Morning Urine Specimens Research Articles

The relationship between obstructive sleep apnea, nocturia, and daytime overactive bladder syndrome in women

The purpose of this study was to corroborate the association between obstructive sleep apnea (OSA) and nocturia in a clinical sample of urogynecologic patients and to explore whether night-time urine concentration predicts the presence of OSA. Patients with nocturia and control subjects underwent a home sleep study, completed validated nocturia questionnaires, and provided evening and morning urine specimens that were analyzed for osmolarity. Twenty-one patients with nocturia (16 of whom also had daytime overactive bladder [OAB] symptoms) and 10 control subjects were studied. OSA was present in 17 of 21 women (81%) with nocturia: 13 women (81%) with OAB, 4 women (80%) with nocturia/no OAB, and 4 control subjects (40%; P < .001). The percentage of rapid eye movement sleep time was correlated inversely with nocturic frequency (rho = -.51; P < .004). The presence of diluted nighttime urine in a patient with nocturia was 88% sensitive for the presence of OSA. We should consider a diagnosis of OSA in all patients with nocturia, even those patients with daytime OAB.

Association of haptoglobin phenotypes with markers of diabetic nephropathy in Type 2 diabetes mellitus

Background Recent studies have suggested an inheritable influence of haptoglobin phenotypes on the development of microalbuminuria in diabetic patients. In this study, we aimed to investigate whether microalbuminuria and serum levels of Cystatin C (Cys C) were correlated with haptoglobin phenotypes in patients with Type 2 diabetes mellitus. Methods Fasting blood samples and first morning urine specimens were collected from 216 patients with type 2 diabetes (mean age 60.8±6.8) and from 108 healthy controls (mean age 59.3±6.5 years). Serum was used for the determination of Cys C, creatinine, and haptoglobin (Hp) phenotypes, while urine specimens were used for the determination of microalbuminuria. Microalbuminuria was expressed as albumin (mg)/creatinine (g) ratio [ACR (mg/g)], and patients were divided into three groups according to the values of ACR: normoalbuminuria (<30), microalbuminuria (30–300) and macroalbuminuria (>300). Results Irrespective of Hp phenotypes, Cys C, but not creatinine, was significantly higher in patients than that in controls. According to haptoglobin phenotypes, however, the levels of Cys C, duration of diabetes, and age, were significantly higher in patients with Hp1-1 phenotype than that in patients with the other phenotypes. Moreover, micro- and/or macroalbuminuria were present in all diabetic patients, with no significant difference in frequency of occurrence among the three Hp phenotypes. Multiple linear regression revealed that duration of diabetes and age of patient were significant predictors of Cys C ( P<.0001), whereas creatinine associated with age only ( P=.016). Logistic regression analysis showed that duration of diabetes [ P≤.0001; odds ratio (OR)=1.678, 95% CI=1.43–1.97], and age ( P=.0004; OR=0.847, 95% CI=0.77–0.93), significantly associated with micro- and/or macroalbuminuria. Hp phenotypes however, were not associated with any marker of kidney function. Conclusion Findings from this study demonstrate no association between Hp phenotypes and markers of diabetic nephropathy. Markers of diabetic nephropathy however, are greatly influenced by duration of diabetes and age of patients.

Studies on the aetiology of non-gonococcal urethritis (author's transl)

Tests performed on urethral secretion and morning urine specimen identified the causative micro-organism in 143 of 164 males with non-gonococcal urethritis. In 59 patients (36%) there was an infection with Chlamydia trachomatis, in 48 (29.2%) with Ureaplasma urealyticum in significantly high bacterial counts (greater than or equal to 10(4) KbU/ml) urethral secretion (greater than or equal to 10(3) KbU/ml first urine sample), and in a further 18 patients (11%) double infections with Chlamydia trachomatis and Ureaplasma urealyticum. Other causative organisms such as Mycoplasma hominis, enterococci, streptococci of groups A and B, enterobacteria and Trichomonas were isolated in 18 patients (11%). In 21 patients (12.8%) no causative organism was demonstrated. In several instances, Chlamydia was demonstrated in ureaplasma-negative non-gonococcal urethritis, while Ureaplasma was demonstrated in Chlamydia-negative cases. In cases of urethritis caused by Chlamydia gonorrhoeal urethritis was more frequent in the past history than when urethritis was due to Ureaplasma. Treatment with tetracyclines led to clinically and microbiologically good results in 77% of patients with Ureaplasma urethritis, in 64% of patients with Chlamydia urethritis. Adnexial infections such as prostatitis and epididymitis were among the complications seen.

