LEUKOCYTURIA

From Big Medical Encyclopedia

LEUKOCYTURIA (a leukocyte[s] + grech, wetting uron) — allocation with urine of leukocytes in the quantity exceeding normal. A leukocyturia consider existence in draft in the simple analysis of urine more than 20 leukocytes under review, 4 000 000 at 24 o'clock at Kakovsky's test — Addis (see. Kakovsky — Addis a method ), 400 000 in an hour at Ambyurzhe's test, 10 in 1 mkl — on Stansfelda — to Webb, 4000 in 1 ml — across Nechiporenko. When impurity of pus in urine is so big that is defined visually, speak about a pyuria.

At healthy people leukocytes get into urine from blood through the unimpaired renal balls and tubules, and also a mucous membrane of uric ways. At an inflammation owing to a hyperpermeability and cellular infiltration premises for an excess exit of leukocytes in urine are created. On this basis of L. consider a symptom of nonspecific and specific inflammatory processes in kidneys, uric (at women) and urinogenital (at men) ways.

For establishment of a source of L. (pyurias) apply two - and trekhstakanny tests (see. Stakanny tests ). Initial L. it is inherent to an urethritis (see), L. allows to suspect of the third portion received after massage of a prostate prostatitis (see), total L. — damage of a bladder and upper parts of uric system.

L. — one of constant symptoms of pyelonephritis and tuberculosis of kidneys. To be absent L. can only at the very beginning of a disease or at impassability of uric ways on the party of defeat. Sometimes L. happens intermittent, and its identification requires a repeated research of urine. Sudden emergence of impurity of pus in urine during a serious feverish condition can result from opening in uric ways of abscess of a kidney or adjacent body.

At microscopic examination of urine reveal a large number of the leukocytes (more than 10 000 in 1 mkl netsentrifugirovanny urine) which are densely covering all field of vision and forming accumulations.

L. can serve as criterion of efficiency of the carried-out treatment. Effective antibacterial therapy leads to bystry normalization of an uric deposit. It is necessary to reckon with it at interpretation of analyses of urine at patients with" as not clear diagnosis, treated shortly before the research by antibacterial agents.

L. can be the only symptom latentno of the current pyelonephritis. Diagnostic value such L. increases if in the course of receiving urine for a research the possibility of its pollution by leukocytes is expelled from other bodies. To specification of a source of L. supravital coloring of uniform elements of urine by Shterngeymer's method — Malbina allowing to reveal the so-called cells of a purulent inflammation having according to authors of a method, a renal origin helps. Shterigeymer's cells — Malbina represent active segmentoyaderny leukocytes which under the influence of various factors, first of all gipoosmolyarny urine, changed the form and tinktorialny properties. Considering the last, A. Ya. Pytel and V. S. Ryabinsky for the purpose of fuller identification of active leukocytes suggested to create artificial hypoosmosis by addition to the studied urine of the diart. of water. Without recognizing behind Shterngeymer's cells — Malbina strict specificity, many believe that detection of these cells increases probability of recognition pyelonephritis (see).

During remission of pyelonephritis of L. can be absent. The solution of a question is helped by provocative tests about phosphate-Prednisolonum or pyrogenal after which not only the general increases L., but also allocation of active leukocytes.

L. as the component of an uric syndrome often, by data A. Ya. Yaroshevsky in 74% of cases, meets at acute glomerulonephritis (see), but in these conditions she is moderate (provided that urine has sufficient osmolarity). At hron, a glomerulonephritis of L. can prevail over an erythrocyturia.

At the same time often find active leukocytes that complicates diagnosis of a combination piyelo-and a glomerulonephritis.

Acute renal failure (see) the L is followed. in the early recovery period. Gradually L. disappears and only regarding cases passes into chronic, confirming accession of pyelonephritis. L., especially the limfotsituriya, can arise also at reaction of rejection (see. Immunity transplant ) and some diseases of a transplantirovanny kidney (see. Renal transplantation ).

Leukocyturia at children occurs practically at the same pathology, as at adults. Short-term L. it is possible in the period of acute respiratory diseases, sepsis. Quite often L. at children it is accompanied by an inflammation of a mucous membrane of external genitals (a vulvitis, a vulvovaginitis, a phymosis, etc.), a helminthic invasion.

Healthy children have an allocation of leukocytes with urine always more, than erythrocytes. At a research of a morning portion of urine at children no more than 1 — 3 leukocytes under review are defined. Hidden L. reveal at quantitative calculation of uniform elements of urine which at children of early age is the most convenient for making by Nechiporenko or Ambyurzhe's method.

Source of L. there can be any department of urinogenital system. It is necessary to distinguish abacterial and bacterial L. Poslednyaya at children it is observed at a microbic inflammation of renal tissue (pyelonephritis), a bladder (cystitis), an urethra (urethritis). 85 — 90% of the leukocytes defined in an urocheras make neutrophils. Neutrophylic L. at pyelonephritis it is connected with development of pyoinflammatory infiltrates in interstitial tissue of a kidney and destruction of tubules in a zone of an inflammation. At a glomerulonephritis, lupoid nephrite penetration of leukocytes into urine is caused by disturbance of permeability of a glomerular membrane as a result of an immune inflammation of renal fabric.

Abacterial L. at children can testify about specific (tuberculosis, leptospirosis, etc.) or a toksiko-allergic inflammation in renal fabric. At a glomerulonephritis at children abacterial L. it is observed in the first weeks of a disease and has lymphocytic character. Emergence neutrophylic L. confirms accession of microbic and inflammatory process. Patients with a hyperoxaluria, an uraturia and a cystinuria in an urocheras can have eosinophilic granulocytes that testifies to a toksiko-allergic inflammation in renal fabric.

Degree of manifestation of L. defines activity of inflammatory process (microbic, toksiko-allergic, immune) in uric ways.

Treatment pathogenetic. It it is necessary to carry out after careful comparison a wedge, symptoms of a disease with character of L. At bacterial L. use antibacterial drugs, vitamins, sanitation of the centers of an infection.



Bibliography: Achievements of nephrology, under the editorship of E. I. Chazov, page 124, M., 1970; Yezerskiy R. F. Pyelonephritis at children, page 49, L., 1977; Nechiporenko A. To 3, O technique of quantitative definition of uniform elements in urine and its value in diagnosis of chronic pyelonephritis, Urology, No. 4, page 43, 1961; Petrov with to and y B. V, etc. Renal transplantation, page 203, M. — Warsaw, 1969; Pytel A. Ya., etc. Elected heads of nephrology and urology, p.1, page 163, L., 1968; Pytel A. Ya. and Pugachev A. G. Sketches on children's urology, page 122, M., 1977; Yaroshevsky A. Ya. Clinical nephrology, page 147, L., 1971; Choro-by nerek, pod red. T. Orlowskiego, s. 105, Warszawa, 1976; L i t t le P. J. a. De Warden e r H. E. The use of prednisolone phosphate in the diagnosis of pyelonephritis in man, Lancet, v. 1, p. 1145, 1962; Nierendiagnostik, hrsg. v. H. Dutz, S. 64, Jena, 1976.

O. L. Tiktinsky; H. A. Korovina (ped.)

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