Urine Dipstick Research Articles

Acute kidney injury in paediatric kidney transplant recipients.

Acute kidney injury (AKI) in paediatric kidney transplant recipients is common. Infection including urinary tract infection (UTI) and rejection are the most common causes in children. Surgical complications often cause AKI early post-transplant, whereas BK polyomavirus nephropathy rarely occurs in the first month post-transplant. Understanding kidney physiology helps to appreciate the sensitivity of the allograft to AKI, more so than native kidneys. Although the cause of AKI is often multi-factorial, there may be an underlying process that is treatable. Eliciting the aetiology, in this regard, is of paramount importance. Pre-renal and post-renal causes of allograft dysfunction are important to distinguish from intrinsic kidney disease. Clinical information and examination of fluid balance, urine dipstick testing, blood tests, bladder and kidney transplant ultrasound, and kidney transplant biopsy remain vital assessment tools in narrowing the differential diagnosis. A careful prescribed and recreational drug history is always warranted as many drugs including supplements are nephrotoxic. Additional causes such as allograft rejection, recurrent disease, and calcineurin inhibitor toxicity need to be considered in cases of allograft dysfunction, which would not affect the native kidneys. Early detection and assessment of AKI is crucial in promoting recovery. Significant progress has been made in specific pathologies over the last 20years, which has improved kidney allograft survival rates considerably. Research into identifying AKI biomarkers to assist early diagnosis, before the serum creatinine rises, is ongoing.

Proteinuria and the risk of Incident atrial fibrillation according to glycemic stages: a nationwide population-based cohort study

BackgroundDiabetes mellitus (DM) and proteinuria each independently raise the risk of atrial fibrillation (AF). We aimed to investigate the relationship between proteinuria and the risk of incident AF across glycemic stages.MethodsA cohort of 4,044,524 individuals without prior AF and type 1 DM was selected from the 2009 Korean National Health Insurance Service health checkup data. The individuals were categorized into five glycemic stages: normal, prediabetes, new-onset DM, early DM (< 5 years), and late DM (≥ 5 years). Proteinuria was graded using a urine dipstick test. The development of incident AF was tracked until 2023.ResultsOverall, the cohort (mean age 47 ± 14 years, 44.8% female) showed increasing annual AF incidence rates from 2.05 to 7.22 per 1000 person-years from normal to late DM (p < 0.001). Incidence rates increased from 2.46 to 8.18 per 1000 person-years with increasing proteinuria (p < 0.001). Adjusted Cox regression models revealed a heightened AF risk with higher proteinuria across all glycemic stages (adjusted hazard ratios for urine dipstick 3+/4+: 1.58, 1.64, 2.39, 2.12, and 2.53 for normal, prediabetes, new-onset DM, early DM, and late DM, respectively). The proteinuria-AF association was more pronounced in individuals with DM than in those without DM but was similar among the new-onset and established DM groups.ConclusionsProteinuria is an independent and significant risk factor for incident AF at all glycemic stages. The risk of incident AF in patients with DM can be stratified by measuring the level of proteinuria rather than comparing the duration of DM. Tailoring clinical strategies to proteinuria level could potentially mitigate this risk, improving patient outcomes.Graphical abstract

Hybrid remote and in-clinic maternal-fetal surveillance for women with gestational diabetes: A prospective pilot study.

