Urinary infection and kidney - World Class Holistic
Homeopathy Treatment
URINARY SYSTEMS – All about urine
Water is essential for survival of life. The water we
take washes and
cleans our body and comes out as urine. Water usually is lost from our body
through skin, lungs faeces and urine. Our body’s outer surface is kept clean by
bathing with water and cleaning of inner organs and tissues are done by blood
plasma by the process of osmosis or electrolyte transportation between tissues
with our water intake. This blood plasma is filtered by kidneys and liver and
kept clean and perfect. The waste product thus filtered out by the kidneys is
urine.
Drinking water and pissing (process of urination) is inevitable for every
animal or human being. There is a saying that “we can well control our bouts of
anger, but not the urine”. Everyone might have experienced the pleasure of
passing urine after controlling it for a long time. Children do pissing as an
art. A newborn has to urinate within 12 hours of the birth time or otherwise it
should be seriously investigated. Urination is so much important for our body
to maintain it clean and make it non-toxic. The digestive tract or stool habit
can go on strike (without passing stool) for days, sometimes even for a week,
but our kidneys cannot take rest even for a single day.
Urine can indicate
1. Urinary tract infection with lab analysis
2. Systemic illness with increased frequency and volume of the urine, such
as renal excretory disorders, hypertension (in initial stage, by natural
process, urination frequency and volume of urine is increased, so automatically
blood volume as well as blood pressure gets lowered), anaemia,etc.
3. Metabolic disorders with increased frequency and volume of the urine
with glucose (diabetes), increased elimination of fructose (fructosuria),
uricosuria (gout), etc.
4. Pregnancy in women. It can also show adulteration in foods (food
colours, presence of toxic substances, etc.), chemicals in water, etc. when
analysed in a lab
5. It can also show the culprit or cheat who takes steroids in sports.
Likewise, it can also help to identify persons who have ingested alcohol or
drugs
Urine often cautions one about a disease in the early stages itself. If we
do not take care, the disease will get rooted and expand leading to damage of
the inner organs. Nowadays, everyone hears about old people or devotees or
leaders or their followers or diseased people drinking their own urine to stay
healthy or cure their problems. Is it needed for cleaning the bowels, as said
by urine therapists? Does urine contain active ingredients or has medicinal
values? What is urine? How it is formed? Why does it get eliminated? Does
disease get reflected in urine? What are all the diseases or conditions that
get reflected in urine? What is to be noted during urination? Someone complains
about yellowish urine and someone else about hot urine. Does this denote body
heat or is there any inference from it? How to test it? Why is urine analysed
in a lab? We shall analyse these questions one by one.
What is urine? Urine is a body’s eliminating fluid which is supposed to
be a waste product. It usually contains waste or excess materials from our
body, toxic substances, etc. Its main constituent is water.
Normal composition of urine is water – 95 per cent, other major and common
constituents are sodium – 0.4 per cent, ammonia – 0.05 per cent, phosphates –
0.6 per cent, urea – 2 percent, sulfate – 0.2 per cent and creatine,
urobilinogen, casts, etc. in minute quantities. Normally, soluble substances
are excreted in the urine.
How it is formed?
Urine is produced by the kidneys as a process of cleaning the blood and
excreting the unwanted soluble waste products from the body. Millions of
nephrons in the kidney filter out the waste products, toxins, excess water and
mineral salts from the bloodstream. Kidney, the leader of water balance
mechanism, eliminates nitrogenous wastes in a non-toxic concentrated form. To
maintain fluid balance, it filters, cleans and purifies about 150-180 litres of
blood and recycles it daily. The urine formed in the kidney is drained by
ureter into the bladder for storage. The urethra brings out the urine from the
bladder, when time and place permit. Urination is normally controlled by a
reflex phenomenon with urinary sphincters.
Since kidneys work as an eliminator and absorber with their permeability,
they can also control the blood volume by adjusting urine volume to control
blood pressure naturally. When there is dehydration, it reabsorbs the water
from distal tubules and balances the blood volume. In case of hypertension or
excess fluid intake, it eliminates the water and reduces blood volume and blood
pressure. So, till the urine gets into the bladder from the kidney, it has
control over urine in every aspect. The kidneys maintain blood acidity by
excreting excessive alkaline salts for controlling infection in the blood. The
action of the kidney is mainly controlled by endocrinal glands.
Why does it get eliminated?
Urine is eliminated because it is considered a waste product or an excess
product. So, nature cares for its elimination, to avoid overdose or toxicity
and compels the kidney to do the elimination process i.e. elimination of urine.
