URINARY SYSTEM

Anatomic and physiologic features URINARY SYSTEM

Weight, size and shape of the kidneys

Weight and size of the kidneys in young children is relatively greater than in older children
and adults. The length of the kidney in the newborn is 4-4,5 cm, weight - 12, the most rapid
growth of the kidney occurs during the first 1.5 years of life: its dimensions are increased
approximately 1.5-fold, while the mass reaches 37 Mr. K school age length of the kidney is
an average of 8 cm and weight - 56 g. In adolescents length of the kidney is increased to 10
cm and weight of up to 1 20 .

Kidney in newborns and infants due to convergence rounded upper and lower poles. In
children older than 1 year of life is straightening of the kidneys, it takes the bean-shaped
form.

Topography kidneys

Topography of the kidneys with age changes, as the body grows the child many times faster
than the kidneys. Because of the relatively large size of the kidneys and the relatively short
lumbar spine of the kidney in the newborn are lower than those of older children, the lower
pole of the kidney is located below the iliac crest bone. The upper pole of left kidney is
projected at the lower edge of T X1, and the right - is below half the height of the
vertebra. By 3-5 months the top edge of the left kidney is lowered to mid-T X | 1, and by 1
year - before its lower edge, which is associated with the rapid growth of the spine. Lower
pole of the kidney in children older than 2 years is located above the iliac crest. After 5-7
years the situation of the kidneys on the spine close to that of an adult. The difference in
the position contralateral kidney is normal does not exceed the height of the body of a
lumbar vertebra. Kidneys in infants are nearly parallel, only at an older age is closer to the
upper poles.

"Renal leg" newborn relatively long, constituting its artery and vein are located
obliquely. In a subsequent "renal leg": gradually take a horizontal position. i

Kidney fiber

Pararenal cellular tissue in infants and young children-time, Vita enough, so the front
surface of the kidney is removed from the environ-j rounding organs only a thin sheet of
parietal peritoneum. Weak time-[vitie adipose tissue, as well as pre-and pozadipochechnoy
fascia [determine significant mobility of the kidneys in young children. Uwe-\ An increase
of adipose tissue occurs in 8.9 years in the period reduction of subcutaneous tissue. By
this age ends with the formation of kidney fixation mechanisms. Normally older children
kidney is displaced no more than 1,8% of body length. Fibrous capsule J Kidney becomes
pronounced to 5 years of a child's life to 10-14 years on it, its structure is close to the
fibrous capsule of an adult.

Structure of the kidney

The surface of the kidney in infants and young children nodular: through lobed structure of
the kidney. Tuberosity kidneys stored up to 2-5 years, and then gradually disappears.

In infants the thickness of the kidney medulla predominates over) thick cortical layer
(4:1). The development of the cortex is especially intense in the age of 5-9 and 16-19
years.Weight increases its blah-I Godard growth in length and width of the convoluted
tubules and ascending parts of the ne-) Tel nephrons. The growth of the brain substance
ceases to 12 years. In general, "since the period of neonatal cortical thickness of the layer
increases by 4 times, and the brain - in 2 times.

In children under 2 years of age nephron not differentiated. In the fetus and newborn,
visceral piece of the renal capsule body with J consists of a cubic epithelium, resulting in a
filtration process for-] harder. Children up to 2 months cubic epithelium present in all renal
clubs, \ barrels, at the 4 th month of life in the glomeruli, located closer to the (marrow,
begin to appear flat epithelium, and by 8 months planar + cue epithelium and detect in the
peripheral glomeruli. At the age of 2-4 years for child j is still possible to find remnants of
cubic epithelium, after 5 years \ glomerular structure is the same as in adults. The process
of morphological- cal maturation of glomerular barrier includes flattening of cells
[endothelium, the appearance of these holes (fenestrae), the formation of a
common basal-I Noi membrane between the endothelium and the podocyte and the
formation oflegs-I dotsitov (visceral epithelial cells of the leaf capsules Shymlanskaya-I th
-Bowman). |

The number of glomeruli per unit volume of tissue in newborns and infants than in adults,
but their diameter is much smaller. Because of the small size of the total glomerular
filtration area of the glomeruli in neonates is relatively small (about 30% of the adult
standards).

Tubules and loop of Henley neonatal shorter, and educate them in 2 times narrower than in
adults. In this regard, in infants and children in the first year of life significantly decreased
reabsorption of the primary urine.

In general, the morphology of the kidneys is similar to the kidney in an adult only to school
age.
Functional features of the kidneys in children

From the first minutes of life of renal blood flow in the newborn grows, and the kidney
takes homeostatic functions.

Plasma flow in the kidneys in young children both in absolute and relative terms (per unit
body surface area) is smaller than in adults, and only after the year is approaching this
level.

Filtration capacity of the newborn kidney is low due to the specific histological structure
of the visceral leaf of the capsule of the glomeruli (cubic epithelium), their small size and
low hydrostatic pressure. In adults, the volume of ultrafiltrate is about 120-130 ml /
(minh1, 73 m 2 of body surface), and neonatal filtrate volume is 4 times less. As the child
grows index clubs, barrel filter increases and approaches the level of an adult until the end
of the 2 nd year of life.

