Dipstick Urinalysis Research Articles

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Yield of screening for long-term complications using the children's oncology group long-term follow-up guidelines.

The Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines use consensus-based recommendations for exposure-driven, risk-based screening for early detection of long-term complications in childhood cancer survivors. However, the yield from these recommendations is not known. Survivors underwent COG-LTFU Guideline-directed screening. Yield was classified as negligible/negative (< 1%), intermediate (≥ 1% to < 10%), or high (≥ 10%). For long-term complications with high yield, logistic regression was used to identify subgroups more likely to screen positive. Over the course of 1,188 clinic visits, 370 childhood cancer survivors (53% male; 47% Hispanic; 69% leukemia/lymphoma survivors; median age at diagnosis, 11.1 years [range, 0.3 to 21.9 years]; time from diagnosis, 10.5 years [range, 5 to 55.8 years]) underwent 4,992 screening tests. High-yield tests included thyroid function (hypothyroidism, 10.1%), audiometry (hearing loss, 22.6%), dual-energy x-ray absorptiometry scans (low bone mineral density [BMD], 23.2%), serum ferritin (iron overload, 24.0%), and pulmonary function testing/chest x-ray (pulmonary dysfunction, 84.1%). Regression analysis failed to identify subgroups more likely to result in high screening yield, with the exception of low BMD (2.5-fold increased risk for males [P = .04]; 3.3-fold increased risk for nonobese survivors [P = .01]). Screening tests with negligible/negative (< 1%) yield included complete blood counts (therapy-related leukemia), dipstick urinalysis for proteinuria and serum blood urea nitrogen/creatinine (glomerular defects), microscopic urinalysis for hematuria (hemorrhagic cystitis, bladder cancer), ECG (anthracycline-related conduction disorder), and hepatitis B and HIV serology. Screening tests with a high yield are appropriate for risk groups targeted for screening by the COG-LTFU Guidelines. Elimination of screening tests with negligible/negative yield should be given consideration.

Evaluation of the prevalence of urinary tract infection in rural Panamanian women.

ObjectiveUrinary tract infection (UTI) is the most common non-intestinal infection worldwide. In the developed world, incidence and prevalence of UTI would be similar owing to the relatively short duration of illness experienced by women with ready access to healthcare services. We hypothesize that, in the developing world, factors limiting access to care and those which may increase the likelihood of developing UTI, result in increased morbidity. This difference is reflected in an increased prevalence of UTI in regions where women suffer the effects of UTI for extended periods of time.MethodsThis study represents a cross sectional analysis of UTI prevalence in rural western Panama conducted over the course of a 3-day medical mission. All women 18–45 years of age reporting to the medical brigade clinic were tested for UTI by dipstick urinalysis and a brief history regardless of whether they themselves were presenting with a complaint.ResultsUTI was diagnosed clinically by providers in 29.8% of the women tested although only 21.15% of these same women met the evidence-based study criteria. This prevalence of 21.15% is seven times greater than reported by the Panamanian Ministry of Health. When comparing the effectiveness of clinical diagnosis relative to urinalysis by dipstick, a Kappa coefficient revealed only low moderate agreement (0.42; SE 0.0955).ConclusionsThe prevalence of UTI in rural western Panama is greater than would be expected based on prevalence data from either the US or Panamanian Ministry of Health and may represent an opportunity for targeted interventions, including educational programming about UTI prevention.

