Dipstick Urinalysis Research Articles

COMPARISON OF URINE DIPSTICK WITH URINE CULTURE IN DIAGNOSIS OF URINARY TRACT INFECTION IN CHILDREN.

BACKGROUND: Urinary tract infection (UTI) is a common cause of morbidity in the paediatric age group. In general practice, 6-8% of febrile infants who are unwell and older children having urinary complaints will have UTI. It may lead to long- term complications like loss of normal function, renal scarring and hypertension. Thus, prompt detection and treatment of UTI is important. AIMS AND OBJECTIVES: 1. To evaluate the accuracy of dipstick leukocyte esterase and nitrite tests for rapid screening of urine samples, keeping semi quantitative Urine culture as the gold standard for the diagnosis of UTI. 2. To study the clinical prole of UTI in children. METHOD: A hospital based, prospective, cross sectional study was conducted with a total of 100 febrile children between the age of 1year to less than 18 years who came to department of Paediatrics, MMIMSR, both inpatient and out-patient department were included in the study. Two urine samples were collected out of which one was sent for urine culture and the other was used for urine dipstick test and urinalysis. RESULTS: Out of 100 febrile children suspected to have UTI, Urine culture was found to be positive in 49% cases. E.coli was found to be the most common organisms causing UTI. Out of 49% culture positive cases, 55% were females. The most common age group to have culture positivity was found to be 12 years to less than 18 years of age. The most common features associated with culture positive UTI were found to be vomiting and pain abdomen along with fever. The leukocyte esterase test and nitrite test have a sensitivity and specicity of 81.63%, 88.24% and 32.65%, 96.08% respectively. Thus, leukocyte esterase can be used to screen UTI in paediatric age group. Microscopic urinalysis is comparable to leukocyte esterase with sensitivity of 73.47% and specicity of 92.16%. When leukocyte esterase and nitrite tests are used in combination, the sensitivity increases to 86% and specicity to 88%. When all three are used together the ability to diagnose UTI improves further. CONCLUSION: Urine dipstick test (leukocyte esterase and nitrite reduction test), is a rapid and feasible method to screen urinary tract infection in children.

Using dipstick urinalysis to predict development of acute kidney injury in patients with COVID-19

BackgroundAcute kidney injury (AKI) is a common complication in patients hospitalized with COVID-19 and may require renal replacement therapy (RRT). Dipstick urinalysis is frequently obtained, but data regarding the prognostic value of hematuria and proteinuria for kidney outcomes is scarce.MethodsPatients with positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) PCR, who had a urinalysis obtained on admission to one of 20 hospitals, were included. Nested models with degree of hematuria and proteinuria were used to predict AKI and RRT during admission. Presence of Chronic Kidney Disease (CKD) and baseline serum creatinine were added to test improvement in model fit.ResultsOf 5,980 individuals, 829 (13.9%) developed an AKI during admission, and 149 (18.0%) of those with AKI received RRT. Proteinuria and hematuria degrees significantly increased with AKI severity (P < 0.001 for both). Any degree of proteinuria and hematuria was associated with an increased risk of AKI and RRT. In predictive models for AKI, presence of CKD improved the area under the curve (AUC) (95% confidence interval) to 0.73 (0.71, 0.75), P < 0.001, and adding baseline creatinine improved the AUC to 0.85 (0.83, 0.86), P < 0.001, when compared to the base model AUC using only proteinuria and hematuria, AUC = 0.64 (0.62, 0.67). In RRT models, CKD status improved the AUC to 0.78 (0.75, 0.82), P < 0.001, and baseline creatinine improved the AUC to 0.84 (0.80, 0.88), P < 0.001, compared to the base model, AUC = 0.72 (0.68, 0.76). There was no significant improvement in model discrimination when both CKD and baseline serum creatinine were included.ConclusionsProteinuria and hematuria values on dipstick urinalysis can be utilized to predict AKI and RRT in hospitalized patients with COVID-19. We derived formulas using these two readily available values to help prognosticate kidney outcomes in these patients. Furthermore, the incorporation of CKD or baseline creatinine increases the accuracy of these formulas.