Newborn tubular reabsorption of electrolytes and low molecular weight substances is

reduced, so in this age point higher urinary excretion of amino acids, phosphates and
bicarbonates. Nevertheless, the concentration of each amino acid in the blood plasma in
newborn infants and adults is maintained at a fairly close level. Systems reabsorption of
various substances formed gradually, and in the process of ontogenesis reabsorption in the
tubules could increase by nearly 10 times.

-- System reabsorption of glucose formed in the tubules of the fetus with the onset of
glomerular filtration, which contributes to the conservation of glucose as an important
energy substrate.

-- Intensity occurs in newborns reabsorption of sodium ions. At a load of sodium chloride

kidneys newborns continue to reabsorb sodium ions rapidly, whereas in adults are
depression of the absorption, which is one of the causes of neonatal propensity to
edema. The kidneys of newborn babies are able to excrete excess salt in their excessive
introduction.

In newborns and infants secretion of organic acids and bases much reduced. As you age, it
increases by increasing the number of transporting units in the cells of the tubules or to
increase their synthesis and to slow the destruction of functioning elements and
approaches the level of adults between the ages of 6 months to 7 years. The daily excretion
of uric acid in the calculation of 1 kg of body weight with age is not increased.

Newborns are not capable of adequate excretion of water and isotonic sodium chloride
solution. They are characterized by a lower osmolar concentration of urine. Only 5 months
of life begins to manifest the dependence of osmotic pressure of urine on the magnitude of
diuresis, and from 7 months she had already expressed in adults. In the early postnatal
period is poorly developed capacity for excretion of potassium, calcium, magnesium. The
kidneys are able to provide newborn homeostasis only under conditions where the
organism was not the case overload, indicating incomplete of formation of all major
elements of ion regulation at the time of birth. Maintaining KSCHS determined
reabsorption of bicarbonate, the formation and secretion of hydrogen ions and ammonium.

Concentration function of the kidneys in young children is low, so their urine in their
characteristics differ from the urine of adults. The low concentration of urine depends on
the small diameter of the glomeruli, lack of education ADH, underdevelopment of
regulatory mechanisms, functional insufficiency of the epithelium of distal tubules, etc.
Therefore, for the newborn is characterized by low specific gravity of urine (1,008-1,010).
The increase in renal blood flow and glomerular filtration rate plays a significant role in the
development of the ability of the kidney to the cultivation and concentration of urine,
because it ensures the delivery of sufficient volumes of fluid in the lumen of the tubules of
the nephron. During the first months of life increases the length of loops Henley, thus
creating better conditions for counter-work system. Concentrating ability, similar to adults,
children reach the kidneys to 9.12 months.

Kidneys infants are capable of breeding and urinary excretion of large quantities of liquid
only if its fractional flow. From the first weeks of life the child develops the capacity for the
removal of excess hydrogen ions; ammoniogeneza mechanisms are already well developed
at birth.

Diuresis

The first urine in the majority of term infants usually occurs during the first days of life and
almost all within 2 days. Lack of urine within 72 h suggests pathology. Number of urination
per day in infants (except for the first days of life) is 20-25, in children aged 1 year - 15-16,
in 2-3 years - 10, at school age - 6-7. Amount allocated per day of urine in the newborn
during the first 2-3 days of life is usually small (transient oliguria) due to a small collection
of fluid in the body of the child, ekstrarenal-tion losses, etc. In a further amount of urine
increases. It should be noted that the amount allocated in the urine per standard body
surface area with age does not change. Children up to 10 years the amount allocated for the
day of urine can be roughly calculated by the formula:

X = 600 +100 x (n-1),

where: X - amount of urine in ml, n - age in years.

At high temperature environment produces less amount of urine, and low - more than that.

Urinary tract

Pelvis and ureter. Because of the proximity of the poles of the kidneys in infants, renal sinus
is weak, and therefore the pelvis is intrarenal, and has the shape of crescents, and the
ureter leaves at right angles. Final formation pelvis occurs only at the end of the first year
of life. Intrarenal pelvis position prevails among children under 5 years, at an older age is
predominantly extrarenal pelvis. Volume pelvis in children the first 2-3 years of life is 0,1-1
ml, older than 2 years - 2 ml, and in the pubertal age - 6-8 ml.

Ureters a newborn in the lumbar greatly expanded and have a knee-shaped bends. Ureteral
length of a newborn is 5-7 cm, to 4 years increased to 15 cm length of intramural ureter,
the department increased from 4-6 mm in the newborn to 10-13 mm in 12-year old
children.

The walls of the ureter and pelvis are poorly developed. Muscle and elastic elements are
thin, but peristaltic contractions are characterized by high evacuation capability and
frequent rhythm.

Bladder. In the newborn bladder has a relatively large size, its bottom is not formed, and
the tip reaches half the distance between the navel and the pubic symphysis, in contact
with the thin loops of bowel and sigmoid. As the child grows, the bladder drops in a small
basin, and its front wall close to front wall of the rectum. At the age of 1-3 years the bottom
of the bladder is located at the upper edge of the pubic symphysis; adolescents bottom of
the bladder is at the middle, and late teens - at the lower edge of the pubic symphysis. In
the future, is lowering the bottom of the bladder depending on the state muscles of the
urogenital diaphragm.

