Urine analysis according to Zimnitsky: how to collect, what does it show?

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Urine analysis according to Zimnitsky: how to collect, what does it show?
Urine analysis according to Zimnitsky: how to collect, what does it show?
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Urine analysis according to Zimnitsky: what does it show?

Urinalysis according to Zimnitsky
Urinalysis according to Zimnitsky

Urine test according to Zimnitsky is an additional laboratory test that can be used to assess the functional abilities of the kidneys and suspect pathologies in time, manifested by malfunctions in the urinary system. The technique was developed by the doctor S. S. Zimnitsky at the beginning of the twentieth century - in 1924, and is still actively used in clinical practice. Its essence lies in the collection of all urine excreted by the patient per day, in separate containers marked by the hour. This allows you to draw conclusions about the quality of glomerular filtration of the kidneys "in real time", that is, to track how the organs cope with their duties throughout the day.

The indisputable advantages of the technique include its simplicity and accessibility - no sophisticated equipment is required for analysis, all the necessary instruments and reagents are at the disposal of any laboratory. Since urine collection according to Zimnitsky is carried out at regular intervals during the day, and the accumulated biomaterial has a rather large volume and takes up a lot of space, this study is usually carried out in a hospital. But you can also collect urine correctly at home - we will tell you how to do this, and we will also give the norms for the results of a urine test according to Zimnitsky, explain in an accessible language what this test shows, why it is needed, what deviations can be and what is their probable cause.

What does the Zimnitsky urinalysis show?

What does a urinalysis show according to Zimnitsky
What does a urinalysis show according to Zimnitsky

The following indicators are determined during the study:

  • Amount of liquid consumed by the patient per day - for this you need to keep a food diary, which records the time of drinking or taking liquid meals, as well as the volume of servings in milliliters;
  • Daily diuresis is the total volume of urine excreted during the control period. To calculate it, the laboratory assistant adds up the contents of all containers;
  • The ratio of fluid drunk to diuresis – normally, 65-80% of the incoming water is excreted from the body with urine, the rest goes to current needs, and also comes out with sweating;
  • Ratio of nighttime to daytime diuresis - a he althy person does not wake up during sleep in order to go to the toilet, and the volume of the morning portion of urine accumulated by the body during the night does not exceed one thirds of daily diuresis;
  • Urine production rate after taking large volumes of liquid - well-functioning kidneys quickly filter the water that has come from the digestive tract and evacuate everything superfluous with it from the body;
  • Variation in the density of urine in different portions - it should not differ too much in amplitude;
  • Urine density in the control container and its average density in all containers must comply with the established norms.

The main thing that shows the analysis of urine according to Zimnitsky is precisely its density or, in other words, specific gravity, that is, the ratio of the solid part of the solution to water. This solid part is formed by nitrogenous compounds, various organic substances, acids and s alts. Serious deviations in the density of urine from the norm in one direction or another, as well as strong fluctuations in specific gravity during the day, are unfavorable diagnostic signs and may indicate a number of serious diseases.

Indications for testing

Indications for the study
Indications for the study

Urine analysis according to Zimnitsky is prescribed for both adults and young children, and especially often for expectant mothers. During pregnancy, the fluid balance in a woman's body changes to meet the needs of the growing fetus, and her kidneys are forced to temporarily work for two. Alarming results of a general urine test, the presence of glucose, protein, an increased level of leukocytes in it, as well as edema, severe toxicosis and jumps in blood pressure - all this is a reason for conducting a urine test according to Zimnitsky in pregnant women.

As for other categories of patients, the indications for them are as follows:

  • Violation of the urination regime - frequent urge, prolonged absence of urine, its abnormally small or large volumes;
  • Pain during or after urination, pain in the lower abdomen or back;
  • Change in color, consistency or smell of urine, the presence of pathological impurities in it (foam, flakes, blood, pus);
  • Permanent thirst;
  • Hyperhidrosis (excessive sweating);
  • Systematic occurrence of edema;
  • Dizziness, weakness, headaches, fainting;
  • High or rare heartbeat, chest pain;
  • Cold extremities, clammy sweat, bouts of fear;
  • Poor results of other tests (general or biochemical blood test, urinalysis);
  • Pre-existing diagnoses - diabetes mellitus, glomerulonephritis, amyloidosis, cirrhosis of the liver, renal or heart failure, hypertension or hypotension, heavy metal poisoning, and so on - to determine the severity of the disease or control the course of treatment.

How to prepare for urine collection according to Zimnitsky?

How to prepare for the collection of urine according to Zimnitsky
How to prepare for the collection of urine according to Zimnitsky

This study does not require special preparation, diet or any special drinking regimen is also not necessary. The test should show how your kidneys work under normal conditions. It is only recommended to refrain from eating very s alty and spicy foods that provoke severe thirst. It is not worth it to somehow artificially load the body by drinking a lot of water just like that.

The main preparatory activities are the purchase of sterile medical containers for collecting and transporting urine. Their standard capacity is 200-250 ml, the minimum quantity is 8 pieces, but it is better to take 2-3 spare ones. If you do not have the opportunity to acquire such containers, it is quite possible to adapt glass jars of a similar volume (like those in which mayonnaise is sold) to collect urine for analysis according to Zimnitsky. The containers must be sterilized over steam for 2-3 minutes, and the lids should be boiled.

Prepared containers or jars should be labeled with time intervals:

  • 09:00-12:00
  • 12:00-15:00
  • 15:00-18:00
  • 18:00-21:00
  • 21:00-00:00
  • 00:00-03:00
  • 03:00-06:00
  • 06:00-09:00

How to collect urine for analysis according to Zimnitsky?

