Random Urine Specimens Research Articles

A-317 Development of a patient-focused volumetric absorptive microsampling strategy to assess urinary amino acid excretion

Abstract Background Biochemical determinations of urinary amino acid excretion patterns can diagnose specific inborn errors of metabolism (IEM). Clinical management of these genetic metabolic patients may require frequent urine amino acid tests. A simplified process for transporting home collected urine specimens would benefit the IEM community. Volumetric absorptive microsampling (VAMS) is an emergent alternative sampling technique for the collection of dried biological specimens. We describe the development and preliminary validation results of a VAMS strategy for the analysis of creatinine and amino acids (N=22) from microsampled dried urine. Methods Urine creatinine and amino acids were respectively measured in a clinical laboratory setting using established assays on a CobasPro (Roche) and a MassTrak ultra-performance liquid chromatography (UPLC) amino acid analysis (AAA) solution (Waters). Two 30 µL VAMS tips from a Mitra device (Neoteryx) were used to sample each random urine specimen. An ultrasonication-based solvent extraction procedure was optimized to extract the amino acids and creatinine from the VAMS tips. Solvent extracts were subsequently dried by centrifugal evaporation. Extract from one tip was re-dissolved in water and tested for creatinine using an enzymatic method. The other extract was re-dissolved in 0.02 N sodium hydroxide and tested according to the MassTrak AAA procedure, which deploys pre-column AccQTag derivatization with reversed-phase UPLC on a C18 column (2.1 × 150 mm; 1.7 µm) and UV detection at 260 nm. Accuracy, within-batch precision and short-term stability of the optimized VAMS protocol were determined. Results Extraction solvent with a 60:40 (v/v) water:methanol mixture provided the highest average amino acid recovery. This extraction solvent produced higher average amino acid recoveries at pH 11 (89±13%), than pH 3 (82±10%) or pH 7 (72±11%). Creatinine measured from the VAMS tips (N=44) had a consistent negative bias of 20% relative to neat urine (R=0.9905, slope=0.802, intercept=0.02). The creatinine corrected urine amino acid results from the Mitra device were corrected for this observed concentration bias. The accuracy of the amino acid results derived from the VAMS tip vs neat urine was 104 ± 14%. The average within-batch precision (CV%) of the amino acids was 9.8% (range=6.7% (cystine) to 17.6% (arginine)) and 6.2% for creatinine. The average 1 week storage stability at ambient temperature was 91% (range=73% (ornithine) to 107% (glycine)) for the amino acids and 107% for creatinine. The devised VAMS strategy was applied to the analysis of microsampled dried urine from a patient with cystinuria (OMIM no. 220100). Marked elevations in arginine, cystine, lysine and ornithine were respectively observed and are consistent with the biochemical diagnosis of the patient. Conclusions Creatinine corrected amino acid results from the devised VAMS strategy exhibit good precision and accuracy when compared to tradition analyses of neat urine. The potential use of microsampled dried urine for the diagnosis and monitoring of selected IEM has been demonstrated. The analytical and clinical performance of this VAMS protocol must be further validated, including the use of microsampled dried urine from home specimen collections.

Obstacles to Early Diagnosis of Acute Hepatic Porphyria: Current Perspectives on Improving Early Diagnosis and Clinical Management.

Porphyrias are, for the most part, inherited disorders of the heme biosynthetic pathway which lead to accumulation of specific intermediates responsible for most of the symptoms and signs of biochemically active disease. Acute hepatic porphyrias usually come to clinical attention primarily in women in their reproductive years who present with episodic, severe, generalized abdominal pain. Such acute attacks may also be associated with tachycardia, systemic arterial hypertension, hyponatremia, recent history of dark reddish to brownish urine, and anxiety, delirium, and sensory or motor neuropathies. Diagnosing AHPs is often challenging, requiring a high index of suspicion and the appropriate testing showing elevated ALA and/or PBG in a random urine specimen. Obstacles to diagnosis include inappropriate testing for porphyrins only, inadequate sample handling, and ordering genetic testing as the initial diagnostictest. While some of these pitfalls in diagnosis are surmountable with current knowledge, others are in need of more research.