Gouty arthritis and kidney function outcomes and serum uric acid level variations in obese patients following bariatric surgery

BackgroundObesity is an independent risk factor for chronic kidney disease (CKD) and is the strongest known modifiable risk factor for hyperuricemia and gout. We aimed to discover the outcome of serum uric acid (SUA), gouty arthritis, and kidney function in obese patients after bariatric surgery and possible links with BMI variations.MethodsRetrospective study has been performed in National Hospital in Riyadh, KSA, between Jan. 2018 to Jan. 2020. We studied only 98 patients who met our inclusion criteria. Patients followed-up at 1 month (for gouty attack only) postoperative, 3 months postoperative, and 6 months postoperative for body mass index (BMI), serum creatinine, dipstick urinalysis, SUA, and estimated glomerular filtration rate (eGFR). Radiological studies, medical history, follow up radiological studies, and clinical follow up were obtained from the hospital data system.ResultsA total of 98 patients with mean eGFR were 90.65 ± 29.34 ml/min/1.73 m2, mean SUA 5.56 ± 1.84 mg/dl, and mean BMI was 45.28 ± 7.25 kg/m2, at surgery. Mean BMI had decreased significantly to 38.52 ± 6.05 kg/m2 at 3 months and to 34.61 ± 5.35 kg/m2 at 6 months (P < 0.001). The mean GFR had improved significantly (99.14 ± 23.32 ml/min/1.73 m2) at 6 months (P < 0.001). Interestingly, proteinuria had resolved in 17 patients out of 23 patients at 6 months. Number of gouty attacks was decreased during the first month post-surgery (P < 0.001). SUA level was significantly decreased (4.32 ± 1.27 mg/dl) (P < 0.001). SUA showed significant negative correlations with eGFR at 3 months and positively significant correlations with BMI at 3 and 6 months. By multinomial logistic regression, BMI and initial eGFR were the independent predictive variables for the outcome of eGFR at 6 months, while male gender and initial SUA were the independent predictive variables on the outcome of SUA at 6 months. Postoperatively in gouty arthritis patients, the number of joints affected, patient global VAS assessment, and number of gouty attacks were significantly reduced (P < 0.001).ConclusionBariatric surgery has been associated with reduction of BMI and subsequently reduction of SUA levels, gouty attacks, and improvement of eGFR.

Dipstick urinalysis profile of an asymptomatic female group in south-east Nigeria.

Routine dipstick urinalysis is a useful and inexpensive method for the early detection of asymptomatic diseases. Our study was carried out to detect the prevalence of urinary abnormalities among an apparently asymptomatic healthy female group and emphasize the value of routine dipstick urinalysis. A cross-sectional study was carried out among second to sixth (final)-year female medical students of Nnamdi Azikiwe University, Nnewi campus between 8 and 30 September 2019. A total of 100 subjects were enrolled. First-morning midstream urine samples were collected and promptly tested with dipstick strips. Subjects with abnormal findings were informed and treated appropriately. In all, 54 (54%) of the subjects had urine abnormalities. Trace proteinuria was the commonest abnormality seen with a prevalence of 33%, followed by abnormal urine appearance (17%), leucocytes (14%), nitrites (8%) and urobilinogen (2%). Urine abnormalities were commoner in students who resided in the school hostel. Abnormal urine appearance was significantly associated with nitrites (0.003) and leucocytes (0.001). Routine dipstick urinalysis should be performed among students and apparently healthy individuals for early detection and diagnosis of renal diseases to facilitate quick interventions and prevent further progression.

β2-microglobulin measurement with dried urine spots for congenital anomalies of the kidney and urinary tract screening in 3-year-old children.

Screening using dipstick urinalysis has long been performed in 3-year-old children; however, it is ineffective in detecting congenital anomalies of the kidney and urinary tract (CAKUT). Measurement of the urinary β2-microglobulin (β2MG)/creatinine (Cr) ratio may be more effective for this purpose. Analysis of dried urine spots (DUS) on filter paper is suitable for mass screening since operational costs are low and samples are easy to collect and transport. We examined the accuracy of measuring the urinary β2MG/Cr ratio in DUS on filter paper. We collected 2,623 urine samples from 3-year-old children. β2MG and Cr levels were measured in DUS on filter paper. We examined the correlation between the β2MG/Cr ratios measured in DUS and using the conventional method in 640 samples using the coefficient of determination test. Children with high β2MG/Cr ratios (>0.6 µg/mg Cr) in DUS samples were further examined to establish a definitive diagnosis. There was strong correlation between the two methods for determination of β2MG levels (r2 = 0.68; P < 0.001) and β2MG/Cr ratios (r2 = 0.69; P < 0.001). Of the 2,623 children, 38 (1.45%) had β2MG/Cr ratios >0.6. Thirty-five children were subsequently examined, resulting in findings of renal hypodysplasia (n = 2, 0.08%), horseshoe kidney (n = 1, 0.04%), renal tubular dysfunction with hepatoblastoma (n = 1, 0.04%), data abnormality (high urine β2MG level, n = 6, 0.23%; high serum Cr level, n = 1, 0.04%), and normal values (n = 24, 0.91%). We evaluated a practical method for measuring β2MG/Cr ratios in DUS as a screening method to detect CAKUT in 3-year-old children.