Empty your bladder in newborns has a spindle-shaped, the children of the first years of life
- a pear, aged 8-12 years - and only the egg into adolescence takes the form typical for
adults. The capacity of the bladder in newborns of 50-80 ml. By age 5 he holds 180 ml of
urine, and after 13 years - 250 ml. The physiological level of the bladder (ie the volume at
which there uriesthesia) up to 1 year is 20-40 ml in 2-5 years - 40-60 ml in 5-10 years - 60-
100 ml an older age - 100-200 ml.

The thickness of the walls of the bladder in a newborn infant and a relatively large, it
decreases with age. Newborn circular muscle layer in the wall of the bladder is
underdeveloped. Mucosa is well developed, the folds formed. The front wall of the urinary
bladder in a newborn is not covered by peritoneum and predlezhit to the front wall of the
abdominal cavity. In older age the rear wall of the urinary bladder in boys is covered with
peritoneum all over, the girls - except for the section, located below the confluence of the
ureters.

Urethra. In boys, the length of the urethra at the age of 1 month is about 60 mm in the
subsequent year is lengthened by an average of 5 mm, reaching to 16 years in length and
16 cm Different departments ? urethra grow irregularly. Newborn proto - > Receivables
membranous and prostatic parts is 1 / 3 of total length \ HN, and in 11 years - 1 / 6
part. The length of the urethra in novorozhden - | Noah girls is 10 mm, and width - 4
mm. By 1 year, urine \ Channel is lengthened to 22 mm, and the age of 16 - to 32
mm. Muscle shell mo - | Cheispuskatelnogo channel and its external sphincter finally forms
- | ARE for 12-13 years. The curvature of the urethra in boys and | Girls infants expressed
more strongly than adults. [

The act of urinating |

Emptying the bladder is a reflex. Conditionally reflections \

reflex inhibition of the urge to urinate for some time vyrabaty - \

Vaeth in the upbringing of the child. Newborn arbitrary per - :

support of voiding it. The ability to arbitrarily adjust ,

urination develops only towards the end of the first year of life. On \ 2 nd year of life, this
ability becomes stable.

MATERIALS AND METHODS OF URINARY SYSTEM

Inquiries

In questioning the child and his parents can identify the following complaint \

be: change the appearance of urine, urinary retention, abdominal pain, poyasnich - I

Noi area in lower abdomen (young children are poorly localized pain \

In addition to the healthy side pain can be reflex in nature); ;

violation of urination (urinary or neuderzhanie urine, frequent or .

rare urination, etc.), painful urination, edema, higher - \

tion of blood pressure, the allocation of a large amount of urine and thirst. [

It should be clarified family history (heredity, professional |

WIDE harmfulness parents), life histories and illness of a child. \

Inspection [

In general examination include: \

 pallor, dry and earthy shade of skin color (observed when chromium j chronically
impaired renal function); \

edema (swelling in the kidney primarily appear on the face, in periorbi - I tal area,
usually in the morning, may have widespread and I localize face, legs, torso, for nefrotiches
- 5Who syndrome characterized by generalized edema, fluid accumulation \ In the cavities
of the body, until the development of anasarca); I

pronounced lag in physical development may indicate I develop chronic renal failure;

stigma dizembriogeneza characteristic of hereditary nephropathies;

skeletal deformities are possible in severe forms of renal rickets.

On examination, the abdomen can detect an increase in left and right halves
(hydronephrosis, polycystic, kidney tumor), or protrusion in the bottom half of the
abdomen (enlarged bladder). Seen from the lumbar region can be identified redness,
swelling, and palpation - morbidity and fluctuation, which is typical paranefrita.

Palpation

Palpation helps determine the presence of edema or pastosity (see above section "fatty
tissue").

Palpation of the kidneys hold on both sides outward from the lateral margin of the recti.
Infants because of the weakness of the abdominal wall, the lower the location of the
kidneys and the relatively large size of the kidneys palpated (customary law) not more
frequently than in older children, the which in normal kidneys are not
palpable. In older childrenpalpation of the kidneys available in the following situations.

Increasing the kidneys is characteristic of hydronephrosis, tumor, horseshoe kidney,

hypertrophy of the auxiliary sole kidneys, etc.

Misplacement or pathological displaceability (Nephroptosis, "floating kidney").

Aplasia or hypoplasia of the muscles of the anterior abdominal wall. Penetrating

palpation is used to detect pain in the projection of the kidneys and ureters, which usually
indicates the presence of an inflammatory process. Upper and lower "ureteral point"
located at the intersection of the outer edges of the recti from the umbilical and pectinate
lines.
Reminiscent of the bladder is easily detectable in infants. In older age filled bladder in the
form of a rounded education tugoelasticheskoy consistency is determined by acute or
chronic urinary retention. Palpation voiding can be found in it a tumor, calculus,
diverticulitis.

Percussion

Percussion abdomen reveals ascites (see above section "Digestive System"). Positive
symptom effleurage (occurrence of pain in the lumbar spine with moderate effleurage on
her arm across the body attached to the palm of the other hand) may be due to concussion-
stretched and strained capsule and renal pelvis, concussion stones, irritate mucous
membranes pelvis, suppuration adipose tissue. Percussion of the bladder is carried out
after his discharge. Increasing the size of the bladder in the suprapubic region appears dull
sound.