Review on adherence of the literature to official recommendations on albuminuria harmonization and standardization.

Albuminuria standardization is a key issue to produce reliable and equivalent results between laboratories. We investigated whether official recommendations on albuminuria harmonization are followed in the literature. The PubMed database was searched from June 1 toSeptember 26, 2021. The search terms included urine albumin, urine albumin-to-creatinine ratio (uACR), and albuminuria. A total of 159 articles were considered eligible; 50.9 % reported the type of urine collection. Specifically, 58.1 % collected a random spot urine specimen, 21 % collected a first morning void, and 6.2 % collected a 24-h specimen. Overall, 15 % of articles reported data on sample shipping, storage, and centrifugation and 13.3 % mentioned the preanalytical phase without any data on albuminuria. The method for albuminuria was properly described in 31.4 % of articles; of these, 54.9 % used immunological methods, and 8.9 % contained errors or missing data. Most articles (76.7 %) expressed test results as albuminuria-to-creatininuria ratio. Different decision levels were utilized in 130 articles; of these, 36 % used a decision level of≤30 mg/g creatininuria and 23.7 % used three decision levels (≤30, 30-300, and≥300 mg/g). The failure to follow guidelines on albuminuria harmonization was mainly found in the preanalytical phase. The poor awareness of the importance of preanalytical steps on test result may be a possible explanation.

#2804 ALBUMINURIA IS ASSOCIATED WITH DECREASED SEVR AND ANKLE-BRACHIAL INDEX IN PATIENTS WITHOUT CKD

Abstract Background and Aims Albuminuria signifies subclinical vascular damage in the kidneys and other organs and is associated with systemic endothelial dysfunction and increased future cardiovascular risk. Subendocardial viability ratio (SEVR) is defined as diastolic to systolic pressure-time integral ratio and is a marker of subendocardial perfusion. Reduced SEVR has been uncovered in patients with chronic kidney disease (CKD) and simultaneous albuminuria. Albuminuria is also considered a risk factor for peripheral artery disease, especially in patients with additional atherosclerosis risk factors or diabetes mellitus. The aim of our study was to determine the impact of albuminuria on SEVR and ankle-brachial index (ABI) in patients without known CKD. Method We included 111 patients (73% male, mean age 64.2±9.3 years) that were hospitalized at our Cardiology department between 2016-2020 due to elective cardiac catheterization. Albuminuria was determined by urine albumin to creatinine ratio (UACR) from a random urine specimen. SEVR was determined by using applanation tonometry on radial artery (Sphygmocor, Atcor Medical, Australia). Ankle-brachial index (ABI) was measured by using an automated, non-invasive waveform analysis device (MESIÒ, Slovenia), mean ABI between the left and right side was used. Glomerular filtration rate was estimated (eGFR) by using the CKD-EPI 2009 creatinine equation. All the data were obtained prior to cardiac catheterization and only patients with eGFR ³60 ml/min/1.73 m2 were included. Statistical analysis was performed with the Statistical Package for Social Sciences version 22.0 (SPSS Inc, USA). Results Basic descriptive statistics, comorbidities, and medications are presented in Tables 1 and 2. Spearmann's correlation test showed significant correlation between UACR and SEVR (r = - 0.238; p = 0.017) and UACR and ABI (r = - 0.304; p = 0.003). Multiple regression analysis with SEVR as the dependent variable and waist-to-hip ratio, body mass index (BMI), arterial hypertension, diabetes, dyslipidemia, eGFR and UACR as independent variables, showed a significant association between UACR and SEVR (b = - 0.232; p = 0.029). The same model was used for ABI as the dependent variable, and a significant association was found only between UACR and ABI (b = - 0.232; p = 0.029). Conclusion Albuminuria is independently associated with decreased SEVR and ABI even in the absence of CKD.