In order to maintain blood acidity, excess alkaline salts are filtered in the
kidney. The filtered product should be excreted anyway, so with the vehicle of
water medium these salts are excreted in the urine.
Is it needed for cleaning the bowels, as said by urine therapists?
No, it is not necessary. The water we take is enough for the business in the
bowels.
Does urine contain active ingredients or has any medicinal value?
No. Nothing has been proved like that till now. Since urine is decided as an
unnecessary waste product by nature or the body, it gets eliminated from the
body by or as natural process, so we do not need to recycle it for any purpose.
People who follow urine therapy mainly claim by quoting that the amniotic
fluid that surrounds babies in the womb is supposed to be primarily the urine
of the embryo which has quick healing effects on abrasions or bruises or cuts
or any lesion, like sea water.
Till now, with active research, no medicinal value is evaluated as such.
Do diseases get reflected in urine?
Yes, most of the diseases in the initial or final period reflect their nature
in colour, volume, sp gravity and contents of the urine. Most of the diseases
of the bladder or urinary tract are often faced by women than men since the
male urethra is 6-8 inches long whereas the female urethra is only 1½ inches
long. So any infection can easily enter into the bladder and ascend to the
kidney to disturb the urine and its constituents. Also the urethra of women is
very close to the vagina, so any infection of one can spread to the other.
Diseases often reflect their occurrence or presence with the following
symptoms or problems:
·
Dark, scanty and strong smelling urine – in case of
infection (cystitis- infection of the bladder, nephritis – infection of the
kidney, urethritis – infection of the urethra, ureteritis – infection of
ureter, etc.)
·
Burning urination, difficulty in urination and painful
urination – infection and obstruction
·
Reduced volume (oliguria) – infection, obstruction, renal
stones, kidney failure, etc.
·
Increased volume of urine (polyuria) – hypertension,
diabetes, nephrotic syndrome, intake of beer or alcohol or drugs, endocrinal
disorders
·
Absence of urine (anuria) – obstruction or kidney failure
or stenosis
·
Sweetish smell of urine or sugar in the urine
(glycosuria) – diabetes, kidney damage due to drugs, toxins, etc.
·
Offensive urine or proteins in the urine (proteinuria) –
diabetes, kidney damage due to drugs, toxins, etc.
·
Bloody urine (haematuria) – infection or renal stones
·
Yellowish urine with bilirubin in the urine – liver
disorder – jaundice, cirrhosis, etc.
·
Semen in urine with great exhaustion (semonorrhoea) –
prostate problems
·
Backache early in the morning – infection, renal stones
(due to fullness of kidney, pelvis)
·
Urinary tract infection with Leucorrhoea in females – due
to spread of infection into the urinary tract (honeymoon cystitis occurs in
newly-married females due to overindulgence in sex)
·
Fatigue and exhaustion – Renal problems when excreting
needed constituent in urine
·
Lower abdominal pain or supra pubic pain – due to
infection or stones
What are the diseases or conditions that get reflected in urine?
Diabetes, hypertension, metabolic disorders, renal disorders, liver disorders,
jaundice, urinary tract infection, high fever, etc., can reflect their presence
in urine. Nervous disorders like paralysis, paraplegia, cerebral lesion &
cerebellar lesion can hinder bladder emptying capacity and reflect in
stagnation and infection. Conditions like increased sweat, summer,
air-conditioned room, heavy exercises can also reflect in urine in its
concentration and volume.
What is to be noted during urination?
Force, flow, frequency, control, volume, pain, colour, odour and gravels or
deposits.
Force, flow, frequency and control of urine – Always talk to a doctor and get the urine analysed, if there is any
intermittent flow, uncontrolled urine, difficulty in starting the urine stream,
spraying of urine during urination, lack of a force in stream of urination,
dribbling urination, slow thin stream of urination, etc. The common problems
affecting force and flow of the urine are urinary tract infection, urinary
obstruction, urethral stricture, phimosis, renal stone, congenital
abnormalities like narrow urethral opening (meatal stenosis), etc.
Frequency of the urine is often found when there is increased intake of
water or in diseased condition like diabetes, hypertension, etc. Small bladder
and urinary tract infection can also cause frequency of the urine due to early
fullness or irritability due to infection and a disability to hold the urine
for a long time. Here also, there won’t be any satisfaction after passing the
urine since the weak bladder cannot constrict fully to empty the urine. The
stagnated urine further irritates the bladder and produces the impulse for
urination and makes the person go to the toilet often. Urinary incontinence or
uncontrollability can be seen in nervous affections like paralysis or
paraplegia or autism or cerebral lesion or cerebellar lesion or spinal injury
causing damage to spinal nerves. To treat these types of ailments, the
complaints should be evaluated in a detailed manner to attain diagnosis and
treatment. Anxiety and tension in mind also causes frequent urination due to
increased blood circulation.
