Negative Urine Dipstick Research Articles

Chronic Kidney Disease in Police Forces Households in Khartoum, Sudan: Pilot Report

Introduction: In the Police Forces Hypertension, Diabetes, Renal Insufficiency and Thyroid Derangement (HyDRIT) pilot study we explored the prevalence, risk factors, awareness, treatment adequacy and complications of chronic kidney disease (CKD) and other non-communicable diseases among adult Police Forces households in two housing complexes in Khartoum, Sudan. Methods: Serum creatinine measurements and urine dipstick testing were performed for 273 individuals. The glomerular filtration rate (GFR) was estimated using the standardized Cockroft-Gault and the four variable MDRD formulas. CKD was defined as an estimated GFR of less than 60 ml/min/1.73m2 and/or proteinuria. Results: The overall prevalence of CKD was 11% (30/273) using the standardized Cockroft-Gault equation and 7.7% (21/273) using the four variable MDRD equation. According to the standardized Cockroft-Gault formula, 14 subjects had reduced GFR with negative urine dipstick testing, two subjects had both proteinuria and reduced GFR, and 14 subjects had proteinuria without reduction in GFR. None of those subjects was aware of his kidney problem. According to the standardized Cockroft-Gault formula, 14 of the identified CKD cases were hypertensive (46.7%); eight of them (57.1%) had a prior diagnosis of hypertension but none achieved therapeutic targets. Four of the identified CKD cases were diabetic (13.3%), three of whom had a prior diagnosis of diabetes mellitus with reasonably controlled blood sugar levels. Only age above 50 years and low educational level proved to be independent risk factors for CKD in multivariate analysis. Conclusion: The prevalence of CKD in the study population seems to be comparable to other countries. Keywords: awareness, chronic kidney disease, diabetes mellitus, hypertension, prevalence, Sudan

Crohn's disease and enterovesical fistulae: common things are common

A 39-year-old Caucasian male presented with a 5-day history of acute severe left iliac fossa pain (radiating to the umbilicus), vomiting and episodic pneumaturia associated with brown urinary sediment. There had been no reported alteration in bowel habit, anorexia or weight loss. On examination he was apyrexial and haemodynamically stable with only mild tenderness limited to the area of the left lower rectus sheath, inferior to the umbilicus. Four years earlier he had been diagnosed with Crohn's disease at a nearby hospital, following a similar episode of left iliac fossa pain; the diagnosis of Crohn's disease was based on computed tomography findings of a thickened ascending colon despite normal histology at colonoscopy. Since the diagnosis of Crohn's disease he had remained on regular mesalazine, with five episodes of similar pain (and occasional pneumaturia) treated with intravenous steroids for presumed exacerbations of Crohn's disease. Given the history of pneumaturia he was pending an outpatient magnetic resonance imaging scan to establish the presence of an enterovesical fistula. At admission, initial investigations revealed a negative urine dipstick for leucocytes and nitrites and only mildly raised inflammatory markers. A computed tomography scan demonstrated an abnormal sigmoid colon adherent to the bladder and anterior abdominal wall (Figure 1). There was also evidence of fluid within the left rectus abdominal sheath and of a fistulous tract between the bladder and sigmoid colon (Figure 2). Flexible sigmoidoscopy revealed an area of narrowing with tight angulation in the sigmoid colon and an abnormal red spot of uncertain aetiology, but there was no evidence of Crohn's disease macroscopically or histologically. Flexible cystoscopy showed thickening of the anterior dome of the bladder with a likely fistula opening superiorly, with non-specific cystitis on histology. Multidisciplinary team discussions concluded that the findings were more suggestive of a localized perforation of a sigmoid diverticulum 4 years earlier leading to secondary inflammatory erosion with the creation of a persistent enterovesical fistula. He therefore underwent a sigmoid colectomy and bladder wall repair. At operation a mass was found in the left iliac fossa adherent to the bladder and abdominal wall and 5 ml of pus drained from an abscess in the anterior abdominal wall. Histology showed an inflamed and ulcerated diverticulum in the sigmoid and an acute and chronic inflammation with foreign body type multinucleated giant cell reaction in the bladder. The patient made a good recovery postoperatively with an early discharge and his longstanding medication for Crohn's disease was stopped.

Women’s health—what’s new worldwide

Women’s health—what’s new worldwide

Trimethoprim was more effective than placebo in shortening the duration of dysuria for women with negative urine dipstick tests

Trimethoprim was more effective than placebo in shortening the duration of dysuria for women with negative urine dipstick tests

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

Cat-scratch disease; Negative urine dipstick, positive culture; Oryx initiative

Cat-scratch disease; Negative urine dipstick, positive culture; Oryx initiative

The Diagnostic Accuracy of Rapid Dipstick Tests to Predict Urinary Tract Infection

This study summarizes the diagnostic accuracy data for dipstick nitrite and/or leukocyte esterase tests (the index tests) as predictors of bacterial urinary tract infection as defined by quantitative culture (the reference test). On-line search of the literature using the MEDLARS database identified 1,017 citations, 51 of which were relevant and contained sufficient data for further analysis. From each citation, 2 x 2 tables of true-positive, true-negative, false-positive, and false-negative results were extracted. Four categories of index test were assessed: nitrite only, leukocyte esterase only, disjunctive pairing (dipstick positive if nitrite, leukocyte esterase, or both were positive), and conjunctive pairing (dipstick positive only if both nitrite and leukocyte esterase were positive). The true- and false-positive rates were calculated from each 2 x 2 table. Plots of true-positive rates versus false-positive rates demonstrated widely scattered points, indicating heterogeneity. A receiver-operating characteristic curve was fitted to the data using logistic transforms and weighted linear regression. This analysis revealed that the disjunctive pair is the most accurate index test. However, in many clinical settings, the posterior probability of urinary tract infection given a negative dipstick is too high to exclude it. Within most clinically relevant ranges of true- and false-positive rates, a negative urine dipstick test cannot exclude the diagnosis of urinary tract infection in patients with high prior probabilities of contracting this infection. For lower prior probabilities, the clinical efficacy of these rapid tests would best be determined by decision analysis, for which these receiver-operating characteristic functions would serve as valuable analytical tools.