Prevalence of LDL-hypercholesterolemia and other cardiovascular risk factors in young people with type 1 diabetes

BackgroundMortality and morbidity in people with Type 1 diabetes (T1D) is mainly caused by cardiovascular disease (CVD). Early treatment of cardiovascular risk factors (CVRFs) is of great importance. ObjectiveTo analyze the prevalence of LDL-hypercholesterolemia and other CVRFs in youth with T1D. MethodsClinical and laboratory parameters, and vascular thickness measurement were obtained in youth with T1D (age 6-18 years, T1D duration >1 year) attending a diabetes clinic. LDL-hypercholesterolemia, microalbuminuria and arterial hypertension were defined as CVRFs. ResultsA total of 333 youth (48% girls; age: 13.3 years [10.3-15.5], median [interquartile range]) participated in the study. The T1D duration was 5.9 years [3.5-9.4] with HbA1c of 7.4% [6.8-8.0]. Intima media thickness (N=223) was 538.0 µm [470.0-618.0]). LDL-hypercholesterolemia was present in 30 participants (9%; 18 girls; age: 14.3 years [11.2-15.7]). None of the participants had persistent microalbuminuria, although 59 (18.3%) had elevated albumin excretion in a random urine specimen. LDL-hypercholesterolemia was associated with increased blood pressure (p<0.05), insulin requirement (p<0.05), HbA1c (p<0.05), triglyceride (p<0.001) and total cholesterol (p<0.001), and a family history of premature CVD (p<0.001), but negatively correlated with HDL cholesterol levels (p<0.05). Sex, pubertal status, duration of diabetes, type of therapy, and physical activity did not differ between participants with and without LDL- hypercholesterolemia. Arterial hypertension was present in 11 participants (3.3%; 4 girls; age: 14.1 years [11.1-16.1]). ConclusionLDL-hypercholesterolemia affected 9% of youth with T1D in this cohort and was associated with other CVRFs. A holistic therapeutic concept for these young people is essential.

Current Concept and Research Progress of Pre-Eclampsia (Early-Onset and Late-Onset Pre-Eclampsia)

Pre-eclampsia is a syndrome that belongs to the group of hypertensive disorders of pregnancy. It is a multi-organ disease and can affect the kidney, liver, brain and the blood clotting system [1,2]. Pre-eclampsia is one of the most common causes of maternal and fetal morbidity and mortality [3]. Pre-eclampsia is defined as new-onset hypertension developed after 20 weeks of gestation (systolic or diastolic blood pressure ≥140 and/or ≥90 mmHg, respectively, measured at least two occasions, 4 hour to 1 week apart) and proteinuria(≥300 mg in a 24- hour urine collection, or two random urine specimens obtained 4 hours to 1 week apart containing≥1+ by dip stick or one dipstick demonstrated ≥2+ protein)[22,23]. Mild pre-eclampsia was diagnosed as pre-eclampsia was systolic blood pressure &lt;160 mmHg, diastolic blood pressure &lt;110 mmHg, platelet count≥100,000 per mm3, non-elevated liver enzymes, absence of renal insufficiency, pulmonary edema, cyanosis, new-onset cerebral/visual disturbances, and/or right upper quadrant or epigastric pain[24,25]. Severe pre-eclampsia is diagnosed as pre-eclampsia with systolic blood pressure ≥160 mmHg, or diastolic blood pressure ≥110 mmHg, platelet count &lt;100,000 per mm 3, elevated liver enzymes, renal insufficiency, pulmonary edema or cyanosis, new-onset cerebral/visual disturbances, and/or right upper quadrant or epigastric pain [24,25]. A major advance in the classification of pre-eclampsia is its subdivision into early-onset and late-onset pre-eclampsia[26,27]. Especially, early-onset and late-onset pre-eclampsia have a serious threat to the maternal and neonatal lives, and in the clinical practice, it is of great difficulties and challenging in its treatment. Therefore, it is of great importance to pay enough attention to early-onset and late-onset pre-eclampsia. According to the statistics of recent years in China, the prevalence of pre-eclampsia has become less due to increase in attention paid to the pregnant women with the hypertensive disorder and in the maternity examination during their period of antenatal check-up.

