Early Morning Urine Specimens Research Articles

Diagnostic accuracy of Lipoarabinomannan detection by lateral flow assay in pleural tuberculosis

BackgroundLipoarabinomannan (LAM) antigen serves as an attractive biomarker to diagnose Tuberculosis (TB). Given the limitations of current diagnostic modalities for Pleural TB, current study evaluated LAM’s potential to serve as a point-of-care test to diagnose pleural TB.MethodsA cross sectional, diagnostic accuracy study was conducted during February to November 2021 in a tertiary care hospital in India. LAM antigen detection was performed on pleural fluid as well as early morning urine specimen of suspected pleural TB patients by “Alere/ Abott Determine TB LAM” lateral flow assay (LAM-LFA). The results were compared to microbiological reference standards/MRS (Mycobacterial culture or NAAT) and Composite reference standards/CRS (MRS plus Clinico-radiological diagnosis).ResultsA total of 170 subjects were included in the analysis, including 26 with Definite TB, 22 with Probable TB, and 122 with No TB. Compared to MRS and CRS, the sensitivity (61.54% & 45.83%) and positive predictive value (PPV) (57.14 & 78.57%) of Pleural LAM-LFA testing were found to be suboptimal, whereas the specificity (91.67% & 95.08%) and negative predictive value (NPV) (92.96% & 81.69%) of the assay were found to be good. Urinary LAM-LFA performed even worse than pleural LAM-LFA, except for its higher specificity against MRS and CRS (97.2% and 98.3%, respectively). Specificity and PPV of pleural LAM detection increased to 100% when analysed in a subgroup of patients with elevated ADA levels (receiver operating curve analysis-derived cut off value > 40 IU/ml).ConclusionDetection of LAM antigen by LFA directly from pleural fluid was found to be a useful test to predict absence of the disease if the test is negative rather than using as a POCT for diagnosis.

TUBERCULAR TESTICULAR ABSCESS: A CASE REPORT

Objective: This study aims to provide fellow physicians a better insight in diagnosing and managing similar cases. Case(s) Presentation: A 36 year old male presented to the emergency department with a chief complaint of red, painful, and progressively enlarging swelling of the left scrotal pouch since 1 week ago. The patient had a history of similar complaint and recurrent cloudy urine which were left untreated 1 year before. Based on physical examination and ultrasonography findings, the patient was diagnosed with left scrotal abscess and was treated by incisional drainage of abscess and necrotomy debridement under spinal anesthesia. Discussion: Tuberculosis infection of scrotal contents is rare and occurs in approximately 7% of the patients with tuberculosis, although tuberculosis itself is a global epidemic with more than 2 billion of the world population infected. In patients with genital tuberculosis, pulmonary and renal tuberculosis can be documented in 50% and 80-85% respectively. It is often secondary to the pre-existing tuberculosis of the urinary tract, which may be confirmed by the culture of early morning urine specimens. Conclusion: Treatment of testicular abscess is administration of appropriate antibiotics according to its causative organism accompanied by surgical drainage. Early diagnosis and prompt treatment of testicular abscess is necessary, since chronic and severe cases, as happened in this patient, usually resulted in nonviable testicular tissue and necessitate orchidectomy. This may be due to cumulative ischemia of the testicles from multiple mechanisms: inflammatory infiltration causing compression of the spermatic cord, thrombosis secondary to venous congestion and/or bacterial exotoxins.

Relationship between microalbuminuria and glomerular filtration rate in children with sickle cell anemia in steady state

