is filled before the end of the 3-hour period, the patient urinates into an additional jar, and does not pour urine into the toilet.
• In the morning after the last urination, all jars (including additional ones), along with a sheet of records of the liquid drunk, should be taken to the laboratory within 2 hours.
  

Deciphering the result of the Zimnitsky test

Norm:

• The total daily volume of excreted urine is 1500-2000 ml.
• The ratio of fluid that has entered the body and the volume of daily urine is 65-80%.
• The volume of urine excreted in the daytime is 2/3, at night - 1/3.
• Significant increase in urination after drinking liquid.
• Fluctuations in the density of urine in samples within 1003-1035 g/l.
• The density of urine in several or one jar is more than 1020 g / l.
• The density of urine in all samples is less than 1035 g/l.

Pathology:

Indicators for children and adult patients differ in daily diuresis. The exact volume of daily urine in children under 10 years of age is calculated as follows: 600 + 100 * (n - 1), where n is the child's age. Normal diuresis in children from 10 years old approaches the adult norm and is approximately 1.5 liters.

Urinalysis according to Zimnitsky is one of the most common laboratory diagnostic methods that allows you to assess the ability of the kidneys to concentrate and dilute urine.

The kidneys regulate the composition of urine using three processes: reabsorption - the absorption of fluid from the urine, filtration and secretion - the release into the urine of those substances that are to be excreted. During these processes, the kidneys can osmotically concentrate or dilute urine, leaving only vital substances in the blood in the required quantities. The remaining liquid containing nitrogenous compounds (urea, uric acid, creatinine, glucose, purine bases, proteins, indican, etc.) forms secondary type urine and is excreted.

The specific gravity of urine shows the concentration of nitrogenous compounds dissolved in it, and the ability of the kidneys to excrete urine with a high concentration of toxins is an indicator of the normal nitrogen excretion function of the kidneys.

Often, polyuria accompanies pregnancy, especially the third trimester, due to the strong pressure of the growing uterus on the bladder.

With a decrease in fluid intake, the volume of urine decreases, the concentration of nitrogenous salts in it increases, the color changes to rich yellow. An increase in fluid intake into the body, respectively, is accompanied by the excretion of a large volume of weakly concentrated and less colored urine.

A study according to Zimnitsky allows you to determine:

• the total volume of daily urine;
• distribution of the total volume of urine separated during the day;
• the concentration of substances dissolved in urine;
• the relative density of each portion of urine.

The concentration of substances in the urine can vary significantly during the day, which is associated with the intake of water, food, fluid loss by the body. Therefore, their determination in a single portion of urine is uninformative. The study according to Zimnitsky is to identify the relative density of each individual portion of urine.

An indication for the purpose of the analysis is the diagnosis of the following conditions:

• kidney failure;
• chronic glomerulonephritis and pyelonephritis;
• pregnancy with toxicosis in the first trimester and preeclampsia in the last.

How to collect urine for analysis according to Zimnitsky?

As a rule, the doctor who prescribes the study tells where you can take the test and how to properly prepare for it. Urine for analysis according to Zimnitsky is taken in any clinical laboratory, but the reliability of the result directly depends on how responsibly the patient treats the collection of material. Proper preparation of the patient for the delivery of urine ensures the reliability of the result of the study.

In children, the ability of the kidneys to concentrate urine is reduced, so the upper limit of the norm for the volume of daily diuresis is greater, and the relative density of urine is less.

Urine collection algorithm for research:

• prepare in advance eight clean and dry containers (glass jars or plastic containers), number them and indicate the time for taking a portion of urine;
• on the first day of collection, urination in the morning is not taken into account, the first portion of urine is released into the toilet;
• urine will need to be collected eight times throughout the day (for each urination - a new jar), every three hours;
• immediately after urination, the container is tightly closed and stored in the cold (preferably in the refrigerator);
• you should record the amount of liquid and liquid food consumed during the day;
• if during any three-hour interval there was no urge to urinate, then the jar corresponding to the missed time is left empty. And vice versa: if the container is filled before the end of the time period, urine is collected in an additional container, indicating the number and time on it;
• in a day, all eight jars must be handed over to the laboratory.

Urine is collected at certain hours during the day, while preparing, they follow the rules: during the analysis, diuretics should not be taken, and medication should be agreed with the doctor. Before collecting each portion of urine, hygiene procedures (washing of hands, genitals) should be performed. There are no restrictions on food intake and drinking regimen: the patient adheres to his usual diet, without excessive water load.