THE ASSOCIATION OF EGFR AND ALBUMINURIA WITH SYSTOLIC HYPERTENSION IN PATIENTS WITH DIABETES

Objective: Large epidemiological studies have shown that the prevalence of hypertension increases in parallel with the staging of chronic kidney disease. However, it remains unclear whether the decline in estimated-glomerular-filtration-rate (eGFR) or the severity of albuminuria is a stronger determinant of systolic hypertension. Design and method: In 483 outpatients with diabetes, the eGFR was determined using the CKD-EPI equation and albuminuria was assessed by measuring the albumin-to-creatinine ratio (ACR) in a random urine specimen. Triplicate automated office blood pressure (BP) recordings were obtained with the validated device HEM-705 (Omron, HealthCare) under standardized conditions requiring an at least 5-minute seated rest period in a quiet room. Results: The average office systolic BP was 138.3 ± 19.4 mmHg, whereas 69.6% of the patients were being treated with an average of 2.2 ± 1.1 antihypertensive medications daily. In univariate linear regression analysis, office systolic BP was associated with age, body mass index (BMI), antihypertensive drug use, the number of prescribed antihypertensive medications, severity of albuminuria and decline in eGFR. In multivariate analysis, however, it was logUACR (P = 0.022) and not eGFR (P &gt; 0.05) the factor that remained a significant determinant of office systolic BP. Other parameters associated with office systolic BP in the multivariate model were higher age (P = 0.014), BMI (P = 0.012) and the number of prescribed antihypertensive medications (P = 0.045). Conclusions: The present study suggests that the severity of albuminuria and not the decline in eGFR is possibly a stronger determinant of systolic hypertension in patients with diabetes.

ATHEROSCLEROSIS AND INCIPIENT NEPHROPATHY IN DIABETIC PATIENTS

Objective: The association between nephropathy, particularly microalbuminuria, and cardiovascular disease, is becoming increasingly apparent. Atherosclerotic process is a combination of fatty degeneration (atherosis) and of vessel stiffening (sclerosis) of the arterial wall. The aim of the study was to assess relationship between diabetic nephropathy and structural changes in arteries, such as carotid intima – media thickness (IMT). Design and method: We selected 80 adults with type 2 diabetes. 47 were women and 33 were men, mean age 51 ± 14. They were divided into three groups based on albuminuria status: Group I = no albuminuria (&lt;30 mg albumin/g creatinine), numbers of patients 27; Group II = microalbuminuria (30 to 300 mg/g) numbers of patients 26; and Group III = macroalbuminuria (&gt;300 mg/g) numbers of patients 27. Albuminuria was measured by collection of fasting random urine specimen on arrival to the clinic, usually in the morning. The IMT was measured by a B-mode ultrasound, 10 MHz transducer. Each group was evaluated for body mass index (BMI), glycosylated hemoglobin (HbA1C), lipid profile, blood pressure. Results: Systolic blood pressure in the II-group was 143.3 ± 15.2mmHg and significantly higher (p &lt; 0.01) than in the I-group (132.5 ± 18.1mmHg) and III-group (139.8 ± 18.9mmHg). No significant differences in age, smoking and kind of antihypertensive agent used were found between three groups. IMT level in the II-group was 1.28 ± 0.35 mm and significantly higher than in the I and III group (1.09 ± 0.28 mm; 1.19 ± 0.44 mm, respectively). There were no significant differences in HbA1C, lipid or serum creatinine between three groups Conclusions: The carotid IMT was significantly higher in the patients with microalbuminuria and so, the last one is associated with structural changes in arteries.

Amniotic fluid and urine metabolomic alterations associated with pregnant women with Down syndrome fetuses