Comparing Urine Specimen Collection Methods for Urinalysis and Culture Agreement: A Paired Sample Design.

The primary aim of this study was to determine if results from clean catch urine specimens agree with results from catheterized specimens in a urogynecology patient population. The secondary aim was to identify clinical scenarios in which catheterized specimens are preferred over clean catch specimens. Both a midstream clean catch and a catheterized specimen were obtained for each participant. Dipstick urinalysis was performed. If either specimen was positive for nitrites, leukocyte esterase, or blood then both were sent for urine culture.Kappa statistics were calculated to measure agreement between the paired specimen data for the total sample and for stratified samples. We agreed to accept clean catch results as preferable to catheterized results if the κ statistic was 0.7 or greater. Three hundred forty-two participants were enrolled. For all participants, the agreement between the paired samples was strong for nitrite (κ = 0.884), moderate for blood and colony count (both κ = 0.656), weak for culture species (κ = 0.566), and minimal for leukocyte esterase (κ = 0.382). When data were stratified for menopause, vaginal estrogen use, body mass index, and prolapse, there were no clinical scenarios in which the κ values were consistently greater than our accepted value of 0.7. Our data indicate that catheterized urine specimens should be used in the evaluation of urinary tract infection or microscopic hematuria in the typical patient presenting to a urogynecology office who is often menopausal, overweight, and may have prolapse.

Associations of kidney tests at medical facilities and health checkups with incidence of end-stage kidney disease: a retrospective cohort study

No study has assessed the association between no health checkup and end-stage kidney disease (ESKD). This retrospective cohort study, including 69,147 adults aged ≥ 40 years in Japan who were insured by the National Health Insurance and the Late-Stage Medical Care System for the Elderly, assessed the associations of kidney tests at medical facilities and health checkups with incident ESKD. The main exposure was the histories of kidney tests using dipstick urinalysis and/or serum creatinine measurement at medical facilities and checkups in the past year: “checkups,” “no kidney test (without checkup),” and “kidney tests (without checkup)” groups. During the median observational period of 5.0 years, ESKD was observed in 246 (0.8%) men and 124 (0.3%) women. The “no kidney test” group was associated with ESKD in men (adjusted subhazard ratio of “no kidney test” vs. “checkups”: 1.66 [95% confidence interval, 1.04–2.65], but not in women. Age-specific subgroup analyses identified the “no kidney test” group as a high-risk population of ESKD in elderly men (1.30 [0.70–2.41] and 2.72 [1.39–5.33] in men aged 40–74 and ≥ 75 years, respectively). Elderly men with no kidney test at medical facilities and no health checkup were at higher risk of ESKD.

Prevalence of leukocyturia in a cohort of French asymptomatic aircrews

ObjectivesSexually transmitted infections (STIs) can cause leukocyturia. We aimed to estimate the prevalence of leukocyturia in asymptomatic aircrews and the proportion of STIs in those presenting leukocyturia. MethodsThe LEUCO survey was a prospective cohort study conducted among aircrews between 14th October 2019 and 13th March 2020 at the Toulon aeromedical centre in France. All participants performed a dipstick urinalysis. Those positive for leukocyturia were offered STI screening by nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis. ResultsAmong the 2236 included asymptomatic participants (1912 men and 324 women), 127 (36 men and 91 women) were positive for leukocyturia. The prevalence of leukocyturia was 1.9% (1.3–2.6) in men and 28.1% (23.3–33.3) in women (p < 0.001). In men positive for leukocyturia, the NAAT positivity rate for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis was 28.6% (3.7–71.0) in the age group 18–24, 20.0% (0.5–71.6) in the age group 25–34, and zero in the older age group (p 0.65). In women positive for leukocyturia it was 16.7% (4.7–37.4) in the age group 18–24, 18.2% (2.3–51.8) in the age group 25–34, and zero in the older age group (p 0.16). ConclusionsIn asymptomatic individuals, leukocyturia is rare in men and more common in women. In asymptomatic adults under 35 years of age with leukocyturia, multiplex NAAT shows a high proportion of STIs and might be useful in improving STI detection.