Haemoglobinuria among children with severe malaria attending tertiary care in Ibadan, Nigeria

BackgroundHaemoglobinuria is one of the manifestations of severe malaria and results from severe intravascular haemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been implicated in its aetiology. Haemoglobinuria may be associated with severe anaemia and, less frequently, acute renal failure.MethodsA prospective case-control study was carried out to determine the incidence of haemoglobinuria as confirmed by dipstick urinalysis, microscopy and spectrophotometric measurement, among children with severe malaria. A total of 251 children presenting at the Children’s Emergency Ward with severe malaria were recruited over a period of 21 months. The G6PD status and the outcomes of severe malaria in children with and without haemoglobinuria was studied with respect to renal failure, the recurrence of haemoglobinuria and blood pressure changes over a three-month follow-up period.ResultsIt was found that the incidence of haemoglobinuria among children with severe malaria is 19.1%. Children <5 years constituted 76.8% of all the study patients. Patients with haemoglobinuria had median age of 52.5 months, which was significantly higher than 35 months in patients without haemoglobinuria (p=0.001). Although, haemaglobinuria was commoner among boys (54.2%) than girls (45.8%), the difference was not statistically significant. There were no significant differences between children with and without haemoglobinuria regarding their nutritional status or parasite densities. Among the clinical features of the study patients, only jaundice was significantly associated with haemoglobinuria (p=0.0001). Renal failure occurred in three out of 48 children with haemoglobinuria and in none of the 203 without. There was not recurrence of haemoglobinuria in the follow-up period. At discharge, blood pressure was elevated in six children (one previously haemoglobinuric), but all returned to normal within the follow-up period.ConclusionsHaemoglobinuria was a prominent feature of severe malaria and it was significantly associated with jaundice at presentation. Haemoglobinuria was commoner in older children than younger children but not related to sex. G6PD deficiency was not an independent predictor of the occurrence or outcome of haemoglobinuria. Blood pressure was not affected by haemoglobinuria on admission nor during follow-up.

Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy

BackgroundImmunoglobulin (Ig) A nephropathy (IgAN) is characterized by mesangial deposits of IgA1 and C3, often with co-deposits of IgG. We attempted to clarify the clinical significance of mesangial IgG deposition in patients with IgAN.MethodsWe retrospectively reviewed 57 patients who were diagnosed with IgAN on the basis of pathological examination of renal biopsy specimens obtained between October 2006 and December 2010. Subjects were divided into two groups: IgA+IgG deposition (IgA-IgG) group (n = 29) and IgA deposition alone (IgA) group (n = 28). The study outcome was complete remission (CR), defined as negative proteinuria by dipstick urinalysis and urinary erythrocytes of less than 1–4/high-power field.ResultsProteinuria was greater in the IgA-IgG group than the IgA group (1.1 ± 0.8 vs. 0.7 ± 0.6 g/day, Mann–Whitney U test, P = 0.042). Capillary wall IgA deposits were noted more frequently in the IgA-IgG group than the IgA group (59 vs. 11 %, Fisher’s exact test, P = 0.014). During the median follow-up period of 33.3 months (range 6–55 months) in the 57 patients, we observed CR in 24 cases (42.1 %). After the start of treatment, urinary abnormalities disappeared earlier in the IgA group than in the IgA-IgG group (log rank test, P = 0.012). Cox’s regression model showed that IgG deposition reduced the hazard ratio for CR (hazard ratio 0.35; 95 % confidence interval 0.14–0.82, P = 0.014). Therefore, IgG deposition is a risk factor for persistent urinary abnormalities.ConclusionMesangial IgG deposition is associated with more severe clinical features in patients with IgAN.

Routine dipstick urinalysis in daily practice of Belgian occupational physicians

BackgroundLittle work has been done to assess the quality of health care and the use of evidence-based methods by occupational physicians in Belgium. Therefore, the main objective is to describe one aspect of occupational health assessments, namely the common use of dipstick urinalysis, and to compare the current practice with international guidelines.MethodsA self-administered questionnaire was mailed to 211 members of the Scientific Association of Occupational Medicine in the Dutch speaking part of Belgium.ResultsA total of 120 occupational physicians responded, giving a response rate of 57%. Dipstick urinalysis was a routine investigation for the vast majority of physicians (69%). All test strips screened for protein and in 90% also for blood. Occupational health services offered clinical tests to satisfy customer wants as international guidelines do not recommend screening for haematuria and proteinuria in asymptomatic adults. A lack of knowledge concerning positive testing and referral criteria was demonstrated in almost half of the study participants.ConclusionsBelgian occupational physicians still routinely perform dipstick testing although there is no evidence to support this screening in healthy workers. To practice evidence-based medicine, occupational physicians need more instruction and training. Development and implementation of more guidelines is not only of use for the individual practitioner, it may also enhance professionalization and efficiency of occupational health care.