Background Down syndrome (DS) is a chromosomal disorder caused by a third copy of all or part of chromosome 21. Clinical observations and preclinical studies both suggest that DS may be associated with significant metabolic and bioenergetic alterations. But the metabolic alterations in pregnant women carrying DS fetuses still remains unclear. In this study, we investigated the characteristic metabolomics and lipidomics changes during fetal development of DS. Methods The AF and random urine specimens were selected from 20 pregnant women carrying DS fetuses and 20 pregnant women carrying healthy fetuses. The diagnosis of DS was screened according to chromosome karyotype analysis, and untargeted metabolomic and lipidomic analyses were performed. Results Through the analyses of AF, 308 differential metabolites were selected between DS and controls. The metabolites with significant changes mainly involved lipid molecules, organic acids, nucleotides and carbon. Further analysis of lipidomics showed 64 differential metabolites, mainly involving glycerides, sphingolipids and glycerolipids. As for urine metabolomic and lipidomic analyses, there existed consistent metabolites with AF, but the number was much less. Conclusions Compared with the controls, carbon metabolism, amino acid metabolism, glyceride metabolism, sphingolipid metabolism and glycerophospholipid metabolism were significantly changed in DS cases. In addition, characterized biomarkers in AF and urine were screened for DS diagnosis, and these metabolites were mainly involved in energy metabolism and liver dysfunction. This finding may help improve the efficiency of prenatal screening for DS.

Are point-of-care urine drug testing devices suitable for antenatal drug screening? A study verifying the Alere® Drug Screen Test Cup for the detection of six classes of drug in a pregnant population.

Currently, there are no national guidelines for antenatal drug testing. At Colchester Hospital, we use a strategy of screen-only using point-of-care testing to detect illicit drug use in pregnancy. To determine the suitability of this approach, we have compared the results of urine analysis by point-of-care testing with another NHS specialist clinical toxicology service that uses confirmation mass spectrometry. A total of 482 anonymized random urine specimens from antenatal clinics were tested for six drug classes: amphetamine, benzodiazepines, buprenorphine, cocaine, methadone and opiates using the Alere™ Drug Screen Urine Test Cup. The manufacturer's claims for positive cut-off and result stability were verified using spiked blank urine. Confirmatory testing was performed using ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) for detection of 26 individual drugs. Of 473 urine samples with adequate volume for point-of-care screening, 4.4% tested positive: 19 opiate and 2 cocaine. Concordance between point-of-care screening and UPLC-MS/MS confirmation was 97.9% for all drugs and 78.9% for opiates. Using spiked urine, only positive results for opiates were stable when read up to the manufacturer's recommended time of 60 min. The key advantages of using point-of-care devices to detect drug use in pregnancy are that is convenient and cheap. However, the clinical utility of point-of-care testing is limited by its poor sensitivity. Best practice is to confirm results using a more specific and sensitive method. As a result of this study, we are now reviewing our own procedures to consider introducing routine confirmation by mass spectrometry.

Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes.

Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.

Evaluation of conductivity‐based osmolality measurement in urine using the Sysmex UF5000

BackgroundAutomated flow cytometry‐based urine analyzer is increasingly being used to identify and enumerate cells and particles in urine specimens. It measures electrical conductivity which could be transformed to osmolality. Using this machine, all urine specimens could be screened for osmolality without requiring a separate dedicated device. We evaluated the performance of the new instrument, the UF‐5000 (Sysmex Corporation), in the measurement of urine osmolality.MethodsThe precision of urine osmolality measurement by the UF‐5000 was evaluated for 20 days and 4 times a day for 2 concentrations. The linearity and detection capability were evaluated according to the Clinical and Laboratory Standards Institute guidelines. For comparison, 270 random urine specimens from patients were tested simultaneously using the UF5000 and the OsmoPro micro‐osmometer (Advanced instruments).ResultsThe laboratory‐based coefficient variations were less than 5%. Urine osmolality using the UF‐5000 has a verified linear range (y = 1.097x + 16.91, R 2 = .997). Within the comparison analysis, the mean difference was not large (−7.72%) but each differences were largely dispersed with 95% limits of agreement (LoA) from −70.5 to 55.06%, and the mean absolute difference −28.3 mOsm/kg with 95% LoA from −295.13 to 238.45 mOsm/kg. Cohen's kappa value was 0.54 (95% CI, 0.45‐0.63).ConclusionsThe UF‐5000 measured conductivity and generated an acceptable quantitative analysis of urine osmolality. When compared with the results of the freezing point depression method used by the OsmoPro, a percentage of the measured urine osmolality by the UF‐5000 was outside the allowable limit.

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.

Exertional hematuria: definition, epidemiology, diagnostic and clinical considerations.