Proteinuria in hospitalised internal medicine adult patients

RationaleDipstick proteinuria may be a sign of a renal disorder, false-positive or associated with acute disease, and consequently, transient in hospitalised patients.ObjectiveTo assess (a) the prevalence of proteinuria in hospitalised...

Validity of dipstick urinalysis for predicting urinary tract infection in febrile children aged 2-12 years in a tertiary care centre, South Kerala

Background: Urinary tract infection (UTI) warrants an early accurate diagnosis in children. Use of rapid diagnostic tests like urine dipstick and microscopy was found to be economical and effective. There is lack of sufficient studies on rapid diagnostic tests in developing countries like India. This study looked at the single as well as combination of parameters that provided maximum sensitivity and specificity, providing a better diagnostic criterion in detecting UTI. The objective was to assess the diagnostic validity of urinary dipstick in the diagnosis of UTI in comparison with urinary culture.Methods: This cross-sectional diagnostic evaluation study was conducted in a tertiary care centre in Southern Kerala. Total of 75 children between the age group of 2 years to 12 years who attended the paediatric OPD with the clinical features of UTI were included in this study. Two urine samples were obtained in sterile containers. The first urine sample was assessed with dipstick and the second sample was sent for culture to confirm the UTI. The results obtained were analysed using SPSS software.Results: Using culture as gold standard, the results for nitrate alone had lower sensitivity at 69.69%, specificity at 90.4%. The results for LE (LE) alone had higher sensitivity at 81.8%, specificity at 80.95% and the results for combined urine dipstick had higher sensitivity at 84.8% than individual nitrite and LE. The combined positive predictive value (PPV) was lower than individual nitrite and LE 75.6%. The combined negative predictive value (NPV) was higher than individual LE and nitrite at 86.8%.Conclusions: Dipstick urinalysis alone may not be a completely adequate screening tool for UTI. Since urine dipstick test has high sensitivity it can be used as a bedside tool in detecting UTI in children.

MP34-19 HEMATURIA REFERRALS AT A SAFETY NET HOSPITAL: A FOCUS ON PATIENT DEMOGRAPHICS AND COMPLIANCE

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-19 HEMATURIA REFERRALS AT A SAFETY NET HOSPITAL: A FOCUS ON PATIENT DEMOGRAPHICS AND COMPLIANCE Liz Wang, Remington Lim, Christopher Noyes, Batsheva Rubin, Shaun Wason, and David Wang Liz WangLiz Wang More articles by this author , Remington LimRemington Lim More articles by this author , Christopher NoyesChristopher Noyes More articles by this author , Batsheva RubinBatsheva Rubin More articles by this author , Shaun WasonShaun Wason More articles by this author , and David WangDavid Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hematuria accounts for over 20% of referrals to urology with completion rates of only 5-18%. Our study characterizes the referral trends for hematuria and analyzes the socioeconomic factors affecting follow-up appointment rates at a safety net hospital. METHODS: We performed a retrospective review of patients referred to urology at an urban safety net hospital for microscopic and gross hematuria from 2018-2019. Demographics of patients were analyzed with an emphasis on gender, race, language, and insurance status. Appropriateness of the referral and completion of the workup, including imaging and cystoscopy, were studied. Univariate analysis was performed using chi-square test, Fisher’s exact test or t-test, and odds ratios were calculated. RESULTS: 333 patients were referred for microscopic or gross hematuria. We excluded 45 patients who did not show for consultation and 53 patients with a known history of genitourinary malignancy or urolithiasis. 59.2% patients had a pre-referral urinalysis with microscopy and 28.9% had a urine culture. 5.5% patients had only a dipstick urinalysis and 16.2% had no urine studies. The majority of patients were non-White (68.5%), publicly insured (75.3%). 40.8% were non-English speaking. Only 150 (63.8%) completed the hematuria workup with both upper tract imaging and cystoscopy. Of the remaining 85, 28 missed cystoscopy, 26 missed imaging, and 31 missed both. Odds of completing a hematuria evaluation was not significantly associated with any factors, including age, gender, BMI, smoking status, race, language, insurance status, or referral center. CONCLUSIONS: Within an urban safety net hospital system, 40% of hematuria referrals were missing the recommended urinalysis with microscopy. Although workup completion rates were higher compared to prior studies, they remain relatively low regardless of socioeconomic factors. Stratified 2020 AUA hematuria guidelines, which obviate the need for cross sectional imaging, may improve hematuria completion rates. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e623-e624 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Liz Wang More articles by this author Remington Lim More articles by this author Christopher Noyes More articles by this author Batsheva Rubin More articles by this author Shaun Wason More articles by this author David Wang More articles by this author Expand All Advertisement Loading ...