PP025. Urinary dipstick proteinuria testing – Does automated strip analysis offer an advantage over visual testing?

The visual urinary test strip is widely accepted for screening for proteinuria in pregnancy, given the convenience of the method and its low cost. However, test strips are known to lack sensitivity and specificity. The 2010 NICE (National Institute for Health and Clinical Excellence) guidelines for management of pregnancy hypertension have recommended the use of an automated test strip reader to confirm proteinuria (http://nice.org.uk/CG107). Superior diagnostic test performance of an automated (vs. visual) method has been proposed based on reduced subjectivity. To compare the diagnostic test properties of automated vs. visual read urine dipstick testing for detection of a random protein:creatinine ratio (PrCr) of ⩾30mg/mmol. In this prospective cohort study, consecutive inpatients or outpatients (obstetric medicine and high-risk maternity clinics) were evaluated at a tertiary care facility. Random midstream urine samples (obtained as part of normal clinical care) were split into two aliquots. The first underwent a point-of-care testing for proteinuria using both visual (Multistix 10SG, Siemens Healthcare Diagnostics, Inc., Tarrytown NY) and automated (Chemstrip 10A, Roche Diagnostics, Laval QC) test strips, the latter read by an analyser (Urisys 1100®, Roche Diagnostics, Laval QC). The second aliquot was sent to the hospital laboratory for analysis of urinary protein using a pyrocatechol violet molybdate dye-binding method, and urinary creatinine using an enzymatic method, both on an automated analyser (Vitros® 5,1 FS or Vitros® 5600, Ortho-Clinical Diagnostics, Rochester NY); random PrCr ratios were calculated in the laboratory. Following exclusion of dilute samples with urinary creatinine concentration <3mM (given inflation of PrCr values in dilute urine by our method), diagnostic test properties were determined for visual and automated dipstick proteinuria testing (⩾1+) for detection of a random PrCr ⩾30mg/mmol. 160 women (81.9% outpatients) were screened at one/more antenatal visits, providing a total of 233 urine samples for analysis. Both visual and automated read urinary dipstick testing showed low sensitivity (56.0% and 53.9%, respectively). Positive likelihood ratios (LR+) and 95% CI were 15.0 [5.9,37.9] and 24.6 [7.6,79.6], respectively. Negative LR (LR-) were 0.46 [0.29,0.71] and 0.47 [0.31,0.72], respectively. Automated dipstick urinalysis is not more sensitive than visual read urinalysis for detection of proteinuria in a primarily outpatient setting in pregnancy. Both have excellent LR+ but only fair to poor LR- as previously recognised for visual dipstick testing. Performance of automated strip analysis testing may vary with the test strips and analyser used.

Diffusion des recommandations pour la pratique clinique concernant l’incontinence urinaire de la femme

Recommendations for good clinical practice concerning the treatment of urinary incontinence in women are available from the HAS (Haute Autorité de santé or French National Authority for Health), the Collège national des gynécologues obstétriciens français (French national college of gynaecologists and obstetricians) and Association française des urologues (French association of urologists). We wanted to conduct the first investigation of these recommendations to primary care physicians (GPs) and gynaecologists in the cities located in the same area of health. A questionnaire was sent to GPs and gynaecologists (French administrative divisions 78 and 92), with questions on the recommendations, as well as the methods of dissemination of these recommendations. Response rate: 22%. A total of 72 questionnaires were usable from 51 (71%) GPs and 21 (29%) gynaecologists. Of these, 76% of gynecologists and 47% of GPs were aware of recommendations from the HAS for clinical practice for urinary incontinence in women (P=0.04). Only 56% of doctors prescribed a urinalysis (dipstick or bacteriological urinalysis) and evaluated the residual urine in women seeking care for symptoms of urinary incontinence. Training for one or two days was the most desirable/popular method of dissemination of the recommendations (30 out of 72 doctors), followed by journals such as Prescrire, then the mailing and forms provided by the HAS, especially when combined with office visits from a representative of the HAS. This study provided an interesting perspective on the knowledge, dissemination and application of recommendations for good clinical practice concerning urinary incontinence in women.

