Dipstick Urinalysis Research Articles

Discrepancy in results between dipstick urinalysis and urine sediment microscopy.

With the advancement of urine test automation and the large-scale application of quality management policies, the source of the most crucial errors has become the pre-analytical phase. This study is an attempt to compare the results obtained from the examination of urine strips with those obtained by microscopic examination of urinary sediment, highlighting discordant results. This observational study was conducted between February and August 2019 in a private medical laboratory in Mureş County, and 2,600 urine samples were analyzed. We calculated the sensitivity, specificity, positive predictive value, negative predictive value for leukocytes, nitrites and red blood cells, taking as reference the microscopic examination of urine summary screening. Urine samples were collected from patients who presented to the laboratory. The 2,600 urine samples were analyzed using strips with 10 parameters: glucose, protein, bilirubin, urobilinogen, pH, specific density, red blood cells, nitrite, and leukocytes, and then using the microscope to examine the urinary sediment. We identified a small percentage (1.92%) of inconsistencies from the 2,600 samples of urine, between urinalysis and the microscopic examination and we identified the causes. The most common discordant results were: false-negatives for nitrite (72%), followed by false-positives results for red blood cells (22%), false-negative results for leukocytes (16%), false-negative results for red blood cells (4%) and false-positives for leukocytes (4%). The study confirmed that discrepancies appear despite the proper instruction of patients.

Leukocyturia and Sexually Transmitted Infections: A Cohort Study of 2236 Asymptomatic Adults

Background: Sexually transmitted infections (STIs) can cause leukocyturia in asymptomatic patient. We aimed to evaluate leukocyturia prevalence in asymptomatic aircrew and STIs proportion in leukocyturia. Methods: The LEUCO survey was a prospective, monocentre cohort study among aircrew, done at aeromedical center in France. Aircrews were included during five months. Systematic dipstick urinalysis leukocyturia result was collected. Participants with leukocyturia were proposed to perform a Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis, nucleic acid amplification test (NAAT). We calculated leukocyturia prevalence and STIs proportion among this. We used a logistic regression model to search for associations between leukocyturia and variables collected. This study was registered in our Institutional Review Board, number IRB 0011873202022. Findings: Between Oct 14, 2019, and Mar 13, 2020, 2236 participants performed dipstick urinalysis, of whom 127 (5.7%) had a leukocyturia. The prevalence of leukocyturia was significantly different between men, 1.9% (1.3−2.6) and women, 28.1% (23.3−33.3) (p<0.001). Female gender was associated with leukocyturia OR 21.6 (13.1−36.4) (p<0.001). In men with leukocyturia, NAAT positivity rate was very high in the 18-24 age group, 28.6% (3.7−71.0) and in the 25-34 age group, 20.0% (0.5-71.6). In women with leukocyturia, it was high in the 18-24 age group, 16.7% (4.7−37.4) and in the 25-34 age group, 18.2% (2.3−51.8). Interpretation Leukocyturia is rare in asymptomatic subjects. Patients with leukocyturia under 35 years old have high proportion of STIs. Multiplex NAAT has utility for STIs diagnosis in asymptomatic subjects under 35 years old presenting a leukocyturia. Trial Registration: Trial number IRB 0011873202022. Funding: French Army Health Service Declaration of Interest: None to declare. Ethical Approval: The survey received a favorable ethical opinion from the clinical trials validation commission of the Sainte-Anne military hospital Toulon, France, registered as an Institutional Review Board (IRB 0011873202022 ).

Schistosomiasis in Norwegian students after travel to Africa.

