Microscopic Examination Of Urine Research Articles

Acoustofluidic-based microscopic examination for automated and point-of-care urinalysis.

Urinalysis is a heavily used diagnostic test in clinical laboratories; however, it is chronically held back by urine sediment microscopic examination. Current instruments are bulky and expensive to be widely adopted, making microscopic examination a procedure that still relies on manual operations and requires large time and labor costs. To improve the efficacy and automation of urinalysis, this study develops an acoustofluidic-based microscopic examination system. The system utilizes the combination of acoustofluidic manipulation and a passive hydrodynamic mechanism, and thus achieves a high throughput (1000 μL min-1) and a high concentration factor (95.2 ± 2.1 fold) simultaneously, fulfilling the demands for urine examination. The concentrated urine sample is automatically dispensed into a hemocytometer chamber and the images are then analyzed using a machine learning algorithm. The whole process is completed within 3 minutes with detection accuracies of erythrocytes and leukocytes of 94.6 ± 3.5% and 95.1 ± 1.8%, respectively. The examination outcome of urine samples from 50 volunteers by this device shows a correlation coefficient of 0.96 compared to manual microscopic examination. Our system offers a promising tool for automated urine microscopic examination, thus it has potential to save a large amount of time and labor in clinical laboratories, as well as to promote point-of-care urine testing applications in and beyond hospitals.

Risk Factors for Urinary Tract Infections in Children with Hematuria in the Emergency Department.

Hematuria is a worrisome symptom in children and is sometimes associated with urinary tract infections (UTIs). This study aimed to identify useful clinical factors that can predict UTIs in hematuria patients without pyuria in the pediatric emergency department (ED). We retrospectively recruited patients with hematuria from the pediatric ED. Clinical symptoms, urine biochemistry and microscopic examination results, and blood laboratory tests were analyzed to identify the predictors of UTIs. Patients were divided into the verbal group (age ≥ 2 years) and non-verbal group (age < 2 years) for identifying predictors of UTIs. Causes of hematuria were also investigated. A total of 161 patients with hematuria without pyuria were evaluated. Among symptoms, dysuria was significantly correlated with UTIs. Regarding urine biochemistry data, urine esterase and urine protein > 30 mg/dl were found to be significant parameters for predicting UTIs, while urine esterase and urine nitrite showed significant differences in children with age < 2 years. In the urine microscopic examinations, urine red blood cells (RBC) > 373/µL in children aged ≥ 2 years and urine RBC > 8/µL in children aged < 2 years were associated with UTIs. In addition, UTIs and urinary tract stones were found to be the top two causes of hematuria. Dysuria, urine esterase, urine nitrite, and urine protein may be useful parameters for predicting UTIs in pediatric patients with hematuria but no pyuria in the ED. In addition, a UTI was the most commonly identified etiology of hematuria without pyuria, followed by urinary tract stones.

Use of an intravenous catheter to treat urinary distension in cases of feline lower urinary tract disease

Urolithiasis is a disease that commonly affects the urinary organs due to blockage of crystal stones in the urinary tract of male cats. A 3.5 year old male mixed breed domestic cat was examined at the Royal Purple Vet Clinic with complaints of a lack of appetite, fever, and vomiting. The results of the physical examination showed that the body temperature was 39.6°C, bladder distention occurred, and there was a pain response when palpated. Under emergency conditions, urinary distension was treated by insertion of an intravenous catheter (26G). Supporting examinations included urinalysis and microscopic examination of urine. Urinalysis results showed the presence of red blood cells, white blood cells, and protein in the urine. Meanwhile, the results of the microscopic examination showed that there were deposits of calcium oxalate crystal particles. The cat was diagnosed with urolithiasis with a Fausta prognosis. The treatment includes fluid therapy, antibiotics, anti-inflammatories, supplements, and herbal medicine. The cat experienced changes after being treated for four days, characterized by normal urination and no blood found in the urine