Prevalence of chronic kidney disease and its risk factors among family practice patients in Lithuania

Early detection of chronic kidney disease (CKD) by the first line is essential. In many countries, serum creatinine measurements are reimbursed in home practice. In Lithuania however, until recently they were not. Therefore, the aim of this study was to assess the prevalence of risk factors of CKD in primary care patients, to evaluate the awareness of family practitioners and, finally, to investigate renal function parameters in patients at risk. We reviewed the charts of adult patients (n = 4,082) from four home practices in Kaunas and identified patients at increased risk for CKD (severe arterial hypertension, diabetes, cardiovascular disease (CVD), other causes of kidney damage). We noted age and gender in all patients, and renal function measurements performed over the preceding 24 months in the patients at risk. In the second part, we assessed nephrological status (history, clinical characteristics, serum creatinine, dipstick urinalysis and microalbuminuria, estimated glomerular filtration rate (eGFR) by the abbreviated MDRD formula) for those at risk who were referred by their family practitioners. In total, 458 (11.2%) patients had risk factors for CKD. Severe arterial hypertension was found in 62.6% of these patients, diabetes in 20.9%, CVD in 6.2% and 34.5% had a history of kidney damage. Kidney tests had been performed by family practioner in 59% of these patients. Only 30.3% of these patients were referred to the nephrologist and an additional 20.1% came after receiving an invitation letter. eGFR < 60 ml/min/1.73 m2 was found in 42.9% of these patients, 23.4% had microalbuminuria and 7.8% overt proteinuria. Optimal blood pressure control (< 130/85 mmHg) was achieved in a minority (10.4%). 79.7% had abnormal BMI, 39% used no ACEI/ARB, and 16% were smokers. Kidney dysfunction was associated with a higher prevalence of microalbuminuria and a lower use of ACEI/ ARB. Risk factors for CKD were present in 11% of the patients in this primary care cohort. Kidney dysfunction was found in almost half of the patients at risk. However, awareness of this problem by family practitioners was low.

Urological Screening of a Wild Group of Japanese Macaques (Macaca fuscata yakui): Investigating Trends in Nutrition and Health

Primates are among the most threatened of animal taxa, and it is therefore increasingly important to examine ways to monitor their health in the wild. We here investigate trends in nutrition and health in Japanese macaques (Macaca fuscata yakui) under natural conditions using a common tool from human and veterinary health practices: urinalysis. Between October 2007 and August 2009, we collected 103 urine samples ad libitum from 29 identified individuals of a group of macaques on Yakushima Island. We used multireagent dipstick analysis to examine variation in 10 urine chemistry parameters across subjects in combination with systematic monitoring of clinical signs of disease (via focal sampling). Positive tests tended to be transient and weak, i.e., analytes detected in trace amounts, and were not associated with clinical signs of disease. In addition, most urine samples we collected were highly concentrated (urine specific gravity ≥1.030), which could have increased the likelihood of detecting clinically insignificant amounts of analytes that can occur in urine. However, we found that ketone bodies, which are not normally found in urine, were more prevalent during winter than summer, which may indicate that Japanese macaques inhabiting the richest habitat available to the species nonetheless experience an energy deficit during periods of low food quality and high thermoregulatory costs. We conclude that dipstick urinalysis can be used to examine general trends in nutrition and health, but that results must be interpreted with care because positive tests may not reflect clinically significant urological conditions in many cases.

