Urinalysis Screening Research Articles

Evaluation of Urinalysis Results in Asymptomatic Primary School Children in Kermanshah city (2003)

Introduction: As other attempts for prevention of disease by vaccination or early diagnosis of asymptomatic diseases (by screening examination of children in several ages), search for early diagnosis of renal diseases that are treatable or preventable is continuing. Our review of other researches showed several different and paradoxical results about it's cost benefit; some researchers advise employing it seriously while some others reject using it. Because our country is very different from developed countries in several parameters, we attempted to determine value of one time urinalysis (as screening) by dipstick and microscopy in asymptomatic children. Materials and Methods: This study is a descriptive-cross-sectional study. Sampling was randomized cluster, all 6831 cases (52.36% boys and 47.64% girls) selected from primary school children in Kermanshah City. Urine was examined for four parameters, blood , protein, pus, and glucose. Asymptomatic children with abnormal results re-examed. Result: All abnormal findings in first and second urinalysis were (1.06% and 0.56%) for boys (8.17% and 3.38%) for girls and (4.45% and 1.9%) for total subjects. The final results for four parameters are as follows: 1) For Hematuria these numbers were (0.39% and 0.25%) (0.8% and 0.25%) and (0.59% and 0.25%). 2) For Proteinuria they were (0.36% and 0.17%) (1.66% and 0.49%) (0.98% and 0.32%) 3) For Glucosuria they were (0.08% and 0.06%) ( 0.18% and 0.06%) (0.13% and 0.06%) and finally, for Pyuria they were (0.28% and 0.14%) (6.39% and 2.89%) (3.19% and 1.45%). Conclusion: The results of this study was comparable with those of Kaplan’s. These results in all parameters, in comparison with that of Kaplan’s (except for Glucosuria and proteinuria) had more frequency. In this study the effect of sex on pyuria and proteinuria was statistically significant. Therefore we recommend to obtain single screening urinalysis (by Dipstick and Microscopy) at early school age.

The value of urine screening in a young adult population.

GPs in England and Wales are required to perform screening urinalysis on all newly registered patients. The value of this practice, however, is unclear. The purpose of this study was to identify the prevalence of persistent urine abnormalities and to establish the added value of screening for both haematuria and proteinuria in a large cohort of young adults in the UK. Urine screening was carried out in a cohort of young adults in a student health centre and a university hospital nephrology unit in a large British city. University students enrolling for health screening in a university health centre over a 2-year period were tested for haematuria and/or proteinuria by dipstick urinalysis. Subjects with persistent urine abnormalities were evaluated for the presence of significant renal tract pathology. Of 3808 students screened, 3570 provided an initial urine sample; 220 were abnormal. Of these, 38 (1% of original cohort) had persistent abnormalities (haematuria, 14; proteinuria, 16; both, eight). Subjects with isolated haematuria or proteinuria did not have significant pathology. In contrast, all the students with both haematuria and proteinuria had identifiable renal disease. Our findings do not support the value of routine screening for proteinuria or haematuria in young adults. However, the combination of haematuria and proteinuria is a powerful predictor for parenchymal renal disease. Thus, if proteinuria is detected, further testing for haematuria should be performed.

Hypertension in adolescents: a review of diagnosis and management.

Long-term hypertension contributes to significant cardiovascular and renal morbidity and mortality. Although chronic hypertension is much rarer in the adolescent population than in adults, identifying the hypertensive adolescent and intervening with risk factors such as obesity that may promote hypertension is important for the clinician treating adolescents. Since both primary and secondary causes of hypertension may exist in the adolescent, a thorough and sequential clinical and diagnostic evaluation must be undertaken, including screening urinalysis, blood chemistries, and renal sonography. There are pitfalls in interpreting casual blood pressure measurements in adolescents, and the role of ambulatory blood pressure monitoring is evolving. Lifestyle modifications, including diet, exercise, and limitation of sodium intake, remain the foundation of treatment. Commonly used medications include calcium channel blockers, angiotensin receptor blockers and converting enzyme inhibitors, beta blockers, and diuretics. When considering medication in the hypertensive adolescent, potential complications of therapy must be reviewed in light of the physical and psychosocial changes ongoing in this age group.

The clinical utility of routine urinalysis in pregnancy: a prospective study.

To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinued in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Prospective observational study. A metropolitan public hospital and a private hospital in Sydney (NSW). One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampsia, or pre-eclampsia superimposed on chronic hypertension). Thirty-five women had dipstick proteinuria at their first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women.