B-029 Validation of an Automated Analyzer for Urine Microscopic Examination

Abstract Background Microscopic examination of urine sediment can be time-consuming and labor intensive. Automated analyzers can help to standardize resulting and reduce manual work. Urinalysis has traditionally utilized semi-quantitative grading scales, eg. “0–3/high power field”. The Sysmex UF 5000 (Symex, Kobe, JP) uses flow cytometry to enumerate microscopic particles including white and red blood cells (WBC, RBC), bacteria, casts, and epithelial cells (EC). We sought to validate the counting of these microscopic particles against our reference manual method, and also determine if the research parameters from the analyzer could be used to accurately measure other particles in urine (eg. crystals). Methods Residual urine samples were analyzed for microscopic particles both by the UF 5000 and manually using KOVA tubes (KOVA International, Garden Grove, CA). Particles were enumerated using the laboratory’s current semi-quantitative grading system. Exact agreement and agreement +/- one level were calculated. Results Conclusion The analyzer results were comparable to manual resulting; in discrepant cases, the UF result was typically higher than manual, which may reflect the increased sensitivity of this method. Additional studies are ongoing to determine if the UF 5000 research parameters are accurate for semi-quantitative reporting of pathologic casts, crystals, and yeast.

Accuracy of Diagnostic Tests for Detecting Schistosoma mansoni and S. haematobium in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Schistosomiasis is causing high morbidity and significant mortality in endemic areas. Kato-Katz stool examination and urine filtration techniques are the conventional methods for the detection of intestinal and urinary schistosomiasis. The most appropriate diagnostic tools for the detection of schistosomiasis especially in low-prevalence settings should be used. Therefore, this study is aimed at investigating the diagnostic accuracy of S. mansoni and S. haematobium diagnostic tools in sub-Saharan Africa. Electronic databases such as PubMed, PubMed Central/Medline, HINARI, Scopus, EMBASE, Science Direct, Google Scholar, and Cochrane Library were reviewed. The pooled estimates and heterogeneity were determined using Midas in Stata 14.0. The diagnostic accuracy of index tests was compared using the hierarchical summary of the receiver operating characteristic (HSROC) curve in Stata 14.0. Twenty-four studies consisting of 12,370 individuals were tested to evaluate the accuracy of antigen, antibody, and molecular test methods for the detection of S. mansoni and S. haematobium. The pooled estimate of sensitivity and specificity of CCA was 88% (95% CI: 83-92) and 72 (95% CI: 62-80), respectively, when it is compared with parasitological stool examination for S. mansoni detection. On the other hand, ELISA showed a pooled estimate of sensitivity and specificity of 95% (95% CI: 93-96) and 35% (95% CI: 21-52), respectively, for the examination of S. mansoni using stool examination as a reference test. With regard to S. haematobium, the pooled estimate of sensitivity and specificity of polymerase chain reaction was 97% (95% CI: 78-100) and 94% (95% CI: 74-99), respectively. Moreover, the sensitivity and specificity of urine CCA vary between 41-80% and 55-91%, respectively, compared to urine microscopy. The effort of schistosomiasis elimination requires accurate case identification especially in low-intensity infections. This study showed that CCA had the highest sensitivity and moderate specificity for the diagnosis of S. mansoni. Similarly, the sensitivity of ELISA was excellent, but its specificity was low. The diagnostic accuracy of PCR for the detection of S. haematobium was excellent compared to urine microscopic examination.

Studi kasus : Urolithiasis pada kucing milky di klinik DRD veteriner

Urolithiasis is a disorder of the urinary tract or urinary tract due to the presence of stones or calculi or crystals. These calculi can cause blockages to injury to the urinary tract. Specific clinical manifestations in this case are non-specific and highly variable, depending on the size, number, and location of calculi. Urolithiasis is generally followed by hematuria, dysuria, and stanguria. Milky cat came on 19 May 2022 at DRD Veterinary Veterinary Clinic with conditions of Hematuria, stranguria, and dysuria. When the temperature was measured using a thermometer, the temperature was 36.3 oC indicating the cat's temperature had decreased. examination to help diagnose milky cases by means of microscopic examination of urine, hematology and urinalysis, catheter insertion and cystotomy surgery.

Human urogenital schistosomiasis in West and Sub-Saharan Africa migrants in Sardinia, Italy: A retrospective monocentric study.