Anti‐microbial Activity of Urine after Ingestion of Cranberry: A Pilot Study

We explore the anti-microbial activity of urine specimens after the ingestion of a commercial cranberry preparation. Twenty subjects without urinary infection, off antibiotics and all supplements or vitamins were recruited. The study was conducted in two phases: in phase 1, subjects collected the first morning urine prior to ingesting 900 mg of cranberry and then at 2, 4 and 6 h. In phase 2, subjects collected urine on 2 consecutive days: on Day 1 no cranberry was ingested (control specimens), on Day 2, cranberry was ingested. The pH of all urine specimens were adjusted to the same pH as that of the first morning urine specimen. Aliquots of each specimen were independently inoculated with Escherichia coli, Klebsiella pneumoniae or Candida albicans. After incubation, colony forming units/ml (CFU ml−1) in the control specimen was compared with CFU ml−1 in specimens collected 2, 4 and 6 h later. Specimens showing ≥50% reduction in CFU ml−1 were considered as having ‘activity’ against the strains tested. In phase 1, 7/20 (35%) subjects had anti-microbial activity against E. coli, 13/20 (65%) against K. pneumoniae and 9/20 (45%) against C. albicans in specimens collected 2–6 h after ingestion of cranberry. In phase 2, 6/9 (67%) of the subjects had activity against K. pneumoniae. This pilot study demonstrates weak anti-microbial activity in urine specimens after ingestion of a single dose of commercial cranberry. Anti-microbial activity was noted only against K. pneumoniae 2–6 h after ingestion of the cranberry preparation.

Microalbuminuria in Children with Vesicoureteral Reflux

Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that may be inherited. Reflux of infected urine may cause scarring in susceptible kidneys with the potential to compromise renal function. The aim of the study was to evaluate the possible influence of different grades of VUR on glomerular damage using microalbuminuria as a parameter. Children with VUR detected by voiding cystourethrography (VCUG) were investigated. According to the grade of VUR, patients were separated into three groups. The first group included 12 children with VUR grade I–II. The second group consisted of 12 children with grade III of VUR. Patients with VUR grade IV–V (n = 11) were members of the third group. The control group consisted of 17 healthy children. Microalbuminuria was examined in samples of morning urine specimens using a microalbumin/creatinine reagent kit. Serum urea, creatinine levels and creatinine clearance (CCR) were measured as markers of renal function. The mean value of microalbumin excretion in the third group showed a statistically significant increase (p < 0.001) compared to all other groups. CCR in the third group was statistically significantly decreased (p < 0.05) in comparison to the group of healthy children. There were no statistically significant changes of microalbumin excretion and CCR in the first and second group compared to control values. We discussed the presence of microalbuminuria and decrease of CCR in children with high grade of VUR as a possible consequence of retrograde urine flow (intrarenal reflux), glomerulosclerosis, and consecutive hyperfiltration.

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.

Idiopathic membranous nephropathy in pediatric patients: presentation, response to therapy, and long-term outcome