Normal volume
Normal volume of urine excreted is 800 ml – 2200 ml/24 hrs. It varies with
the intake of the water or fluids. Urine volume normally reflects the organism
hydration state. It is according to body activity or exercise, but usually ¾ th
of the ingested liquid should be excreted as urine. It is mostly regulated by
ADH (anti diuretic hormone). The increased amount of water intake will induce
increased excretion of urine (polyuria). In case of increased water intake and
increased urine elimination, the excreted urine will be very much diluted or
has low concentration of solutes. In a dehydrated state or during diarrhoea or
vomiting, the anti-diuretic hormone gets increased in circulation and increases
the permeability of the renal collecting tibule epithelium, so that maximum
amount of water is re-absorbed. Hence, urine formed in this occasion will be
scanty and very much concentrated with solutes.
The volume of urine usually increases in case of increased fluid intake,
diabetes, hypertension (BP) and decreased in case of reduced fluid intake, low
blood pressure, nephritis, fever, diarrhoea, vomiting, shock, burns, etc. The
volume of the urine mainly depends on the presence of sodium, which in turn
depends on aldosterone – a mineralocorticoid hormone secreted by the adrenal
glands. Sodium holds water in plasma itself, so only in case of odema or
hypertension doctors often advise reduced salt intake.
Colour
It is normally pale yellow or amber
or clear depending upon a person’s health, water intake and diet. Even an
uneducated man would get suspicious if there is any change in colour of the
urine. Change in colour is mainly due to bilirubin. It may also change due to
drugs, colours, dyes and chemicals used in sweets, foods, etc.
·
Yellowish urine indicates presence of bilirubin
(jaundice) or excess of vitamin-B
·
Cloudy turbid urine always denotes infection and loads of
bacteria
·
Smoky urine indicates the presence of blood cells or any
other chemicals
·
Red or brown urine indicates the presence of blood (renal
stones, infection, etc.)
·
Whitish urine indicates the presence of phosphate of lime
Frothy urine is often passed in case of
jaundice or renal damage. It indicates the presence of bile salts or albumin.
Odour
Urine mostly has the odour of
ammonia, due to the nitrogenous wastes present in the urine. Aromatic foods can
also affect the odour (large amount of asparagus intake can cause a putrid
odour during urination). Urine may smell like sweet or fruit in case of
diabetes and large amount of ketone bodies excretion. Usually, adult urine is
smellier than children’s since adults take a higher protein diet. The bacteria
present in the urine usually reduce nitrate to nitrite with the presence of
ammonia in the urine. This gives it the smell. Normally, this bacterial action
needs 4-5 hours to occur. So, morning urine or concentrated and stagnated urine
is smellier than normal, frequently passed, diluted urine.
Gravels or deposits
are minute sediment particles
present in the urine. They are noticed when the urine is much concentrated and
are seen at the bottom of the sample or found like sand in the urine. They can
be viewed easily after getting centrifuged in the lab. They are supposed to be
coagulated protein casts, cell debris, RBCs, WBCs, bacteria, pus cells, tiny
stone gravels, etc.
Somebody may often complain about yellowish urine and
some others about very hot urine. What is the inference?
Actually, yellowish urine denotes its concentration. It is always seen in
cases of scanty urine, especially after heavy exercises or long distance travel
or sunbath. Urine is scanty and concentrated due to an alternative pathway of
water elimination, i.e., through sweat, to maintain the thermostat of the body.
If sweat is more, then urine will be concentrated more due to less availability
of water to carry solutes. If water intake is increased, the concentration
automatically gets diluted and the colour will resume to normal. But if you
find yellowish urine even after plenty of water intake, it is better to rule
out jaundice.
Usually, morning urine is more concentrated than at other times since we do
not drinking water at night. So, to maintain the water balance of our body,
less water is excreted and thus the urine becomes more concentrated.
Hot urine is a reflection of the body’s internal temperature, i.e., it is
felt more during the cold weather (where the body maintains internal
temperature as warm as it can) or after violent exercises (where the body
temperature is high due to increased body metabolism).
How to test urine?
By urinalysis
What for it should be analysed in the lab?
Urine tests are simplest, painless, cheapest, non-invasive and highly
informative, which can guide treatment. In all urinalysis, normal value varies
with age, sex, time, device used, solvents or kit used, analyser, sample
collecting techniques (after fasting, before fasting, etc.), etc.
