How to collect daily urine for protein during pregnancy

Daily proteinuria - the essence of the study

The study of daily proteinuria (proteinuria literally means protein in the urine) is aimed at determining the concentration of protein in the urine. Normally, it should not be present in urine, but in some cases it may be present in extremely small quantities.

Protein itself is a necessary organic compound, which is a kind of “building material” for the cells of the human body. In fact, a person himself largely consists of various protein compounds. However, its appearance in the urine indicates pathology, primarily of the kidneys.

Using this analysis, two types of protein compounds can be determined in urine:

• albumins;
• globulins.

  

  Neither albumins nor globulins should be systematically detected during urinalysis

  Read also:  General urine test during pregnancy and its interpretation

Most often, albumin is detected, which indicates diseases of the urinary system. Globulins are detected in urine very rarely, but their presence indicates autoimmune pathologies, which, however, is not always an accurate marker, since under certain conditions the presence of this organic compound is a physiological norm.

The main value of this research method is that with its help, serious diseases of the urinary system can be identified at an early stage, when they still remain asymptomatic.

The disadvantage of the analysis is that it has to be taken several times to get an accurate result. This is due to the fact that in some cases, protein may appear in the urine for physiological reasons not related to the development of pathology.

Video: what does protein in urine mean?

How to collect daily urine during pregnancy

In the process of bearing a child, a woman has to regularly take tests and undergo various diagnostic examinations. Experts can assess the health of the expectant mother and the unborn child by the amount and biochemical composition of urine excreted. It is important to find out exactly how to collect daily urine during pregnancy. Proper preparation for analysis will allow you to obtain the most accurate results.

Urine released per day contains substances that allow you to evaluate the functioning of the kidneys, urinary system, liver, heart and blood vessels. With the help of such a study, you can easily identify the inflammatory process in the body.

The daily urine intake for pregnant women in liters is 1-2 liters. The run-up is quite large. The volume of urine depends on the drinking regime, the duration of pregnancy, and the presence of concomitant pathologies. If your analysis is significantly more or less than normal, do not rush to panic. Doctors will prescribe additional research and give advice on correcting your diet and drinking regime.

Pregnant women often have to submit daily urine for laboratory analysis. There are several studies that require 24-hour urine collection:

• Study of daily diuresis. This analysis shows fluid retention in the body of the expectant mother. Allows you to determine the cause of toxicosis and severe swelling.
• Analysis for the identification of protein elements. This type of diagnosis is prescribed to patients with symptoms of nephropathy or late toxicosis.
• Study of the glucosuric profile of urine. The analysis shows the quality of carbohydrate metabolism. Prescribed in the presence of symptoms of gestational diabetes mellitus.
• Analysis according to Zimnitsky. In the laboratory, specialists study separately 24-hour, daytime, and nighttime urine.

The doctor usually explains correctly how to donate daily urine during pregnancy. Collect the discharge in a clean, sterile container. You can buy such a jar, with a volume of at least 2 liters, at any pharmacy. There is no need to send all your urine to the laboratory.

The liquid is mixed well and poured into a container with a volume of 100 - 150 ml. All urine collected per day may be needed in rare cases, only as prescribed by the gynecologist.

There are several simple rules for collecting daily urine, compliance with which will allow you to obtain the most accurate results.

• Use only clean, dry containers with tight-fitting lids.
• All urine excreted during the day should be collected in a jar.
• Urine should be stored in the refrigerator.
• After collecting the last portion of urine output, go to the hospital immediately. Tests can be transported without refrigeration for a maximum of 2 hours.

Indications and contraindications for diagnosis

The indication for determining daily proteinuria is suspicion of the following pathologies:

• infectious and inflammatory kidney diseases;
• autoimmune diseases;
• malignant tumors;
• chronic non-infectious kidney damage.

In addition, the study is also carried out for preventive purposes after illnesses to identify possible relapses.

Determination of the concentration of protein compounds in urine is mandatory in pregnant women, since the load on the kidneys during this period is especially high.

There are no contraindications for this study.

general information

Based on the results of laboratory tests of daily urine, the following information is obtained:

• The volume of fluid that is released from the body during the day. On average, it is 1750 ml and can fluctuate both down and up depending on the volume of liquid drunk.
• Sugar. This indicator is especially important for patients suffering from diabetes.
• Oxalates. Exceeding the permissible limits is fraught with the formation of sand and stones in the kidneys.
• Metanephrine. This substance is formed after the breakdown of hormones. Deviations from the norm in the direction of increase are a sign of pathology of the kidneys, cardiovascular system, etc.
• Protein. In healthy people, this indicator should not be observed in urine. This is one of the important parameters that is detected during daily urine analysis. An elevated level indicates signs of kidney pathology and diseases of the central nervous system. In addition to the total amount of protein, laboratory testing of biological fluid can also detect protein compounds, which are also important for correct diagnosis.

