Urinalysis is a simple but extremely informative method. The composition of the excreted liquid can determine how well the body digests these or other substances and how it reacts to taking the medicine. Almost any changes in the work of the kidneys, liver, heart, CNS affect the composition of urine. The analysis of Addis Kakovski allows to determine the number of red blood cells, leukocytes, cylinders and other elements.
Urine analysis according to Addis-Kakovsky
To determine the presence of erythrocytes or leukocytes allows one-time collection of urine. However, the specific work of the excretory system is such that the composition of urine varies depending on the time of day, the food intake and the volume of the fluid drunk. As a result, for the quantitative analysis, it is required to evaluate the composition of the liquid for a longer time in order to take into account the daily fluctuations.
The following elements are determined in the selected sample:
- red blood cells - red blood cells. In urine, unchanged erythrocytes - containing hemoglobin, and altered - leached, not containing hemoglobin can be detected. Normally, there should not be any blood cells in the urine, so their finding is an immediate reason to consult a doctor;
- white blood cells are white blood cells. A small number of them are present in the urine of a healthy person;
- cylinders are specific cells of cylindrical shape. They can have different origins - protein, granular, hyaline, the latter in some quantity is always present in the urine of a person after severe physical exertion. The presence of the rest indicates irregularities in the functioning of the kidneys of a different nature. Typically, an assessment of the number and type of the cylinder helps to identify the infectious origin of the kidney disease.
It is important to determine not only the quantity of each element, but also their ratio. These indicators allow you to clarify the diagnosis and specify the method of treatment. In addition, the analysis of Addis Kakowski is an excellent way to monitor the effectiveness of treatment: the use of drugs necessarily affects the composition of urine.
Analysis is assigned to both adults and children, carried out according to the same scheme. Since the collection of daily urine in children is much more difficult, as a rule, young children are prescribed an analysis by the method of Ambourg.
Indications
The Addis-Kakowski analysis, like all the others, is one of the diagnostic methods. Assign it for suspected renal pathology. Especially effective is the test for violations of the kidneys, accompanied by hypertension, when other urine tests do not provide specific information.
Assay is assigned if suspected:
- on kidney cystosis;
- on glomerulonephritis - an inflammatory disease that affects the glomeruli of the kidney;
- for pyelonephritis is a nonspecific inflammation in which tubules are damaged;
- for urolithiasis;
- for chronic renal failure. In this case, the analysis serves as an instrument for evaluating the effectiveness of treatment.
Preparation and how to assemble
The collection of urine for the Addis-Kakovskiy analysis is not particularly complicated.
A day or two before the test, the patient should stick to a meat diet with enough protein. This is due to the need to evaluate the number of cylinders. The latter are sensitive to the acidity of urine and in a liquid with a neutral, much less alkaline reaction, simply disappear. To make the analysis informative, it is necessary to acidify the urine - no more than pH = 5,5, which is achieved with the use of high-protein food.
With certain kidney diseases, particularly urolithiasis, this may not be necessary. The doctor, when assigning the Addis-Kakowski analysis, usually already knows the acidity of the urine, so this question needs to be clarified by the treating specialist.
- The day before the meeting, the amount of liquid used is limited. Limitations are selected individually, taking into account the diagnosed diseases and the habitual mode of drinking the patient.
- The collection is carried out in a dry, clean container - sterile.
- The collection time depends on the start time of the analysis. If the urine is collected in the evening, then for the analysis enough urine collected in 10-12 hours - from the evening to the morning. If in the morning, then you need to collect 24-hour urine. At the same morning on the first day of collection is not preserved - only time is recorded, and the morning one is collected the next day.
- It is advisable to avoid visiting the toilet at night, and collect the entire nighttime urine in the morning for 1 time.
- Before each urination, it is necessary to thoroughly wash the genitals.
- Keep the material in the refrigerator.
- After collection, the daily volume should be transferred to the laboratory as soon as possible - within 2 hours after the last urination, the analysis ceases to be objective.