Working Conditions and Urinalysis Dipstick Testing among Female Rice Farmers: A Preliminary Cross-Sectional Study.

This cross-sectional study aimed to assess working conditions and renal function among female rice farmers in Nan Province, Thailand. Purposive random sampling was used to select participants who met the inclusion criteria. Data were collected from 65 female rice farmers using in-depth interviews. A walk-through survey was performed to examine hazards in the rice farm and a dipstick test was used for urinalysis. The results demonstrated that all rice farming stages contained risks from physical, chemical, biological and ergonomic hazards and that no measures had been implemented to protect participants’ health from these risks. The screening test results showed low urinary pH (5–6) in 54 women (83.0%), but high urinary specific gravity (1.030) in 25 women (38.5%). Participants’ urine contained leukocytes in 15 women (23.1%), protein in 14 women (21.5%) and blood in 13 women (20%). This study results suggest that farming activities affect female rice farmers’ health and safety. Urinalysis dipstick tests, which can be administered at the local public health promoting hospital, should be used to assess the occupational health status. The results will be useful for health surveillance and follow-up of the participants. These preliminary findings need to be confirmed in a larger study including non-farmers.

Effect of Renin-Angiotensin-Aldosterone System Blocking Agents on Progression of Glomerulopathy in Sickle Cell Disease

▪Introduction: Chronic kidney disease (CKD) is common in patients with sickle cell disease (SCD) and is associated with increased mortality. Current practice guidelines recommend treatment of albuminuria with angiotensin converting enzyme (ACE) inhibitors in hopes of slowing the decline in kidney function. Although short-term studies of ACE inhibitors show significant reductions in albuminuria, there are no published long-term studies of the consequences of treatment with these agents in patients with SCD. The purpose of this study was to evaluate the effect of ACE inhibitors/angiotensin receptor blockers (ARBs) on proteinuria and estimated glomerular filtration rates (eGFR) over time in adult patients with SCD. We also evaluated the effect of treatment with these renin-angiotensin-aldosterone system (RAAS) blocking agents on mortality.Methods: We conducted a retrospective study of patients seen between January, 2004 and December, 2013 at an adult Sickle Cell Clinic. Clinical and laboratory variables were obtained from medical records. Proteinuria (at least 1+) was ascertained by dipstick urinalysis. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Patients had confirmed diagnoses of SCD, were at least 18 years old, and were evaluated during routine clinic visits. Mixed effects models were fit to ascertain the effect of RAAS blocking agents on proteinuria and eGFR over time among individuals who had a history of proteinuria. We included interaction terms between laboratory variables, time and treatment to evaluate the effect of these variables on the response to treatment over time, controlling for age and sex. Cox regression model was used for mortality analysis.Results: Four hundred and forty seven patients with SCD (SS = 280, SC = 102, Sb0 = 22, Sb+ = 33, SE = 2, SLepore = 2, SD = 2, SHPFH = 4), median age of 28.5 years (IQR: 20 - 40 years) and 238 females (53%) were evaluated. The median duration of follow-up was 2.8 years (IQR: 0.99 - 6.3 years). Patients on RAAS blocking agents for proteinuria (N = 65) had significantly greater odds of proteinuria over time vs. patients with proteinuria but not receiving RAAS blocking agents (N = 112) (estimate: 0.87 [95% CI : (0.78, 0.96) 0.053], p = 0.008). No significant difference was seen in the decline of eGFR in patients on RAAS blocking agents vs. patients with proteinuria not receiving such treatment (estimate: 0.43 [SE: 0.31], p = 0.17). In age- and sex-adjusted univariate analysis for laboratory variables, higher baseline hemoglobin, hemoglobin F, WBC count, and lower baseline LDH were significantly associated with lower treatment effect on the rate of change in log-odds of proteinuria over time (Table 1). In the multivariable analysis, hemoglobin F was associated with lower treatment effect on the rate of change in log-odds of proteinuria over time (estimate: -0.077 [SE: 0.03], p = 0.012).Presence of proteinuria at baseline was associated with an increased risk of death (HR: 2.74 [95% CI: 1.51, 5.0], p = 0.001). In addition, higher eGFR was associated with a lower risk of death (HR: 0.98 [95% CI: 0.97, 0.98], p < 0.0001). Treatment with RAAS blocking agents was not associated with a decreased risk of death (HR: 1.48 [95% CI: 0.38, 1.53], p = 0.33).Conclusion: Treatment with RAAS blocking agents was not associated with a decline in eGFR, but was surprisingly associated with greater odds of proteinuria. Furthermore, although both proteinuria and decrease in eGFR were associated with an increased risk of death, treatment with RAAS blocking agents had no significant effect on the risk of death. Prospective studies are needed to evaluate the effect of RAAS blocking agents on progressive kidney disease in patients with SCD. [Display omitted] DisclosuresAtaga:Global Blood Therapeutics: Research Funding; Global Blood Therapeutics: Honoraria; Novartis: Membership on an entity's Board of Directors or advisory committees; Reprixys Pharmaceuticals Corporation (formerly known as Selexys Pharmaceuticals Corporation, which is not affiliated with Selexis S.A.): Research Funding; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria.