BackgroundIdiopathic membranous nephropathy (IMN) is one of the most common causes of primary nephrotic syndrome in adults. However, it is a relatively rare entity in the pediatric population and there is a paucity of data about the incidence, prognosis, and optimal treatment of IMN in children and adolescents. We conducted this study to evaluate pediatric patients with IMN in order to clarify the presentation, response to therapy, and clinical outcome.MethodsA retrospective chart review was performed on patients identified with biopsy-proven IMN between 1988–2005. Patients with systemic lupus erythematosus or hepatitis-related lesions were excluded. The following data were tabulated: age, gender, ethnicity, presenting clinical and laboratory findings, proteinuria in a first morning urine specimen, estimated glomerular filtration rate (GFRe), histopathology, type and duration of treatment, and clinical status at final evaluation.Results13 cases of IMN were identified out of 460 renal biopsies performed for evaluation of primary kidney disease during the study interval. Mean age was 9.6 ± 4.6, gender 6 M:7 F, ethnicity 8 W:2 B:3 H. At the initial visit hematuria was present in 9 patients, edema in 5, nephrotic-range proteinuria in 5, and hypertension in 3. Mean urinary protein:creatinine ratio 3.3 ± 2.5 and all patients had a normal GFRe. Classic glomerular findings of IMN were seen in all renal specimens, with concomitant interstitial changes in 2 cases. Treatment included an angiotensin converting enzyme inhibitor or angiotensin receptor blocker in 11 cases. Most patients were also given immunosuppressive medications – prednisone in 10, a calcineurin inhibitor in 5, and mycophenolate mofetil or azathioprine in 3 patients. At the last follow-up, 42 ± 35 months after the diagnostic biopsy, 7 children were hypertensive and the urine protein:creatinine ratio was 2.3 ± 3.1. The mean GFRe was 127 ± 57 mL/min/m2. Three patients had Chronic Kidney Disease Stage 3, all of whom were also hypertensive.ConclusionIMN is a rare but serious glomerulopathy in pediatrics. We estimate that it accounts for approximately 3% of renal biopsies. Long-term prognosis is guarded because approximately 50% of patients may have evidence of progressive kidney disease.

Free DNA in Urine: A New Marker for Bladder Cancer? Preliminary Data

The aim of the present preliminary study was to investigate the presence of free DNA (FDNA) in urine as a possible marker for the diagnosis of bladder cancer. Naturally voided morning urine specimens were collected from 57 patients with suspected bladder cancer before cystoscopy. A standard urine test was performed; the specimens were then processed in order to obtain a quantitative evaluation of the presence of free DNA in the urine. Twenty-two patients were excluded from the study because they had leukocyturia and/or bacteriuria. Free DNA concentrations higher than 250 ng/mL were found in all 16 patients showing bladder cancer at cystoscopy and in seven (36.8%) of the 19 patients with negative cystoscopy. Urinary FDNA seems to have an excellent sensitivity: we observed no false negative cases and 36.8% false positive cases. By contrast, only 6.25% of the bladder cancer patients had positive urine cytology. Our results seem promising, although further studies and larger numbers are needed to define urinary free DNA as a reliable marker of bladder cancer.

Urinary creatinine concentration is inversely related to glycaemic control and the presence of some diabetic complications in patients with newly diagnosed Type 2 diabetes

Background The ratio between urinary albumin concentration (UAC) and urinary creatinine concentration (UCC) is widely used to estimate renal involvement. We examined how UAC and UCC associate with each other, with other risk factors, and with diabetic complications in a population-based sample of Type 2 diabetic patients. Methods A freshly voided morning urine specimen was provided by 1284 consecutive, newly diagnosed diabetic patients aged 40 years or over in general practice. Albumin was measured by a polyethyleneglycol radioimmunoassay and creatinine by a modified Jaffe method. Results In a multivariate model including UAC, UCC, age, sex, HbA1c, and urinary glucose concentration, UAC increased with both age ( P=.042) and HbA1c ( P=.014), while UCC decreased ( P<.001 and P<.001, respectively). In two regression models, the prevalence of diabetic retinopathy ( P<.001) and relatively high resting heart rate ( P<.001) increased with increasing UAC but decreased with increasing UCC ( P=.002 and P=.005, respectively). Conclusion The use of albumin/creatinine ratio (ACR) may introduce bias of unpredictable size and direction in comparisons of ACR with variables that are associated with UCC in their own right. In daily clinical practice, renal involvement in the individual patient can be estimated reliably with UAC or ACR measured in a freshly voided morning urine specimen, especially when considered together. However, the associations of the combined measure ACR should be interpreted with great caution in clinical and epidemiological research.