Even though urinalysis is mostly done in case of a urinary tract infection
and renal complaints, it is necessary to do in all cases of prolonged
complaints or diseases, to rule out any systemic complication. Also, it should
be made part and parcel of routine periodic health examination to analyse our
body condition.
How should urine be analysed?
For analysis, urine samples must be collected in a proper way, i.e. care must
be taken in collecting the sample in a clean, fresh, sterilised bottle or
container without any contamination. The best urine sample is midstream of
first (morning) urine.
Most of the laboratories are now doing urine test and blood test with
automated analyser which gives report in printed colour strip form. They
measure everything electronically.
Investigations
Microscopic examination – urine should always be evaluated microscopically for the presence
of casts, crystals, cells and bacteria.
Lab or chemical analysis of urine – is done for evaluating pH, specific gravity, sugar, albumin, ketone
bodies, bile salts, pigments, blood, etc.
pH – (hydrogen ion concentration which helps in
denoting acidity or alkalinity of the solution variation from 1-14 i.e. from
most acid to most alkali). Urine is usually slightly acidic i.e. below 7
(indicated by blue litmus paper turning red on getting dipped) but normal range
is between 5.5- 8.0. Occasionally, it becomes alkali (red litmus paper turns
blue) during infection where pH is raised.
pH of urine in case of child – 6.2 – 6.8
pH of urine in case of adult – 5.2- 8.0
Specific gravity of the urine changes according to the volume of the
urine and solute present in the urine. In case of reduced volume of the urine
in normal excreting solutes, the sp gravity is raised; whereas in increased
volume of urine with normal excreting solutes, it is lowered. Increased level
of protein in the urine also elevates the sp gravity.
Humans are soft-skinned persons who sweat more to produce more hypertonic
(highly concentrated) urine. Insects, spiders, reptiles, birds and other
animals excrete less hypertonic urine since they have hard body protective
surface or hair or feathers which usually protect loss of fluids from sweat.
Fish and other water animals always pass hypotonic (less density) urine. Also,
humans take a good amount of sodium salt in diet which will hold or retain
water content in the body. The distal renal tibules in humans are also designed
in such a way to reabsorb most of the water and salts to maintain our body
water balance which causes urine to be more hypertonic.
Specific gravity normally ranges from – 1.001 – 1.035
Normal sp gravity of urine in children – 1.002
Normal sp gravity of urine in adult – 1.030
Sugar or glucose in urine – Glucose is always absorbed more
rapidly than water. If there is excess glucose in the blood due to lack of
insulin (which is essential for glucose metabolism in the body) or when there
is kidney damage due to drugs or toxins, glucose can occur in urine (glycosuria).
In this case, urine test for glucose should be done in 12 hours fasting time
and also, after two hours of food intake (post prandial) to analyse it
thoroughly. The presence of sugar is now analysed by two methods, i.e., one by
old Benedict’s reagents and another by latest dipsticks. In case of Benedict’s
test, if results shows
Blue colour – Nil
Green colour – + (0.1- 0.5 g/dl)
Yellow colour – ++ (0.5- 1.0 g/dl)
Orange colour – +++ (1.0- 1.5 g/dl)
Brick red colour – ++++ (1.5- 2.0 g/dl)
Protein in urine (proteinuria)
Acceptable normal excretion range of protein in urine is below 0.15 gms/24
hours of urine. This occurs usually due to day-to-day activities or exercises
where protein metabolism is used for energy. Proteins occur in urine in
diseases like kidney disorders (nephrotic syndrome, renal failure,
pyelonephritis, etc.) heart failure, gout, malignant hypertension, toxicity of
high fever, drugs, eclampsia (convulsive disease due to high BP and proteinuria
in pregnant women), etc. They usually appear as casts in urine, which can be
confirmed by their coagulation or white precipitation while heating.
Albumin
Normal range of albumin in urine is <3.5mg/mmol. Test for
Microalbuminuria (increased elimination of albumin) is most important test to
be done in diabetic patients to rule out kidney involvement or damage. Since
albumin level varies with day-to-day activities and exercises, it is better to
test after overnight rest. It is often traced in cases of heart failure, renal
failure, hypertension, urinary tract infection, etc.
Urea
is the end product of protein metabolism. A high protein diet will increase
urea level (normal 20-40 mg /100ml) in blood and urine. It will be abnormally
high in cases of kidney disorders (where there is defect in filtration and
elimination) and diabetes (due to use of protein metabolism for energy since
glucose metabolism is impaired). Normal acceptable range of urea in urine is
180-600mmol/24 hours.