Background: Microalbuminuria (MA), a common phenomenon in children with sickle cell anemia (SCA), is defined as an increased urinary albumin–creatinine ratio of 30–300 mg/g of creatinine in an early morning or random urine specimen. Whereas some studies have shown that MA reflects early kidney damage, other studies have documented that it is a manifestation of advanced nephropathy. The reports about the relationship between glomerular filtration rate (GFR) and MA in children with SCA are conflicting. Materials and Methods: This was a longitudinal study. Serum creatinine, GFR, and albumin–creatinine ratio were determined at baseline. The individuals were followed up over 3 months during which albumin–creatinine ratio and GFR were assayed monthly, and the relationship between them was determined. Results: One hundred and seventy children aged 1–18 years with SCA and MA were studied. The mean albumin–creatinine ratio was 120.9 ± 66.8 mg/g, 138.32 ± 101.79 mg/g, 117.12 ± 78.09 mg/g, and 106.73 ± 38.82 mg/g at baseline, 1, 2, and 3 months, respectively, whereas the mean GFR was 121.7 ± 33.0 ml/min/1.73 m2, 117.69 ± 29.70 ml/min/1.73 m2, 117.56 ± 35.77 ml/min/1.732 m2, and 116.22 ± 30.28 ml/min/1.73 m2 at baseline, 1, 2, and 3 months, respectively. There was no significant relationship between MA and GFR in the participants throughout the study period (Pearson's correlation coefficients: 0.050, 0.250, 0.268, and 0.143 and corresponding P: 0.95, 0.88, 0.15, and 0.36). Conclusions: GFR is normal in SCA children with MA. There is no significant relationship between MA and GFR in children with SCA.

Microalbuminuria and Its Risk Factors in Type 2 Diabetic Patients.

Diabetic nephropathy is one of the dreaded complications of diabetes leading to chronic kidney disease and end stage renal failure globally. Microalbuminuria is the most sensitive marker of early recognition of the diabetic nephropathy. This study was carried out to find out the prevalence and potential risk factors of microalbuminuria which is the marker of diabetic nephropathy among diabetes patients in Nepal. A cross-sectional study was conducted on a random sample of 227 in T2DM patients in private diabetic clinics and Bir hospital in Kathmandu. Data were collected using standard questionnaire format to collect demography, anthropometry, and laboratory assessment of, HbA1c, post prandial, fasting glucose and micro albumin in urine. Micro albuminuria was measured using early morning urine specimen. Micro albuminuria was considered positive when urinary albumin to creatinine ratio was found to be 30-300 mg/g creatinine in preferably an early morning or a spot urine sample. The entire lab test will be done by applying the internationally accepted standards of tools and techniques.Those that were reported >30mg/mL of micro albumin were considered as positive. Out of total 217 diabetic patients, 56.2% (122/217) were male and 43.8% (95/217) were female. Among all age groups, maximum patients enrolled were between the age group 41 to 80 (95%).Of the total, 20% (44/217)) patientswereMA positive. A statistical significant association was seen between MA and BMI (p=0.029), duration of DM (p=<0.001, hypertension (p=<0.001, smoking (p=<0.001) and physical activity (p=<0.001). Diabetic patients in Nepal have prevalence of 20.3% microalbuminurea. Hypertension, obesity, sedentary lifestyles, duration more than 5 years of illness are found the most important risk factors for the development of microalbuminurea in diabetes. Keywords: Mellitus; microalbuminuria; type 2 diabetes.

Microalbuminuria and Its Risk Factors in Type 2 Diabetic Patients

Background: Diabetic nephropathy is one of the dreaded complications of diabetes leading to chronic kidney disease and end stage renal failure globally. Microalbuminuria is the most sensitive marker of early recognition of the diabetic nephropathy. This study was carried out to find out the prevalence and potential risk factors of microalbuminuria which is the marker of diabetic nephropathy among diabetes patients in Nepal. Methods: A cross-sectional study was conducted on a random sample of 227 in T2DM patients in private diabetic clinics and Bir hospital in Kathmandu. Data were collected using standard questionnaire format to collect demography, anthropometry, and laboratory assessment of, HbA1c, post prandial, fasting glucose and micro albumin in urine. Micro albuminuria was measured using early morning urine specimen. Micro albuminuria was considered positive when urinary albumin to creatinine ratio was found to be 30–300 mg/g creatinine in preferably an early morning or a spot urine sample. The entire lab test will be done by applying the internationally accepted standards of tools and techniques.Those that were reported &gt;30mg/mL of micro albumin were considered as positive. Results: Out of total 217 diabetic patients, 56.2% (122/217) were male and 43.8% (95/217) were female. Among all age groups, maximum patients enrolled were between the age group 41 to 80 (95%).Of the total, 20% (44/217)) patientswereMA positive. A statistical significant association was seen between MA and BMI (p=0.029), duration of DM (p=&lt;0.001, hypertension (p=&lt;0.001, smoking (p=&lt;0.001) and physical activity (p=&lt;0.001). Conclusions: Diabetic patients in Nepal have prevalence of 20.3% microalbuminurea. Hypertension, obesity, sedentary lifestyles, duration more than 5 years of illness are found the most important risk factors for the development of microalbuminurea in diabetes. Keywords: Mellitus; microalbuminuria; type 2 diabetes