Relationship of Day-to-day Reproductive Hormone Levels to Sleep in Midlife Women

We analyzed data from a single menstrual cycle from 630 women, aged 43 to 53 years, in the Daily Hormone Study component of the Study of Women's Health Across the Nation to determine whether hormone levels are associated with trouble sleeping as women enter the menopausal transition. Women recorded whether they had trouble sleeping the previous night. Morning urine specimens were obtained for daily determinations of levels of luteinizing hormone, follicle-stimulating hormone, estradiol metabolites (ie, estrone conjugates), and the progesterone metabolite (pregnanediol glucuronide). Women were categorized as premenopausal or early perimenopausal by bleeding patterns. Average adjusted odds of reporting trouble sleeping were 29% higher in perimenopausal than in premenopausal women. The highest percentages of women in both menopausal groups reported trouble sleeping in the beginning or at the end of their cycle. After controlling for covariates, pregnanediol glucuronide level was associated with increased trouble sleeping in perimenopausal women and follicle-stimulating hormone level was associated with increased trouble sleeping in premenopausal women. Mood and vasomotor symptoms were the strongest and most consistent cocontributors to trouble sleeping. In this community-based sample of middle-aged women, the most trouble sleeping was observed at the beginning and end of the menstrual cycle.

Short-Term Urine Deoxypyridinoline Biological Variability in the First 5 Years after Menopause

There is evidence that bone turnover in women is more rapid during the first years after menopause than in subsequent years. The assessment of deoxypyridinoline (DPD) cross-links in a fasting urine sample is considered a specific index of bone resorption by osteoclasts and also can be used for monitoring the response to pharmacologic antiresorption treatment. The interpretation of results, however, is hampered by biological and other preanalytical variability (1)(2)(3)(4). Specific degradation products of the bone matrix, such as DPD and pyridinoline (PYD), closely reflect the rate of bone metabolism. Vesper et al. (1) reported mean within-day variabilities of 67% for DPD (range, 53%–75%) and 71% for PYD (57%–78%). The mean between-day variability was 16% for both PYD and DPD (ranges, 5%–24% and 12%–21% for DPD and PYD, respectively). The mean between-person variabilities across different studies were 34% for DPD (8%–98%) and 26% for PYD (12%–63%) in healthy premenopausal women and 40% (27%–54%) and 36% (22%–61%), respectively, in postmenopausal women. Specimen instability and errors in creatinine measurements were additional sources of variability(1). Some authors have reported that the variability can be reduced by collecting urine for 24 h (or longer) instead of using single voids and by expressing the results as ratios to creatinine(5)(6). The usefulness of urinary markers of bone turnover in monitoring therapy depends on the within-person variability of these markers compared with their changes in response to treatment (7). Thus, the biological and laboratory variabilities of DPD cross-links are important considerations for clinical evaluation. We evaluated the biological variability of DPD cross-link concentrations in fasting morning urine specimens collected during a 2-week period from women in their first years of menopause. We examined 64 postmenopausal women (mean age, 53 years; range, 49–57 …

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.

LATENT REPRODUCTIVE AND IMMUNOLOGICAL EFFECTS OF GESTATIONAL EXPOSURE TO HEPTACHLOR

ISEE-225 Introduction/Aim: The aim is to determine whether gestational exposure to the chlorinated cyclodiene pesticide, heptachlor, results in latent effects on reproductive or immunological function. The study is based on a well characterized episode in which the commercial milk supply on the Hawaiian island of Oahu was contaminated with heptachlor epoxide (HE) during a 15 month period (1981–82), resulting in gestational exposure to offspring of women who drank cows' milk during that period. Previous research in Hawaii verified that that HE concentrations in human serum and breast milk were significantly higher in the Oahu population than in the unexposed Neighbour islands' population following the period of milk contamination. Studies also demonstrated a significant association between HE concentrations and reported cows' milk consumption during 1981–82. A study conducted from 1999–2003 of 1,891 young adults who were born during 1981–82 and lived on Oahu, found that mothers' reported cows milk consumption during pregnancy was associated with lower neurobehavioural performance, and more reported behavioural problems in the young adults who were born on Oahu during the milk contamination. Methods: The current study follows up the young adults who participated in the earlier neurobehavioural study, to recruit 400 Oahu-born young adults and 200 comparison participants who were not born on Oahu, matched by age and ethnicity. Indicators of reproductive function include: serum testosterone in males, estradiol and progesterone in females; and LH and FSH in both sexes; semen samples; and daily first morning urine specimens in females for one menstrual cycle to measure LH, estrone-3-glucuronide, and pregnanediol 3-alpha-glucuronide. Indicators of immune function include skin tests for recall antigens; antibody titer response to immunization with tetanus and pneumococcal vaccine; and Th1 and Th2 type CD4+ cell subsets in blood. Results: The study has completed follow-up of the sampling frame and enrolled 250 participants, including 238 participants with substantially complete data collection. Of these, 209 were born on Oahu and 29 were born elsewhere. Initial analysis of the reproductive and immune function parameters has indicated no clear associations with place of birth or, among Oahu-born participants, mothers' reported cows' milk consumption during pregnancy. Findings on approximately 375 participants will be completed by Summer 2005. Conclusion: The findings indicate that gestational exposure to HE may be associated with subtle latent effects on neurobehavioural performance, although there is no apparent effect on reproductive or immune function, based on the initial analysis. Data collection prior to the ISEE conference will achieve sufficient statistical power to address the hypotheses. This study is funded by the US Environmental Protection Agency.