Schistosoma (S.) haematobium is the aetiological agent of urogenital schistosomiasis endemic in Sub-Saharan Africa and the Middle East. Microhaematuria is strongly associated with schistosomiasis diagnosis. Praziquantel (PZQ) is the treatment of choice. We conducted a monocentric survey among African migrants from January 2017 to December 2018. The diagnosis of S. haematobium was performed by direct microscopic examination of urine. The treatment was PZQ 40 mg/Kg/die for three days. We enrolled 91 male patients with a median age of 20.2 years (IQR 18.9-23.4)]. Forty-five (49.5%) described a history of haematuria. Sixteen (17.6%) evidenced the presence of red blood cells (RBCs) during urine microscopy. Eighteen (19.8%) had urogenital schistosomiasis. Their median white blood count (WBC) was 5.15 x 109/L (IQR 4.45-6.08) and it was 6.37 x 109 /L (IQR 5.14-8.27), p = 0.009, after 15 days from treatment. Baseline eosinophil count was 0.5 x 109/L (IQR 0.3-0.6) and 0.7 x 109/L (IQR 0.2-1.9; p = 0.032). According to the univariate analysis, origin from Mali [odds ratio (OR) 3.6 (CI 1.2-10.9), p = 0.022] and microscopic evidence of RBCs [OR of 10.7 (CI 2.5-45.1), p = 0.001] were main predictors of urogenital schistosomiasis diagnosis. One (5.6%) treatment failure was registered. Three (16.7%) patients had bladder cancer. Detection of RBCs was a significant predictor of S. haematobium infection and could be used as a screening method in migrants coming from endemic areas. Early urogenital schistosomiasis diagnosis and ultrasound diagnostic tools are crucial for reducing the risk of potential neoplastic evolution.

Clinical spectrum of immunoglobulin A vasculitis in children and determining the best timing of urine examination to predict renal involvement

ABSTRACT Background Immunoglobulin A (IgA) vasculitis (also known as Henoch-Schonlein purpura) is the most common small vessel vasculitis of childhood. The long-term prognosis depends on renal involvement. The aim of this study was to evaluate the risk factors associated with renal involvement in children with IgA vasculitis and to investigate the best timing of urine examination to predict the presence of renal involvement at the sixth month after the diagnosis. Methods In this prospective observational study, medical records, demographic data, clinical findings, laboratory tests, and urine microscopic examinations of pediatric patients diagnosed with IgA vasculitis were evaluated to identify potential risk factors associated with renal involvement. Results A total of 178 patients with a median age of 6 years were involved in the study. Renal involvement was found in 24 (13.5%) patients. Most of the patients (85.7%), whose urine examination was found to be abnormal at the sixth month after the diagnosis, also had abnormalities in the first month urine examination. Factors significantly associated with renal involvement were as follows: older age, presence of hematuria and or proteinuria in the first month urine examination and patients who presented the disease in the spring season. Multivariate logistic regression analysis showed age ≥8 years (p = 0.005), the season of onset (p = 0.025), serum creatinine levels (p = 0.016), and abnormal urine examinations at the first-month visits (p = 0.005) significantly increased the risk of renal involvement. Conclusion This study has demonstrated that the optimal date to predict the presence of hematuria and/or proteinuria in the sixth month is the urine examination performed in the first month of the disease. Therefore, we think that patients with IgA vasculitis who show a presence of hematuria and/or proteinuria in the first-month urine examination should be followed more closely.