Urinary Specific Gravity Decreases over Time in Adult Sickle Cell Patients

▪Introduction: Altered urinary concentration is one of the earliest and most common features of kidney disease in patients with sickle cell disease (SCD). This phenomenon is reversible in early age by transfusion but becomes fixed with time. Little data exist as to which additional clinical features are associated with impaired urinary concentration. Further, longitudinal changes in urinary concentration over time in adults have not been examined.Methods: We conducted a retrospective study of adult sickle cell patients seen between January, 2004 and December, 2013 at a single center. Clinical and laboratory variables were abstracted from medical records. Specific gravity was assessed from random dipstick urinalysis results. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Patients had confirmed SCD, were at least 18 years old, and were evaluated during routine clinic visits. Mixed effects models were fit to evaluate the change in specific gravity over time. Clinical and laboratory variables, including measures of kidney function or disease, hemolysis markers and associated comorbidities, were evaluated for their association with baseline specific gravity and on specific gravity over time in age- and sex-adjusted analyses. We also compared those with severe phenotypes (SS/Sβ0) to those with mild phenotypes (SC/Sβ+). A multivariable model was constructed utilizing covariates identified in univariate analyses with a final model produced via backward elimination with age and sex adjustment retained. We included interaction terms between covariates and to evaluate the longitudinal association of these variables on change in specific gravity. We also employed similar approaches in analyses stratified for those with SS and Sβ0 disease from those with milder SC and Sβ+disease.Results: Four hundred and forty-seven patients with SCD (SS = 280, SC = 102, Sβ0 = 22, Sβ+ = 33, SE = 2, SLepore = 2, SD = 2, SHPFH = 4) were followed over a median duration of 2.8 years (IQR: 0.99 - 6.3 years). Median age was 28.5 years (IQR: 20 - 40 years) and 238 were female (53%). Over time, specific gravity decreased (-0.00011 per year, SE 0.000030; p=0.0002). In stratified analysis, patients with SS/Sβ0 had a similar decrement (-0.00011, SE 0.000032; p=0.0005) while SC/Sb+ had a slightly lower decline (-0.00008, SE 0.000079; p=0.3) that was not statistically significant. Patients with SS/Sβ0 trended toward slightly higher baseline specific gravity (0.00079, SE 0.00035; p=0.03) compared to SC/Sb+ patients. At baseline, hemoglobin level (0.00017, SE 0.000079; p=0.03) and hemoglobinuria (0.00096, SE 0.00046; p=0.04) were associated with higher specific gravity. In multivariate modeling, only hemoglobinuria (0.0012; SE 0.00048; p=0.01) and SS/Sβ0 phenotypes (0.00096, SE 0. 00036; p=0.009) were associated with higher specific gravity. Over time, ferritin; (-0.00011, SE 0.000048; p=0.02) and priapism in men (-0.00029, SE 0.00010; p=0.006) were associated with annual decline in specific gravity. Use of angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) (0.00018, SE 0.000076; p=0.02) was associated with a rise in specific gravity. In multivariate analyses, only ferritin (-0.00012, SE 0.000048; p=0.01) was associated with annual decline in specific gravity When evaluated separately, SS/Sβ0 demonstrated nearly identical findings in multivariate analysis for ferritin (-0.00013, SE 0.000057; p=0.02).Conclusion: Even in adult patients with SCD, specific gravity declines over time, and decline may be more prominent in those with SS/β0. Higher ferritin, a measure of iron overload, is associated with greater decline in specific gravity. Future prospective studies of kidney disease in SCD patients should include measures of specific gravity to better understand this phenomenon and its long-term consequences. DisclosuresAtaga:Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Reprixys Pharmaceuticals Corporation (formerly known as Selexys Pharmaceuticals Corporation, which is not affiliated with Selexis S.A.): Research Funding; Global Blood Therapeutics: Research Funding; Global Blood Therapeutics: Honoraria; Novartis: Honoraria; Novartis: Membership on an entity's Board of Directors or advisory committees.