This study explores a hybrid approach to maternal-fetal care for gestational diabetes (GD), integrating virtual visits seamlessly with in-clinic assessments. We assessed the feasibility, time efficiency, patient satisfaction, and clinical outcomes to facilitate wider adoption of maternal-fetal telemedicine. We conducted a 4-week prospective study involving 20 women with GD at ≥32 weeks of pregnancy, alternating between remote and in-clinic weekly visits. Remote assessments began with women self-measuring vital signs and using a digital urine dipstick. The remote encounter started with a midwife performing anamnesis and remotely connecting women to the fetal nonstress test. A physician concluded the meeting with remote sonographic assessment of amniotic fluid maximal vertical pocket that together with the nonstress test provided the modified biophysical assessment as well as a video encounter and ongoing glycemic control assessment. We assessed the feasibility of remote visits, compared visit durations, evaluated women's satisfaction using the Telehealth Usability Questionnaire, examined glucose documentation adherence during hybrid care compared with the following period until birth, and assessed GD-related clinical outcomes. Remote visits had a success rate of 97.4% (38 of 39), with significantly shorter durations compared with in-clinic visits (median 59.0 min vs. 159.0 min, P < 0.001). Women expressed high satisfaction (6.6 of 7), and adherence with recording fasting glucose values during the study period was significantly higher than the following period until birth (92.2% vs. 61.8%, P = 0.001). Notably, none required induction of labor for glycemic control imbalance, and there were no cases of macrosomia, shoulder dystocia, or neonatal hypoglycemia. The hybrid approach to maternal-fetal care for GD demonstrated feasibility, safety, time efficiency, improved patient satisfaction, and enhanced glycemic control adherence.

No Injury Observed in Kidneys Treated with Burst Wave Lithotripsy in Therapeutically Anticoagulated Pigs.

Introduction: Current American Urological Association guidelines recommend that patients with acute obstructive kidney stone requiring continuous anticoagulation/antiplatelet therapy should not be treated by shockwave lithotripsy or percutaneous nephrolithotomy because of the risk of catastrophic renal hemorrhage possible with those techniques. Currently, ureteroscopy is the only recommended surgical treatment. We evaluated if burst wave lithotripsy (BWL) could be used in these cases by treating pigs with BWL while undergoing anticoagulation therapy. Materials and Methods: Six pigs (31-37 kg) were given 200 units/kg porcine heparin, and then the right kidney of each animal was treated with a dose of BWL (18,000 ultrasound pulses at 10 Hz, 20 cycles/pulse, peak positive pressure of 12 MPa) known to fracture kidney stones. The contralateral kidney served as a control. Therapeutic anticoagulation was confirmed by evaluating activated partial thromboplastin time (aPTT). Microhematuria was checked by urine test strips. Kidneys were subsequently evaluated for hemorrhagic injury via MRI. Results: aPTT was significantly elevated (>100 seconds) throughout the entire treatment period (p = <0.001) indicating therapeutic anticoagulation. Gross hematuria was not observed in any of the pigs. After BWL, microhematuria averaged 145.8 red blood cells (RBC)/μL in the BWL-treated kidney and 48 RBC/μL in the control kidneys, and there was no statistically significant difference noted in microhematuria rates between the two groups (p = 0.16). Hemorrhagic injury measured only 0.10 ± 0.02% of the tissue in the BWL-treated kidneys and 0.12 ± 0.04% in the control side, with a paired difference of -0.03 ± 0.05%, showing no significant difference (p = 0.58). Conclusions: A typical clinical dose of BWL causes no hemorrhagic injury to the kidney even during therapeutic anticoagulation therapy. This result suggests that BWL should be safe to use in patients with stone undergoing anticoagulation/antiplatelet therapy.

Utility of a novel point-of-care test for albuminuria in communities at high risk for chronic kidney disease in Thailand

IntroductionChronic kidney disease (CKD) is a major public health concern, and early detection is crucial to prevent adverse outcomes. Albuminuria is an early marker and key prognostic marker in CKD,...

Improving UTI Diagnostics in Oncology: Reliability of Reflex Urine Culture in Immunosuppressed Neutropenic and Non-neutropenic Cancer Patients.

Urinary tract infections are prone to overdiagnosis, and reflex urine culture protocols offer a valuable opportunity for diagnostic stewardship in this arena. However, there is no recommended standard testing approach. Cancer patients are often excluded from reflex urine culture protocols, especially if severely immunosuppressed or neutropenic. The aim of this study was to evaluate the performance characteristics of urine screening studies, including dipstick urinalysis for nitrite and leukocyte esterase and urine microscopy for white blood cell count, to detect significant pathogen growth. A retrospective study of 58,098 urine cultures with a paired dipstick urinalysis with or without urine microscopy was performed at Memorial Sloan Kettering Cancer Center in New York City, evaluating data from January 1, 2018, to December 31, 2020. A dipstick urinalysis was considered negative only if leukocyte esterase and nitrite were undetected. A negative dipstick urinalysis had a negative predictive value (NPV) of 98% for clinically significant bacteriuria in voided urine, and 95% for catheterized urine. Notably, a negative urine dipstick test screen maintained a high NPV among patients with neutropenia and in those with antibiotic exposure before testing. Finally, the presence of pyuria ≥10 white blood cells per high power field on urine microscopy offered negligible incremental diagnostic benefit in samples with a negative dipstick urinalysis. Reflex urine culture protocols contingent upon a screening dipstick urinalysis are a safe and effective platform for diagnostic stewardship in patients with cancer including those with neutropenia.

