Sample in the winter

Reference urine values ​​in the Zimnitsky study:

■ daily diuresis is 0.8-2 l or 65-80% of the drunk fluid per day;

■ significant fluctuation during a day of the amount of urine in individual portions( 40-300 ml) and its density( 1.008-1.025 g / l);

■ diuresis prevails over night( 2: 1);

■ the density of at least one portion is not lower than 1,020-1,022 g / l.

The test allows to study the concentration function of the kidneys. The patient remains in the normal diet, but takes into account the amount of liquid drunk. After emptying the bladder at 6 o'clock in the morning every 3 hours, urine is collected into separate jars within a day, only 8 servings. In the study of urine according to Zimnitsky, the main thing is to take into account density fluctuations in individual portions of urine. If it remains at a low level, despite interruptions in the intake of food and liquid, this indicates a disruption in the ability of the kidneys to concentrate urine. If the density remains at the usual level, or its fluctuations do not exceed 0.007 g / l after fluid intake, this indicates a loss of ability to breed by the kidneys. For various diseases in the sample according to Zimnitsky, the following deviations can be detected.

■ When comparing daily diuresis with the amount of fluid drunk, it may turn out that during the day, not 3/4( 65-80%) of the drunk liquid is discharged with the urine, but much more or, conversely, less. An increase in diuresis in comparison with the volume of the fluid consumed is observed with the convergence of edemas, a decrease in the swelling of the edemas( regardless of their cause) and due to increased sweating.

■ Daily diuresis and nocturnal diuresis are the same, or even nocturnal diuresis is more than daytime( nocturia).The increase in nocturnal diuresis caused by the intake of liquids at night can occur as an adaptive reaction when the concentration function of the kidneys is limited, as well as in case of heart failure.

■ The density of urine in all portions may be low, and its fluctuations in individual portions during the day will be less than 0.012-0.016, i.e., isostenuria may be detected.

Isostenuria is an important sign of renal failure and may be in patients with chronic glomerulonephritis, chronic pyelone

nephritis, sometimes in patients with essential hypertension. In amyloid( or amyloid-lipoid) nephroses, the concentration function of the kidneys can remain undisturbed for a long time, isostenuria appears when the amyloid-wrinkled kidney develops. Isostenuria can occur with hydronephrosis and expressed polycystosis. This is an earlier sign of kidney failure, rather than an increase in creatinine and urea blood, it is possible with their normal content in the blood. It should be remembered that the low density of urine and its small fluctuations during the day can depend on extrarenal factors. So, in the presence of edema, density fluctuations can be reduced. The density of urine in these cases( in the absence of renal failure) is high;hypostenuria is observed only during the period of convergence of edemas( in particular, when using diuretics).With prolonged compliance with protein-free and salt-free diets, the density of urine can also remain low throughout the day.

Low density of urine with small fluctuations( 1,000-1,001) with rare up to 1,003-1,004 is observed only in diabetes insipidus, it does not occur in any other diseases, including kidney diseases that are deficient in their concentration function. Nicturia can sometimes be due to prostatic hypertrophy of various etiologies.

Increasing the density of urine in all portions causes hypovolemic conditions, urine acid diathesis.