Purple urine bag syndrome is a rare manifestation of bacteriuria on bladder catheter: case report

BackgroundPurple urine bag syndrome (PUBS) is a complication of bacterial colonisation of bladder catheters in which urine turns purple in the tubing, as well as in the catheter bag. This rare phenomenon can be very worrisome and stressful for the patients and their families, as well as for the healthcare team taking care of them. Recognising this complication is essential in order to avoid misdiagnosis and erroneous treatment. We report a case of PUBS in a 71-year-old female patient.Case presentationA 71-year-old woman with previous medical history of schizophrenia was admitted to the emergency department for anorexia and suspicion of psychotic decompensation. Acute urine retention and rectal faecal impaction were clinically suspected and confirmed by bladder ultrasound and rectal examination, respectively. The patient underwent bladder catheterisation as well as a rectal enema. The day after her admission, our medical team was approached by the nurse in charge of the patient because of purple urine in her catheter bag and tubing. The diagnosis of PUBS was made with the help of the Oxford urine chart. A dipstick urinalysis revealed alkaline urine (pH = 8), and the urine culture was subsequently positive for Proteus mirabilis, which is sensitive to quinolones, beta-lactams and nitrofurantoin. The bladder catheter was changed. The patient received empiric antibiotic therapy with Levofloxacin 500 mg once daily. After obtaining the antibiogram, the targeted antibiotic therapy was adapted with oral Cefuroxime 500 mg three times a day for a total duration of seven days of antibiotic therapy. There was no recurrence of purple urine.ConclusionPUBS is a rare complication of bacteriuria, which induces a purple colouration of the tubing as well as the catheter bag. It is a simple spot diagnosis, as there is no other known cause of purple urine. This is why we believe that the Oxford urine chart represents a very interesting and easily accessible tool to help clinicians to investigate any abnormal urine colour.

The Sensitivity and Specificity of White Blood Cells and Nitrite in Dipstick Urinalysis in Association With Urine Culture in Detecting Infection in Adults From October 2016 to October 2019 at King Abdulaziz Medical City.

BackgroundUrinary tract infection (UTI) is one of the most common clinical presentations that exhaust the patients and confuse physicians. Some of the risk factors that contribute to UTIs are age, female gender, and diabetes. Urinalysis is used to detect abnormalities in the urine, such as the presence of leukocytes, blood, and nitrite. However, urinalysis accuracy depends on the patient and the analyzer. On the other hand, urine culture is considered gold standard for diagnosing UTI. For that, the aim of this study is to determine the sensitivity of white blood cells (WBC) and nitrite in dipstick urinalysis in detecting UTI.MethodsA cross-sectional study was conducted at King Abdulaziz Medical City on adult patients aged 19-65 years who underwent dipstick urinalysis and culture at the same visit from October 2016 to October 2019. The data were collected from the medical records from all the departments by using a data collection sheet through Best Care system. The sample was selected conveniently, and it was determined to be 359 patients with a confidence interval of 95%. Data were analyzed using IBM SPSS version 20 (IBM Corp., Armonk, NY, USA). Chi-square test was used to analyze the association between the outcome and the results of the dipstick urinalysis and urine culture. P-value lower than 0.05 was considered significant.ResultsThree hundred and fifty-nine patients were included into the study with a majority of females (81.1%) with a mean age of 47.5 years. Two hundred and fifty-two patients were culture positive, WBC sensitivity and specificity were 62.7% and 100%, and nitrite sensitivity and specificity were 20.6% and 93.5%, respectively. Ninety-nine diabetic patients were culture positive; for diabetic patients, WBC sensitivity and specificity were 65.7% and 100% and nitrite sensitivity and specificity were 18.2% and 97.6%, respectively, while for non-diabetic patients, WBC sensitivity and specificity were 60.85% and 100% and nitrite sensitivity and specificity were 22.2% and 90.8%, respectively.ConclusionOur study showed that results of WBC are more sensitive and specific than those of nitrite in comparison to the gold standard (urine culture). Diabetics and non-diabetics have slightly different results. According to our results it is difficult to depend on the dipstick urinalysis without culture. More studies are recommended in this field.