Schistosomiasis is a tropical infectious disease in which early diagnosis and treatment can prevent serious illness. This study examined the incidence and diagnosis of schistosomiasis in Norwegian exchange students who had been exposed to freshwater in Africa. Students (n = 318) from Bergen and Oslo who had travelled to Africa as part of an exchange programme in the period 2003-18, were contacted and included in the study if they had been exposed to freshwater during their stay. A routine workup was performed comprising Schistosoma antibody testing, microscopy and/or PCR analysis of urine and faeces, dipstick urinalysis, and blood samples for analysis of eosinophilic granulocytes, creatinine and total IgE. Time, place and type of exposure were recorded in a questionnaire, along with symptoms. Schistosoma antibodies were detected in 46 (30%) of the 151 students included in the study. None of the seropositive individuals had eggs detected in their urine or faeces, and none had eosinophilia. Two students reported cercarial dermatitis, while one had symptoms consistent with acute schistosomiasis. Rafting was the only form of freshwater exposure reported by 22 (55%) of the 40 seropositive individuals. A large proportion of the students who had been exposed to freshwater were diagnosed with schistosomiasis. The majority reported no symptoms. Rafting was the most common form of exposure. All were diagnosed by serologic tests, while other routine diagnostic tests for schistosomiasis proved less useful. Serological analysis should be the preferred form of testing for the diagnosis of schistosomiasis in travellers.

Spot Urine Protein-to-Creatinine Ratio Compared with Dipstick Proteinuria as a Primary Screening Tool for Renal Disease in a Community Setting.

The Kidney Disease: Improving Global Outcomes (KDIGO) advocates the use of dipstick proteinuria as a primary screening tool. However, the performance of dipstick urinary for proteinuria has been adjudged to be weak, unreliable with poor predictive value. This study aimed to determine and compare significant proteinuria (SP) using spot urinary protein-to-creatinine ratio (UPr/UCr) as a primary screening tools with dipstick proteinuria among the high-risk African children. This study was a cross-sectional study, involving 33 schools in Ogbomoso land, Southwestern Nigeria. A total of 1316 apparently healthy children were recruited through a multistage sampling technique from both rural and urban communities using a semi-structured questionnaire. Dipstick urinalysis was performed on early morning urine samples. Urinary protein was determined using a turbidimetric method, while Jaffe's reaction was used to measure urinary creatinine concentration. Statistical analysis was performed using IBM SPSS Statistics version 23.0 for Windows. The prevalence of SP using spot UPr/UCr (≥0.2) and dipstick proteinuria (≥1+) was 18.0% and 0.8%, respectively (P <0.001). Of the 224 subjects with SP using UPr/UCr, the females (140; 20.1%) had higher proportion of SP compared to males (84; 15.4% - P = 0.032). Nephrotic range proteinuria was detected in 9/10 (90%) using UPr/UCr, while urinary dipstick method identified only 3/10 (30%). A biserial correlation coefficient (r = 0.092; P =0.001) and inter-rater agreement (Cohen's Kappa = 0.01) were poor and McNemar's test was P<0.0001. In the community, UPr/UCr ratio appeared to perform better than dipstick as a primary screening tool for renal disease and may be adopted in the early detection of SP as a marker of kidney disease against the current KDIGO guideline of dipstick proteinuria.

A comparative study on the prevalence and intensity of urinary schistosomiasis among primary (formal) and almajiri (informal) school pupils in kura local government area of Kano State, Nigeria.

Urinary schistosomiasis remains one of the most prevalent neglected tropical diseases in the world today, particularly in developing countries including Nigeria. Chronic infection can affect the genitourinary system. School pupils, particularly the informal Almajiri school pupils are at increased risk of the infection. The objective of this study was to determine and compare the prevalence and intensity of urinary schistosomiasis among primary and Almajiri school pupils in Kura Local Government Area (LGA) aged 5-15 years. We also aim to determine the presence of haematuria and proteinuria among these pupils. It was a cross-sectional comparative study involving 200 primary and 200 Almajiri school pupils aged 5-15 years in Kura LGA who met the inclusion criteria. Urine samples were analysed by the dipstick urinalysis and microscopically examined for the egg S. haematobium. The Almajiri school pupils had a significantly higher infection (55.5%) than the primary school pupils (43.0%). The infection was predominantly of light intensity in both school types (67%). The overall mean egg intensity was 51.6 ± 35 EPC. The infection was higher among boys and those aged 10 years and above. Majority of the pupils had microhaematuria (88.3%) and and proteinuria (71.1%), which were statistically significantly associated with the infection with P < 0.1 and P < 0.001, respectively. The prevalence of urinary schistosomiasis is higher among the Almajiri school pupils compared to the primary school pupils. Control programmes should focus on these Almajiri pupils in addition to the primary school pupils.