Free DNA in Urine: A New Marker for Bladder Cancer? Preliminary Data

The aim of the present preliminary study was to investigate the presence of free DNA (FDNA) in urine as a possible marker for the diagnosis of bladder cancer. Naturally voided morning urine specimens were collected from 57 patients with suspected bladder cancer before cystoscopy. A standard urine test was performed; the specimens were then processed in order to obtain a quantitative evaluation of the presence of free DNA in the urine. Twenty-two patients were excluded from the study because they had leukocyturia and/or bacteriuria. Free DNA concentrations higher than 250 ng/mL were found in all 16 patients showing bladder cancer at cystoscopy and in seven (36.8%) of the 19 patients with negative cystoscopy. Urinary FDNA seems to have an excellent sensitivity: we observed no false negative cases and 36.8% false positive cases. By contrast, only 6.25% of the bladder cancer patients had positive urine cytology. Our results seem promising, although further studies and larger numbers are needed to define urinary free DNA as a reliable marker of bladder cancer.

Tubular and Glomerular Proteinuria in Diagnosing Chronic Allograft Nephropathy With Relevance to the Degree of Urinary Albumin Excretion

The diagnosis of chronic allograft nephropathy (CAN) is based on pathological examination according to Banff 97 schema. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria for noninvasive recognition of CAN. One hundred and thirty renal allograft recipients (at least 90 days after transplantation) who had undergone diagnostic allograft biopsy were included in the study. Beta2-microglobulin, alpha1-microglobulin, albumin, immunoglobulin G, total protein, and creatinine concentrations were obtained from the second morning urine specimen. Raw data and values calculated per 1 g of creatinine excreted in urine along with time after transplantation, serum creatinine, and its change over a period of 2 months prior to biopsy were taken for analysis. Urine proteins were measured using a nephelometric method. Statistical calculations were performed using MANOVA and stepwise discriminant analysis (SDA). Statistical diagnosis and staging of CAN matched the pathological method in 68% of a preliminary SDA. Therefore patients were divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. There was no significant differences between protein excretion, except alpha1-microglobulinuria (CAN 0 vs 2, P = .018; CAN 1 vs 2, P = .041), beta2-microglobulinuria (CAN 0 vs 2, P = .026; CAN 1 vs 2, P = .0033), and total proteinuria (CAN 0 vs 2, P = .042) in the normoalbuminuric group. Nevertheless, diagnoses obtained using SDA were 89%, 91%, and 92% identical to the results of pathological examinations, for normoalbuminuric, microalbuminuric, and macroalbuminuric groups, respectively. In conclusion, tubular and glomerular proteinuria measurements may be useful for a noninvasive CAN diagnosis and staging only with regard to degree of urinary albumin excretion.

Optimal bedside urinalysis for the detection of proteinuria in hypertensive pregnancy: a study of diagnostic accuracy