Deciphering the result of a urine test according to Zimnitsky

The total daily volume of urine excreted is determined using a measuring cylinder, summing up the daytime and nighttime diuresis. Normally, the total amount of daily urine excreted is 1500-2000 ml.

An increase in the level of urine density may be the result of taking certain medications, radiopaque substances.

Comparing the daily diuresis with the volume of fluid that entered the body during the day, the percentage of fluid excreted in the urine is determined. The daily amount of urine should be 65-80% of the liquid drunk. Normally, there should be an increase in urination after drinking a liquid.

The normal functioning of the kidneys is evidenced by the variation in the volume of collected urine. The amount of urine in portions varies on average from 50 to 300 ml, daytime diuresis prevails over nighttime.

Daily fluctuations in the density of urine are acceptable within the range of 1.001-1.030 g / ml (according to some reports, up to 1.040 g / ml). The difference between the figures for the maximum and minimum urine density should be greater than 7. During the daytime, there should be from 2/3 to 3/4 of the daily volume of urine.

Relative density is determined using a laboratory instrument - an urometer, which has the form of a float with an elongated thin neck, on which divisions are applied. Its principle of operation is based on comparing the density of urine with the density of water. For analysis, the urometer is immersed in a transparent cylinder filled with urine so that it does not touch its walls. The deeper the urometer is immersed in the cylinder at a urine temperature of 20 °C, the greater its specific gravity. The preserved concentration ability of the kidneys is indicated by the density of morning urine equal to or greater than 1.018.

Table of reference values ​​in the analysis of urine according to Zimnitsky

In children, the ability of the kidneys to concentrate urine is reduced, so the upper limit of the norm for the volume of daily diuresis is greater, and the relative density of urine is less. Normal indicators of the relative density of urine in newborns are 1.002-1.020 g / ml. Then the density level gradually increases and by the age of 5 reaches 1.012–1.021. From the age of 12, this indicator reaches normal values ​​for an adult.

With a decrease in fluid intake, the volume of urine decreases, the concentration of nitrogenous salts in it increases, the color changes to rich yellow.

During pregnancy, the normal specific gravity of urine is 1.010-1.025 g / ml.

Deviations from the norm and their causes

With violations of the functioning of the kidneys in the analysis of urine according to Zimnitsky, deviations from the norm are revealed.

Hypostenuria

Polyuria

Polyuria is an increase in the volume of daily urine with a low specific gravity. The cause of polyuria can be chronic renal failure, nephrolithiasis, pyelonephritis, sarcoidosis, diabetes mellitus, heart failure, prostate disease.

The concentration of substances in the urine can vary significantly during the day, which is associated with the intake of water, food, fluid loss by the body.

Often, polyuria accompanies pregnancy, especially the third trimester, due to the strong pressure of the growing uterus on the bladder.

Oliguria

Oliguria is a decrease in the volume of daily urine. The causes of oliguria can be nephrological diseases (glomerulonephritis, renal vein embolism, pyelonephritis, acute renal failure), hemolytic anemia, urinary tract obstruction, heart failure. Slowing down the formation of urine can be caused by increased sweating, diarrhea, vomiting, bleeding, restriction of drinking regimen, prolonged fasting, taking certain medications. During pregnancy, a decrease in the volume of daily urine can be caused by compression of the ureters by an enlarged uterus.

), and conduct instrumental (ultrasound, excretory urography) studies.

Video from YouTube on the topic of the article:

Urinalysis according to Zimnitsky is used in clinical practice to assess the functional state of the kidneys. This method belongs to advanced diagnostics, it is carried out after traditional urine and blood tests. This study is prescribed for adults by a general practitioner, for children - by a pediatrician. In chronic kidney diseases, nephrologists use it to monitor the condition of the kidneys, and obstetricians and gynecologists to assess the functional activity of the urinary system during pregnancy.

Indications

The study is indicated to confirm long-term, chronic diseases in which a violation of the kidneys has developed.

Assign a urine sample according to Zimnitsky if you suspect:

• acute and chronic pyelonephritis;
• interstitial lesions of the kidneys with possible disruption of the functioning of the tubules;
• diabetes insipidus and diabetes mellitus;
• kidney damage in hypertension;
• clinical manifestations of renal failure.

If the glomeruli are affected (glomerulonephritis), pathological changes in this urine test do not confirm the diagnosis. Why, then, do doctors prescribe this study in these situations? This is done to exclude concomitant damage to the tubular kidney. This combination most often develops in severe, long-term forms of diabetes mellitus.

Execution rules

The technique of collecting urine for analysis according to Zimnitsky determines the accuracy of the results obtained. This research requires awareness and discipline.