Cessation of Dipstick Urinalysis Reflex Testing and Physician Ordering Behavior

The purpose of our study was to determine the effect of the elimination of laboratory-initiated reflex testing on physician ordering behavior. In 1999, we stopped laboratory-initiated reflex testing and did microscopic analysis only on physician request. The number of urinalysis dipstick tests, microscopic analysis tests, and urine cultures done during 6-month periods for the next 10 years was extracted from our laboratory information system that includes data from the middle of 1999. The number of physician complaints was also recorded. Before the intervention, we did 106,000 urine analysis tests per 6-month period, with 19,006 microscopic examinations (17.9%) that decreased to less than 0.2% after the change in policy. During the 10-year period, physician requests for microscopic urinalysis decreased gradually to around 50 in any 6-month period.

World Kidney Day – Don’t Forget The Children

BACKGROUND: World Kidney Day (WKD) is an annual global campaign meant to raise awareness about the importance of kidneys and reduce the frequency and impact of kidney disease but the focus is usually on adults and not children. This is a report of screening of children during WKD 2011 in Giwa, a semiurban community in Nigeria. METHODOLOGY: The importance of screening was communicated through talks, songs and plays. Blood pressure (BP), weight and height were measured and dipstick urinalysis done. Proteinuria, hematuria, glycosuria and nitrituria were defined as 1+ or more, hypertension as BP greater than 95% for age, gender, and height. RESULTS: A total of 115 children (3 to 15 years, mean 9.97±3 years) participated; 93(80.8%) were male, 89(77.4%) were students. Six (6.4%) of 94 children whose BP were measured were hypertensive. Proteinuria, haematuria, glycosuria was detected in 3(2.7%), 2(1.8%) and 16(14.9%) respectively of 107 children. No child had nitrituria. Only one child went to the tertiary centre for follow up.CONCLUSION: Mass screening for hypertension, proteinuria, haematuria, glycosuria may be worthwhile but not for urinary tract infection. Data collected during WKD on a national scale could help determinate the cost benefit of screening and contribute to development of national screening policies in resource constrained countries. WKD offers opportunities to screen children who might otherwise be missed (e.g. those who don’t attend school and/or in rural areas). Greater effort must be made to follow up those with abnormalities. This could be done by evaluating them in local health centres.

Dipstick urinalysis should be documented prior to initiating antiretroviral therapy

Dipstick urinalysis should be documented prior to initiating antiretroviral therapy

Prevalence of Risk Factors for Chronic Kidney Disease in a Coastal Area of Tamil Nadu, South India.

Communicable Diseases which were the leading causs of mortality in the beginning of the twentieth century have now been replaced by Non-Communicable Diseases which account for almost two-thirds of all deaths presently in India. Considering the high prevalence of CKD risk factors it has long been presumed that CKD represents a major public health problem in our country. This study was conducted to determine the risk factors of CKD. Materials and Methods: A community based cross sectional study was conducted among the 1200 respondents, 20 years and above, residing in a coastal area of Villupuram district, over a period of 6 months (Feb-July) using a pre-structured and validated questionnaire. The questionnaire included information on demographic characteristics, lifestyle habits, and awareness of CKD risk factors. Random blood sugar and spot urinary protein and sugar using urinalysis dipsticks were measured. Data was analyzed using SPSS 16.0 version, p value <0.05 was considered significant. Results: Majority of the respondents were females (67.8%) with maximum belonging to the age group of 20- 29yrs (23.8%), followed by 30-39yrs (22.8%).Most of them belonged to upper lower class (31.8%), followed by lower middle class (25.8%). 93.1% of the population were Muslims with 87.9% belonging to backward caste. The prevalence of CKD risk factors among the respondents were Proteinuria(12.5%), Glycosuria(8.4%), Hypertension (24.3%), Diabetes Mellitus(18%) and Obesity( 44.4%). Conclusion: Prevalence of CKD risk factors in the study area was moderate to high. Hence, policies and programmes should focus on these areas and IEC should focus on creating awareness about CKD risk factors in the community.

Renal status of children with sickle cell disease in Accra, Ghana.