Papillary Urothelial Carcinoma

A 70-year-old man with a history of hypertension and asymptomatic atrial flutter presented with pyuria on urine microscopic examination. Cystoscopy revealed bladder lesions emanating from the left ureteral orifice and posterior lateral wall (Figure, A and B). Upper tract evaluation with ureteropyelograms revealed no other lesions. Transurethral resection of the bladder tumors was performed to further characterize these lesions. Histopathological examination revealed the presence of noninvasive high-grade urothelial carcinoma (Figure, C and D). Specifically, these grossly exophytic lesions correspond to papillary structures with well-defined fibrovascular cores that are lined by urothelial cells with loss of cell polarity and marked cytologic atypia. Tumor grade, presence of tumor invasion, tumor size, recurrence, and multifocality are some factors that predict the risk of disease progression.1Babjuk M. Böhle A. Burger M. et al.EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016.Eur Urol. 2017; 71: 447-461Abstract Full Text Full Text PDF PubMed Scopus (1253) Google Scholar In this patient, the presence of high-grade lesion would stratify him as having a high risk of progression.2Soukup V. Čapoun O. Cohen D. et al.Prognostic performance and reproducibility of the 1973 and 2004/2016 World Health Organization grading classification systems in non-muscle-invasive bladder cancer: a European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review.Eur Urol. 2017; 72: 801-813PubMed Google Scholar Patients with high-risk disease are typically managed with transurethral resection of the bladder tumor coupled with intravesical therapy.1Babjuk M. Böhle A. Burger M. et al.EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016.Eur Urol. 2017; 71: 447-461Abstract Full Text Full Text PDF PubMed Scopus (1253) Google Scholar,3Hall M.C. Chang S.S. Dalbagni G. et al.Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update.J Urol. 2007; 178: 2314-2330Crossref PubMed Scopus (633) Google Scholar This is typically followed by surveillance to monitor for disease recurrence or progression.

Prevalence of Urinary Tract Infections (UTIs) in Children with Inguinal Hermia Repairs

This case control study was carried out in Baghdad city from 1st of April 2018 to 1 March 2019 included40 studied cases (children with inguinal hernia) and 40 healthy children to evaluate the prevalence of UTIsin children with inguinal hernia repairs. it was known that the children are infected or not with urinarytract infection through clinical examination of the signs that indicate urinary tract infection, as well as alaboratory examination of the urine to detect the presence of bacteria that cause urinary tract infectionin the laboratory. All children under 15 years of age were included in the study who attended pediatricsurgery clinics. Ages over the age of 15 years old, children with complex inguinal hernia such as blocked,irreducible, strangulated hernia and children with recurrent hernia were excluded. All children included inour study included in the study were examined through routine and microscopic examination of urine, urineculture and sensitivity. children with urinary tract infections were treated according to sensitivity culturereports. This case control study included children with inguinal hernia (90% males and 10% females), theirage range was &lt;1 year to 15 year (mean: 9.52±1.3 year), the study also included 40 healthy children (ascontrol group) with the same characteristics of patient. Thestudyrevealedthaturinary tract infection wasobserved in 25% of (10 of 40) of children with inguinal hernia compared with 5% of (2 of 40) of thecontrol group (P&lt;0.001).This study showed that most of children with inguinal hernia were suffered fromabdominal pain, urge to urinate, polyurea , cloudy urine, fever and pyelonephritis. The study found that,50% of children with inguinal hernia who suffered from UTI were due E. coli, S. aureus with rate 40% andKlebsiella spp with rate 10%. The study showed that 80% of E. coli isolates were sensitive to ampicillin,60% to amikacin and 40% to Amoxiclave, while 100% of S. aureus were sensitive to Ceftriaxone and cand75% to Cefotaxime.It was concluded that, there significant positive correlation between UTIs and inguinalhernia repairs in children.

Clinical investigation on acute pyelonephritis without pyuria: a retrospective observational study.

BackgroundThe current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.MethodsA retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0–5/high power field [HPF] vs. >5/HPF) in urine. ResultsMore than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0–5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140–0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room. ConclusionThe diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.

Molecular approach to the epidemiology of urinary schistosomiasis in France

BackgroundThe diagnosis of urogenital schistosomiasis is based on the complementarity of serological technique and microscopic examination (ME). Between 2015 and 2019, the number of urinary schistosomiasis tests received in our laboratory increased sharply from 300 to 900 per year.Therefore, we wanted to evaluate the reliability of urine microscopic examination (ME, reference and routine technique) from urine sample by comparing it to other techniques (antigenic technique and PCR). To this end, we optimized two real-time PCRs targeting respectively Schistosoma haematobium (Sh) and Schistosoma mansoni (Sm).Methodology/Principal findings914 urine samples from 846 patients suspected of urogenital schistosomiasis were prescribed and analyzed by PCR and also by antigenic technique for the first 143 samples. The antigenic technique evaluated was Schisto POC-CCA, Rapid Medical Diagnostics. These results (antigenic technique and PCR) were compared to ME which was performed from all urines.The percentage of 14% (128/914) positive cases with the PCR technique and the percentage of 6.0% (54/914) positive cases with ME is significantly different (Chi 2 test, p<0.001). These 128 positive PCRs correspond to 120 different patients, 88.3% (106/120) of them were young migrants and 11.7% (14/120) were French patients returning from travel. Among these migrants, more than 75% (80/106) came from French-speaking West Africa.In addition, the Schisto POC-CCA showed a specificity of 39% (46/117), too poor to be used as a screening tool in low or non-endemic areas.Conclusion/SignificanceTargeted Sh and Sm PCRs in urine are reliable techniques compared to ME (reference technique). In view of our results, we decided to screen urinary schistosomiasis by direct ME always coupled by the PCR technique, which has shown better reliability criteria.