There is no special training, moreover, it is important that the drinking and motor regimen be normal. In order to successfully pass the analysis, it is better not to leave your own home or hospital for a long time, but to devote these days to a qualitative examination.

You need to prepare in advance:

• 8 clean (ideally sterile) jars with a volume of 200-500 ml, where three-hour intervals are recorded, starting from 6 in the morning of the first day and ending at 6 in the morning of the second;
• a working alarm clock or device with a reminder function;
• a sheet of paper, a pen for recording the amount of fluid drunk, as well as the time of admission (you can use laptops, tablets, phones).

The rules for collecting a urinalysis include the obligatory emptying of the bladder into the toilet in the morning on the day the study begins. This is usually done after waking up, between 6 and 7 in the morning. And only subsequent portions are handed over for analysis.

The sequence of the urine collection algorithm:

1. During 8 three-hour periods of time of the day, it is necessary to urinate in separate jars.
2. The first jar is filled up to 9 o'clock on the first day, the last one - until 6 o'clock in the morning of the next day.
3. At the same time, the volume and time of taking the liquid are recorded.
4. After passing the analysis, each test is sent to the refrigerator shelf.
5. The fully assembled analysis is delivered to the laboratory within 2 hours.

It is not necessary to go to the toilet on an alarm clock (exactly at 9 am, exactly at 12). It is only important that during the period of time all the urine (urine) allocated during this period be placed in an appropriate jar.

If within 3 hours the amount of urine exceeds the capacity of the prepared dishes, then take another jar, on which the same period of time is recorded and marked with a stroke or note that this is an additional capacity. This is why additional jars are needed, which should be prepared before starting the study.

If there was no urine output within a certain three-hour period, then this jar remains empty, and the laboratory assistants who will conduct the study must be informed about the absence of diuresis during this time.

Urinalysis according to Zimnitsky during pregnancy is collected in sterile jars, delivery is carried out according to general rules

Analysis of the results

In laboratory conditions, the volume of each portion, night and day diuresis are counted separately. Using chemical reagents, the specific gravity, concentration of protein and glucose in each container is determined.

Information about all drunk clean water, drinks, broths and soups during the day when the analysis was taken, allows you to accurately assess the ratio between the accepted and excreted liquid.

When deciphering a urine test according to Zimnitsky, they evaluate:

• total amount per day;
• the ratio between the volumes allocated during the day and at night;
• fluctuations in the relative density of urine throughout the day;
• the relationship between relative density and serving volume;
• the percentage of the allocated fluid relative to the accepted.

These indicators characterize the ability of the kidneys to concentrate and dilute urine, determine the clinical significance of urinalysis according to Zimnitsky.

The laboratory evaluates the characteristics of portions depending on the time of day, volume, amount of liquid drunk and the time of its intake.

The norm indicators in the analysis of urine according to Zimnitsky are presented in the table:

Normal indicators for children and adults are different only with respect to daily diuresis. The most accurate determination of the volume of daily urine in a child not older than 10 years is carried out according to the formula: 600 + 100 * (n - 1), n ​​is the child's age in years.

After 10 years, normal diuresis is about one and a half liters and approaches that of adults.

In the conclusion, the results obtained and their compliance with the criteria of the norm are indicated. The attending physician evaluates the effectiveness of the study, its indicativeness and compliance with a particular disease.

Diagnostic value of the method

What does the analysis of urine according to Zimnitsky show, what changes in the activity of the kidneys can be detected in this study? The main indicator is a violation of the concentration function. Normally, with a decrease in the volume of urine filtered by the kidneys, the content of salts and other compounds in it increases. This ensures the removal of metabolic products from the body. With a large daily diuresis of the kidney, the concentration of substances in the urine is reduced due to the system of renal tubules.

In chronic diseases, the ability to concentrate and dilute urine deteriorates. These disorders occur both in inflammatory diseases (pyelonephritis) and non-inflammatory (diabetes mellitus, hypertension).

Signs of pathology:

• reduced in all portions;
• no increase in relative density during periods when the volume of urine decreases (by 30-50 percent);
• no decrease in the specific gravity of urine at large volumes (more than 200-250 ml);
• violation of the ratio between nocturnal and daytime diuresis (urine secretion increases at night).

To denote the same specific gravity of urine in different portions, doctors use the term "isostenuria", if it is below 1010 - "hyposthenuria", above 1035 - "hyperstenuria".

Hyperstenuria is not directly related to kidney function, it shows the saturation of urine with substances that increase its density. It is most often observed in severe forms of diabetes mellitus and the excretion of large amounts of glucose.