Availability and Affordability of Kidney Health Laboratory Tests around the Globe

Background: Kidney disease is a major global public health problem, and laboratory testing of kidney health measures is essential for diagnosis and monitoring. The availability and affordability of kidney health laboratory tests across countries has not been systematically described. Methods: The International Society of Nephrology (ISN), in partnership with leaders of a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, surveyed a representative subset of ISN-Global Kidney Health Atlas (ISN-GKHA) respondents from April to June 2020. We assessed the association between country gross national income (GNI) per capita and laboratory testing availability and affordability. Results: Of 33 regional expert nephrologists invited, 24 (73%) responded, representing all 10 ISN regions around the world. Availability of kidney health laboratory tests was as follows: serum Cr (100%), serum cystatin C (67%), urine albumin (96%), urine Cr (100%), and dipstick urinalysis (100%). Median (IQR) reimbursement values in international dollars were as follows: serum Cr Int$ 6.61 (3.42–8.84), serum cystatin C Int$ 31.51 (17.36–46.25), urine albumin Int$ 10.22 (5.90–15.42), urine Cr Int$ 7.50 (1.66–8.84), and dipstick urinalysis Int$ 6.26 (2.56–8.40). Reimbursement values did not differ significantly by World Bank income group or by GNI per capita. Conclusion: There was widespread availability of kidney health laboratory tests and substantial variation in reimbursement values. To achieve meaningful progress across nations in mitigating the growth of kidney disease, access to affordable diagnostic technology is essential. Our results are highly relevant to policymakers and researchers as countries increasingly consider national strategies for kidney disease detection and management.

Asymptomatic Bacteuria among Healthy Cohort Using Dipstick Urinalysis from a Tertiary Health Care Facility in South East Nigeria

Dipstick urinalysis is a simple and cost effective method for screening of urinary abnormalities, thus enabling early detection and prompt management of renal pathologies. The aim of the study was to determine the pattern of urinalysis profile among apparently healthy cohorts using medical doctors of Nnamdi Azikiwe University Teaching Hospital. One hundred (100) medical doctors aged 20 to 50 years were selected through convenience sampling in a descriptive cross sectional study from August 20, 2020 to September 10, 2020. Ninety-One (91%) had their urine tested with dipstick test strips by Wellkang Ltd. Abnormal urinary findings occurred in 48 (52.8%) of the subjects which were blood 5 (5.50%), glucose 8 (8.80%), protein 15 (16.50%), nitrite 10 (11.00%), leucocyte 6 (6.60%) and Ascorbic acid 4 (4.40%). The prevalence of urine abnormality was higher in the 25-30year age group (48.4%), though not statistically significant (P&gt;0.05). No significant association existed between pH and urine abnormality (p=0.5). No significant association existed between specific gravity and urine abnormality (p=0.5). It was concluded that the prevalence of urine abnormalities was significantly high (52.8%) with proteinuria and (11.0%) nitrites being the commonest abnormalities. Routine dipstick urinalysis is a cheap and simple method for early identification of urine abnormalities in apparently healthy cohorts using medical doctors and a positive dipstick test for proteinuria should prompt further evaluation for the presence of kidney disease. It is recommended that Urinalysis should be instituted as a routine test for medical doctors in hospitals because of its importance in disease surveillance.

Diapers as Promising Alternative Collection Method for Urine Specimens in Nursing Home Residents: A Noninferiority Study