A / Cheek tatsiya

Auscultation abdominal spend in the projection of the vessels of the kidneys on both
sides. Identification of systolic murmurs in the kidneys suggests a possible lesion of the
renal artery (congenital or acquired stenosis of the renal artery) or the aorta in this area
(artery atherosclerosis with the formation of plaques in the ground a discharge of the renal
artery).

Laboratory studies

Of paramount importance in the identification of diseases of the urinary system attached to

changes in the urine. Urinalysis included determination of physical properties, protein,
sugar and microscopy of sediment.

Features of urine in children

Color of urine depends on the content it mainly urohromov, urobilin, uroeritrina,

urorozeina. Immediately after the birth of the child urine colorless. At the 2-3rd day of life
(sometimes up to 2 weeks), urine can buy amber-brown color due to the allocation of a
large quantity of uric acid crystallizes easily and leaves the diaper stains brick red (urine
acid myocardial neonatal kidney, see Chapter 4 "Border state"), and then it again becomes
a light yellow with the increase in diuresis. Uric acid - the end product of purine
metabolism and pirimidiiovyh bases, formed from the nucleic acids of nuclei decaying in a
large number of cells. infants urine lighter, than in older children and adults, in whom it
varies from straw yellow to Jahn-packaged yellow.

Transparency of urine in a healthy child is usually full.

 The reaction of urine in neonates acid (pH 5,4-5,9), and preterm more than full-term. At
the 2-4-day life, the pH increases in the future depends on the type of feeding: breast with a
pH of 6,9-7,8, and artificial - 5,4-6,9 (ie for children characterized physiological acidosis). In
older children the reaction of urine is usually weak acidic, less neutral.

Specific weight of urine in children is normal during the day varies 1,002-1,030
depending on water pressure. The lowest proportion is the urine of children during the
first weeks of life, it usually does not exceed 1,016-1,018.

The urine of healthy children contains a minimal amount of protein (up to 0,033 g / l).
One day in the urine normally allocated to 30-50 mg of protein, and these numbers are
increasing at a fever, stress, physical exertion, the introduction of NORAD-renalina. In the
newborn can develop physiologic protein-ences of up to 0,05%, due to the failure of the
renal filter characteristics of hemodynamics in this period and the loss of fluid in the first
days of life. In term infants, it disappears at the 4-day 10 of life (preterm later).

Organic elements of urine sediment containing red cells, leukocytes, cylinders, epithelial
cells (Table 2-15). Their number in the urine of children is the same as in adults. To clarify
the source of hematuria and leuco-cyturia spend dvuhstakannuyu sample. Inorganic salts
of uric sediment before. The nature of the settled salt depends primarily on the colloidal
state, pH and other properties of the urine, as well as the state of the epithelium of the
urinary tract. For newborns is characterized by sediment of uric acid. In older age such
precipitate is formed when there is excessive use of meat-eating, exercise, fever,

Table 2-15. Contents of elements of organic sediment in the urine of healthy children

Cardinality
Elements In single servings In the daily urine In 1 ml of urine (method
Draft (in sight) (method of Addis Nechiporenko)
Kakovsky)
Leucocytes Boys 3.4 Up to 2 OOO OOO Before 2000
In girls, 5.6 Before 4000
Erythrocytes 0-1 Before I OOO OOO Up to 1000
Cylinders Isolated Up to 20 Ltd Up to 250
Epithelial Isolated cells --
cells squamous epithelium

Urine of a healthy child does not contain bacteria. Bacteria in the urine detected mainly in
inflammatory diseases mochevyvodya-ing ways, the external genitalia. Bacteriuria
considered diagnostic if in 1 ml of urine reveal 0,5-1,0 x10 5 or more microbes (for children
3-4 years - 1,0 x10 4). The evaluation of bacteriuria has a meaning and nature of the
microflora. In order to identify the microorganism, determining its sensitivity to
antibacterial drugs and count the number of microbes per unit volume of produced urine
culture.

Sugar, ketone bodies (acetoacetic and P-hydroxybutyric acid), bilirubin, urobilinogen

and urobilin (metabolic products of bilirubin) in the urine of normal children do not reveal.

Investigation of renal function. To investigate renal function determined by glomerular

filtration clearance of endogenous creatinine (modified test Reberga): the first day of life
the rate is very low and amounts to 10 ml / min, in 6 months - 55 ml / min, over 1 year -
100 +20 ml / min, which corresponds to the index in adults. The value of glomerular
filtration rate increases with the infusion therapy or receiving large volumes of fluid inside,
a lot of protein in the diet, decreases under the influence of heavy physical exertion, change
in body position from horizontal to vertical, under the influence of stress. Also, determine
the value-ing tubule reabsorption (normal 97 -99%).

The concentration of kidney function was evaluated using samples of Zim-nitskogo (in
infants urine obtained during natural urination). The presence of portions of the relative
density of 1,018 or more indicates preserved concentrating ability, and the difference
between the maximum and minimum relative density of 0,012-0,015 units indicates
preserved the ability of the kidney to con

starvation, the use of cytostatic agents, glucocorticoids, causing increased

catabolism. Oxalate present in the urine of individuals consuming foods rich in oxalic acid,
but the crystals detected only after prolonged standing urine.

centration and breeding. Daytime diuresis in healthy child is 2/3-3/4 daily.