A1446 Association between salt intake and uric acid, and its interaction on the risk of prehypertension among Chinese young adults

Objectives: High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and daily salt intake, as well as its interaction on the risk of prehypertension. Methods: A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Salt intake was estimated from early-morning urine specimens using an equation validated for this study population. Results: Increasing quartiles of salt intake were associated with high urinary UA/creatinine levels in prehypertensive participants. Estimated salt intake positively correlated with urinary UA/creatinine excretions in the prehypertensive group. In addition, the prehypertensive group had higher levels of salt intake and serum UA than the normotensive group. The multivariate-adjusted odds ratios (95% confidence interval) for prehypertension compared with normotension were 1.68 (1.27–2.22) for salt intake and 1.71 (1.21–2.42) for serum UA. Increasing salt intake and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest salt intake and serum UA quartiles entailed 3.48 times greater risk of prehypertension. Conclusion: Salt intake is associated with urinary UA excretion in prehypertensive participants. High levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

The Risk Factors for Rapid Decline of Renal Function in Japanese Patients with Diabetes Mellitus

Background: To prevent the end-stage renal failure, it is important to identify the high-risk patients with rapid decline of renal function (RDRF). Aim: We intended to clarify the risk factors for RDRF in Japanese patients with diabetes. Methods: One hundred sixteen out-patients with diabetes (type 1/2, 38/78; M/F, 60/56; age 60.1±12.3 years; BMI, 25.3±4.8; HbA1c, 7.3±1.0%; eGFR, 68±22mL/min/1.73m2) were enrolled in this study, and were followed for one year. We defined RDRF as more than 20% of annual decline of eGFR. The sodium intake was estimated from the urine sodium excretion from early morning urine specimen according to previous report (J Hum Hypertens. 2002). The visceral fat area (VFA) was determined by the impedance method (HDS-2000, Omron Healthcare, Japan) Results: 8.6% of participants were matched to the criteria of RDRF. In subjects with RDRF, the energy intake (45.6±10.6 kcal/kg BW/day), sodium intake (12.5±1.8 g/day), VFA (157±51 cm2) and prevalence of hypertension (100%) were higher than those without RDRF. Annual decline of eGFR was significantly correlated with the stage of diabetic nephropathy, VFA, systolic and diastolic blood pressure, urinary albumin excretion rate, triglyceride, and daily intake of energy, sodium and protein (p&amp;lt;0.05). The logistic regression analysis revealed that the independent determinants of RDRF were energy intake, sodium intake, and visceral fat area. In addition, the Receiver Operating Characteristic (ROC) analysis revealed that the cut-off values of these parameters were 46.8kcal/ kg BW/ day of energy intake (AUC 0.84, p&amp;lt;0.01), 11.8g/day of sodium intake (AUC 0.90, p&amp;lt;0.01), and 117cm2 of visceral fat area (AUC 0.88, p&amp;lt;0.01). Conclusion: Visceral obesity, and high intake of energy and sodium contributed to rapid decline of renal function in Japanese patients with diabetes. Body weight management with adequate energy and sodium intake, therefore, may contribute to prevent progression of diabetic kidney disease. Disclosure M. Matsuhisa: None. H. Mori: None. M. Ohishi: None. M. Ishizu: None. R. Suzuki: None. I. Takikawa: None. S. Taniguchi: None. M. Tamaki: None. Y. Akehi: None. K. Kurahashi: None. S. Yoshida: None. I. Endo: None. K. Aihara: None. M. Funaki: Research Support; Self; Otsuka Holdings Co., Ltd., The Knowledge Cluster from the Ministry of Education, Science, and Culture of Japan. Board Member; Self; Mechanogenic C.C.. A. Kuroda: None.