The study can show an increase in the volume of daily urine (polyuria), its decrease (oliguria), up to critical numbers (anuria). If against the background of polyuria there is a high density of urine, then this may indicate the development of diabetes mellitus, if it is reduced, then diabetes insipidus must first be ruled out.

In pregnant women, this examination provides information about chronic pyelonephritis, kidney changes in diabetes mellitus, the course of which may worsen at certain stages of childbearing. These processes affect the course of pregnancy, require observation and medical intervention.

Only if the urine is collected technically correctly can such extensive and accurate information be obtained. If part of the urine is poured into the toilet bowl (especially if the containers for analysis are small and the volume of urine released per urination is large), then the information content of the method drops sharply.

Repeating the tests over time allows you to monitor the progression of the disease or the improvement in kidney function with effective treatment.

Thus, the study of eight servings of daily diuresis allows us to differentiate the two most common pathological processes: damage to the tubular system and glomeruli of the kidneys. It is possible to confirm the chronic nature of the disease, with control studies - control of the course of the disease. Awareness of how to collect a urine test according to Zimnitsky makes this procedure easier, and the result informative.

Urinalysis does not always give a complete picture of the condition of the kidneys, and, accordingly, identify some problems, which is necessary to determine an accurate diagnosis.

For this, additional analyzes of the biological secreted fluid are prescribed, one of which is the collection of urine and the analysis according to Zimnitsky.

This is an additional more complete laboratory analysis. It gives a more accurate assessment of the work of the kidneys, and also allows you to identify some violations in their functioning. As a rule, it is prescribed for inflammatory processes in the urinary organs or kidney failure.

Analysis according to Zimnitskyrefers to relatively simple and fairly informative methods for examining urine, as it does not require special laboratory equipment.

The most indicative way to determine the pathologies of the excretory functionality of the kidneys and pathologies in their work is to check the urine, especially the Zimnitsky test.

What diseases require testing

Surrendering it is necessary for diseases such as:

• diabetes;
• swelling during pregnancy;
• hypertension;
• pyelonephritis;
• glomerulonephritis;
• heart pathology.

The obtained analysis data may vary within the normal range, because they depend on many factors.

The purpose of the analysis is to determine:

• daily volume of urine excreted;
• the ratio of fluid drunk and excreted within 24 hours;
• urine density - the content in it of various products excreted from the body;
• daytime diuresis;
• nocturnal diuresis.

Biological fluid can change color, smell and volume during the day. It contains various nitrogen compounds. Other impurities, organic substances (protein, glucose), products of protein metabolism (urea), as well as any salts in the urine are not allowed. Their presence means that malfunctions caused by certain diseases occur in the work of the urinary organs. The main thing in the analysis is the definition of 3 main indicators:

• urine density;
• the volume of urine excreted during the day;
• portions of total urine output in 24 hours.

Zimnitsky's testallows you to set the concentration of substances dissolved in urine. The kidneys filter and detoxify about 1,000 liters of blood per day, retaining the components necessary for normal functioning.

Analysis indicators, taking into account other patient data, allow you to confirm or exclude certain diseases and make an accurate diagnosis.

Take the same analysisaccording to Zimnitsky in children. This is necessary to exclude any dangerous pathologies in the child's body that provoke the risk of developing kidney failure.

Collection of urinalysis according to Zimnitsky

Patient preparationto this analysis is simple. Urine is collected during the day at the appointed hours. (Alarm clock required). No restrictions on food and drink are needed. A necessary condition is only the refusal to take any drugs with a diuretic effect, as well as excessive fluid intake is undesirable. It is advisable to drink no more than 1-1.5 liters of water and other drinks. Ignoring these rules can lead to an unreliable result of the Zimnitsky test. Before taking the test, you should not eat foods that can color urine (rhubarb, beets), do not eat salty-spicy dishes that can greatly increase thirst.

To collect a urine according to Zimnitsky, you need to prepare:

• 8 cleanly washed jars;
• an alarm clock so as not to forget and not miss the time when you need to urinate again;
• paper to record the amount (in ml) of liquid drunk during the analysis.

How to passanalysis. Start collecting Zimnitsky urinalysis at 6.00 am: at this time the patient should urinate into the toilet, as nighttime urine is not included in the analysis. Further: every 3 hours it is necessary to urinate in new clean jars for 24 hours.Urine collection algorithm:

• the first portion (1st jar) - at 9.00 in the morning;
• the second - at 12-00;
• further - on an alarm clock (every 3 hours);
• the last portion (8th jar) - at 6.00 in the morning.