To assess the function of proximal tubules investigate clearance of free amino acids and
phosphates, and to assess the function of distal tubules are exploring the ability of the
kidneys to excrete H + ions and electrolytes (sodium ions, potassium, chloride, phosphorus,
calcium, etc.).

To assess kidney function and determine the content in the blood of nitrogen-containing
substances (urea, creatinine, uric acid), total protein and its fractions, electrolytes.

Instrumental study

The most widely in clinical practice using ultrasound, which has a wide range of
possibilities and allows us to estimate the size, shape, position and structure of the kidney
to assess renal blood flow and functional status of the kidneys, bladder condition, to
identify the swelling in body cavities.

To evaluate the anatomical and functional condition of kidneys and urinary tract,
urodynamic evaluation and monitoring of the dynamics of pathological process conducted
excretory urography. If there is no excretion of contrast material on retrograde
pyelography urogram performed, which allows us to estimate the anatomical condition
chashech-but-lohanochnoy system and cross-segment pieloureteralnogo .

In Pediatric Nephrology also using radioisotope methods of investigation. Radioisotope

renography to evaluate renal blood flow, secretory function of renal tubules and
urodynamics of the upper urinary tract. Dynamic scintigraphy to determine the shape, size
and position of the kidneys, estimate the number of functioning parenchyma, the functional
activity of its various sections, and static scintigraphy - reveal a mass in the parenchyma.

Angiography of renal arteries to evaluate renal blood flow and condition of the kidneys in
their hypoplasia, atrophy, presence of cysts or tumors.

To clarify the type of jade and assess the possibility of pathogenetic therapy hold needle
biopsy of the kidneys.

With miktsionnoy urethrography assess the anatomical and functional state of the
bladder and urethra, thus possible to identify vesicoureteral reflux and vaginal reflux in
girls.

To assess the state of the mucous membrane of the urinary bladder, anatomical location
and condition of the ureters, bladder assessment used cystoscopy. To study the
urodynamics of lower urinary tract spend cystometry and Uroflowmeter.

SEMIOTICS INJURIES URINARY SYSTEM

Anomalies of development of urinary organs

Anomalies of the kidneys include an extra kidney, double kidney (in the division on one
side of the bookmark of the primary buds), agenesis (complete lack of authority), aplasia
(absence of a body in the presence of vascular pedicle). When seam lower or upper ends
formed horseshoe kidney, and at seam both ends - ring-shaped kidney. Possible
misplacement of the kidneys (the location of embryonic favorite), anomalies of rotation.

Hypoplasia of kidney simple - reduce the relative body weight by more than half of a one-
sided and more than a third of the bilateral lesions, reducing the number of
cups.Hypoplasia displastiches-kai - a decrease of relative weight of kidneys in violation of
their structure.

Dysplasia of the kidneys - a group of congenital malformations of the kidneys in violation of

the differentiation of renal tissue and the presence of embryonic structures.

Anomalies of the ureter include doubling of its one or both sides, splitting in the cranial or
caudal division, stricture, ectopic (located in atypical location) estuaries, diverticulitis,
megaloure ter retrokavalny ureter.
Anomalies of the urinary bladder include his agenesis, ecstrophy (congenital cleft of the
urinary bladder and abdominal wall), diverticulitis and PERSYS-types / urahusa.

Anomalies of the urethra to include agenesis, atresia or stenosis, hypospadias, epispadias.

Amendment 1 urine

Changes in urine - the most permanent, and often the only sign of the defeat of the urinary
system.

Urinary Syndrome. Under the urinary syndrome in a broad sense is understood as a

violation of excretion of urine (change in amount of urine, frequency and rhythm of
urination, pain with it), and the appearance of pathological changes in the urine. In a
narrow sense of uric syndrome involves only the presence of changes in urine in the form
of proteinuria, hematuria, leykotsiturii, cylindruria, changes in salt composition of the
urinary sediment. These changes may occur in isolation or in various combinations.

Changing transparency. Partial transparency of urine occurs in the presence of its cellular
elements and mucus. The urine becomes turbid due to the presence of bacteria in it and a
large number of salts, troubled - in the presence of fat droplets.

Change the color of urine. Urine color changes in many pathological conditions, taking
certain medicines, as well as in healthy children after eating some food.

Pale, colorless urine may be due to the strong dilution (low relative density) after taking
the diuretic, infusion therapy, diabetes, chronic renal failure.

Dark yellow urine indicates an increased concentration of bile pigments in oliguria

caused by extrarenal fluid loss (vomiting, diarrhea), fever, receiving ascorbic acid.

Red color of urine is at eritrotsiturii, hemoglobinuria, mioglo-binurii, purpurinuria,

uraturia with glomerulonephritis, heart attack, trauma, kidney, nephrolithiasis, after eating
beets, cherries, blackberries, after receiving amidopirina, phenolphthalein.

The color of a meat slops "appears when there are changes of erythrocytes in
glomerulonephritis.

Dark brown urine makes the presence of urobilinogen hemolytic anemia.

The orange color typical uraturia (including the background of uric acid first heart
attack in newborns), while taking rifampicin, furadonina, Furagin.

