A pregnant woman has to regularly undergo various tests: doctors must monitor the process of bearing the baby. And a 24-hour urine test for protein is one of the most significant studies. The level of protein in urine is important because it demonstrates the level of health of a woman’s urinary system.
This study clearly shows whether there are any infections or inflammations in the genitourinary area, in the kidneys, so not a single pregnant woman can do without taking this test. In this article, we will look at how to take a daily urine test for protein during an existing pregnancy, find out what indicators should be the norm, and how to properly prepare biomaterial for research.
What urine tests are taken during pregnancy?
General (clinical) urine analysis is the main type of study, which is of paramount importance. It is taken to determine the physical and chemical properties of the liquid - transparency, color, smell, density, volume, etc. Equally important is the assessment of such indicators as protein, sugar, acetone, salts, bile pigments, bacteria and fungi, as well as certain cells (erythrocytes, leukocytes, epithelium) and their particles.
All pregnant women, without exception, undergo a general clinical urine test. If necessary, for a more in-depth study, the following is prescribed:
1. Urinalysis according to Nechiporenko - designed to study the formed elements per 1 ml of urine and clarify the level of leukocytes, as well as erythrocytes. The middle stream of urine is examined.
2. Urine analysis according to Zimnitsky - allows you to determine the work of the kidneys by concentrating and the ability of organs to secrete specific salts. According to Zimnitsky, urine is given throughout the day, every three hours, including at night.
Types of analysis
Mandatory urine tests taken during pregnancy can be of two types:
For sterility
Becomes relevant in case of a poor result of the general analysis. Its delivery is necessary to confirm the presence or absence of leukocyte cells and pathogenic microorganisms in the sample material, which are evidence of a progressive process of inflammation.
- General urine analysis in pregnant women: interpretation and norm in the table
Morning urine should also be collected for analysis. Before collection, genital hygiene is performed with warm water. To avoid unreliable information content of subsequent results, no means are used.
Bacteriological culture
Such an analysis is carried out by a doctor in order to identify the types of bacteria that carry out their vital functions in the mucous tissues of a pregnant woman.
- Urine analysis for BAC culture during pregnancy
Urine, collected in accordance with all the rules, is transported within a short period of time to the laboratory, where the sample is applied to sugar broth or agar. Subsequently, the vital activity of specific types of bacteria is monitored, as well as how intensively their reproduction occurs. This study is performed on average over a 5-day period.
Interpretation of urine analysis during pregnancy
As a rule, the indicators in any urine tests between pregnant women and the average person are practically the same. A slight increase in the level of leukocytes is equated to the norm (if there are no deviations in other numbers), the presence of protein indicates gestosis and serious impairment of kidney function, diabetes mellitus is indicated by the sugar content, and inflammation in the urinary tract is indicated by a significant increase in leukocytes in the urine. However, let's look at all aspects in more detail.
Importance of Analysis
It is known that during gestation the female body undergoes serious metamorphoses. Thus, there may be a disruption in the functioning of some internal systems, which, in particular, may affect the activity of the kidneys and bladder. In the case of squeezing or clamping of a certain area of the urinary system, difficulty in urinary outflow in a natural mode is observed. As a result, pathological processes begin, as a result of which renal enlargement can occur.
If clamped for a long time, there is a high risk of pathogenic microorganisms entering the kidneys. Thus, the process of inflammation, complicated by pregnancy, begins in the urinary system. For this reason, it is very important to take a urine test during pregnancy. If the laboratory performs the tests correctly, it becomes possible to detect inflammatory changes at the initial stages. Moreover, such diagnostics during gestation prevents the development of gestosis, which is a late toxicosis.
Leukocytes in urine during pregnancy
Normally, the level of leukocytes in the urine of pregnant women fluctuates:
— general analysis — within 6-8 in the field of view; - according to Nechiporenko - no more than 2,000 per 1 ml
Exceeding the listed norm indicates an inflammatory focus in the urinary system (bladder, kidneys, excretory tract). Since leukocytes perform an important function in destroying foreign agents, it is natural that there will be a lot of them in the painful area. A slight excess of the norm - up to 10-20 in the field of view, is most likely a consequence of low-grade inflammation or insufficiently thorough treatment (washing) of the external genitalia before taking tests.