Exertional hematuria can be considered a subcategory of exercise-induced hematuria, characterized by painless appearance of erythrocytes in urine after recent physical exercise, not directly attributable to external traumatic injuries to the genitourinary system, and spontaneously resolving with rest. Although its frequency has enormous heterogeneity, depending on the athlete population, duration and intensity of exercise, technique used for identifying or quantifying hematuria and relative diagnostic thresholds, what clearly emerges from the scientific literature is that a certain degree of hematuria is commonplace after non-contact sports, especially running. This exertional hematuria, which appears self-limiting, may be attributable to some frequently concomitant causes, involving organs of the genitourinary system, and mostly encompassing bladder or urethral injuries. Renal injuries caused by internal movements, vascular spasm and ischemia are also potential causes of increased glomerular permeability to erythrocytes, whilst the presence of preexisting genitourinary diseases cannot be ruled out, especially when post-exercise hematuria is recurrent or endures. Therefore, whenever hematuria is observed in a random urine specimen, recent sports performance (especially running) should be investigated and urinalyses scheduled for the following days. When no temporal association of hematuria with exercise can be found, when genitourinary traumas have been excluded or hematuria persists for >72 h, specific diagnostic investigations should be planned to identify possible genitourinary diseases.

Is Urine dipstick as accurate as 24 hour urine protein? A Comparative Study

Introduction: Hypertensive disorder in pregnancy (HDP) is one of the most common medical complications affecting approximately 5-10% of pregnancies. It remains a major cause of maternal/perinatal mortality and morbidity. Proteinuria is a sign of preeclampsia where there is &gt;300 mg of protein in 24 hour urine collection. This usually correlates with 30mg/dl or 1+ reading in a random urine specimen. The main objective of this study is to find out whether urine dipstick correlates with 24 hour urine protein.&#x0D; Methodology: This is a hospital based comparative study, where proteinuria by dipstick method was compared with 24 hour urinary protein in 60 cases of pre eclampsia at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu.&#x0D; Results: The dipstick method of detecting proteinuria significantly correlated with the total 24 hour urine protein excretion by Esbach Albuminometer. A dipstick factor of ≥300mg/24 hour indicates proteinuria with sensitivity of 97.5%, specificity of 65%, positive predictive value of 84.78% and negative predictive value of 92.85%. 3+ value in dipstick had high significance with 24 hour urine protein by Esbach’s Albuminometer (R=0.983 ). The cost of dipstick was Nepalies Rs (NPR) 14 in comparison to 24 hour dipstick which cost NPR 80.Time needed to get report was immediate in case of dipstick but takes 48-50 hour in case of 24 hour urine protein.&#x0D; Conclusion: Timely collection of six hourly urine for detection of proteinuria by dipstick is comparable to 24 hour urinary protein determination in laboratory by Esbach Albuminometer, which is more time consuming and expensive.

The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes

AimsTo determine among adolescents and young adults with youth-onset type 1 diabetes and type 2 diabetes the rates and risk factors for albuminuria regression and progression. MethodsData from SEARCH, a longitudinal observational study of youth-onset type 1 diabetes (N = 1316) and type 2 diabetes (N = 143) were analyzed. Urine albumin:creatinine ratio (UACR) was measured from random urine specimens at baseline and follow-up visits (mean 7 years later). Albuminuria regression was defined as halving of baseline UACR when baseline UACR was ≥30 μg/mg; progression was defined as doubling of baseline UACR when follow-up UACR was ≥30 μg/mg, respectively. Multivariable regression assessed risk factors associated with low-risk albuminuria category (combined persistently-low albuminuria and regression) versus moderate-risk albuminuria category (combined persistently-high albuminuria and progression). ResultsAlbuminuria progression was more common in type 2 diabetes versus type 1 diabetes (15.4% versus 6.0%, p<0.001). Moderate-risk albuminuria was associated with increasing HbA1c (adjusted OR (aOR) = 1.3, 95% CI 1.1–1.6) and lack of private health insurance (aOR = 2.7, 95%CI 1.1–6.5) in type 1 diabetes; and African American race (OR = 4.6, 95% CI 1.2–14.2), lower estimated insulin sensitivity score (aOR = 2.1, 95% CI 1.4–3.3), baseline UACR (aOR = 3.2, 95% CI 1.7–5.8), and follow-up estimated glomerular filtration rate (eGFR) (10-unit increase aOR = 1.3, 95% CI 1.0, 1.5) in type 2 diabetes. ConclusionsIn the first decade of diabetes duration, kidney complications in type 2 diabetes are significantly more aggressive than in type 1 diabetes and may be associated with less modifiable risk factors including race, insulin sensitivity, and eGFR. Early interventions may help reduce long-term kidney complications.