ASSOCIATION BETWEEN SALT INTAKE AND URIC ACID, AND ITS INTERACTION ON THE INCIDENCE OF PREHYPERTENSION AMONG CHINESE YOUNG ADULTS

Objective: High uric acid (UA) level and high salt intake are reportedly associated with cardiovascular disease. This study investigated the association between UA and daily salt intake, as well as its interaction on the risk of prehypertension. Design and method: A total of 1869 participants without hypertension were recruited from a previously established cohort in Shaanxi Province, China. The participants were classified as normotensive or prehypertensive on the basis of their blood pressure. Salt intake was estimated from early-morning urine specimens using an equation validated for this study population. Results: Increasing quartiles of salt intake were associated with high urinary UA/creatinine levels in prehypertensive participants (from quartile 1 to quartile 4: 0.12, 0.17, 0.24, and 0.33, P for trend < 0.001)). Estimated salt intake positively correlated with urinary UA/creatinine excretions in the prehypertensive group (r = 0.496; P < 0.001). In addition, the prehypertensive group had higher levels of salt intake and serum UA than the normotensive group [salt intake: 13.22 ± 3.52 vs. 12.35 ± 3.42 g/day, P < 0.001; serum UA: 290.0 (233.6–340.6) vs. 255.6 (211.6–305.0) μmol/L, P < 0.001]. The multivariate-adjusted odds ratios (95% confidence interval) for prehypertension compared with normotension were 1.68 (1.27–2.22) for salt intake and 1.71 (1.21–2.42) for serum UA. Increasing salt intake and serum UA were associated with higher risk of prehypertension. Compared with the lowest quartiles, the highest salt intake and serum UA quartiles entailed 3.48 times greater risk of prehypertension.Conclusions: Salt intake is associated with urinary UA excretion in prehypertensive participants. High levels of salt intake and serum UA simultaneously are associated with a higher risk of prehypertension.

A Modified Protocol with Improved Detection Rate for Mis-Matched Donor HLA from Low Quantities of DNA in Urine Samples from Kidney Graft Recipients.

BackgroundUrine from kidney transplant recipient has proven to be a viable source for donor DNA. However, an optimized protocol would be required to determine mis-matched donor HLA specificities in view of the scarcity of DNA obtained in some cases.MethodsIn this study, fresh early morning urine specimens were obtained from 155 kidney transplant recipients with known donor HLA phenotype. DNA was extracted and typing of HLA-A, B and DRB1 loci by polymerase chain reaction-specific sequence primers was performed using tailor-made condition according to the concentration of extracted DNA.ResultsHLA typing of DNA extracted from urine revealed both recipient and donor HLA phenotypes, allowing the deduction of the unknown donor HLA and hence the degree of HLA mis-match. By adopting the modified procedures, mis-matched donor HLA phenotypes were successfully deduced in all of 35 tested urine samples at DNA quantities spanning the range of 620–24,000 ng.ConclusionsThis urine-based method offers a promising and reliable non-invasive means for the identification of mis-matched donor HLA antigens in kidney transplant recipients with unknown donor HLA phenotype or otherwise inadequate donor information.

Reduction in sodium intake is independently associated with improved blood pressure control in people with chronic kidney disease in primary care.

Decreasing sodium intake has been associated with improvements in blood pressure (BP) and proteinuria, two important risk factors for CVD and chronic kidney disease (CKD) progression. We aimed to investigate the role of sodium intake by examining the effect of changes in sodium intake over 1 year on BP and proteinuria in people with early stage CKD. From thirty-two general practices, 1607 patients with previous estimated glomerular filtration rate of 59-30 ml/min per 1.73 m² and mean age of 72.9 (sd 9.0) years were recruited. Clinical assessment, urine and serum biochemistry testing were performed at baseline and after 1 year. Sodium intake was estimated from early morning urine specimens using an equation validated for this study population. We found that compared with people who increased their sodium intake from ≤ 100 to >100 mmol/d over 1 year, people who decreased their intake from >100 to ≤ 100 mmol/d evidenced a greater decrease in all BP variables (Δmean arterial pressure (ΔMAP) = -7.44 (SD 10.1) v. -0.23 (SD 10.4) mmHg; P<0.001) as well as in pulse wave velocity (ΔPWV = -0.47 (SD 1.3) v. 0.08 (SD 1.88) m/s; P<0.05). Albuminuria improved only in albuminuric patients who decreased their sodium intake. BP improved in people who maintained low sodium intake at both times and in those with persistent high intake, but the number of anti-hypertensive increased only in the higher sodium intake group, and PWV improved only in participants with lower sodium intake. Decreasing sodium intake was an independent determinant of ΔMAP. Although more evidence is needed, our results support the benefits of reducing and maintaining sodium intake below 100 mmol/d (2.3-2.4 g/d) in people with early stages of CKD.