The green color of urine can be caused bilirubinemia with obstructive jaundice.
 Greenish-brown (color of beer) the color of urine is in bilirubinemia and uro-
bilinogenurii caused by parenchymatous jaundice after eating rhubarb.

The smell of urine. Urine smell gets acetone at ketonuria, faeces, with infections caused by
Escherichia coli, stinking - the presence of fistula between the urinary ways and purulent
cavities and intestines. Various pathological urine odors noted in inborn errors of amino
acid exchange.

Changing the reaction of urine. Acid reaction of urine can occur in healthy children after
handling meat diet. Acid reaction is characteristic of glomerulonephritis, diabetic coma,
and at loss of urate, uric acid. The urine becomes alkaline when vegetable diet, the use of
alkaline mineral water, as a result of vomiting due to loss of chloride ions, as well as in
inflammatory diseases of the urinary tract, hypokalemia, phosphaturia, resorption of
edema, bacterial fermentation in the gut.

Changing the relative density of urine

Fluctuations of the relative density below 1,010 indicates a violation of the concentration
of renal function, a condition called gipostenu-Ria. The presence of a constant relative
density of urine, the corresponding density of the primary urine (1,008-1,010), called
izostenuriey.;

Reducing the relative density of urine occurs at a dilution of the urine I or violation of its
concentration, which is chronic glomeruli-1 jade with severe tubulointerstitial tissue inter |
stitsialnom nephritis, congenital and hereditary kidney diseases, | chronic pyelonephritis in
the stage of interstitial sclerosis.

Increasing the relative density of urine - baruria (specific gravity above 1.030) - observed
in the presence of her sugar, protein, salt, i Glycosuria. It may occur when there is
excessive consumption of sugar, infusion -

cient treatment of glucose, diabetes mellitus. In the absence of these factors, glucosuria
indicates a violation of glucose reabsorption in the proximal nephron (tubulopatii,
interstitial nephritis),

Ketonuria. Characteristic for atsetonemicheskoy vomiting, diabetes.

Urobilinogenuriya and urobilinuria. Watching with hemolysis, liver damage,

constipation, enterocolitis, intestinal obstruction.

1
Epithelial cells. Epithelial cells in large amounts appear in urine in various pathological
conditions: a flat epithelium (top layer of the epithelium of the urinary bladder) - acute and
chronic cystitis; cylindrical or cubic epithelium (epithelium of urinary tubules, pelvis,
ureter) - in inflammatory diseases, dis-metabolic nephropathy.

Crystalluria. The precipitate of uric acid and its salts in children with mo-chekislym
diathesis, with a number of diseases of the kidneys, leading to a violation of Education
tubular epithelium of ammonia. Tripelfosfaty and amorphous phosphates found in the
urine of microbial and inflammatory diseases of the kidneys and urinary tract, as well as
primary and secondary tubulopatiyah against giperfosfaturii and violations of acido-and
ammoniogeneza. Oxalate is found in urine at extrarenal fluid losses, some tubulopa tayah-
and-under oksadshe (hereditary disease characterized by a violation of metabolic
precursors of oxalic acid).

Hematuria (detection in morning urine more than 2 red blood cells in the field of
view). There are macro-and microhematuria.

In gross hematuria the urine becomes reddish or brownish hue, which may indicate the
presence in it of free hemoglobin or damaged red blood cells. Isolation of unmodified blood
is characteristic of urological diseases.

In microhematuria red blood cells found in urine sediment microscopy (visually urine is
not changed). There are three degrees microhematuria: small - up to 10-15 in the field of
view, moderate - 20-50 in the field of view; significant - 50-100 red blood cells in the field
of view and more. Hematuria may be extrarenal origin and is due to a breach of coagulation
and thrombosis. In early childhood hematuria may be a sign of infectious diseases (VUI,
sepsis), in likistoza kidney, Wilms tumor, thrombosis of the renal arteries or veins,
obstructive nephropathy, toxic nephropathy, and metabolic , a syndrome of disseminated
intravascular coagulation (DIC) or gemoliti-to-uremic syndrome, as well as the first sign of
hereditary nephritis, certain forms of renal dysplasia in children of preschool and school-
age hematuria varying degrees of severity observed with lesions of the glomeruli of the
kidneys (glomerulonephritis, IgA-nephropathy, hereditary nephritis, lupus nephritis,
interstitial nephritis, etc.).

Ekstraglomerulyarnaya hematuria case with vascular anomalies of the kidneys and their
defeat, the stone pelvis, trauma, cystic disease. In addition, hematuria observed with
lesions of the urinary tract: ureteral stones, lesions of the urinary bladder (after
catheterization, with hemorrhagic cystitis, tuberculosis, after introduction of
cyclophosphamide), urethra (trauma, urethritis).

Leykotsituriya (increased content of leukocytes in urine above normal). Neutrophilic type

urotsitogrammy urine mark in the microbial and inflammatory diseases of the kidneys and
urinary tract (pyelonephritis, cystitis, urethritis, tuberculosis and other infections), as well
as external genital
bodies. Mononuclear and lymphocytic types urotsitogrammy characteristic of
tubulointerstitial injury in kidney tissue glomerulonef Rita and interstitial and lupus
nephritis.