Preparation for testing for daily proteinuria

It is recommended to refrain from active physical activity one day before the test. This is due to the fact that under their influence the filtration function of the kidneys may decrease, which will lead to protein compounds entering the urine. You should also avoid eating foods high in protein, including:

• fish;
• meat;
• legumes;
• milk, cottage cheese, cheese;
• eggs

The day before the test, it is recommended to exclude foods high in protein.

Urine collection is carried out according to the following rules:

• Urine excreted immediately after waking up is not suitable for analysis, as it contains too many breakdown products.
• During subsequent acts of urination, urine should be collected in one container.
• Before collecting urine, it is necessary to thoroughly clean the genitals.
• During breaks between trips to the toilet, the urine container should be stored in a cool, dark place.
• Urine is collected in this way throughout the day.
• The next day, the collected urine should be mixed by shaking and about 50 ml of liquid should be poured from the container into a smaller container specially purchased for this purpose, which should be taken to the laboratory for testing.

  

  Urine should be submitted for testing in a disposable sterile container purchased from a pharmacy.

To collect urine from infants, you should use special urinals, which can be purchased at the pharmacy. Urine collection from bedridden patients is carried out through special bedpans. It is also permissible to use a catheter for this purpose, however, this technique is applicable in hospital settings.

A urine bag is a soft, sterile plastic container that is attached to the child's external genitalia with an adhesive part.

How to prepare to submit the material

If 24-hour urine collection is scheduled, you should stop taking diuretics 1-2 days before it begins. Spicy and sour foods are excluded from the diet, and do not drink alcohol. You should stay at home during the urine collection period.

You need to prepare a container for liquid. This can be a 3 liter container purchased at a pharmacy or a bottle of the same capacity. The jar should be washed, doused with boiling water, and allowed to dry.

Methodology

In the laboratory, the protein content in urine is determined using two methods:

• Test with nitric acid. The essence of the method is that a small amount of nitric acid is taken into a test tube, and urine is added on top of it. With an increased content of proteins in it, a whitish ring forms between the layers of urine and acid.
• Test with sulfosalicylic acid. Sulfosalicylic acid is added to the test tube containing urine. If the protein is missing, then no reaction will occur. When present, the liquid becomes cloudy and a small suspension appears.

The quantitative content of protein in urine is calculated using special formulas. The accuracy of this type of research is considered quite high.

Preparation and collection of urine

To obtain the most accurate and reliable test results, you need to collect urine correctly and follow several important rules. Be sure to pay attention to your diet. You should exclude too spicy and salty foods from your daily menu. Smoked foods and products containing dye are prohibited. On the day of urine collection, drink at least 1.5 - 2 liters. liquids. This may include teas, fruit juices, and first courses.

The first morning portion of urine is not collected in a container, but the time of urination must be recorded. In a notebook, also write down the amount of liquid you drink (approximately).

Collecting urine for the Zimnitsky test

If a pregnant woman experiences symptoms of the development of kidney pathologies, the doctor recommends a laboratory test of urine using the Zimnitsky method. It is necessary to collect secretions for such analysis according to a certain schedule. We collect a portion of urine at a certain time, the secretions are distributed into different containers.

You will need about 8 tightly sealed jars. We visit the toilet for the first time at 6-00 in the morning, but we don’t collect urine. The time of urination is recorded. Then we go to the toilet every 3 hours, each time collecting the waste in separate containers. If any containers are left empty, they must also be submitted to the laboratory, indicating the time of the expected urination, which did not occur.

Study of glucosuric profile

In late pregnancy, the risk of glucose entering the urine is quite high. It is because of this that at this stage doctors recommend studying the daily glucosuric urine profile. The increasing size of the fetus affects the functioning of the pancreas and kidneys.

Diuresis should be collected according to the following scheme.

• The first morning urination is performed in the toilet. We fix the time.
• We collect the first portion of urine in the morning (from 9 a.m. to 2 p.m.).
• The second portion is placed in the container (from 14 to 19 hours).
• Third evening gathering (from 19 to 23 hours).
• Night collection (from 23 to 4 am).
• The last container is filled from 6 to 9 am.

Decoding the results

The normal indicator for this study is the absence of protein in the urine or its concentration is not more than 0.014 g/l. This value completely excludes kidney problems and indicates the good condition of the urinary system.