Measurement of a urinary marker (8-hydroxydeoxy-guanosine, 8-OHdG) of DNA oxidative stress in epidemiological surveys: a pilot study.

8-Hydroxydeoxyguanosine (8-OHdG) is a commonly used marker of DNA oxidative stress in epidemiological studies. The aim of this study was to establish whether the urinary concentration of 8-OHdG varies during the first part of the day, when clinical tests are usually performed, and whether it can therefore be measured without bias in spot urine samples. Spot urine samples were collected using a convenience sample. A linear mixed-effects model for repeated measurements was used to analyze 8-OHdG levels. A significant increasing trend in time in the 8-OHdG concentration was found among smokers, but not in the case of nonsmokers. In epidemiological studies on oxidative stress, all participants should collect their early morning urine specimens - before their first cigarette if they are smokers - to gather information on individual background oxidation levels.

Development of a Formula for Estimation of Sodium Intake from Spot Urine in People with Chronic Kidney Disease

Background/Aims: High sodium intake is associated with adverse cardiovascular and renal outcomes in people with chronic kidney disease (CKD), and simple methods to facilitate assessment of sodium intake are required. The objective of this study was to develop a new formula to estimate 24-hour urinary sodium (24hUNa) excretion from urinary Na concentration measured on an early morning urine specimen (EM UNa). Methods: Seventy participants from a prospective cohort of patients with CKD stage 3 in primary care, the Renal Risk in Derby (RRID) study, agreed to collect an additional EM UNa on the day after completing a 24-hour urine collection. A formula to estimate 24hUNa from EM UNa and body weight was developed using the coefficients from a multivariable linear regression equation. The accuracy of the formula was tested by calculating the P30 (proportion of estimates within 30% of measured sodium exection), and the ability of the estimated 24hUNa to discriminate between measured sodium intake above or below 100 mmol/day was assessed by receiver operating characteristic (ROC) curve. A Bland-Altman plot was used to estimate the bias and limits of agreement between estimated and measured 24hUNa. Seventy-four additional paired 24hUNa and EM UNa from 50 CKD stage 3 patients in the RRID study were used to validate the formula. Results: The mean difference between measured and estimated 24hUNa was 2.08 mmol/day. Measured and estimated 24hUNa were significantly correlated (r = 0.55; p < 0.001) but accuracy of estimated 24hUNa was low (P30 = 60%). Analysis of the ROC curve with a cut-off point >100 mmol/day yielded an area under the curve of 0.668, sensitivity of 0.85 and specificity of 0.52. Conclusions: We have developed a simple formula to identify people with a high sodium intake from EM UNa, suitable for use in large-cohort or population studies.

High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients.

An increased risk of mortality and cardiovascular disease (CVD) is observed in people with chronic kidney disease (CKD) even in early stages. Dietary sodium intake has been associated with important CVD and CKD progression risk factors such as hypertension and proteinuria in this population. We aimed to investigate the relationship between sodium intake and CVD or CKD progression risk factors in a large cohort of patients with CKD stage 3 recruited from primary care. A total of 1733 patients with previous estimated glomerular filtration rate (eGFR) of 30-59 ml/min/1.73m(2), with a mean age 72.9±9.0 years, were recruited from 32 general practices in primary care in England. Medical history was obtained and participants underwent clinical assessment, urine and serum biochemistry testing. Sodium intake was estimated from three early-morning urine specimens using an equation validated for this study population. Sixty percent of participants who had estimated sodium intake above recommendation (>100 mmol/day or 6 g salt/day) also had higher diastolic blood pressure, mean arterial pressure (MAP), urinary albumin-to-creatinine ratio, high-sensitive C-reactive protein and uric acid and used a greater number of anti-hypertensive drugs. In multivariable regression analysis, excessive sodium intake was an independent predictor of MAP (B=1.57, 95% confidence interval (CI) 0.41-2.72; P=0.008) and albuminuria (B=1.35, 95% CI 1.02-1.79; P=0.03). High sodium intake was associated with CVD and CKD progression risk factors in patients with predominantly early stages of CKD followed up in primary care. This suggests that dietary sodium intake could afffect CVD risk even in early or mild CKD. Intervention studies are warranted to investigate the potential benefit of dietary advice to reduce sodium intake in this population.