MO313A CASE OF ALPORT SYNDROME WITH PREGNANCY-RELATED ATYPICAL HEMOLYTIC UREMIC SYNDROME, AND CRESCENTIC GLOMERULONEPHRITIS

Abstract Background Thrombotic microangiopathy (TMA) is one of the most important complications in pregnant patients with chronic kidney disease (CKD) causing clinical deterioration. However, little is known about the pregnancy course in women with Alport syndrome (AS). Case A 28-week pregnant, 22-year-old woman was admitted to our clinic because of widespread edema. Her medical history was notable only for hearing impairment. On examination, vital signs were normal except for the blood pressure (150/90 mmHg). There were diffuse crackles at the lung bases, and 3+ pitting edema in both legs. Lab results revealed heavy proteinuria with 11 gr/day and isomorphic erythrocytes with granular casts in microscopic urine examination. An emergency c-section was performed due to severe preeclampsia at 30 weeks’ gestation. After delivery, her edema did not improve, serum creatinine and lactate dehydrogenase levels elevated, anemia and thrombocytopenia developed (Table 1). Additional tests revealed negative Coombs test, schistocytes on peripheral smear and normal ADAMTS13 level. There was no pathology in serological studies. She received four sessions of plasmapheresis therapy, and with the diagnosis of aHUS, eculizumab therapy was started. Despite improving thrombocytopenia and anemia, serum creatinine levels continued to rise and her urine output decreased. A kidney biopsy was performed (Figure 1). In the light microscopy, 11 of 15 glomeruli had circumferential cellular crescents and 4 had partial cellular crescents. The sample had no findings consistent with TMA. No staining was seen with IgG, IgA, IgM, C3, C1q, κ and λ in immunofluorescence. Further evaluation of hearing impairment revealed bilateral sensorineural hearing loss. A homozygous mutation was identified on COLA4 gene, while homozygous polymorphism on complement factor H (CFH) c.1204C&amp;gt;T and heterozygotic polymorphisms on CFH c.2808G&amp;gt;T and c.3148A&amp;gt;T were revealed. After discharge, her kidney function remained poor requiring maintenance hemodialysis despite 6 months of eculizumab therapy. Discussion Alport syndrome is a genetic disease with the triad of hematuria, sensorineural hearing loss, and ocular symptoms due to the defect in the synthesis of α3, α4 and α5 chains of Type 4 collagen. The increase in proteinuria, hypertension and the presence of CKD are shown as poor prognostic factors for both maternal and fetal health in pregnant women with AS. However, crescentic glomerulonephritis is not the classical biopsy finding of AS. In a few studies, crescents in AS have been reported to correlate with rapid disease progression. There is increasing knowledge that the complement system is involved in the pathogenesis of pauci-immune crescentic GN. High plasma c3a, c5a, c5b-9, Bb and low plasma properdin levels were found to show alternative complement activation and correlate with disease activity in pauci-immune crescentic GN patients. Few reports show that anti-complement therapies might be an option in these cases. Although our case’s kidney functions did not improve on eculizumab, we conclude that the polymorphisms in the complement genes may have induced crescent formation in the presence of pregnancy and abnormal glomerular structure due to AS. Conclusion Here we presented a case with AS complicated by aHUS and crescentic GN. Given this complex combination of rare causes of acute kidney injury, detailed clinical evaluation is of great importance in the evaluation of acute kidney injury during pregnancy.

Amelioration of lithiatic injury to renal tissue by candesartan and sodium thiosulfate in a rat model of nephrolithiasis.

