Анализ мочи по Нечипоренко

The Nechiporenko urine test (urinalysis by Nechiporenko; microscopic urine sediment count) quantifies erythrocytes, leukocytes, and urinary casts per milliliter of sediment to assess inflammation and structural injury within the urinary tract and renal parenchyma. By providing standardized counts, the method complements routine urinalysis and strengthens interpretation when initial findings are equivocal. It supports diagnosis of acute and chronic urinary tract disorders—including pyelonephritis, glomerulonephritis, cystitis, and urethritis—facilitates differential diagnosis of glomerular versus lower tract sources of abnormalities, and helps evaluate kidney involvement in systemic diseases such as diabetes mellitus, systemic lupus erythematosus, amyloidosis, and vasculitis, as well as after trauma. The test is also used to monitor response to therapy in diseases of the urinary system.

Compared with standard urinalysis, which frequently reports cells per microscopic field, the Nechiporenko approach counts formed elements in a defined urine volume, yielding more precise quantification of erythrocytes, leukocytes, and casts. This allows finer discrimination of pathologic processes when interpreting urinary sediment. Under normal conditions, the glomerular filtration barrier restricts blood cells and albumin; damage to this barrier alters urine composition. Marked hematuria may indicate glomerular injury, but erythrocytes can also arise from any level of the urinary tract due to stones, inflammation, neoplasms, or trauma involving the renal pelvis, ureter, bladder, or urethra. A renal (glomerular) source is suggested by erythrocyte casts or dysmorphic red cells. Leukocytes are normally scant in urine; elevated counts accompany inflammatory diseases of the urinary tract, urinary tract infections, and some acute systemic inflammatory conditions. When leukocyturia is present, urine culture is warranted to define the etiology and guide therapy. In clinical practice, the relative patterns of leukocyturia and hematuria assist in distinguishing glomerulonephritis from pyelonephritis. Casts are protein-based molds of renal tubules that form when urine physicochemical conditions favor protein aggregation. Tubular epithelial cells give rise to epithelial casts; degeneration of epithelial cells and leukocytes results in granular casts; and broad waxy casts develop from advanced degeneration of granular casts, indicating severe renal injury, progression toward renal failure, and a poor prognosis. Hyaline casts form from protein, including Tamm–Horsfall glycoprotein, which participates in local urinary tract defense. Hyaline casts may also appear transiently after strenuous physical activity or with minimal renal abnormalities.