ObjectiveThere is unmet need for an easy, noninvasive urine collection method to diagnose urinary tract infections (UTIs) in nursing home residents suffering from urinary incontinence or cognitive impairments. UTIs are highly prevalent in nursing home residents, and urine specimen collection can be difficult. The objective of this study was to assess if urine specimens collected from super-absorbing incontinence pads (adult diapers) are a reliable collection method for UTI diagnosis. DesignThis was a paired noninferiority laboratory study, in which pairing refers to UTI diagnostics performed directly using clinical urine specimens (reference specimen) and indirectly using urine extracted from diapers (diaper specimen). Setting and participantsIn this study, remnants of 250 clinical urine specimens were used to assess noninferiority in diagnosing UTIs, based on a 1-sided type I error of 2.5%, a power of 90%, and a noninferiority margin of 15%. MethodsUrine specimens were poured on super-absorbing disposable adult diapers and extracted after 3 hours, to use for dipstick urinalysis and bacterial culture. UTIs were defined as presence of leukocytes and a positive bacterial culture. Noninferiority was assessed by calculating a Wald-type test statistic. ResultsNoninferiority was established for diagnosing UTIs in diaper specimens, and for each of its components (dipstick leukocyte detection and bacterial culture positivity). Positive bacterial cultures were found in 72 (29.0%) diaper specimens compared with 65 (26.2%) reference specimens (difference −2.8%, 97.5% CI −7.1% to 1.5%). Leukocytes were present in 162 (64.8%) diaper specimens, compared with 175 (70.0%) reference specimens (difference −5.7%, 97.5% CI: −10.6% to −0.7%). Conclusion and implicationsOur results on diagnosing UTIs, by dipstick analysis and bacterial cultures, using super-absorbing adult diapers are promising. Before translation into clinical practice, further studies are needed to evaluate the risk of bacterial contamination by wearing adult diapers, possibly resulting in overdiagnosis of UTI.

Dipstick Urinalysis Can Identify Patients with Early CKD Who Lack a Quantified Proteinuria Measurement

Dipstick Urinalysis Can Identify Patients with Early CKD Who Lack a Quantified Proteinuria Measurement

Values of urinalysis dipstick in evaluating high-protein, low-carbohydrate, low-fat diets in male wistar rats

One popular diet pattern currently recommends a high-protein, low-carbohydrate diet as a weight-loss strategy in obese patients. Diets high in protein appear to reduce appetite, energy intake, body weight, and fat buildup. The purpose of this study was to determine the effect of long-term high-protein, low-carbohydrate and low-fat (TPRKRL) diets on body function. With a focus on urine analysis using the urinalysis dipstick and the Urine Analyzer Verify U120 tool from 22 samples of male Wistar rats that were given the standard diet and the TPRKRL diet for 8 weeks. The results showed that the TPRKRL diet on 8 variables had lower mean values than standard rats and there were significant differences in leukocyte counts, pH, specific gravity, ketones and bilirubin between the two groups. Whereas in the urobilinogen, protein and blood variables there were no significant differences. As well as other parameters namely nitrite and glucose abnormal abnormalities were not found.

Urinalysis and Urine Culture

Key Points Bagged specimens are adequate for dipstick urinalysis but not urine culture. Routine screening urinalysis for asymptomatic patients is not recommended. Proteinuria, hematuria, glucosuria, and positive nitrites and/or leukocyte esterase on dip urinalysis requires further workup.

Reliability of urinalysis for identification of proteinuria is reduced in the presence of other abnormalities including high specific gravity and hematuria

Chronic kidney disease (CKD) is classified according to cause, glomerular filtration rate, and proteinuria. Identification of proteinuria with urinalysis (UA) is less accurate than quantification via other methods. We investigated factors leading to discordant UA findings when compared against paired albumin-to-creatinine ratio (ACR) testing. Four thousand three hundred and twenty-three UAs were grouped by proteinuria level (A1-A3); concordance with ACR was examined. Classification of UA with confounding factors (UA+CF) or without (UA-CF) was based on CF that resulted in >10% increase in false-positive proteinuria readings. The presence of ≥3+ blood, ≥3+ leukocyte esterase, any ketonuria, specific gravity ≥1.020, ≥1+ urobilinogen, ≥2+ bilirubin, ≥2+ bacteria, ≥3 RBC/hpf (high powered field), ≥10 WBC/hpf, and/or ≥6 epithelial cells/hpf led to UA+CF classification. Proteinuria was determined to be present in 14.1% by UA dipstick and 24.9% by ACR. Using ACR as the standard, overall concordance was 80.4%, with 17.2% false-negatives and 2.3% false-positives by UA. UA+CF represented 55.6% of UA overall (n = 2404), and 98.0% of those false-positive for proteinuria. High specific gravity and hematuria are the strongest predictors of false positives. For A2 proteinuria (30-300 mg/g, 1+,2+,3+ on UA) UA-CF had a higher negative predictive value (NPV) (99.8%) than UA+CF (77.6%); NPV for A3 proteinuria (>300 mg/g, 4+ on UA) was 100% for UA-CF and UA+CF. Additional abnormalities were noted in >50% of outpatient UAs indicating proteinuria. Given the significant proportion of patients having a false-positive UA for proteinuria when these CFs were present, we recommend that such patients undergo ACR confirmatory testing, according to a clinical algorithm for the incorporation of UA results into the management of CKD.

