Cylindruria
Description:
Cylinders in urine represent the mold from protein or kleyotochny elements which is formed in a gleam of renal kanalyyoets. Existence of cylinders in urine always indicates organiyochesky damage of kidneys (nephrites, nefroza).
Distinguish sleyoduyushchy types of cylinders in urine:
- purely proteinaceous (hyaline, wax-like, fibrous);
- on a protein basis the stuck elements (granular, epithelial, leukocytic, erythrocyte);
- cylindrical educations from salts;
- pigmental;
- cylindroids;
- pseudo-cylinders.
Cylindruria symptoms:
Hyaline cylinders (Tamm-Horsfalla's mucoprotein) - single in drug can occur in the general analysis of urine of healthy people as about 100 mg of protein are normal allocated per day. They predyostavlyat themselves the turned serum protein filtered in balls and not реабсорбировавшийся in proyoksimalny tubules. Moving ahead on a tubule gleam, curled up squirrels gets a form of this gleam, i.e. cylindrical. Coagulation is promoted by a high kontsenyotration of protein in a gleam of canalicular liquid and an acid reyoaktion of the last. At alkali reaction they are not formed, and in urine with sharply acid reaction of urine quickly collapse and do not obyonaruzhivatsya.
The more protein of a blood plasma passes through the glomerular filter and the less it reabsorbirutsya in proksiyomalny departments of tubules, the gialinoyovy cylinders are formed more. So, at patients with a nephrotic syndrome of which the high proteinuria is characteristic the most expressed cylindruria in the form of hyaline tsiyolindr at urocheras microscopy is observed.
Granular cylinders are defined at degenerative changes of epithelial cells. Curled up in kanalyyoets of squirrels becomes covered by fragments (in the form of grains) распавшихся (died) cells of an epithelium of proximal departments of kayonalets.
Coloring of these cylinders more dark, than hyaline, and an ischerchenny surface has the granular (granulated) structure.
Wax-like cylinders, unlike hyaline and zeryonisty, well and more widely, yellowish color, consist of the gomoyogenny unstructured material having a wax appearance.
Cylindruria reasons:
Hyaline cylinders are observed at any form of a proteinuria, even not svyayozanny with damage of kidneys (a physiological proteinuria - an orthostatic proteinuria, zayostoyny, after an exercise stress, overcooling). Giayolinovy cylinders are found in urine at all zaboleyovaniye of the kidneys which are followed by a pathological proteinuria.
Wax cylinders are formed in a gleam of distal departments of tubules vsledyostvy death (dystrophies and atrophies) a canalicular epithelium of these departments. The gleam of tubules is wider here, than in proximal departments and therefore wax-like cylinders are thicker than granular.
Existence in urine of wax-like cylinders in the prognostichesyoky relation is the adverse symptom testimonial of dystrophic or atrophic izmeyoneniye of an epithelium of distal departments of tubules. Such izmeyoneniye are observed at a heavy current of an acute glomerulonephritis or at далеко the come stage of chronic diseases of kidneys.
Erythrocyte cylinders testify to a renal origin of a hamaturia (at an acute glomerulonephritis, a chronic glomerulonephritis, kidney cancer, fornikalny bleeding, etc.).
Leukocytic cylinders appear at the expressed leukocyturia (pyuria) at patients with acute pyelonephritis (especially gnoyyony).
Epithelial cylinders in the absence of pathology почек in urine are not found. Emergence of epithelial cylinders testifies to heavy degenerative izmeyoneniye of the tubular device of kidneys. Meet at nefroyoza and severe defeats (corrosive sublimate, etc.).
Fibrinny cylinders are characteristic of hemorrhagic fever with a renal syndrome and appear usually on a disease piyoka, in process of recovery the quantity them uveliyochivatsya.
Pigmental cylinders — at different types of a haemoglobinuria (incompatible blood transfusion, influence of toksiyochesky substances) are found the cylinders of brown coloring consisting of blood pigments.
Cylindroids are the threads of slime rounded since one end and extended from another. They quite often meet in urine at the end of nephrotic process.
Pseudo-cylinders are formed of slime, have similarity to giayolinovy cylinders. Can be formed of a deposit of urate salts: they red color reminding pigmental blood cylinders.
Treatment of the Cylindruria:
Treatment of a basic disease against the background of which there was a cylindruria is carried out.