In West Africa, the prevalence of sickle cell disease (SCD) is 2%. The disease adversely affects growth, development and organ function including the kidneys. There is however a dearth of information about the renal status of SCD children in Ghana. To assess the renal status of children with SCD in steady state. A cross-sectional case-control study. Paediatric Sickle Cell Clinic, Korle Bu Teaching Hospital, Accra. Cases-357 SCD cases and 70 of their HbAA siblings as controls. Documentation of their socio-demographic data, clinical data and dipstick urinalysis findings, and renal ultrasonography on selected participants. The mean [SD] age was 7.18 [3.15]yrs for cases and 5.16[3.28]yrs for controls. The genotypes were Hb SS (76.7%), Hb SC (21.8 %), and Hb Sβthal (1.4%). Urinalysis showed leucocyturia in 12.6% versus 5.7% (χ2=62.5 and the p=0.000)), isolated proteinuria in 2.8% versus 1.43% (χ2=10.01 and p=0.001) haematuria in 2.6% versus 0% (χ2=9.233, p=0.002) and nitrites in 2.2% versus 1.4% (χ2=16.3,p=0.02) of cases and controls respectively. The youngest SCD case with proteinuria was 2 yrs. old. Proteinuria prevalence increased with age, , occurring in 5.7% of cases aged 9-11yrs. and 20.6% of cases aged 12 yrs. Two-thirds of the proteinuria cases were aged 9-12 yrs., of whom 50% were aged 12 yrs. Renal ultrasound findings were normal in all those examined. Urinary abnormalities suggesting nephropathy occur early in SCD patients in Ghana. Routine dipstick screening at clinic visits countrywide would help early detection and prompt intervention to limit renal impairment.

Multiple Versus Single and Other Estimates of Baseline Proteinuria Status as Predictors of Adverse Outcomes in the General Population

The association of proteinuria and adverse clinical outcomes is well established. The optimal method of classifying proteinuria status for study participants in whom it is measured multiple times is unknown, especially when the frequency of measurement varies between participants. Population-based longitudinal study. All adults with at least one outpatient serum creatinine measurement in the province of Alberta, Canada. Proteinuria (dipstick, albumin-creatinine ratio [ACR]). All-cause mortality, end-stage renal disease, or doubling of serum creatinine level. All outpatient urine dipstick and ACR measurements in the 6-month period before and after the first (index) estimated glomerular filtration rate were used to establish baseline proteinuria. Dipstick measures were analyzed as ceiling (median value up to the next integer), floor (median value down to the next integer), high (single highest dipstick value), low (single lowest dipstick value), and first (first available dipstick value only). Measurements of ACR were evaluated similarly and a median (median of all ACR measurements) value was added. Of 920,985 participants, 17% (n = 160,548) had multiple dipstick urinalysis measurements and 22% (n = 22,814) had multiple ACR measurements. With single measurements, absolute rates of mortality and renal outcomes were lower in every proteinuria category compared with multiple measurements. In contrast, the relative increase in rate ratio was greater with increasing proteinuria in patients with single measurements compared with those with multiple measurements. In all classification systems evaluated, more severe proteinuria was associated with significantly higher rates of both outcomes (all P for trend <0.001). Lack of a gold standard for choosing between methods. Rates of adverse outcomes related to multiple baseline proteinuria/albuminuria measurements were similar, independent of the measure of baseline proteinuria that was used to combine results. In contrast, discarding follow-up measurements and relying on only the first measurement led to lower estimates of absolute and relative risk for each proteinuria category.