Yes (Option 2)collect urine analysis according to Zimnitskywith an interval of 4 hours. In this case, 6 jars are prepared. Just as with the collection method every 3 hours, the volume of liquid drunk per day is certainly recorded in a special form.

All jars are placed in a refrigerator, where they are stored at a temperature of 0-8 about From until morning. If there is no urge to urinate at the appointed hour, then the jar prepared for this hour remains empty. If, on the contrary, the volume of urine at this time is greater than the volume of the prepared jar (container), then you need to take another clean jar.

It is impossible to flush urine into the toilet during the collection of the daily analysis! In the morning, all jars (8 pcs. - with the 1st collection option, 6 - with the 2nd one), including all additional ones, must be immediately transferred to the laboratory. Do not forget to attach a sheet (form) with a record of information about the liquid drunk per day.

Analysis results

The specialist doctor deciphers the analysis, taking into account other available studies and analyzes. The patient himself can check his results.

Urinalysis according to Zimnitskymakes it possible to evaluate several indicators by comparing them with existing standards:

1. The density of urine will show the amount and composition of substances dissolved in the analyzed sample. The norm is 1.013–1.025.
2. daily diuresis. Shows the amount of urine excreted per day. The norm is 1500-2000 ml.
3. The ratio of the amount of liquid drunk and the collected urine. The norm is 65–80%.
4. Daytime and nighttime volume of collected urine. Normally, the volume of daily urine should be larger. The volume of daytime urine should be 2/3 of the total volume, and night - about 1/3.
5. Changes in the amount of urine and its density during the day are also compared. These indicators should change during the day.

Deciphering the analysis of urine according to Zimnitskygives a more complete and accurate picture of the functioning of the patient's kidneys.

If indicators Zimnitsky's samples in transcriptdo not go beyond the norm, so the work of the kidneys is not disturbed. If there are deviations, then there are pathological changes in the work of the kidneys.

Possible deviations

Hypostenuria - low density of urine, with an indicator of less than 1.012. occurs in humans in violation of the concentration function of the kidneys. Hypostenuria can be caused by the following reasons:

• taking medications with a diuretic effect;
• chronic renal failure;
• chronic pyelonephritis;
• tubulointerstitial nephritis;
• diabetes insipidus, severe heart failure;
• long-term adherence to a salt-free and protein-free diet.

Hyperstenuria - increased density of urine, if the indicator is above 1.025. Occurs when there is a large amount of high-density substances in the urine (protein, glucose). Occurs under the following conditions:

• diabetes mellitus;
• initial stages of glomerulonephritis;
• nephrotic syndrome;
• toxicosis;
• gestose.

1. Change in daily diuresis.

Urinalysis according to Zimnitsky with decodinganalyzes changes in daily diuresis.

Polyuria is a condition of increased daily urine output (diuresis). The patient at the same time allocates more than 2 liters of urine from the body. Lead to polyuria can:

• diabetes insipidus;
• increased fluid intake;
• renal failure in a chronic form;
• the use of diuretics;
• pyelonephritis.

Oliguria - a significant decrease in the daily volume of urine, less than 400 ml per day. This deviation occurs due to:

• limited fluid intake;
• excessive sweating;
• profuse diarrhea;
• pyelonephritis;
• glomerulonephritis;
• fluid retention in patients with heart failure.

Anuria - a sharp decrease in the daily volume of urine (200-300 ml) or complete non-excretion of urine from the body. It can occur when the bladder fails, while the functionality of the kidneys is preserved.

1. The ratio of drunk and excreted fluid

The volume of urine excreted per day from the body should be at least 65% of the volume of fluid consumed. In heart failure, this figure is lower. Therefore, edema occurs, since excess fluid is not excreted from the body.

1. Volume of day and night diuresis

If the study found that the nighttime amount of urine exceeds the daytime, then the patient has heart failure or other heart disease. When equalizing the daytime and nighttime volume of urine, there is a suspicion of a violation of the concentration ability of the urinary organs.

It is especially important to dourinalysis according to Zimnitsky during pregnancy, because violations in the work of the kidneys are very dangerous, both for a woman and for her unborn baby.

It is important to understand that pregnancy is also accompanied by certain biochemical changes in a woman's body. This causes some deviations from the norm in the analysis of the urine of a pregnant woman according to Zimnitsky. Proteins found in the urine do not necessarily mean pathology, because during pregnancy a woman often develops toxicosis, which provokes violations of protein filtration.

During pregnancy, the load on the kidneys increases significantly. This is facilitated by the restructuring of the woman's body and the growth of the fetus. After childbirth, the situation is normalized.

In any case, the nephrologist should interpret the results of the analysis individually for each patient.