Leukocyturia with an excess of white blood cells by 40 or more during pregnancy is a symptom of kidney disease that requires immediate treatment to avoid the development of serious complications in the mother and child.
Urine collection methods
Knowledge of how to properly take the test can be supplemented by methods of carrying out the procedure. To avoid the inclusion of unwanted microorganisms in the analysis, you can use:
Vatka
Here you will need 3 small pieces of material. After finishing washing, the labia are parted slightly. At the same time, they are treated with cotton wool. The remaining third piece is used to cover the vagina, after which urine is collected.
Tampon
Many people may not like the procedure of collecting urine using sterile cotton wool and may not find it hygienic enough. In this case, a procedure using a tampon is suitable as an alternative option. In this case, the urine collection technique is standard and involves inserting a tampon inside. Thus, there should be a second portion of urine in a sterile container. Regarding how much urine a pregnant woman needs for analysis, it is worth noting that the volume should not be less than half the container in which the test sample is collected.
Protein in urine during pregnancy
Normally, a healthy woman should not have protein in her urine. Although modern sensitive equipment can detect its tiny amount (up to 0.1 g/l), this does not play a significant role. If the protein is still present, and in high titers, then the pregnant woman has developed one of the dangerous conditions: pyelonephritis, proteinuria or gestosis (late toxicosis).
Typically, with pyelonephritis, an increase in protein is accompanied by lower back pain, an excess of leukocytes and bacteria in the urine. Treatment is a must! The sooner it is started, the less likely it is to develop complications in the further course of pregnancy. Sometimes protein in the urine of expectant mothers can be a consequence of intense physical activity, anxiety and stress.
How to prepare
This study does not require special preparation. It is recommended to prepare in advance:
- special containers designed for collecting urine 8-9 pcs.;
- a notebook and pen in which you need to write down the amount of fluid you drink (then the doctor checks this information when he receives the test results);
- set an alarm clock or ask relatives to wake you up at night.
This will not be difficult for pregnant women, since many suffer from sleep disturbances. Also, do not change your usual diet.
The amount of liquid should be normal and not exceed the normal amount. Do not forget that some foods can affect the physiological parameters of urine.
To obtain reliable results, it is recommended to exclude them from the diet for several days. These include: beets, smoked, salted foods. You should also not take diuretics on the day of the test.
Bacteria in urine during pregnancy
The presence of bacteria is evidence of cystitis or kidney disease. If nothing bothers the woman, then we are talking about so-called asymptomatic bacteriuria, which, despite the absence of complaints, is a very dangerous sign. The appearance of bacteria together with an increase in leukocytes indicates a disease of an infectious nature. In order for the treatment to give the expected effect, it is necessary to culture the urine for flora, which makes it possible to determine the type of bacteria and select the optimal tactics of antibacterial treatment.
What pathologies are detected?
Most often, through a urine test, it becomes possible to identify pyelonephritis and glomerulonephritis, which make themselves felt in the middle of pregnancy. The occurrence of such diseases indicates poor functioning of the kidneys, which cannot cope with the existing load. However, even when diagnosed, such pathologies can be successfully treated, since there are various medications for them that are safe for the embryo.
In accordance with the result of a urine test, diabetes mellitus can also be detected, which will subsequently require serious adjustments in nutrition and constant monitoring of the condition of the pregnant woman.
Glucose (sugar) in urine during pregnancy
The appearance of small amounts of sugar in the urine can be observed during the second half of pregnancy, as the mother’s body deliberately increases the level of glucose in the blood to provide the baby with maximum nutrition. After blood is filtered by the kidneys, some of the glucose remains in the urine. Normally, these numbers are so small that they do not raise any suspicion. However, if the level of sugar in the urine remains consistently high, then we are most likely talking about prediabetes or diabetes mellitus. To confirm (refute) the diagnosis, you need to donate blood for sugar and undergo a glucose tolerance test.