A population-based approach for the definition of chronic kidney disease: the CKD Prognosis Consortium

The Kidney Disease: Improving Global Outcomes (KDIGO) foundation promoted the establishment of the Chronic Kidney Disease (CKD) Prognosis Consortium to meta-analyze the association of estimated glomerular filtration rate (eGFR) and albuminuria with incidence of various outcomes in samples of general populations from all over the world. Variables in meta-analysis included eGFR by the Modification of Diet in Renal Disease (MDRD) Study equation, the urinary albumin to creatinine ratio (uACR) as index of albuminuria, together with proteinuria at dipstick urinalysis and classical markers of cardiovascular risk. Overall, 105,872 participants had uACR measurements, and 1,128,310 participants had dipstick measurements. The association with mortality was continuous over the whole range of uACR/proteinuria and J-shaped for eGFR which was associated with an excess risk for values <75 and ≥120 ml/min per 1.73 m². Results were similar for the association of eGFR or uACR/proteinuria with renal failure. The associations of eGFR and uACR/proteinuria with death or renal failure were independent of each other. Findings were consistent across population samples from North America, Asia, Oceania and Europe, as well as in individuals with age <65 years and individuals with age ≥65 years. Data support the threshold of 60 ml/min for CKD definition but suggest that eGFR in the range 60-74 ml/min could represent the early stages of CKD. This first set of results of the CKD Prognosis Consortium represents an important step in the evidence-based definition of CKD. Conclusions should be reevaluated with eGFR calculation by equations less biased for normal-high eGFR.

Dipstick urinalysis for the emergency department evaluation of urinary tract infections in infants aged less than 2 years

The clinical diagnosis of urinary tract infection (UTI) in infants under the age of 2 years is challenging because of the nonspecific symptoms and signs in this age group. Prompt diagnosis and treatment is critical, and although dipstick testing allows rapid testing, there is some doubt about its use in infants. We sought to show the use of the dipstick test in identifying or excluding UTI in infants under the age of 2 years presenting to the emergency department with a febrile illness. We conducted a retrospective diagnostic cohort study for over a 12-month period in a UK Paediatric Emergency Department, including all febrile children who had a urine dipstick and a quantitative culture as part of their diagnostic workup. The gold standard was the quantitative culture. Three hundred and twenty-one samples were eligible for inclusion. The mean age of the children included was 9.3 months. Sixty-three percent were female children. A test positive for nitrite, leucocyte esterase and blood gave a specificity of 97.12% [95% confidence interval (CI): 94.17-98.60] and a positive likelihood ratio of 15.13 (95% CI: 6.99-32.76). A test negative for nitrite, LE, blood and protein had a sensitivity of 97.44% (95% CI: 91.12-99.29) and a negative likelihood ratio of 0.10 (95% CI: 0.02-0.39). In febrile infants who were below 2 years of age, dipstick urinalysis shows promising results in identifying or ruling out a UTI.

P1-271 Prevalence, risk factors and patterns of chronic kidney disease in a rural community in South West Nigeria

IntroductionChronic kidney disease (CKD) is a global public health problem. Despite the long term difficulties of this condition there is paucity of community derived data in sub-Saharan Africa and especially...

Dipstick Urinalysis Screening of Healthy Neonates

Renal disease may accidentally be discovered during urinalysis. This study was conducted to examine the usefulness of dipstick urinalysis screening in healthy neonates for the diagnosis of underlying renal disease and to study the magnitude of abnormal urinalysis in apparently healthy neonates. In this descriptive study, voided urine samples were obtained from 400 apparently healthy neonates and tested using urine dipstick. The reaction of dipstick strip was read visually by a trained nurse. In cases with an abnormal urine analysis, a second screen test was performed within a week, and for those with persistent abnormalities, complete diagnostic tests were done. On the first urinalysis, 375 (94%) subjects were normal and 25 (6%) had abnormalities: 23 had proteinuria (5.75%), one was blood positive (0.25%), and one was both protein and blood positive (0.25%). Male neonates had a higher proportion of proteinuria than female neonates (p=0.038). In the second examination, proteinuria was found in five (1.25%) neonates, but the proportion of other abnormalities did not change. In follow-up investigations, ureteropelvic junction obstruction and vesicoureteral reflux were recognized in two infants who had blood-positive or combined blood- and protein-positive results on their first tests. The findings of this study show that dipstick test during neonatal period could be used for early diagnosis of renal diseases.