Cylindruria. Cylindruria associated with the deposition of protein in the lumen of the
tubules. The cylinders in the urine occur during various physiological and pathological
conditions: hyaline - during physical stress, fever, orthostatic proteinuria, nephrotic
syndrome and other kidney diseases; grainy - in severe degenerative lesions of the tubules;
waxy - when the lesions of the epithelium of tubules nephrotic syndrome, epithelial - at
degenerative changes of tubules in glomerulonephritis, nephrotic syndrome, erythrocytic -
with hematuria of renal origin; leukocyte - with leykotsiturii renal genesis.

Proteinuria (urinary excretion over 100 mg of protein per day). Prerenal-Naya

proteinuria (by the mechanism of "overflow") may be due to enhanced dissolution of
protein in tissues or hemolysis, renal proteinuria is due to dysfunction of glomeruli (more
pronounced) and / or tubules (less pronounced); postrenalnaya proteinuria is usually
negligible and is associated with pathology urinary system (ureter, bladder, urethra), or
genital organs.

Increased glomerular permeability to plasma proteins occurs when damage to the basal
membranes (acute and chronic glomerulonephritis), podotsitarnoy failure (nephritis with
minimal changes). Increased urine specific content of low molecular weight proteins (p 2-
microglobulin, lysozyme), which are easily filtered and reabsorbed apply at the epithelium of
proximal tubules showed lesions of tubules (Fanconi's anemia, hereditary tubular
disorders, effect of nephrotoxic drugs, interstitial nephritis).

Mixed proteinuria characteristic of hereditary nephritis, on-the constructive uropathy,

amyloidosis.

Proteinuria in young children often occurs when fluid loss (dehydration proteinuria),
hypothermia, receiving abundant protein-rich food (alimentary proteinuria), after
palpation of the kidney (proteinuria by palpation), physical fatigue (march proteinuria),
fear (emotional proteinuria). Orthostatic proteinuria may occur more frequently in
children with prolonged upright child.

Urination disorders

Polyuria (increased daily urine output of more than 2 times higher than normal in older
children more than 1500 ml / m 2 per day) may be due to the massive water load, the use of
osmotic diuretics and saluretics converging edema, severely impaired renal function [CRF
or acute renal failure (BSS) in polyuria-parametric phase], diabetes insipidus.

Oliguria and anuria

 Oliguria - reduction of daily urine output to 1/3-1/4 age norm, can be caused by
extrarenal causes (restricted fluid intake, sweating, diarrhea profuse, uncontrollable
vomiting, and an increasing cardiac edema) and renal dysfunction in patients with
glomerulonephritis, pyelonephritis, uremia. Physiological oliguria observed in newborns in
the first 2-3 days of life.

Anuria - a decrease urine output less than 6-7% of the norm or a complete cessation of
urination. Secretory anuria caused a pronounced violation of glomerular filtration and may
be in shock, acute blood loss, uremia. Excretory anuria caused by a violation of separation
of urine from the urethra or bladder function decline, while preserving renal function, is
called ischuria. Ischuria - urinary retention caused by violation of its allocation, which is
characterized by an increase in the size of the bladder. Ischuria may be total or partial. Full
ischuria may occur acutely with full traumatic rupture or obturation stone urethra,
paraphimosis or stored for a long time with marked atony of the bladder.

Partial delay (incomplete emptying, the presence of residual urine) urine observed in the
presence of obstacles at the level of the bladder neck or urethra (fibrosis of the neck, valves
and stricture of the urethra, stones and tumors of the bladder, ureterocele, etc.). For
incomplete chronic urinary retention is characterized by dysuria: discontinuous stream of
urine, the delay of urination, the implementation of it in 2 stages that observed when a
diverticulum of the urinary bladder, ureterogidronefroze, vesicoureteral reflux.

Nocturia

Nocturia (nocturnal urine output on the prevalence day) constitutes a violation of the
kidneys. The tendency to nocturia is typical for various diseases of the kidneys, and
nocturia - for CRF.

Nephrotic syndrome

Nephrotic syndrome - a syndrome that includes proteinuria expressed (more than 3 g / l),
hypoproteinemia, hypoalbuminemia and disproportionation teinemiyu, expression and
dissemination of edema (peripheral, cavernous, anasarca), hyperlipidemia and lipiduriyu.

Primary nephrotic syndrome may be congenital, but also be a manifestation of primary

glomerulonephritis. Secondary nephrotic syndrome is observed in hereditary diseases,
rheumatic diseases, acute and chronic infectious diseases, protozoal infections, worm
infestations, endocrine diseases, tumors, amyloid-se, renal vein thrombosis, etc.
HEMOGLOBIN DISORDERS

Dizurichesky syndrome

Dizurichesky syndrome - Deficit Disorder act of urination. decrease in urination in

children with giporeflektornym bladder, with significant loss of fluid due to heavy
sweating, uncontrollable vomiting, diarrhea, with an increase in edema due to fluid
retention in the body, reducing the daily urine output (acute and chronic
glomerulonephritis , uremia).

Thamuria - increased frequency of urination, may be in healthy children during cooling

and bathing in salt water. Thamuria in combination with pain when urinating - a
characteristic feature of acute and chronic cystitis; thamuria more pronounced during the
day, with the increasing movements characteristic of the stones in the urinary bladder;
painless pollack-Uriah observed when giperreflektornom bladder. In addition, thamuria
may occur when pyelonephritis, urethritis, prostatitis, reflex action of the bowel (anal
fissure, worms), etc.

