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Kidney (urinary) syndromes

Clinical and diagnostic value of the main renal (urinary) syndromes and elements of urinary sediment

Syndrome name
Cause
Pathological conditions

Proteinuria

Increased permeability of glomerular capillaries. Fever, intoxication, physical exertion, hypothermia.
Slowing down of renal blood flow, increased permeability of the glomerular capillaries. Violation of hemodynamics (decrease in the amount of high-density urine), toxic and medicinal nephropathy, with prolonged constipation and severe diarrhea, prolonged insolation.
Focal renal membrane defect. Orthostatic proteinuria.
Increased permeability of the glomerular membrane. Decreased tubule reabsorption. Acute and chronic glomerulonephritis, especially with nephropathic syndrome, pyelonephritis, amyloidosis, renal tuberculosis, cancer, abscess, polycystic, echinococcosis, kidney stones.

Paraproteinuria

Filtration of abnormal low MM proteins synthesized by tumor (myeloma) cells. Myeloma, Waldenstrom's disease.

Myoglobinuria

Low molecular mass protein filtration due to muscle tissue necrosis. Myopathies, myocardial infarction, crash syndrome.

Hemoglobinuria (hemosiderinuria)

Filtration of proteins with low molecular mass during intravascular hemolysis of erythrocytes, destruction of erythrocytes by parasites. Hemolytic anemias, malaria, burns, post-transfusion reactions, poisoning, severe infectious diseases (sepsis, scarlet fever).

Hematuria

Damage to the renal filter (increased permeability of the glomerular membrane) due to destructive, inflammatory processes. Acute and chronic glomerulonephritis, amyloidosis, nephrosclerosis, kidney cancer, nephrolithiasis, renal tuberculosis, angiosclerosis.
Increased vascular permeability due to hypocoagulation. Congenital and acquired coagulopathies (hemophilia, hemorrhagic diathesis, Osler's disease, liver damage, collagenosis).
Glomerular membrane instability.
Damage to the interstitial tissue of the kidneys and epithelium of the tubules, renal intravascular coagulation.
Hemorrhage, trauma, rupture of renal vessels

Pyuria (leukocyturia):

Lymphocyturia

Infectious and inflammatory lesion.
Cystitis, urethritis, disease of the urethra.
Pyelonephritis, renal tuberculosis, cancer, abscess, cystitis, urethritis.
Chronic glomerulonephritis, lupus nephritis, late stage of chronic lymphocytic leukemia.
Neutrophils and Lymphocytes Glomerulonephritis
Eosinophils Chronic pyelonephritis of tuberculous genesis, pyelonephritis, cystitis, allergic urethritis.

Cylindruria:

Hyaline Coagulation of protein in the renal tubules. Proteinuria of any genesis in case of toxicosis, sepsis, jaundice, influenza and other infectious diseases.
Granular Granular renal tubular degeneration. Acute glomerulonephritis and nephrotic form of chronic nephritis.
Waxy Prolonged stay of hyaline and granular casts in the dilated tubules, increased urine viscosity, hemodynamic disturbances, slowing blood flow, hydration, lowering pH, the presence of bile, bile acids, mucoproteins. The types of cylinders depend on the deposition of hemoglobin, bilirubin, epithelial cells, and salts on the protein cast. Acute glomerulonephritis and nephrotic form of chronic nephritis, pyelonephritis, renal tuberculosis, cancer, nephrolithiasis, severe forms of chronic nephritis in diabetes, scarlet fever, lupus erythematosus, osteomyelitis, paraproteinemic nephropathy, lipoid nephrosis, amyloidosis, crimson bud.
Erythrocyte, hemoglobin Hemorrhage in the renal parenchyma. Embolism, kidney infarction.