Evaluation of pre-analytical factors impacting urine test strip and chemistry results.

Careful consideration of the pre-analytical process for urine examination is essential to avoid errors and support accurate results and decision-making. Our objective was to assess the impact of various pre-analytical factors on urine test strip and quantitative chemistry results, including stability, tube type, fill volume, and centrifugation. Residual random urine specimens were identified. Stability of 10 urine test strips and 13 quantitative chemistry parameters were assessed at eight time points (2, 4, 6, 8, 24, 48, 72, and 96 h) at room temperature (RT) and 2-8 °C (n=10-20 samples). The effect of additional pre-analytical variables was assessed, including using preservative tubes for urine chemistry as well as preservative tube underfilling and centrifugation on urine test strip results (n=10 samples). Seven of the ten urine tests strips evaluated met the minimal agreement criteria for stability (Cohen's kappa>0.70) across all conditions. A Cohen's kappa value of<0.70 was observed for pH (48 h), glucose (72 h), and protein (96 h) at RT. All 13 urine chemistry analytes remained stable at defined time points and conditions. Underfilling preservative tubes for urine test strips and centrifugation demonstrated no significant effect. The impact of using preservative tubes for urine chemistry was negligible with the exception of sodium and osmolality. These findings highlight the pre-analytical factors that impact urine specimen evaluation and may be useful in informing clinical laboratory practices. Acceptable stability window for urine test strips should be considered in the context of the proportion of pathological samples evaluated.

Urinary tract infections among pregnant women in rural West Amhara, Ethiopia: Prevalence, bacterial etiology, risk factors, and antimicrobial resistance patterns.

Urinary Tract Infections (UTIs) in pregnant women can lead to pyelonephritis and preterm birth. We assessed UTI prevalence, etiology, antimicrobial resistance, and associated risk factors among pregnant women receiving antenatal care in rural Amhara, Ethiopia. 604 pregnant women were screened for UTI at ≤ 24 weeks gestational age from August 2020 to June 2022. Urine culture, dipstick, and antibiotic sensitivity testing were completed. We conducted descriptive statistics for prevalence and logistic regression to examine UTI risk factors. UTI prevalence was 3.5% (21/604, 95%CI = 2.0%-4.9%), among which 43% were symptomatic and 57% were asymptomatic. Common uropathogens were Escherichia coli (57.1%), Klebsiella pneumoniae (14.3%), and Enterococcus faecalis (14.3%). Among all isolates, resistance was high for ampicillin (66.7%) and amoxicillin-clavulanate (40.0%). The majority of isolates (76.2%) were susceptible to nitrofurantoin, cotrimoxazole, and cefpodoxime. Maternal age > 20 years was a protective factor against UTI (OR = 0.27, 95% CI = 0.10-0.77; ref < 20 years). Urine dipstick (nitrite or leukocyte esterase) had low sensitivity (37.5%) but higher specificity (93.9%) to identify positive culture. This study emphasizes the high resistance to first-line antibiotics used in pregnancy and the need for accurate, low-cost UTI screening methods in LMICs.

Triboelectric Nanogenerator-Based Self-Powered Urinary Protein Detection Utilizing Triboelectric Material with Colorimetric Function.