In pregnant women, especially during the third trimester, this value can increase to a level of 0.033 g/l. This is also a physiological norm for this category of subjects. In children, it is permissible to increase the concentration of protein in the urine to 0.036 g/l, and this is also not a cause for concern.

Causes of High Protein Levels

Let's find out what is causing the increase in the amount of protein in the urine of a pregnant woman, and why this fact is dangerous.

One of the most common facts, which, fortunately, does not pose a threat to the health of the mother and fetus, is non-compliance with hygiene rules when collecting urine. If you didn’t wash the container properly or forgot to perform hygiene procedures, then urine with protein is a completely expected result.

Significant physical activity before taking the test can also affect the increase in protein mass in the urine.

Nervous shocks and stress, in addition to the obvious threat to the well-being and mood of the expectant mother, also affect protein levels.

If you eat too many protein foods: eggs, meat, dairy products, then an increased amount of protein in the urine should not be surprising.

In the case of pyelonephritis, the amount of protein in the urine increases greatly. In addition to pyelonephritis, increased protein levels can provoke the following diseases:

• preeclampsia;
• nephropathy;
• gestosis;
• eclampsia;
• dropsy;
• glomerulonephritis;
• acute inflammation of the kidneys.

It is these diseases that doctors want to exclude when they prescribe a daily test for a pregnant woman. Keep in mind that these diseases are usually accompanied by pain in the lumbar region and sometimes fever. Inflammation of the kidneys and glomerulonephritis, in addition, also color the urine pinkish-red. This fact indicates that the bladder is affected.

Characteristic symptoms

A 24-hour urine test for protein is carried out in the presence of symptoms characteristic of proteinuria. The severity of the clinical picture will largely depend on the severity of the problem. Among the main features are:

1. Dyspeptic disorders.
2. Blood pressure surges.
3. Pain in the lumbar region.
4. With heart failure, pain appears in the sternum.
5. Headache.
6. Aching bones. It is associated with increased leaching of protein from the body.
7. Decreased appetite.
8. In childhood, severe swelling is observed.

With this problem, changes can also be noticed in the process of urination. It can cause discomfort, and the desire to go to the toilet appears more often. A white sediment in the form of flakes is found in the urine.

Treatment

If a repeated analysis shows the presence of protein, the doctor has every reason to prescribe appropriate treatment. In case of a serious diagnosis, a pregnant woman may even be admitted to a hospital to undergo a therapeutic course.

Treatment methods

In the case of pyelonephritis and other inflammatory diseases, the woman is prescribed antibiotics to suppress pathogens. In addition, it is necessary to take anti-inflammatory drugs: drugs such as Phytolysin, Canephron are suitable. Diuretic medications are also prescribed in this case.

If there are inflammatory processes in the kidneys, pregnant women are not recommended to lie on their back for a long time; they are not even allowed to sleep in this position. But it is useful to walk more, as well as perform simple exercises on all fours.

If urine with a high protein content is a consequence of gestosis, then the danger to the health of the mother and the development of the fetus increases many times over. In addition, there is a fair risk of premature birth.

In case of gestosis, it is necessary to adhere to a certain diet, excluding the following foods from the diet:

• high in protein;
• citrus;
• chocolate and confectionery products containing it;
• spices;
• coffee;
• junk, fried foods, processed foods;
• sweet soda.

general characteristics

Daily protein in urine reaches its maximum level during the day, when a person leads an active life, walks a lot, and is in an upright position.

In humans, daily protein loss may be associated with the negative effects on the body of the following factors:

• psycho-emotional overstrain, being in a stressful situation when the nervous system is in an excited state for a long period of time;
• fever, chills, overheating of the body due to exposure to high temperatures (a similar reaction of the kidneys is observed in people with ARVI, when an acute immune reaction occurs, and the patient’s fever remains at 38-39 degrees Celsius);
• hiking over long distances (loss of protein along with urination is caused by prolonged static load on the feet, which negatively affects the glomerular filtration of the kidneys);
• heavy physical activity, lifting weights, intense sports, squats with heavy weights;
• stagnation of fluid in the lower extremities and internal organs, if a person has a concomitant disease in the form of heart failure (in this case, the excretion of protein along with urine continues until sufficient activity of the heart rhythm is restored);
• hypothermia of the body, prolonged exposure to conditions of extremely low atmospheric temperatures (brain centers reduce energy consumption by internal organs to a minimum, the kidneys work almost exclusively on urination, filtration is insignificant, which causes the release of not only protein, but also other unfiltered cells and particles);
• inflammatory diseases of the kidney tissue resulting from bacterial infection of the organ or hypothermia of the lumbar back;
• intoxication of the body due to exposure to harmful chemicals, when the kidneys cannot functionally cope with a large volume of toxic elements that require filtration and excretion along with urine;
• long-term use of medications, the side effects of some of them are to create additional stress on the functioning of the organs of the excretory system;
• other kidney diseases that impair the functions of the glomerular filter.