MO509DOSE-RESPONSE RELATIONSHIP BETWEEN ALCOHOL CONSUMPTION AND THE RISK OF DEVELOPING CKD: RETROSPECTIVE COHORT STUDY

Abstract Background and Aims Drinking habits are one of the most important modifiable lifestyle factors to prevent the development of chronic kidney disease (CKD). Previous studies showed that it was inversely associated with the risk of developing CKD, but the dose-response relationship between alcohol consumption and the development of CKD is still controversial. In the present study, we aimed to examine whether the amount of alcohol consumed at one time is associated with new onset of CKD in general population. Method Study subjects were 11,162 Japanese aged 45 to 74 years, with an estimated glomerular filtration rate ≥60 mL/min/1.73m2, no proteinuria, no past history of cardiovascular disease, COPD or liver disease. The drinking status was obtained by self-administered questionnaires. We categorized the study subjects into four groups based on the amount of alcohol consumption: &amp;lt;20g/time of ethanol equivalent (lowest); 20-40g/time (low intermediate); 40-60g/time (high intermediate); &amp;gt;60g/time (highest). We set non-drinkers as a reference category. The primary outcome was the incidence of CKD, defined as 25% reduction of eGFR and to less than 60 mL/min/1.73 m2 and/or a dipstick urinalysis score of 1+ or greater (equivalent to ≥30 mg/dL) during the follow up period. We employed Cox proportional hazards regression models to examine the dose-response relationship between baseline alcohol consumption and the risk of CKD. Trend tests were performed using Cox proportional hazards regression models that treated alcohol consumption as a continuous linear term. Results Lowest and low intermediate groups were significantly associated with a decreased risk of CKD (hazard ratio [HR] 0.84; 95% confidence interval [CI], and 0.71–0.99; HR 0.79; 95% CI, 0.66–0.96, respectively) compared to non-drinkers. High intermediate group was associated with a decreased risk of CKD (HR 0.92; 95% CI, 0.70–1.21), and highest group was associated with an increased risk of CKD (HR 1.28; 95% CI, 0.84–1.95), but these associations did not reach statistical significance. There was no dose-response relationship between baseline alcohol consumption and risk of CKD (P-trend = 0.30). Conclusion A J-shape association was observed between self-reported alcohol intake and the incidence of CKD. Moderate alcohol consumption at one time may help reduce the risk of CKD.

Low-Cost, Volume-Controlled Dipstick Urinalysis for Home-Testing.

Dipstick urinalysis provides quick and affordable estimations of multiple physiological conditions but requires good technique and training to use accurately. Manual performance of dipstick urinalysis relies on good human color vision, proper lighting control, and error-prone, time-sensitive comparisons to chart colors. By automating the key steps in the dipstick urinalysis test, potential sources of error can be eliminated, allowing self-testing at home. We describe the steps necessary to create a customizable device to perform automated urinalysis testing in any environment. The device is cheap to manufacture and simple to assemble. We describe the key steps involved in customizing it for the dipstick of choice and for customizing a mobile phone app to analyze the results. We demonstrate its use to perform urinalysis and discuss the critical measurements and fabrication steps necessary to ensure robust operation. We then compare the proposed method to the dip-and-wipe method, the gold standard technique for dipstick urinalysis.

Low-Cost, Volume-Controlled Dipstick Urinalysis for Home-Testing

Low-Cost, Volume-Controlled Dipstick Urinalysis for Home-Testing

Risk Factors Associated With Abnormal Urinalysis in Children.

Background: Targeted urinalysis has been suggested to improve screening efficiency in adults. However, there is no well-defined target population in children yet, with limited information on the risk factors for urinalysis abnormalities.Methods: Children from infants to 17 years old were randomly selected. Dipstick urinalysis was initially performed. Among those who were abnormal, a repeat dipstick or dipstick with microscopic urinalysis was performed for confirmation.Results: In total, 70,822 children were included, with 37,866 boys and 32,956 girls. Prevalence of abnormal urinalysis was 4.3%. Age was significantly associated with abnormal urinalysis, with the highest prevalence among 12–14-year-olds. Girls were 2.0 times more likely to exhibit abnormalities. Compared with children whose guardians had a college degree or higher, those whose guardians had a high school degree or lower had a higher likelihood of abnormalities. Geographic location was also associated with abnormal results.Conclusion: Girls, children aged 12–14 years old, and children whose guardians had a low educational level and children in certain geographic locations were significantly associated with abnormal urinalysis. Identification of children at high risk would contribute to targeted urinalysis screening.