Estimating the Prevalence of Ecstasy Use Among Juvenile Offenders

To date, no studies have examined Ecstasy use among criminal justice populations. Focusing on individuals under criminal justice supervision is useful because “new” illegal drugs will typically takeroot in a criminal population before diffusing to the general population. In the current study, self-report drug use data and urine specimens were collected from 209 juvenile offenders surveyed through Maryland's Offender Population Urinalysis Screening (OPUS) Program. Prevalence estimates are generated and associations between Ecstasy use, demographic characteristics, and alcohol and other drug use are explored. Sixteen percent of the sample reponed using Ecstasy within the past 12 months, an estimate almost three times as high as grade school and high school students surveyed through the Monitoring the Future survey. Compared to nonusers, Ecstasy users were significantly more likely to be female (45% versus 20%, p<0.01), White (82% versus 22%, p<0.001), and out of school (39% versus 20%, p<0.05). Associations were also found between Ecstasy use and the use of other drugs. These findings suggest that the recent use of Ecstasy among juvenile offenders is higher than estimated use in the general student population, and that youthful offenders may represent an important population for potential intervention.

Development and evaluation of an HPLC urinalysis screening test for occupational exposure to 3,4- and 3,5-dichloroanilines.

In order to develop a screening test to detect human occupational exposure to aromatic amines such as 3,4-dichloroaniline (3,4-DCA) and 3,5-dichloroaniline (3,5-DCA), we first investigated the urinary excretion of these highly toxic compounds in the rat. The study was performed after both oral and dermal application, even though contact with the skin is the major route of contamination in the workplace. The aim of this study was to develop a rapid screening test for risk assessment in the workplace. An initial group of 3 rats was treated with 40 microl of 3,4-DCA solution (30% in methanol), applied topically to the shaved dorsal skin. A second group of 3 rats were administered the same dose of the amine orally by gavage before urine sampling. The same procedure was performed with 3,5-DCA (2 other groups of 3 rats). The urine samples were collected for a period of 24 hours after treatment and the excretion of 3,4-DCA, 3,5-DCA was studied using a GC-MS and an HPLC method after urine extraction. The urine of 2 workers potentially exposed to the amines for a period of 161 and 147 days, respectively, was analyzed by the same methods with urine collection before and at the end of the work shift. The study of excretion in the rat showed that unchanged dichloroanilines and some metabolites were excreted 24 hours after administration of the amines. Based on these results, we propose an HPLC method for the screening of risk assessment in the workplace. The presence of 3,4-DCA and 3,5-DCA in the urine of workers showed that they were absorbing amines during the workshift. These results successfully allowed us to detect contamination due to 3,4-DCA and 3,5-DCA in exposed workers. The HPLC method described provides a satisfactory and sensitive procedure for urine screening in the assessment and monitoring of the occupational exposure to dichloroanilines.

School urinalysis screening in Korea: prevalence of chronic renal disease.

Since 1998, mass urine screening tests have been performed on Korean school children. We have analyzed those patients who showed abnormal urinary findings in the school screening program. Between January 1998 and January 2000, 452 children with abnormal urinary findings visited the Pediatric Kidney Center, Kyung-Hee University Hospital. Sex, age, 24-h urine creatinine clearance, ultrasonography, Doppler scans and renal biopsies were reviewed retrospectively. Results of initial urinalysis are divided into three groups: solely hematuria group (228 cases, 50.4%), solely proteinuria group (98 cases, 21.7%), and combined hematuria and proteinuria group (79 cases, 17.5%). Among the biopsied cases, the proportions representing renal parenchymal diseases were as follows: IgA nephropathy 11.3%, mesangial proliferative glomerulonephritis 21.9%, others 3.8%. Among the three groups, the combined hematuria and proteinuria group had more frequent chronic renal disease (57.7%) than the other groups. Chronic renal disease was detected in 36.9% of all visiting subjects. In the school screening program a significant number of patients showed abnormal urinary findings, which were associated with chronic renal diseases especially in the combined hematuria and proteinuria group. In conclusion, mass urine screening tests should be mandatory to detect asymptomatic chronic renal disease in school children.

Screening urinalysis for proteinuria in school children

Although asymptomatic proteinuria in children is uncommon, long-term follow-up of children who have persistent proteinuria reveals that they face risks to have significant glomerular changes followed by decreasing kidney function. Since 1970’s urine screening program for asymptomatic hematuria and proteinuria in schoolchildren has been conducted regularly in some countries. So far such program has never been implemented in Jakarta. As a part of The Community Health Program of the Medical School, University of Indonesia, this epidemiologic study aimed especially to look at the urine abnormalities among schoolchildren. The target population was children in grades III, IV and V of 4 elementary schools in Eastern Jakarta. Four hundred and forty nine children (217 boys and 232 girls) were enrolled in this study, held during school time in August 1999. Their mean age was 9.35 (SD 1.2) years. Data collected were history of illness, physical examination, and complete urinalysis using a dipstick method. Proteinuria was found in 30 (6.8%) children, which in repeated urinalyses were determined as orthostatic in 2 (0.4%), transient in 20 (4.5%), and persistent proteinuria in 6 (1.4%) children. Three out of 6 children with persistent proteinuria also had hematuria. One child with persistent proteinuria was considered as having urinary tract infection. We conclude that the incidence of asymptomatic proteinuria in schoolchildren is not high, but because of significant risks that they face, a long-term follow up of them is indicated.