It is important to remember that daily proteinuria is divided into two main types depending on what type of protein compounds are excreted in large quantities over the last 24 hours. The release of negatively charged proteins leads to the development of selective proteinuria, which is the most common and most often encountered in practical urology.

The loss of low molecular weight positively charged proteins is daily albuminuria, which indicates that a person has serious heart disease, intoxication of the body, or infection with a dangerous infection.

Excretion of protein in urine is possible only in small quantities. Most of the proteins that overcome the filtration barrier of the kidneys (at least 98%) are absorbed back into the cavities of the proximal tubules.

Glucosuric profile

During pregnancy, serious changes occur in the female body, the work of internal organs occurs at an accelerated pace. Active functional activity of the kidneys in some cases leads to the release of glucose in the urine. This phenomenon is designated by the medical term “glucosuria” and can be caused by various reasons.

In healthy pregnant women, urinary sugar excretion is not pronounced and cannot be determined using conventional laboratory techniques. In some cases, the symptom of renal glucosuria is observed as part of tubulopathies (kidney diseases with damage to the tubular system and impairment of their function).

The causes of pathological glycosuria are renal dysfunction caused by concomitant chronic diseases. Risk factors for the female body's susceptibility to glucose excretion in urine are considered to be the presence of:

• genetic predisposition to diabetes;
• acute pancreatitis;
• poisoning of various origins;
• extrarenal glucosuria;
• carbohydrate absorption disorders;
• fetal weight more than 4.5 kg;
• pregnancy after 35 years;
• abnormalities of fetal development.

To diagnose glucosuria and clinically differentiate diabetes mellitus from physiological conditions, a profile glucosuric study is used, which allows assessing the increase or decrease in sugar excretion in daily urine. To perform this analysis, it is necessary to examine the glucose concentration in 3 portions of biological fluid.

On the eve of collecting biomaterial, a pregnant woman needs to limit her consumption of sweets and foods containing large amounts of carbohydrates and prepare three large, clean containers.

Samples for testing are collected as follows:

• at 7.00 a woman empties her bladder into the toilet;
• all subsequent portions of urine from 7.00 to 15.00 are collected in the first container;
• from 15.00 to 13.00 - to the second container;
• from 23.00 to 7.00 - on the third.

The normal level of glucose in daily urine is from 105 to 120 ml/min. An increase in concentration indicates the presence of such diseases in a pregnant woman as:

• disorders of the cardiac and vascular systems;
• diabetes;
• Itsenko-Cushing's disease;
• adrenal insufficiency.

Symptoms accompanying this disease

Common signs that urinary protein loss is occurring include:

• edematous manifestations, in particular morning swelling of the eyelids;
• the appearance of whitish foam or dirty white flakes on the surface of urine.

Differentiated signs may include both symptoms of loss of a certain type of protein compounds, and symptoms of the underlying cause of proteinuria. Among the first:

• general decrease in immunity;
• anemic manifestations;
• tendency to bleed;
• weakness, decreased muscle tone;
• hypothyroidism

The second includes mainly signs indicating the presence of renal pathologies:

• kidney pain, including colic;
• discomfort when urinating;
• increased blood pressure;
• high fever, chills, muscle pain;
• weakness, dry skin;
• change in the color, consistency or smell of urine;
• diuresis disorders.

However, the main source of information for making a diagnosis and determining the cause of excess protein is laboratory tests.

How to take a protein test?

The urine of a healthy person is completely sterile, but during its passage through the urinary tract it can become contaminated, so the perineum and genitals must be thoroughly cleaned before collecting it.

Women

Rinse the labia and vagina with water and hypoallergenic soap, then rinse to remove any alkali residue and blot thoroughly with a clean napkin. Before urinating, a hygienic tampon is inserted into the vagina or covered with a cotton wool roll. Important: urine is not collected during menstruation.

For men

The urethral opening of the genital organ is thoroughly washed with warm soapy water, rinsed and blotted dry with a clean napkin.

During the day and during the collection of the analysis, you should limit as much as possible the consumption of salty, spicy and protein foods, as well as coloring products: beets, marmalade, candies with dyes. Antibiotics and diuretics must be discontinued. During the summer period, one day before and during the collection of material, swimming in natural bodies of water is prohibited. It is also advisable to limit physical activity.