Urinary incontinence (urine released without impulse, regardless of the act of urination)
may be true or false. Causes of false incontinence often are the mouths of ureteral ectopia
in the urethra or vagina, schistocystis, vesico-rectal fistula and uretrorektalnye. True
incontinence characteristic for spinal cord injuries, spinal cord hernias, chronic cystitis,
neurogenic bladder dysfunction (giperreflektorny type).

Enuresis (bed-wetting) is most often develops in the pathology of the nervous system, at
least against the background of neurogenic bladder dysfunction, with violations of the
psyche, as well as the pathology of the lower urinary tract.

Neuderzhanie incontinence (inability to hold urine in the appearance of uriesthesia)

appears with acute cystitis, or diverticulum of the bladder stone.

Strangury (pain and cramps during urination) is characteristic of inflammation of the

bladder or urethra. For cystitis pain and stinging usually at the end of urination, and at the
urethra - during urination and persist for some time afterwards.

Pain syndrome

Pain syndrome in kidney diseases may be due to three main reasons: stretching the capsule
of the kidneys, inflammatory edema of the mucosa and / or stretching of the renal pelvis,
spasm of urinary excretory tract.

Tension arises in the kidney capsule of parenchymal kidney disease (glomerulonephritis,

amyloidosis, etc.) and in patients with congestive hyperemia in heart failure. Pain in this
case usually neintensivnye, obtuse, persistent. At the same time, the infarct kidney pain can
occur acutely and be very pronounced.

Any damage to pelvis (pyelonephritis) pain can be intense, growing.

 Acute attacks of very intense pain in the back or in the course of the ureter (renal colic)
are characteristic of urolithiasis. Pain during urination in the lumbar region and one of the
halves

abdomen appear with vesicoureteral reflux. pain in the bladder due to its pathology and
occur in cystitis, the presence of stones, urinary retention. pain in the urethra can be
attributed to its inflammation.

Edema

Edema - a frequent symptom in various diseases of the kidneys. The development of edema
may be due to reduced oncotic pressure of plasma while reducing the concentration of
proteins, primarily albumin, in blood, increased capillary permeability by increasing the
activity of hyaluronidase, the activation of the renin-angiotensin-aldosterone system,
which determines an increase of reabsorption of sodium and water reduction kluboch-
sound filter.

Edema observed in acute and chronic glomerulonephritis, amilo-idose, uremia, poisoning

by heavy metal salts. Pastoznost century can be seen in pyelonephritis.

Hypertension

Arterial hypertension in renal disease in children is developing quite often. Any damage to
the parenchyma of the kidneys or narrowing of blood vessels is disturbed circulation in the
kidneys, which leads to activation of the renin-angio-Tenzing-aldosterone system. The
result is increased total peripheral vascular resistance, there is a delay of sodium ions and
water, resulting in an increase in cardiac output and BCC.

Parenchymal renal hypertension occurs in diffuse renal parenchymal lesions: acute and
chronic glomerulonephritis, interstitial nephritis, congenital anomalies of the kidneys,
amyloidosis, kidney tumor, trauma, kidney, etc.

Vasorenal hypertension cause renal artery stenosis, the presence of multiple renal
arteries, abnormalities of renal vein thrombosis or aneurysm of the renal artery or vein,
aortroarteriit or juvenile polyarteritis with lesions of the renal arteries, etc.

Renal failure

Renal failure - a condition in which decreased kidney excretion of various substances (slag)
from the body: water, ions, potassium, sodium, nitrogen containing substances - creatinine
and urea, medium-molecular toxins. Clinically, renal failure manifested symptoms of
hyperhydration, hyperkalemia, and uremia.
Underlying renal insufficiency is the interaction of three factors: the reduction of perfusion
of blood through the renal vessels, and violations of the embargo in them microcirculation,
renal replacement structures of connective tissue.

Partial transient renal failure is characterized by a significant reduction in kidney excretion

of a substance (usually water) associated with a decrease in renal blood flow or blood flow
through the breach of renal glomerulus. This condition develops when hypovolemia (great
physical stress, diarrhea, vomiting, fever), reducing the pumping function of the heart,
vasoconstriction in hypertensive crises, increased blood viscosity at paraproteinemiyah
etc.

Acute renal failure (BSS) - renal failure, caused by damage to the nephrons, clinically
characterized by oli-guriey. This condition develops when DIC on the background of sepsis
and severe infections, hemolysis, shock, burns, frostbite, immune diseases, massive blood
transfusion; thrombosis and thromboembolism in renal vascular effects of nephrotoxic
substances, violation of ureteral patency.

Chronic renal failure (CRF) - a condition caused irreversible loss of functioning nephrons
and other tissues of the kidneys, with urine output depends on the stage of the disease and
may be inadequate, excessive, in the terminal stages of developing oligo-or anuria. CRF
develops at a fast-and chronic-glomerulonef ritah, chronic pyelonephritis in the
background of the structure of the anomalies of the kidneys, jade in patients with systemic
connective tissue diseases, amilo-idose, arenalnyh states.