Tramadol Dependence With No History of Substance Abuse

Tramadol Dependence With No History of Substance Abuse

Microscopic hematuria as a screening marker for urinary tract malignancies

Although a mass screening urinalysis is a widely accepted procedure, it has not yet been shown if microhematuria is an appropriate and useful screening marker for urologic malignancies. (1) The incidence of hematuria was studied in 113 patients with renal cell carcinoma (RCC), 185 with bladder carcinoma and 51 with renal pelvic or ureteral carcinoma. The association of the T stage with the intensity of hematuria in each malignancy was also examined. (2) In 823 asymptomatic adults with microhematuria, the prevalence of these malignancies was studied retrospectively to find the positive predictive value (PPV). (1) The incidence of hematuria was 35% for RCC, including gross and microhematuria. Advanced RCC (T3 and T4) were diagnosed more frequently in the gross hematuria group than in the microhematuria and no hematuria groups. In contrast, the incidence of hematuria was 94% for urothelial carcinomas either in the upper urinary tract or in the bladder. There was no significant difference in the T stage nor grade between the gross hematuria group and the microhematuria group. (2) Regarding asymptomatic microhematuria, the PPV was 1.7% (14 cases) for bladder carcinoma, 0.4% (3 cases) for ureteral/renal pelvic carcinoma and 0.2% (2 cases) for RCC. In men aged 50 years or older, PPV was 6.2% for urothelial carcinomas. In 14 cases of bladder carcinoma, 3 cases showed muscle invasion. Microhematuria is an appropriate screening marker for urothelial carcinomas, particularly in elderly men, but not for RCC. However, it is unlikely that a mass screening urinalysis using a single voided urine sample would contribute to earlier detection of bladder carcinoma.

Drug Testing in Canadian Jails: To What End?

Since 1995, Corrections Services Canada (CSC) has conducted randomized urinalysis screening of a minimum of 5% of the federal inmate population on a monthly basis. Urine samples are screened for a broad range of psychoactive substances. The stated purpose of such screening is to reduce substance use in federal jails. Analysis of data provided by CSC for testing between 1994 and 1998 reveals small but statistically significant increases in the percentage of all urine samples that tested positive over that time. Analysis of the results of screening for opiates, cocaine and THC from data provided by CSC for the same time period, shows steady rates of opiate and cocaine detection at maximum and medium levels of security, decreases in opiate and cocaine detection in minimum security, and statistically significant increases in THC detection at all levels of security. The implications of these findings are discussed.

Is the Prevalence of HIV-Associated Nephropathy Decreasing?

Initial reports have suggested that approximately 10% of patients with HIV-infection develop HIV-associated nephropathy (HIVAN). It has also been predicted that by the end of the decade, HIVAN is likely to become a third leading cause of end-stage renal disease (ESRD) in African-Americans between the ages of 20–64 years. As the morbidity and mortality from HIV-infection has decreased in the last few years, it is possible that prevalence of HIVAN is also changing. We therefore screened HIV-1-infected patients followed in our hospital for HIVAN. A screening urinalysis was performed in 557 HIV-1-infected adult patients between March and May 1998. Of these, 252 were outpatients and 305 were Texas Department of Criminal Justice inmates (TDCJI). Demographic and laboratory data of these patients was obtained from the HIV patients’ database. Fifty percent of the patients were African-American, 36.6% were Caucasian and 12.7% were Hispanic. The mean age of patients was 37 ± 8 years. Seventy-nine percent of the patients were males and a history of intravenous drug abuse (IVDA) was present in 28%. Twenty-three percent of the patients were concomitantly infected with hepatitis C virus, 4.1% were positive for hepatitis B surface antigen, and rapid plasma reagin test for syphilis was positive in 9.1%. In 38 patients who had more than 100 mg/dl (2+) proteins on screening urinalysis, total urinary proteins were quantitated by collecting 24 h urine specimens. Fifteen of these patients had urinary proteins more than 1.5 g/day (12 patients >3.5 g/24 h and 3 patients >1.5 g/24 h). A renal biopsy was done in 14 of these patients and clinical diagnosis of HIVAN was made in one patient who refused biopsy. Renal biopsies revealed HIVAN [9], diabetic nephropathy [2], membranoproliferative glomerulonephritis [2], Fibrillary glomerulonephritis [1]. All 10 patients (5 TDCJI and 5 outpatients) with HIVAN were African-American. Two of these 10 patients had a history of IVDA and another two were concomitantly infected with hepatitis C virus. The plasma viral load (Pvl) and total CD4 count was not different in patients with or without HIVAN [(Pvl log 10.05 ± 1.39 vs. 9.9 ± 2.18 copies/ml, p = 0.78) (CD4: 187 ± 192 vs. 288 ± 249 cells/μl, p = 1.17) mean ± SD]. We conclude that in our HIV-infected population HIVAN exclusively affected African-Americans and the prevalence in them was 3.5%.