Epitheliuria:

transitional epithelium It is exfoliated in inflammatory processes of the mucous membranes of the urinary tract, pelvis, bladder. Acute and chronic cystitis, pyelitis, infectious diseases, medication, urethritis, intoxication, kidney stone disease.
squamous epithelium Exfoliated. From the mucous membrane of the external genital organs of women and the outer part of the urethra of men.
Exfoliates in layers. Leukoplakia of the bladder.
renal epithelium Degenerative lesions of the renal tubules. Fatty degeneration. Nephrotic form of chronic glomerulonephritis, lipoid nephrosis, acute renal failure.

Glucosuria

A decrease in insulin concentration is accompanied by a decrease in glucose consumption in tissues and in the formation of glycogen. Acute and chronic pancreatitis, diabetes mellitus, acute renal failure, chronic glomerulonephritis with nephrotic syndrome, lipoid nephrosis.
Eating a lot of carbohydrates in food. Alimentary glucosuria.
Enhanced liver glycogenolysis. Central (nervous) glucosuria.
Hormonal glucosuria. With hyperthyroidism, acromegaly, Itsenko-Cushing's disease.
Liver dysfunction. Hepatic glucosuria.
Decrease in glomerular filtration of glucose (decrease or disappearance of glucosuria with hyperglycemia). With the development of glomerulosclerosis and kidney wrinkling.
Impaired resorption of glucose in the renal tubules in case of damage to the proximal tubules or insufficiency of transport systems. Renal (primary) glucosuria with normal blood glucose levels, secondary with chronic nephritis, nephrosis, acute renal failure.

Ketonuria (acetone, acetoacetic acid, beta-hydroxybutyric acid)

Excessive formation (increased ketogenesis) or decreased breakdown of ketone bodies (impaired ketolysis) Diabetes
Enhanced ketogenesis Carbohydrate starvation (toxicosis, prolonged gastrointestinal upset, dysentery)
Enhanced protein breakdown When taking ketogenic-rich foods, postoperative conditions
Violation of ketolysis Glycogenous disease
Increased consumption of carbohydrates Thyrotoxicosis
Loss of carbohydrates Strong renal glucosuria
Increased carbohydrate utilization and fat mobilization Acromegaly (excessive production of growth hormone), Itsenko-Cushing's disease (increased production of glucocorticoids)
Severe irritation and agitation of the central nervous system Traumatic brain injury, subarachnoid hemorrhage

Indicanuria

With increased protein breakdown, intense decay of protein substances in the intestine Tumor, empyema, bronchiectasis, abscess, bowel stenosis, tuberculous peritonitis, typhus, constipation, dyspepsia, uremia.

Nitrituria

Conversion of nitrates in urine by bacteria to nitrites. Nitrites do not form gonococci, streptococci, tubercle bacillus. Bacteriuria, acute yellow atrophy of the liver

Lipiduria (leucine, tyrosine, cholesterol)

Fatty degeneration of epithelial cells Nephrotic syndrome of various origins, lipoid nephrosis

Mucus (in the form of cylindroids)

Excessive production of mucoprotein by cells of the renal tubules of the urinary tract For inflammatory processes in the renal tubules and urinary tract

Bilirubinuria

Violation in the hepatocyte of the process of conjugation and excretion of bilirubin into bile. Parenchymal hepatitis (infectious, toxic-allergic, liver cirrhosis, liver poisoning, cytostatic therapy). Medicinal jaundice, Dubin-Johnson disease, Rotor disease
Interhepatal delay in bile outflow Cholelithiasis, tumor

Urobilinuria

Loss of the ability of the affected hepatocyte to break down urobilinogens Hepatitis of various origins

Porphyrinuria

Hereditary disorders of the synthesis of porphyrins in the liver Porphyrias: acute intermittent, protocoproporphyria, urocoproporphyria.
In erythroblasts of the bone marrow Erythropoietic proto- and coproporphyria, Gunther's disease
Symptomatic disorders of porphyrin synthesis in various pathologies Poisoning, hepatitis, cirrhosis, alcoholism, neoplasms, radiation, cytostatic therapy, myoglobinuria, hemolysis