Ketone bodies (Acetone)
normal level in urine is
<500mg/24 hours – starvation and uncontrolled diabetes can elevate the
levels.
Bile salts and bile pigments
give yellow colour to urine when they occur during jaundice
Urobilinogen
is excreted in increased amount in
case of liver disorders.
Other normal levels
Sodium – 100 -200mmol / 24 hours
Potassium – 25 – 100mmol / 24 hours
Calcium level – 0 – 300 mg / 24 hours
Phosphates – 15 -50mmol / 24 hours
Urate 1.2 -3.0mmol / 24 hours
Copper – <.6micromol / 24 hours
Pus cell and bacteria
should be absent in urine. Their presence always indicates infection
(pyelonephritis, urethratitis, uretitis, cystitis, etc.). If there are pus
cells and bacteria, culture must be done to rule out infection. Pus cells can
be easily identified after centrifuge and sedimentation.
Urine culture
Normally, kidney-filtered or
bladder-stored urine is sterile. The small number of bacteria present in the
urine while passed is due to contamination of bacterial flora in the urethra.
If the result denotes more than 10,000 colonies of bacteria, then it is said to
be confirmed bacterial infection or otherwise it may be due to urethral flora
contamination. The common bacteria which infect are Coliforms, Enterococci,
Gram negative rods, etc.
Bacteria will not sediment by centrifuge, so to identify it, culture or
growth of bacteria in a medium is usually followed which can easily show the
type of bacterial infection. Nowadays culture tests are done with sensitivity
tests, so that the correct drug can be administered in the initial period
itself.
Casts are coagulated proteins seen as sediments in urine,
so proteinuria is the precursor of cast formation. The blood cells (RBCs & WBCs)
and epithelial cells can get lodged to this and form erythrocyte casts,
leucocyte casts and epithelial casts. In normal conditions, casts will not be
seen in urine.
Hyaline casts – are protein casts which occurs usually after violent
exercises and also in case of chronic kidney failure
Leucocytes casts occur after urinary tract infection
Erythrocyte casts occur in hypertension, anaemia, renal stones, urinary
tract infection etc.
Epithelial casts show inflammation and degeneration of kidney
Crystal formation occurs in the urine when it gets supersaturated
with the solutes. It can produce uroliathiasis: for example – stone formation
from increased excretion of uric acid which may sediment and form crystals or
stones. Likewise are the cystines and oxalates.
Round, brick red/orange sediment in the urine of children indicates
Xanthine.
Pink or yellow colour crystals – cystines
Smooth and chalky – phosphates
Dark brown – oxalates
Red urine
The high intake of beetroot usually
resemble blood in the urine; another factor which can mimic bloody urine is
dyes and chemicals used in sweets. In diseased conditions, bloody urine
(Haematuria) may occur due to infection or stones in kidney or bladder or
ureter or urethra or due to infection of the prostate. Everyone should be ever
careful if blood cells are present during urination since it indicates that the
condition is serious. Most of the time, it is passed as microscopic haematuria
(i.e. blood in the urine may not be visualised normally). But sometimes, in
case of massive bleeding, urine appears as bloody or pinkish or smoky or deep
brown, alarming the person. Even though we might pass 1-3 RBCs (red blood
cells), elevated levels will usually indicate internal diseases or
complications. The RBCs occur in the urine in abnormal conditions like kidney
stones, cancer of the kidney or bladder or prostate, heavy urinary tract
infection, sickle cell anaemia, etc.
Gravindex test for pregnancy
following a missed period, even within a week or so, pregnancy can be confirmed
by detecting the presence of HCG (human chorionic gonadotrophin) in the urine.
This lab test is now simplified by colour card test where everyone can use to
test urine for pregnancy at home itself.
Even though urinalysis indicates a problem, finally to evaluate and analyse
the effects and complication of the disease imaging studies like ultrasound
scan, IVP, CT scan and MRI may be necessary to confirm and proceed to the
treatment.
for new hope
Dr. S. Chidambaranathan, BHMS, MD
(Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India
Tel: +91-452-233-8833 | +91-984-319-1011
(Mob)
Fax: +91-452-233-0196
E-mail: drcheena@yahoo.com
www.drcheena.com / www.drcheena.in
(Disclaimer
- The contents of this column are for informational purpose only. The content
is not intended to be a substitute for professional healthcare advice,
diagnosis, or treatment. Always seek the advice of healthcare professional for
any health problem or medical condition.)