Association of Single Measurement of dipstick proteinuria with physical performance of military males: the CHIEF study

BackgroundProteinuria, a marker of kidney injury, may be related to skeletal muscle loss. Whether the severity of proteinuria is associated with physical performance is unclear.MethodsWe examined the association of proteinuria severity with physical performance cross-sectionally in 3357 military young males, free of chronic kidney disease, from the cardiorespiratory fitness and hospitalization events in armed Forces (CHIEF) study in Taiwan. The grades of proteinuria were classified according to one dipstick urinalysis which were collected at morning after an 8-h fast as unremarkable (0, +/−, and 1+), moderate (2+) and severe (3+ and 4+). Aerobic physical performance was evaluated by time for a 3000-m run and anaerobic physical performance was evaluated by numbers of 2-min sit-ups and 2-min push-ups, separately. Multiple linear regressions were used to determine the relationship.ResultsAs compared with unremarkable proteinuria, moderate and severe proteinuria were dose-dependently correlated with 3000-m running time (β: 4.74 (95% confidence intervals (CI): − 0.55, 10.02) and 7.63 (95% CI: 3.21, 12.05), respectively), and inversely with numbers of 2-min push-ups (β = − 1.13 (− 1.97, − 0.29), and − 1.00 (− 1.71, − 0.28), respectively) with adjustments for age, service specialty, body mass index, blood pressure, alcohol intake, smoking, fasting plasma glucose, blood urea nitrogen, serum creatinine and physical activity. However, there was no association between proteinuria severity and 2-min sit-ups.ConclusionsOur findings show a relationship of dipstick proteinuria with aerobic physical performance and parts of anaerobic physical performance in military healthy males. This mechanism is not fully understood and requires further investigations.

Burden and Risk Factors of Chronic Kidney Disease in Children with Sickle Cell Anaemia Aged 5 – 16 Years at the University Teaching Hospital, Lusaka - Zambia

Background: Improved medical care has led to the improved life expectancy of sickle cell anaemia (SCA) patients hence complications associated with SCA such as chronic kidney disease (CKD) are being seen more frequently. Globally, nephropathy of varying severity occurs in 5 to 18 % of the SCA population across all age groups with a third of the adults proceeding to develop CKD while over 30 % of paediatric SCA patients have CKD in Africa. The mortality rate in SCA patients CKD is high. This study sought to determine the prevalence and risk factors of CKD in SCA, information that was not available in Zambia prior to this study. This information will guide in targeting and timing of screening for CKD in SCA in children in our population. Objectives: To determine the prevalence of haematuria, proteinuria, abnormal estimated glomerular filtration rate (eGFR), CKD, and risk factors of CKD among the steady-state SCA patients aged 5 to 16 years at the University Teaching Hospital (UTH), Lusaka. Methodology: This was a prospective cross-sectional study of 197 children aged 5 to 16 years with SCA at the UTH - Lusaka conducted from August 2014 to July 2015. Demographic and clinical data were collected using a structured questionnaire. Urine and blood samples were used to determine the urine albumin creatinine ratio (ACR) and full blood count /blood biochemistry respectively. CKD was defined and determined using the Kidney Disease Outcome Quality Initiative 2012 guidelines employing urine ACR, dipstick urinalysis and eGFR. In this study, spot urine ACR and dipstick urinalysis were done and repeated three months later if initial tests were abnormal. Data was analysed using SPSS version 21. Chi-square and t-test were used to compare proportions between groups. Relation between study variables and CKD were examined using logistic regression. Results: The mean age of the participants was 9.6 years (SD ±3.6). Male to female ratio was 1:1. The median age at diagnosis of SCA was 22 months (IQR = 44). The prevalence of haematuria, proteinuria and CKD among the study participants was 14.2%, 36% and 36 % respectively. Low haemoglobin and elevated mean corpuscular volume (MCV) were associated with CKD-AOR 0.62, 95% CI; 0.46-0.84 and 1.04, 95% CI; 1.01 – 1.08 respectively. Recurrent admissions (due to VOCs, severe anaemia and febrile illness) were also risk factors associated with CKD- AOR 0.52, 95% CI; 0.27-0.98. CKD was not associated with age at enrolment, sex, age at diagnosis of SCA, recurrent Vaso-occlusive crisis (VOCs) or abnormal liver function tests. Conclusion: The prevalence of CKD among the SCA patients at UTH- Lusaka is high (36%) with lower Haemoglobin, elevated MCV and recurrent admissions being risk factors for developing CKD. SCA patients should be screened for CKD routinely at least once a year. Interventions such as the early introduction of hydroxyurea, proactive blood transfusions and ACE inhibitors can reduce the risk of CKD and its progression to end-stage renal disease.