For small patients, a simplified procedure is performed - the urine is collected in 10-12 hours, taking into account all the features of the analysis - mandatory sterility of the container, storage, thorough hygiene and so on. It is desirable to conduct the analysis in stationary conditions.
Performing the
study The analysis technology is simple enough, but time-limited.
Once the urine is collected, it is necessary to proceed immediately to the study:
- The daily urine is mixed, approximately 1/50 or 12 minutes are taken from the whole volume. This quantity is calculated by the formula Q = V /( t * 5) , where:
Q - the volume of urine( in ml), given in 12 minutes;
V - total volume of urine( in ml);
t - time( in hours) for which urine is collected - 12, 24 hours;
5 - the number for calculating the volume allocated in 12 minutes. - This amount is placed in a centrifuge tube and placed in a centrifuge for 3 minutes at 3500 rpm and 5 minutes at a speed of 2000 rpm.
- The top layer - the main part of the liquid, is removed, leaving 0.5 ml with a deposit. If the precipitate is larger, 1 ml of urine is retained.
- The sample is mixed and placed in a counting chamber - Goryaev, Burker, Fuchs-Rosenthal. When determining the number of cylinders, the type of the chamber is crucial: thus, for counting the cylinders, 4 Burker cameras or 1 Fuchs-Rosenthal camera will be needed. If the study was carried out in Burker and Goryaev's chamber, the resulting number would need to be divided by 4.
- The number of elements in 1 μl of precipitate is then calculated. The value for the cameras of Goryaev and Burker is calculated by dividing a certain amount by 0.9 - the volume of the camera. When the analysis is performed in a Fuchs-Rosenthal chamber, the value is divided by 3.2 - such a volume of the apparatus.
- The values obtained are multiplied by 500 if the sample volume was 0.5 ml, or 1000 if the volume reached 1 ml. Thus, the data are obtained in 12 minutes. To translate them into more familiar indicators, the number is multiplied by 5 if you want to get data per hour, and another 24 if you want to determine the number per day.
The analysis itself takes a minimum of time, given to the doctor can be transferred on the same day.
Explanation
The Addis-Kakovski analysis indicates the number of uniform elements allocated per day.
The following figures are the norm for the indicators:
- leukocytes - up to 2 million per day;
- erythrocytes - up to 1 million;
- cylinders - up to 20 thousand for the same period of time.
The norm for children is practically the same:
- leukocytes - up to 2.5 million per day;
- erythrocytes - up to 1 million per day.
Deviations from the norm indicate various diseases. So, the excess of leukocytes indicates an inflammatory process. Excess of the number of leukocytes over red blood cells indicates pyelonephritis, as well as infectious ailments of the urinary tract. Excess of red blood cells over leukocytes testifies to glomerulonephritis.
Disadvantages of
The advantage of this method is the ability to calculate the number of leukocytes and erythrocytes, taking into account the daily fluctuations in the substance.
The drawbacks of the analysis, however, are significant enough to make such a study one of the diagnostic methods that help only to clarify the diagnosis, and not to accurately determine the ailment:
- long storage of urine - up to 24 hours, leads to partial lysis of elements, especially red blood cells due to fermentationAlkaline type. Accordingly, the data on the amount of matter are distorted;The
- method is difficult to apply to small patients;
- change in indicators is associated not only with kidney pathologies, but also with the action of any poisons, purulent inflammatory diseases and other;
- analysis by Addis Kakowski does not apply to express methods;
- in certain cases, the collection of urine according to this scheme is very difficult: some patients are unable to empty the bladder for 10-12 hours, some can not completely empty it. Collection using a catheter is possible only in stationary conditions;The
- method does not allow us to determine which kidney is damaged, since it gives an average value, so that with unilateral organ damage the analysis is practically useless.
Urine analysis by Addis Kakovsky allows to determine the number of erythrocytes, leukocytes and cylinders excreted in urine during the day. These data help to assess the pathological changes in the kidneys and clarify the diagnosis.