Demographic Associations of High Estimated Sodium Intake and Frequency of Consumption of High-Sodium Foods in People With Chronic Kidney Disease Stage 3 in England

The objective of this study was to investigate sodium intake in a cohort of people with chronic kidney disease (CKD) Stage 3 in England to identify demographic characteristics of subgroups with high sodium intake and specific foods that contribute to excessive sodium intake. Study subjects (N = 1,729) included CKD patients from 32 general practices in the Renal Risk in Derby study. Patients had a glomerular filtration rate between 30 and 59 mL/min per 1.73 m(2) on 2 or more occasions at least 3 months apart before recruitment. Sodium excretion (assumed to be equal to intake) was estimated from early morning urine specimens using an equation validated for this study population. The frequency of intake of 12 salty foods was assessed by a food frequency questionnaire. The mean estimated urinary sodium excretion was 110.5±33.8mmol/day; 60.1% had values above the National Kidney Foundation recommendation (<100mmol/day). Subgroups with a greater percentage of participants having sodium excretion above the recommendation were as follows: men, those younger than 75years of age, those with central obesity or diabetes, those with formal educational qualifications, and those who were previous or current smokers. In multivariable analysis, gender, younger age, waist-to-hip ratio, and diabetes mellitus status were the main independent determinants of excessive sodium excretion. Specific food items that contributed to excessive intake were table and cooking salt, salted snacks, hard cheeses, processed meat, and tinned fish. The most important source of sodium varied by subgroup. A high prevalence of sodium excretion above the recommended value was detected, and independent determinants were gender, age, waist-to-hip ratio, and diabetes mellitus. Specific food items that contributed to excessive intake were also identified and varied in different subgroups. These data will be helpful in informing strategies to target dietetic advice to those most likely to have high sodium intake and will allow dietitians to focus on the most likely sources of sodium in different subgroups.

Correlation of urinary excretion of sodium with severity of sleep‐disordered breathing in children: A preliminary study

Nocturnal urinary sodium excretion is related to blood pressure (BP) levels. Elevated BP and increased nocturnal natriuresis have been demonstrated in adults with sleep apnea. Although evidence indicates increased BP in children with obstructive sleep-disordered breathing (SDB), it is unknown whether these children have also enhanced urinary sodium excretion. To evaluate the effects of SDB and morning BP on urinary sodium excretion. Consecutive children with snoring (n = 95) underwent polysomnography and morning BP measurement. Fractional excretion of sodium (FE(Na)) was the primary outcome measure and was calculated using sodium and creatinine concentrations in early morning serum and urine specimens. Subjects with moderate-to-severe SDB had similar log-transformed FE(Na) to that of children with mild SDB and higher than children with primary snoring: -0.13 ± 0.53 versus -0.28 ± 0.41 versus -0.61 ± 0.65 (P = 0.657 and P = 0.003). Obstructive apnea-hypopnea index was significantly related to FE(Na) after adjustment for age, gender and body mass index z-score (P = 0.002). Children with moderate-to-severe SDB had similar systolic BP z-scores to those of subjects with mild SDB and higher than participants with primary snoring: 0.7 ± 1.2 versus 0.1 ± 1.0 versus -0.02 ± 1.0 (P = 0.074 and P = 0.046). In addition, participants with diastolic BP z-scores in the upper quartile of measured values had higher FE(Na) than subjects with z-scores in the lower quartiles: -0.08 ± 0.39 versus -0.41 ± 0.57 (P = 0.007). Morning natriuresis is related to severity of SDB in children and this association may be mediated in part by elevated BP.