Prevalence of Urinary Tract Infection in Nephrotic Syndrome at Zagazig University Children Hospital

Background: Nephrotic syndrome (NS) is the most common chronic glomerular diseases in children. Nephrotic syndrome increases a child's susceptibility to infection. Urinary tract infection (UTI) is the second most common bacterial disease in children after upper respiratory tract infection. Aim of this work: To find out the prevalence of UTI (either community acquired or hospital acquired) in NS children and to uncover the bacterial spectrum and their sensitivity pattern for selecting the empirical antibiotic therapy till the results of culture are awaited. Subjects and methods: This study was descriptive cross sectional. 33 nephrotic syndrome cases were included in study. All patients were subjected to full history taking, complete clinical examination and investigations as urine analysis and urine culture. Results: The percentage of community acquired urinary tract infection (CA-UTI) was 57.6 % and hospital acquired urinary tract infection (HA-UTI) was 42.4 %. E. coli is the commonest organism causing UTI followed by klebsiella and proteus mirabilis. The isolated organisms showed resistance to many oral and parenteral antibiotics. Amikacin gentamycin may be the first option of empiric therapy while waiting for culture reports. Conclusion: Children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic often undiagnosed. Identifying bacterial causes and their susceptibility pattern of UTI will help in selecting the empirical antibiotic therapy till the results of culture are awaited. Although dipstick and microscopic urinalysis can support the diagnosis of UTI, growth of a single type of bacteria on urine culture is the gold standard.

Dipstick urine analysis for detection of renal abnormalities among school children

Background: Urine analysis by dipstick is a useful tool to identify children with asymptomatic renal diseases. Dipstick urinalysis screening was conducted in asymptomatic school children to detect prevalence of renal disease.Methods: A cross sectional study was carried out in 862 children of age 6 to 15 years studying in different schools of Birgunj, Nepal between January 2019 to June 2019. First morning mid-stream urine samples were obtained from students and tested by dipstick method. Children with abnormal findings were re-tested after fifteen days.Results: Ninety-six (11.13%) children had urinary abnormalities at the first screening; 8 children had specific urinary abnormalities after second screening. 4 children had urinary tract infection, followed by glomerulonephritis, type 1 diabetes, hydronephrosis and nephrotic syndrome. Urinary abnormalities were more common in females than in males.Conclusions: Asymptomatic urinary abnormalities are detected by urine screening program at school age. Further work-up reveals the specific diagnosis and effective interventions help reduce the renal disease in future.

Smell - Adding a New Dimension to Urinalysis.

Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.

Dipstick proteinuria and cancer incidence: a nationwide population-based study.