Evaluation of the leukocyte esterase and nitrite urine dipstick screening tests for detection of bacteriuria in women with suspected uncomplicated urinary tract infections.

A positive dipstick urinalysis (i.e., leukocyte esterase test and/or nitrite test) did not reliably detect significant bacteriuria in 479 ambulatory women with suspected uncomplicated urinary tract infection; 18.9% of the urine samples that demonstrated significant bacteriuria would have been rejected by the laboratory based on a negative urinalysis screen.

Consultation with the Specialist: Familial Nephritis/Alport Syndrome

Consultation with the Specialist: Familial Nephritis/Alport Syndrome

Consultation with the Specialist

Consultation with the Specialist

Asymptomatic microscopic hematuria—Is investigation necessary?

Microscopic hematuria is common in asymptomatic adults, but the benefit of screening the general population for blood in the urine has not been established. On the other hand, most studies of referred patients with putatively asymptomatic microscopic hematuria have reported a 2–11% prevalence of urothelial malignancies, leading to the recommendation that all patients with microscopic hematuria be thoroughly investigated. Urinalysis is inexpensive and highly acceptable to the general population, but is neither a sensitive, nor specific test, and has poor predictive value for urothelial malignancies, and nephrological diseases. Furthermore the benefits of early detection of such diseases has not been established. We conclude that screening urinalysis cannot be recommended. Studies are needed to determine which constellation of findings primary physicians use to select patients for referral to centers with urological and nephrological expertise.

Asymptomatic bacteriuria in pregnancy: Screening urinalysis or urine culture

Asymptomatic bacteriuria in pregnancy: Screening urinalysis or urine culture

Urinalysis. When--and when not--to order.

Although routine urinalysis is common, the results are important in management of only certain diseases. Screening urinalysis to detect asymptomatic bacteriuria is recommended in adults 60 years of age or older, diabetic patients of any age, pregnant women, and adolescents. A positive result for protein on dipstick urinalysis should be evaluated in conjunction with other clinical and laboratory data (eg, the patient's age, physical findings, renal function, results of microscopic urinalysis). Evaluation of hematuria should always include dipstick analysis and microscopic examination of urine. Diabetes screening is best done with measurement of plasma glucose levels. Other available urinalysis tests include measurement of pH, specific gravity, ketones, bilirubin, and urobilinogen. In patients with renal or urinary tract disease, microscopic examination of urinary sediment is important.

Problems in assessing screening experience in observational studies of screening efficacy: example of urinalysis screening for bladder cancer.

To evaluate screening urinalysis for its efficacy in preventing fatal bladder cancer. A case-control study of 290 case subjects with fatal bladder cancer upsilon 290 age and sex matched control subjects, with ascertainment of urinalyses by medical record review. In the five years before the symptoms that led to the detection of bladder cancer, case subjects had significantly fewer routine (screening) urinalyses than controls (matched odds ratio for one or more urinalyses upsilon none = 0.60 [95% confidence interval (CI) 0.41 to 0.87], adjusted for cigarette smoking and occupational bladder cancer risk). However urinalyses for urinary symptoms and problems before those that led to bladder cancer diagnosis were more frequent in the cases; hence there was only a small statistically non-significant deficit in cases of urinalyses for all reasons combined (corresponding adjusted odds ratio 0.94, 95% CI 0.61 to 1.46). Since urinalyses for symptoms and problems could have led to the detection of bladder cancer, the latter finding appears more applicable. Methodological problems included: difficulty in assigning the reason for urinalysis; the possibility that clinically indicated urinalyses led to a reduction in screening urinalyses; and difficulty in identifying the detectable and curable preclinical phase for targeting ascertainment of urinalyses. Reducing potential efficacy, haematuria on urinalysis, particularly transient or mild asymptomatic microhaematuria, was often not followed up by cystoscopy. This study did not show that ordinary urinalysis was effective in preventing fatal bladder cancer but because of methodological problems a clear answer may require a randomised controlled trial.

Adult Urinalysis Screening

Adult Urinalysis Screening