Tuberculosis of the urinary tract and male genitalia—a diagnostic challenge for the family practitioner

AbstractTuberculosis (TB) of the urinary tract and male genital system can be very difficult to diagnose unless a high index of suspicion is maintained. The most common presenting features of urogenital tuberculosis (UGTB) are lower urinary tract symptoms (LUTS), haematuria, recurrent urinary tract infection (UTI) by Gram-negative organisms, flank pain, and scrotal swelling. The classically described sterile pyuria should arouse suspicion of UGTB, but in about a third of patients a Gram-negative organism is cultured from the urine, so recurrent bacterial UTI should always be further investigated. Intravenous pyelography (IVP) remains the best imaging study available to screen for UGTB, but ultrasound and computerised tomography (CT) imaging can also be useful. The diagnosis of UGTB is most often confirmed with urine culture: at least 3–5 early morning urine specimens must be submitted and the results may take 4–6 weeks. Histological diagnosis on bladder or testicular biopsies can be made if granulomatous ...

School urinalysis screening in Korea

Since 1998, by law, all school children in Korea must have an annual urinalysis. The first early morning urine specimen is examined by a simple dipstick method for the detection of proteinuria, haematuria and glucose. If a urine test is positive, a second test is performed by paediatric nephrologists. We analysed urinalysis data of school urinalysis screening. We also analysed the results of clinical data and the renal biopsy findings of patients referred to our medical centre due to abnormal urinalysis result. To date, about five million students have been screened since annual school urinalysis started in January 1998. Among them, isolated proteinuria was about 0.2%, occult blood was about 0.8%, and glucosuria was about 0.07% from January 1998 to December 2004. Among referred patients, renal biopsy was taken in 63.1% of isolated haematuria, 10.5% of isolated proteinuria and 69.9% of haematuria combined with proteinuria. Histopathological findings are IgA nephropathy in 43.8%, mesangial proliferative glomerulonephritis in 38.4%, Henoch-Schönlein nephritis in 2.7%, membranoproliferative glomerulonephritis in 1.6% and lupus nephritis in 0.5%. Alport disease showed 0.6% as a hereditary disease. In conclusion, the school urinalysis screening could detect chronic renal disease in its early stage. Early detection using school urinalysis screening and confirmatory diagnosis by renal biopsy seems to be helpful for assessment of prognosis and intervention of chronic renal disease progression.

Long‐term remission rates after pituitary surgery for Cushing's disease: the need for long‐term surveillance

There have been a few reports on long-term remission rates after apparent early remission following pituitary surgery in the management of Cushing's disease. An undetectable postoperative serum cortisol has been regarded as the result most likely to predict long-term remission. Our objective was to assess the relapse rates in patients who underwent transsphenoidal surgery in order to determine whether undetectable cortisol following surgery was predictive of long-term remission and whether it was possible to have long-term remission when early morning cortisol was measurable but not grossly elevated. Endocrinological factors associated with late relapse were also studied. We reviewed the long-term outcome in 63 patients who had pituitary surgery for the treatment of Cushing's disease between 1979 and 2000. Case notes were reviewed and the current clinical and biochemical status assessed. Our usual practice was that early after the operation, an 08:00 h serum cortisol was measured 24 h after the last dose of hydrocortisone. This was followed by a formal low-dose dexamethasone suppression test. Current clinical status and recent 24-h urinary free cortisol values were used as an index of activity of the Cushing's disease. If there was evidence suggesting relapse, a low-dose dexamethasone suppression test was performed. In many patients, sequential collections of early morning urine specimens for urinary cortisol to creatinine ratio were also performed in an attempt to diagnose cyclical and intermittent forms of recurrent hypercortisolism. We did this if there was conflicting endocrine data, or if patients were slow to lose abnormal clinical features. Mean age at diagnosis was 40.3 years (range 14-70 years). Mean follow-up up time was 9.6 years (range 1-21 years). Forty-five patients (9 males/36 females) achieved apparent remission immediately after surgery and were subsequently studied long term. Of these 45 patients, four have subsequently died while in remission from hypercortisolism. Ten of the remaining 41 patients have relapsed. Of those 10, six demonstrated definite cyclical cortisol secretion. Two of the 10 had undetectable basal serum cortisol levels in the immediate postoperative period. Thirty-one patients are still alive and in remission. Fourteen (45%) of the 31 who remained in remission had detectable serum cortisol levels (> 50 nmol/l) immediately postoperatively, and remain in remission after a mean of 8.8 years. Our relapse rate was therefore 10/45 (22%), after a mean follow-up time of 9.6 years, with mean time to relapse 5.3 years. The overall remission rate of 56% (35/63) at 9.6 years follow-up is disappointing and merits some re-appraisal of the widely accepted principle that pituitary surgery must be the initial treatment of choice in pituitary-dependent Cushing's syndrome. Following pituitary surgery, careful ongoing expert endocrine assessment is mandatory as the incidence of relapse increases with time and also with increasing rigour of the endocrine evaluation. A significant number of our patients were shown to have relapsed with a cyclical form of hypercortisolism.