AimNephrolithiasis is a chronic metabolic condition affecting 10% of population worldwide. The present study aimed to investigate the possible protective role of candesartan (CAND) and sodium thiosulfate (STS) in ameliorating ethylene glycol (EG) induced nephrolithiasis.MethodsOne hundred male Wistar rats were divided into five groups: Normal control group, nephrolithiasis (EG) group (1% EG in drinking water), Cystone (CYS) group (EG + 750 mg/kg CYS, orally, once daily), STS group (EG + 0.4 gm/kg STS, intraperitoneally, 3 times/week) and CAND group (EG + 70 μg/mL CAND in drinking water). Treatments and EG administration commenced on the same day and continued for 28 days. CYS was used as reference drug. Urine, blood, and renal tissues were collected at the end of the experiment for assessment of kidney function tests (serum creatinine and urea), urinary (8-hydroxydeoxyguanosine (8-OHdG), calcium and oxalate), inflammatory and oxdative stress biomarkers (transforming growth factor beta (TGF-β), osteopontin (OPN) and ratio of reduced glutathione to oxidized glutathione (GSH/GSSG)) in renal tissue.ResultsSerum (creatinine and urea), urinary (8-OHdG and oxalate) and renal (OPN and TGF-β) were significantly reduced in CAND and STS groups compared to EG group. Furthermore, renal GSH/GSSG and urinary calcium were significantly increased in CAND and STS groups compared to EG group. Histopathological results support the biochemical findings; CAND and STS groups showed less retention of crystals and necrotic damage in kidney. Also, microscopic examination of urine revealed less crystal for CAND and STS groups.ConclusionCandesartan and sodium thiosulfate exhibited protective effect against nephrolithiasis.

COMPARISON OF LIVER FUNCTION TESTS OF NORMALAND PRE-ECLAMPTIC PREGNANT FEMALES: A HOSPITAL BASED STUDY

Background: Pre-eclampsia is a multi-system disorder of unknown etiology involving almost every organ of body including kidney, liver, brain, heart, stomach and adrenals. In liver periportal hemorrhagic necrosis, ischemic lesions and fibrin deposition occurs due to thrombosis of arterioles. Objective: To compare the liver function tests in normal pregnancy and preeclampsia Methodology: This study was conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Kashmir for 18 months. Participants were divided into two groups: Cases: Comprised of 200 patients with toxemia of pregnancy, Controls: comprised of 500 normal, healthy normotensive pregnant women. This group was studied to get the normal values of liver enzymes and served as controls. A complete blood count, microscopic examination of urine, liver function test, kidney function test , 24 hour urinary protein estimation was done on all participants. Results: Among the cases, 49(24.5%) patients while 76 (15.2%) controls had deranged serum bilirubin. Ninety-nine(49.5%) cases had deranged ALT while 16(3.2%) controls had so. Among the cases, 103(51.5%) had deranged AST level while it was deranged in 64(12.8%) controls. ALP and serum total protein followed similar pattern (more deranged in cases than controls). Conclusion: Liver function test impairment occurs in preeclampsia which is characterized by rise in mean level of serum transaminase levels and serum bilirubin level and fall in serum total protein and albumin level.

SO014CHANGES IN CHARACTERISTICS OF CRYSTALLURIA IN PATIENTS WITH RECURRENT NEPHROLITHIASIS

Abstract Background and Aims The study of crystals in the urinary sediment finds application in the diagnosis of hereditary or metabolic nephrolithiasis and in the identification of crystals from drugs. Method We conducted a thorough microscopic urine examination, focused on the determination of crystalluria, associated with the metabolic study at baseline and about 6 months after the start of a metaphylactic therapy, in 21 patients with recurrent nephrolithiasis, followed at the Metabolic Stone Clinic of our Institution. The analysis of the crystals was performed in parallel and blind through direct microscopic examination (MD) and automated instrumentation (SA) (SediMax analyzer - Menarini Diagnostics) of our institution. We used a semi-quantitative approach for both methods. Results We examined 42 sediments (21 at baseline and 21 after an average follow-up of 196±88 days) from 21 patients (8 females, 13 males), all of them showing calcium oxalate crystalluria. The analysis on baseline evaluation and follow-up on both Crystalluria MD and crystalluria SA through spaghetti plots showed a tendency to reduction of severity for the first one only. This trend is consistent with the data obtained from the metabolic studies: urinary oxalate and calcium excretions, the main drivers of calcium oxalate crystallization, which showed decreasing levels. The same examination for urinary citrate excretion showed a rising trend, again in accordance with the on-going changes in urine lithogenic profile. Conclusion The study of crystals in the urinary sediment, repeated over time, may represent a further indicator of the effectiveness of metaphylactic therapy and an indicator of patient adherence to the prescription in metabolic calcium oxalate nephrolithiasis.