Presence of Parent Cocaine in the Absence of Benzoylecgonine in Urine.

Cocaine (COC) is widely abused and associated with significant adverse effects. Forensic and clinical laboratories often test for COC intake through detection of the primary metabolite, benzoylecgonine (BZE) in urine. Testing for BZE alone may result in false-negative determinations in situations where COC is recently administered or metabolism is impaired. To our knowledge, no data have been provided demonstrating the utility of adding parent COC to urine confirmation testing in routine analyses. For this study, random urine specimens from patients undergoing treatment for pain management and/or addiction were collected over six months from 800 clinics across 39 states. A total of 7,587 urine specimens tested positive for a COC marker (COC and/or BZE). A positive result was determined using a liquid chromatography-tandem mass spectrometry (LC-MS-MS) method with a limit of quantitation of 50 ng/mL. Of the positive specimens, 26% and 97% were positive for COC and BZE, respectively. Positive BZE-only specimens represented 74% of total positive specimens. However, 231 of the 7,587 urine specimens (3% of positive specimens) were positive for COC in the absence of BZE. The 231 COC-only positive specimens were collected from 206 patients, and two of these patients provided four COC-only positive specimens. Of a select group of COC-only specimens tested by both LC-MS-MS and immunoassay (IA) (N = 32), 81% were negative by IA, demonstrating the limitation of screening with BZE-specific IAs. A false-negative COC result can have profound impacts such as a delay in patient referral to addiction treatment, unintentional prescribing of a controlled substance to a patient actively abusing an illicit substance, or undetected cocaine use in the workplace. This study highlights the importance of testing for COC in addition to BZE in forensic and healthcare settings.

APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults.

APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.

Ascorbic acid-A black hole of urine chemistry screening.

Study was performed in order: (i) to assess the comparability of glucose, bilirubin, hemoglobin, leukocyte esterase, and protein; (ii) to assess accuracy of glucose, bilirubin, hemoglobin, leukocyte esterase, and protein; and (iii) to evaluate interference of ascorbic acid on the glucose, bilirubin, hemoglobin, and nitrite determination using 2 different dipsticks: iChem Velocity, Iris Diagnostics and Combur-10M, Roche Diagnostics. Random urine specimens were included in the study. Comparability, accuracy, and ascorbic acid interference testing were performed. Obtained results have shown almost perfect agreement for all parameters between 2 dipsticks in samples with negative ascorbic acid. Agreement in samples with positive ascorbic acid was not acceptable for bilirubin, protein, nitrite, and hemoglobin. Accuracy was not acceptable for hemoglobin and leukocyte esterase on both dipsticks. Ascorbic acid interference examination has shown that intensity of interference differs between dipsticks. Ascorbic acid interferes with glucose, hemoglobin, nitrite, and bilirubin at different concentrations causing false-negative results. Obtained results indicate that it is necessary to determine diagnostic accuracy of used dipstick in order to define purpose of urinalysis. It is very important to choose dipstick with ascorbic acid indicator and to examine ascorbic acid impact on dipstick analytes independently of manufacturer claims.

The Urine that Would Not Freeze.

A random urine specimen from a 61-year-old male was collected at an outside clinic for the evaluation of hyponatremia. Although the urine sodium concentration was unremarkable (<20 mmol/L), attempts to measure urine osmolality resulted in a “will not freeze error”; repeat on a separate freezing point depression osmometer yielded the same message. Osmolality is a measure of the number of particles dissolved in a given mass of water. The main contributors to serum and urine osmolality in humans include sodium, chloride, glucose, and urea. Plasma and urine osmolality are typically measured in tandem …