Dissociation between urinary pyrraline and pentosidine concentrations in diabetic patients with advanced nephropathy

It has been reported that the concentrations of both pyrraline and pentosidine, well-characterized advanced glycation end products, are increased in the urine of diabetic patients. To determine factors that influence the urinary excretion of pyrraline or pentosidine, we compared pyrraline or pentosidine concentrations with glycemic-control indexes, urinary albumin excretion, and urinary β2-microglobulin in patients with type 2 diabetes. The study was conducted in 39 age-matched healthy control subjects and 50 diabetic patients, including 22 patients with normoalbuminuria, 15 with microalbuminuria, and 13 with macroalbuminuria. Both urinary pyrraline and pentosidine were measured in early-morning urine specimens with the use of high-pressure liquid chromatography. The urinary pentosidine concentration was significantly higher in diabetic patients than in control subjects ( P < .01). In contrast, the urinary pyrraline concentration was significantly lower in diabetic patients than in control subjects ( P < .001). Urinary pentosidine concentrations were greater in diabetic patients with macroalbuminuria and microalbuminuria than in those with normoalbuminuria. However, urinary pyrraline concentrations were significantly lower in diabetic patients with advanced nephropathy. Both the hemoglobin A 1c (HbA 1c) and the preceding year's mean HbA 1c were lower in patients with macroalbuminuria than in those with normoalbuminuria or microalbuminuria. Urinary pyrraline, but not pentosidine, showed a significantly positive correlation with the preceding year's mean HbA 1c (P<0.01). Multivariate analysis disclosed that urinary β-2-microglobulin was independently correlated with the urinary concentrations of pentosidine and pyrraline ( P < .05 for both). We conclude that the urinary concentration of pentosidine is greater in diabetic patients with overt nephropathy, whereas the urinary pyrraline concentration is significantly lower in diabetic patients with overt nephropathy. Because urinary pyrraline is more directly influenced by glycemia than by pentosidine, the difference in glycemic control among diabetic patients with various grades of nephropathy may be responsible for a dissociation between urinary pyrraline and pentosidine concentrations in patients with overt diabetic nephropathy.

Follow-up of Urinary Neopterin Concentrations in two Healthy Children until Adolescence

Abstract Neopterin is a sensitive marker of the activated cellular (= Thl-type) immune response. Neopterin concentrations in healthy children are higher compared with those of adults and are declining with increasing age. In this study, we present a follow-up of urinary neopterin to creatinine concentrations in two healthy children until adolescence. Data were available from one female (7 - 23 years) and her brother (0 - 18 years), of whom early morning urine specimens were collected on an irregular basis throughout 18 years. In total, neopterin and creatinine concentrations were measured by high pressure liquid chromatography (HPLC) in 343 urinary specimens. In both children, concentrations of urinary neopterin were highest at study entry. With increasing age neopterin concentrations decreased continuously to reach rather constant levels around the age of fifteen years. On several occasions at which individuals presented with common sickness, mostly of infectious origin, neopterin concentrations were found highly increased. In the absence of such infectious episodes, neopterin/creatinine measurements of both individuals fit well to previously established normal ranges. However this was true only for specimens collcctcd when children were older than 10 years, before that age concentrations of neopterin were frequently found to be higher than the established upper limits of the normal range.