The association between proteinuria and malignancy has been frequently reported, but the issue is matter of controversy. Thus, in order to shed light on the association, we evaluated proteinuria as a risk factor for malignancy using the dataset from the Korean National Health Insurance System (NHIS). The subjects had undergone a medical examination in 2009 (index year) among the entire Korean adult population. From a pool of 10,505,818 participants, we excluded subjects who were younger than 19years (15,327), had a previous diagnosis of cancer (152,095), had missing data for at least one variable (544,508), and were diagnosed with cancer within 1year from the index year (79,501). Proteinuria was examined by a single dipstick urinalysis. A total of 9,714,387 subjects were included in this study and tracked until December 31, 2017. The participants were divided into three groups; no (95.2%), trace (2.3%), and overt (2.5%) proteinuria. Over the duration of this study, we observed that overt proteinuria was associated with an increased risk of cancer development (all cancers) (adjusted HR 1.154, 95% CI 1.134-1.173) and the long-term risk of cancer incidence increased proportionally according to the changes in proteinuria over a four-year period. Our study population consisted of Korean adults. Therefore, the results of this study may not be generalized to other ethnicities. We found a significant relationship between proteinuria and the risk of overall and site-specific cancer development. Further studies are needed to find an explanation of these findings.

Decreasing urine culture rates in hospitalized internal medicine patients

There are no previous studies on decreasing urine cultures in hospitalized internal medicine patients by a combination of physician education and reflex cancellation of urine cultures in those with a negative dipstick urinalysis. We compared urine culture rates in all hospitalized internal medicine patients 18 years or older before intervening (2016), during medical education efforts (2017), and after reflex cancellation of urine cultures in patients with a negative dipstick (negative leukocyte esterase and nitrites) (2018, 2019). Compared to the preintervention period (2016), urine cultures decreased from a baseline of 32.7% (95% confidence intervals [95%CI]-31.7-33.6) to 26.6% (95%CI-25.8%-27.4%) after medical education efforts, and to 18.2% (95%CI-17.4%-19.0%) and to 15.2 (95%CI-14.5%-15.9%) during the 2 years after reflex cancellation of the urine cultures. There were no physician complaints and there were no urine cultures orders after reflex cancellation. We conclude that physician education and cancellation of urine cultures in those with negative dipsticks resulted in a persistent decrease in urine cultures of around 50%. Extrapolation to other settings requires caution since the results are dependent on patient selection, physician behavior, and methods of urine testing.

Urinalysis in Great Dane Puppies from Birth to 28 Days of Age.

Simple SummaryStill, nowadays, small animal perinatology is quite an unknown field of veterinary medicine. To help decrease the high mortality rates reported for canine newborns, veterinary practitioners should become more aware of neonatal physiology and pathology, focusing their attention on metabolic balance. It is impossible to discriminate healthy puppies from pathological littermates in the absence of reference ranges for specific parameters, which are obviously different from those of adults. Since blood samples are more difficult and dangerous to collect from newborns, practitioners could rely on urinary samples, easily gathered by the stimulation of the somato-vesical spinal reflex. The present research, based on 624 urine samples, offers results that can be used as references for the first-line evaluation of newborn Great Danes by dipstick rapid urinalysis. In healthy puppies, specific gravity and pH vary from birth to 28 days of age, while glucosuria and proteinuria are never reported. The present results, derived from a sample of single-breed puppies, can represent the starting point for a further multi-breed evaluation.Urinalysis, a common test in infants, could represent a suitable non-invasive clinical tool in puppies. In dog neonates, urine is easily collected by stimulating the somato-vesccal reflex. Information on urine characteristics during the neonatal period is missing. Beside instrumental laboratory analyses, the dipstick was proven useful for rapid urinalysis to evaluate specific gravity (SG), pH, leukocytes, nitrites, glucose, proteins, ketones, urobilinogen, bilirubin, and blood. The present study aimed to describe urinalysis features by the dipstick test and refractometer along the neonatal period. Urine samples (n = 624) were collected by manual stimulation from 48 healthy Great Danes, daily from birth to seven days, then twice a week until 28 days, to assess age-related changes (ANOVA, p < 0.05) and the possible effects of gender and litter (T-test, p < 0.05). The SG and pH significantly changed during the neonatal period. Other parameters did not vary significantly in relation to age. No significant differences were observed either among litters or between genders. The present study confirmed that canine kidneys are able to concentrate urine from the second week of age when the urinary SG started to be similar to adults, while pH still increased towards the typical values of adults at 28 days. Significant glucosuria and proteinuria were never detected. Dipstick urinalysis represents a useful first-line complementary tool in newborns clinical examination, providing information about systemic homeostasis.