To compare semi-quantitative visual and automated methods of urine testing with fully quantitative point of care urinalysis for the detection of significant proteinuria (0.3 g/24 hours) in pregnancy complicated by hypertension. A prospective comparative study. A large teaching maternity hospital. One hundred and seventy-one pregnant women referred to the obstetric day-care unit for assessment of newly arisen hypertension. Early morning urine specimens were tested with four dipstick techniques (Multistix 8SG visual and automated and microalbumin/creatinine ratio visual and automated; Bayer, Elkhart, USA) as well as a fully quantitative measure of the microalbumin creatinine ratio with the DCA 2000 (a point of care assay for albumin; Bayer). These results were compared to a 24-hour urine protein measurement and measures of diagnostic accuracy/prediction are reported. Significant proteinuria (> or =0.3 g/24 hours) measured by laboratory assay. Automated dipstick urinalysis using the Clinitek 50 has significantly better predictive values for significant proteinuria (LR(+) 4.27, 95% CI 2.78 to 6.56; LR(-) 0.225, 95% CI 0.14 to 0.37) than conventional visual dipstick urinalysis (LR(+) 2.27, 95% CI 1.47 to 3.51; LR(-) 0.635, 95% CI 0.49 to 0.82). Dipstick microalbumin/creatinine ratio testing did not improve overall detection rates with automated or visual testing. Fully quantitative point of care measurement of albumin/creatinine ratio (ACR) was significantly better than any dipstick technique (LR(+) 14.6, 95% CI 6.74 to 31.8; LR(-) 0.069, 95% CI 0.030 to 0.16). This study confirms that in pregnancy automated dipstick urinalysis is a more accurate screening test for the detection of proteinuria than visual testing. ACR testing can offer a significant improvement over conventional urinalysis if a fully quantitative method of detection is employed that uses pregnancy-specific thresholds. Dipstick assessment of ACR does not improve the detection rate of significant proteinuria.

Free DNA in urine: A new marker for bladder cancer? Preliminary data

The aim of the present preliminary study was to investigate the presence of free DNA (FDNA) in urine as a possible marker for the diagnosis of bladder cancer. Naturally voided morning urine specimens were collected from 57 patients with suspected bladder cancer before cystoscopy. A standard urine test was performed; the specimens were then processed in order to obtain a quantitative evaluation of the presence of free DNA in the urine. Twenty-two patients were excluded from the study because they had leukocyturia and/or bacteriuria. Free DNA concentrations higher than 250 ng/mL were found in all 16 patients showing bladder cancer at cystoscopy and in seven (36.8%) of the 19 patients with negative cystoscopy. Urinary FDNA seems to have an excellent sensitivity: we observed no false negative cases and 36.8% false positive cases. By contrast, only 6.25% of the bladder cancer patients had positive urine cytology. Our results seem promising, although further studies and larger numbers are needed to define urinary free DNA as a reliable marker of bladder cancer.

Protein-to-creatinine ratio in spot urine samples as a predictor of quantitation of proteinuria

Background Normal individuals usually excrete very small amounts of protein in the urine. Persistently increased protein excretion is usually a marker of kidney damage. Quantifying protein in urine is commonly used in the diagnosis of kidney diseases, detection of treatment effects and evaluation of prognosis. We evaluated the use of the total protein-to-creatinine ratio (P/C) in spot urine specimens as a predictor of urine protein excretion in 24-h collections. Methods The correlation between P/C in first morning and random urine specimens and urinary protein excretion in 24-h collections were analyzed. The cutoff value of P/C in first morning urine specimens for screening urinary protein excretion of 1 and 3 g in 24-h collections was determined by receiver operating characteristics (ROC) curve. Results For patients with Ccr≤10 ml/min, correlation between the urine protein excretion in 24-h collections and the P/C in first morning urine specimens was not significant. For patients with Ccr>10 ml/min, the correlation was highly significant. Similar results were obtained for random urine specimens. By ROC curve analysis, the P/C of 0.94 and 2.84 g/gcr in first morning urine specimens represent the best threshold to detect urine protein excretion of 1 and 3 g in 24-h collections, respectively. There is a good correlation between P/C in first morning urine specimens and random urine specimens from inpatients and outpatients. But the P/C in random specimens is significantly higher than that in first morning specimens in outpatients. Conclusion The P/C in spot urine samples could be used as an alternative to urine protein excretion in 24-h collections in patients with Ccr>10 ml/min. The P/C in first morning urine samples is better than that in random specimens, especially for outpatients.

What characteristics are associated with screening positive for microalbuminuria in patients with diabetes in the community?