Comparison of Trichomoniasis Diagnosis by Microscopic Methods and Indirect ELISA Technique in a Sample of Iraqi Women

Trichomonas vaginalis is an eukaryotic parasite that causes the most common non-viral sexually transmitted infection, trichomoniasis. This disease is responsible for many serious health problems such as preterm birth. More than half of the infected women do not develop symptoms, which makes it difficult to diagnose thedisease. In this study, a specific indirect ELISA method was developed to detect anti-Trichomonas vaginalis IgM and IgG immunoglobulins in the sera of infected females. The aim of this study was to investigate the sensitivity of a simple ELISA procedure in comparison to the classical urine examination and vaginal wet mount preparation for the diagnosis of T. vaginalis. The sensitivity of the indirect ELISA was compared with the classical vaginal discharge swab and urine microscopic examination, and the results showed sensitivities of 65.5% and 57.2%, respectively. Furthermore, the infection was measurable as acute or chronic with the refined test.

Approach to Diagnosis and Management of Hematuria.

Hematuria is one of the alarming manifestations of a renal disease. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or non-glomerular disorders. Clinical presentation and urine microscopy can differentiate glomerular from non-glomerular hematuria. In the majority, a good clinical examination and basic investigations including a urine microscopic examination withsophisticated tools like phase contrast and automated microscopescan help differentiate glomerular from non-glomerular causes for hematuria. Drug induced hematuria, especially secondary to use of analgesics needs to be recognized in routine clinical practice. Rarer causes of hematuria may need more detailed evaluation with a renal biopsy, electron microscopy, urine biochemical testing and imaging. There is no specific treatment to resolve or prevent hematuria. Resolution of hematuria usually occurs with appropriate management of the underlying disorder. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation. Prompt referral to a pediatric nephrologist is indicated in situations when hematuria does not resolve within 2 weeksof onset of glomerulonephritis, there is a need for a renal biopsy, in the presence of persistent microscopic hematuria andneed for specific urine biochemistry testing or imaging studies.

The utility of urinary dipstick in the diagnosis of urinary tract infection in children

Background: Urinary tract infection (UTI) is frequent in children and may have significant adverse effects, especially for young children. Objective: The objective was to assess the sensitivity and specificity of pyuria, leukocyte esterase, and nitrite test in the diagnosis of UTI and whether they can be used as an alternative to the conventional culture, which is expensive and needs more time for the result to be obtained. Methods: This is a cross-sectional study in which 143 patients were prospectively studied in Kerbela teaching hospital for children, who were suspected to have UTI and did not receive antibiotics for at least a week. Urine samples were collected using urine catheter for children who are not toilet trained and midstream urine for older children. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were measured for nitrite, leukocyte esterase, and pyuria. Results: There was a highly significant association between the positive results of urine dipstick (nitrite test and leukocyte esterase test) and microscopic (examination for pyuria) and the positive results of urine culture (P

Acyclovir crystalluria: The utility of bedside urine routine microscopic examination

Acyclovir, an acyclic nucleoside, is commonly used for the treatment of viral infections. Acyclovir is well tolerated in children. However, severe nephrotoxicity has been shown to occur in some children. One of the mechanisms for acyclovir-induced nephrotoxicity is acyclovir-induced crystalluria. Prompt attention to urine microscopy examination can help avoid drug-induced nephrotoxicity. Here, we report a case of a seven-year-old febrile comatose child who received intravenous empirical acyclovir therapy and developed cloudy urine. Bedside urine microscopic examination shows fine-needle-shaped crystal. The urine was cleared within 12 h of stopping the acyclovir and adequate intravascular hydration. A child recovered without evidence of acute kidney injury.