Urinary infection and kidney by Dr S. Chidambaranathan B.H.M.S, M.D Homeopathy Doctor Madurai (Treatment avail for all people around the world)
1. Urinary tract infection with lab analysis
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.
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.
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.
- 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
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.
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.
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
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.
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.
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.
Microscopic examination – urine should always be evaluated microscopically for the presence of casts, crystals, cells and bacteria.
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.
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
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.
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
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.
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.
Pink or yellow colour crystals – cystines
Smooth and chalky – phosphates
Dark brown – oxalates
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.
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