AbstractThe community prevalence of microalbuminuria in patients with diabetes is unknown. The aims of this study were to determine the community prevalence of microalbuminuria and to identify associated characteristics with particular reference to ethnicity.The study was undertaken in 18 Leicestershire general practices. Subjects were recruited either by a written invitation to the entire diabetic register over 16 years of age or by personal invitation to all those attending a practice diabetic clinic. Microalbuminuria status was determined from three first morning urine specimens, using the albumin:creatinine ratio (ACR), microalbuminuria being defined as at least 2.5 mg/mmol in males and 3.5 mg/mmol in females in two or more samples. Nine patient covariates were recorded for each subject.In all, 1860 patients (an estimated overall response rate of 67%) consented to participate (1373 white, 451 Indo‐Asian, 36 other ethnic groups); 1362 (73.2%) completed screening. The prevalence of microalbuminuria in patients with diabetes recruited to the study was 19.3%. The characteristics independently associated with a higher prevalence of microalbuminuria were current insulin use, current smoking, older age, higher systolic blood pressure and poorer metabolic control, but there was no significant association with duration of diabetes, gender or ethnicity.Screening for microalbuminuria using ACR is feasible in the community. Our estimate of the community‐wide prevalence of microalbuminuria (19.3%) is lower than some earlier population‐ and many hospital‐based estimates. Due to difficulties in recruiting, in particular Indo‐Asian subjects, the precise community prevalence of microalbuminuria could only be estimated, although some characteristics of the screened population were representative of the larger unscreened Leicestershire diabetic population. The factors shown to be associated with microalbuminuria were current insulin use, current smoking, older age, higher systolic blood pressure and poorer metabolic control. If Indo‐Asian ethnicity is associated with microalbuminuria, then this association is not as strong as other characteristics. These findings suggest that interventions to delay the progression of diabetic nephropathy support smoking cessation, and better glycaemic and blood pressure control—areas that require sustained action. Copyright ©2004 John Wiley &amp; Sons, Ltd.

TUBULAR AND GLOMERULAR PROTEINURIA IN DIAGNOSING CHRONIC ALLOGRAFT NEPHROPATHY WITH RELEVANCE TO THE DEGREE OF URINARY ALBUMIN EXCRETION

P300 Aims: The diagnosis of chronic allograft nephropathy (CAN) is based on pathological examination according to Banff’97 schema. The aim of the study was to evaluate the usefulness of tubular and glomerular proteinuria in non-invasive recognition of CAN. Methods: 130 renal allograft recipients (at least 90 days after transplantation) who have undergone renal allograft biopsy due to either of following indications (proteinuria, increase of serum creatinine, protocol biopsy), without urinary tract infection or obstruction were included in the study. Beta2-microglobulin (b2-m), alpha1-microglobulin (a1-m), albumin (alb), immunoglobulin G (IgG), total protein (Tp) and creatinine (ucr) concentrations were obtained from the second morning urine specimen. Raw data and values calculated per 1 gram of creatinine excreted in urine along with time after transplantation, serum creatinine (scr), and its change over period of 2 months prior to biopsy were taken for analysis. Urine proteins (b2-m, a1-m, alb, IgG) were measured using nephelometric method. Statistical calculations were performed using MANOVA and Stepwise Discriminant Analysis (SDA). Results: Statistical diagnosis and staging of CAN matched pathological method in 67.7% in preliminary SDA. Therefore patients were divided into normo- [(n-alb) <30 mg/1g ucr], micro- [(mic-alb) 30-300 mg/1g ucr], and macroalbuminuric [(mac-alb) >300 mg/1g ucr] group. Diagnoses obtained using SDA were in 89%, 91%, and 92% identical with the results of pathological examinations, for n-alb, mic-alb, mac-alb group, respectively. N-alb group: statistical analysis allows to correctly identify 100% (7 of 7), 90.6 % (29 of 32) and 80% (8 of 10) patients with CAN stage 0, 1, 2, respectively. Mic-alb group: statistical analysis allows to correctly identify 50% (1 of 2), 93.9 % (31 of 33) and 90% (9 of 10) patients with CAN stage 0, 1, 2+3, respectively. Mac-alb group: statistical analysis allows to correctly identify 100% (18 of 18), 83.3 % (15 of 18) patients with CAN stage 0+1, 2+3 (), respectively. Combination of groups in mic-alb and mac-alb group was necessary for statistical purposes. Tp (026), b2-m/1 g cr ratio (0.62), b2-m/1 g ucr ratio (0.59), were the most indispensable parameters for n-alb, mic-alb, and mac-alb group, respectively. Conclusions: Tubular and glomerular proteinuria measurement may be useful in non-invasive CAN diagnosis and stage prediction only with regard to degree of urinary albumin excretion.