How to collect urine for analysis according to Zimnitsky
How to collect urine for analysis according to Zimnitsky

So, the container is prepared, you woke up at 6:00-7:00 o'clock - go to the toilet as usual and urinate into the toilet. Sample collection for testing will begin at 9 am. It is best to set a series of alarms on your phone or smartphone every three hours until 6 am the next day - a total of 8 calls. There is no need to take special hygiene measures, it is enough to wash with ordinary soap. But this procedure should be repeated before each regular urine collection session.

When the alarm goes off, you need to take a container with the appropriate markings and urinate there, and absolutely all the excreted urine should be in the container. If you don't feel like writing at this point, set the container aside. There will be a urge until the next alarm clock - urinate in the right container. The urge is repeated, the container is not yet full, and the time for the next collection has not come - continue to urinate in the same place. There was not enough volume of the container - take a spare and inscribe it in the same way. Seal filled containers with lids and store in the refrigerator. They will need to be delivered to the laboratory the next morning.

No need to deliberately endure until the designated time - urinate when there is a need. Keep in mind that the collection of biomaterial is carried out not only during the control hours, but also in the time intervals between them, and all the urine allocated for the next period must fall into the containers!

During the day, keep a food diary - write down the volumes of all the liquids that you drink and eat (water, tea, coffee, juices, soups, sour milk drinks, juicy fruits and raw vegetables in meaningful quantities).

To make it very clear how to collect urine for analysis according to Zimnitsky, let's look at this process using the example of a table with data from one patient:

Time Fluid Diary Urine emission Volume of urine excreted
09:00-12:00 Cup of tea (300 ml) 1
Image
Image
12:00-15:00

Soup portion (350 ml)

Coffee cup (180 ml)

1
Image
Image
15:00-18:00

Glass of juice (250 ml)

Watermelon (300g)

2
Image
Image
18:00-21:00 Cup of tea (300 ml) 1
Image
Image
21:00-00:00 Glass of yogurt (200 ml) 1
Image
Image
00:00-03:00 - 1
Image
Image
03:00-06:00 Glass of water (200 ml) 0
Image
Image
06:00-09:00 Coffee cup (180 ml) 1
Image
Image
Drunk liquid: 2260ml
Daily diuresis: 1610ml
Diuresis to fluid ratio: 71, 23%
Ratio of night to day urine output: 29, 19%

Video: urinalysis according to Nechiporenko and Zimnitsky in normal and pathological conditions:

The norm in the table and the interpretation of the results

The results of the Zimnitsky urinalysis will be ready in 1-3 working days - it depends on the internal routine of a particular laboratory. There is very little data in the final form, let's look at each indicator and find out what deviations from normal values \u200b\u200bmay indicate.

Important: the diuresis of children over 10 years of age approaches the values characteristic of an adult. You can calculate the norm for a younger child using the formula: 600 + 100 x (n - 1), where n is the age in years. For example, the diuresis of a three-year-old baby will be approximately 800 ml.

Zimnitsky urinalysis norm:

Daily diuresis 1500-2000 ml
Urine output to fluid intake 65%-80%
Ratio of night to day urine output 1/3
Urine production rate high
Urine density fluctuation 1 003-1 035 g/l
Density of urine in one container >1020 g/l
Urine average density <1035 g/l

Possible pathologies:

Name What is the violation Reasons
Hyperstenuria Urine density over 1035 g/l
  • Toxemia of pregnancy;
  • Sickle cell anemia;
  • Hemolysis after transfusion of unsuitable donated blood or other cause;
  • Diabetes;
  • Acute or chronic glomerulonephritis
Hyposthenuria Urine density below 1003 g/l
  • End-stage renal failure;
  • Exacerbation of chronic pyelonephritis;
  • Amyloidosis;
  • Hydronephrosis;
  • diabetes insipidus;
  • Leptospirosis;
  • Poisoning of the body with s alts of heavy metals
Polyuria

Daily diuresis over 2000 ml

Lower urine density

The ratio of diuresis to the volume of fluid consumed is more than 80%

  • Drinking a lot of liquid during the day;
  • Taking diuretics;
  • Diabetes and diabetes insipidus;
  • Acute renal failure at the polyuric stage;
  • The period of convergence of severe edema
Oliguria

Daily urine output below 1500 ml

Increased urine density

The ratio of diuresis to the volume of fluid consumed is less than 65%

  • Dehydration;
  • Ascites due to liver cirrhosis;
  • Massive edema due to pericarditis or exudative pleurisy;
  • Hemolysis of any etiology;
  • Poisoning with poisonous mushrooms;
  • Heart failure;
  • Acute renal failure at the oliguric stage
Anuria Daily urine output below 50 ml or absent
  • Anaphylactic, traumatic or cardiogenic shock;
  • Transfusion of unsuitable blood donations;
  • Compression of the kidneys;
  • Obstruction of the urinary ducts due to urolithiasis;
  • Acute glomerulonephritis or interstitial nephritis;
  • End-stage renal failure
Nicturia Night diuresis exceeds 1/3 of daytime or even prevails over it
  • Pregnancy;
  • Diabetes or diabetes insipidus;
  • Prostate dysplasia in men;
  • Heart or kidney failure

So, we found out how to collect urine for analysis according to Zimnitsky, what this study shows and what may be the reasons for deviations in the indicators. But we emphasize that it is better to entrust the interpretation of the test results to a doctor, since this can be done objectively only taking into account the medical history of a particular patient and the data obtained during other diagnostic measures. Take care of yourself and stay he althy!

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