Zimnitsky test in pregnant women
The analysis allows you to determine the density and volume of urine excreted at different times during the day.
- Each portion of urine is collected in a separate jar, and all containers are submitted for examination.
- In addition, all liquids consumed and food eaten during the 24 hours during which the material was collected are recorded.
The difference is that urine from the first trip to the toilet after sleep (at 6 am) is not used.
- The first gathering is held at 9 am.
- Then the material is collected 7 more times with an interval of three hours - i.e., at 12.00, 15.00, 18.00, 21.00, 24.00, 3.00, 6.00.
All filled containers must be tightly closed and stored in the refrigerator.
- All urine is collected within 24 hours, i.e., if one jar is not enough, you need to take as much as you need. If during the allotted period of time the required amount of urine has not accumulated, then the container is left empty.
The norms of analysis carried out according to Zimnitsky for pregnant women are as follows:
- The volume of urine is 1500-2000 ml.
- The ratio of fluid entering the body and released is 65-80%.
- During the day, 2/3 of the total volume of urine should be excreted.
- Increased urination should occur after drinking liquid.
- The density of urine in each container is less than 1.035 g/l.
- The specific gravity of urine is 1.003-1.035 g/l, in 1-2 containers it is more than 1.02 g/l.
A reduced density index of less than 1.012 can be observed for the following reasons:
- Taking diuretics.
- Chronic renal failure.
- Non-sugar form of diabetes.
- Severe heart failure.
- Long-term diet without salt and proteins.
- Pyelonephritis, nephritis.
A result exceeding 1.025 indicates the presence of sugar and protein due to:
- Diabetes mellitus.
- Toxicosis.
- Preeclampsia.
- Nephrotic syndrome.
- Glomerulonephritis.
The volume of fluid released is also assessed.
A volume of more than 2000 ml may indicate:
- Diabetes insipidus.
- Pyelonephritis.
- High fluid consumption.
- Kidney failure.
- Use of diuretics.
When the volume of urine excreted is less than 0.4 l, we are talking about:
- Insufficient water consumption.
- Hyperhidrosis.
- Pyelo-, glomerulonephritis.
- Heart failure and swelling.
Indications for prescribing a 24-hour urine test for protein
Due to the fact that changes in the qualitative and quantitative composition of urine begin earlier than the symptoms of the disease, the analysis allows timely detection of pathology. Indications for this type of research in adults and children are the presence of the following diseases:
- amyloidosis (protein metabolism disorder);
- diabetes mellitus;
- nephropathy, which manifests itself as swelling of the legs;
- cardiac ischemia;
- renal failure.
In addition, it is prescribed when the patient is taking certain medications: aminoglycosides, ACE inhibitors, thiazide diuretics and some other drugs.
Types of proteinuria
The main factor influencing the appearance of protein compounds in urine is problems in the absorption of this substance. Proteinuria is distinguished:
- Canalicular. In some diseases, protein absorption is impossible or difficult.
- Glomerular. In this case, protein molecules are not retained and are excreted along with the liquid. This phenomenon is typical for the following pathologies: pyelonephritis, kidney damage from toxins, glomerulonephritis.
- Extrarenal. There are damage to the urinary tract, characteristic of urethritis, colpitis and cystitis.
To determine the type of proteinuria, microscopic examination is used. Further, if necessary, the doctor prescribes other types of examinations, including ultrasound, magnetic resonance imaging and other hardware methods.
What should be normal
Before talking about violations, you need to know what should be normal. A daily analysis without pathology should look like this.
What can affect the performance? The most common option is improperly collected urine. It could also be a dirty container.
On forums, women often share what factors influence analysis parameters:
- serious physical activity;
- stress;
- bad feeling.
You may not believe it, but if your diet is high in protein, your urine will show high total protein. Just reconsider your diet and everything will be fine. But the daily loss of protein in the urine is called proteinuria and is also a potentially dangerous phenomenon.