Chronic kidney disease (CKD) has a high incidence rate, and if not detected and treated in a timely manner, it poses a risk of progressing to renal failure and even uremia. Performing home monitoring of urinary protein, which is a recognized indicator of CKD, is considered an effective means of achieving early warning for CKD. Although the existing urinary protein test strips for home self-testing are cost-effective and simple, they suffer from drawbacks such as susceptibility to contamination and lack of quantitative detection capability. Consequently, they are unable to fulfill the urgent requirement of long-term continuous monitoring. Here, we develop a sensing material that exhibits both colorimetric response for qualitative detection and triboelectric sensitivity for quantitative detection of urinary proteins. Meanwhile, in order to ensure the convenience and accuracy of testing in a home setting, a multichannel portable device that can provide stable mechanical energy input and simultaneously monitor environmental factor has been successfully developed. By utilization of the aforementioned sensing material and device, naked-eye rapid qualitative detection and self-powered quantitative detection of urinary proteins have been achieved. Therefore, this material and device show great potential in the field of home-based urinary protein detection for early warning of CKD.

Isolated microhematuria in potential kidney donors: evaluating kidney biopsy findings with dipstick urinalysis and urine microscopy results.

Isolated microhematuria (IMH) can signal hidden glomerular disease, necessitating detailed evaluations for potential kidney donors, including kidney biopsies. The optimal strategy for deciding on kidney biopsies remains unclear. While the British Transplant Society supports dipstick analysis, KDIGO focuses solely on urine microscopy. This study explored the correlation between kidney biopsy outcomes and results from dipstick urinalysis and urine microscopy in potential kidney donors. This retrospective study encompassed all potential kidney donors who received kidney biopsies following a positive urine dipstick result for IMH, irrespective of whether red blood cells (RBCs) were found on urine microscopy. We performed sensitivity and specificity analyses to assess the effectiveness of microscopy and dipstick urinalysis in identifying histological abnormalities in the kidney biopsies. Approximately 49% of potential donors-133 out of 271-who had kidney biopsies due to positive dipstick tests showed negative results in urine microscopy for RBCs. In total, 168 donor candidates, or 62%, had abnormal findings in their biopsies, with nearly half of those diagnosed with immunoglobulin A nephropathy having negative urine microscopy results. Furthermore, 58% of potential donors with negative urine microscopy results-77 out of 133-also exhibited abnormal biopsy findings. The urine microscopy test displayed a sensitivity of 54.2% (95% confidence interval 46.6-61.5) and a specificity of 54.4% (95% confidence interval 44.8-63.7) for detecting abnormal biopsy results. This study highlighted a significant presence of donors with IMH with underlying glomerular lesions. Using urine microscopy showed limited sensitivity and specificity in identifying abnormal histopathological results. Relying solely on urine microscopy may miss critical pathologies like IgAN in prospective kidney donors. The persistence of IMH during dipstick urinalysis calls for kidney biopsy in potential donors. These findings suggest that our results be incorporated into future global guideline formulations.

Smartphone-assisted colorimetry and array test strip integrated platform for urine multi-index simultaneous precise quantification and personalized healthcare monitoring

As a non-invasive monitoring method, urine analysis is one of the “three routines” of medical examination, which is of great significance for the early diagnosis, therapeutic effect judgment and long-term fine monitoring of chronic diseases such as metabolic system diseases and kidney diseases. It is imperative to develop a home urine routine detection system. In this paper, Smart Urine Analyzer is innovatively developed by combining smartphones with array urine dipsticks, and equipped with the unique design of adjustable bracket suitable for camera position of different smartphones. The optimal colorimetric value was selected for analysis based on chromogenic response characteristics combined with digital image colorimetry, and the breakthrough from qualitative semi-quantification to precise quantification of 9 kinds of urine biomarkers was completed. And a smartphone App for automated image recognition and processing was developed, which was applied for at-home routine healthcare. 100 clinical urine samples were used to evaluate the reliability of the system. Among them, the ROC curve showed a high consistency between Smart Urine Analyzer and the Dirui H-800 urine analyzer in hospital, which further verified the practicability. As a result, the user-friendly Smart Urine Analyzer can share health data and condition with doctors in real time, which provides a new scheme and means for the home detection of urine biomarkers, and has great practical application value as a potential home medical service assistant.

Prevalence of Schistosoma infection and associated factors among pregnant women attending antenatal care at Shewa Robit Health Center, North-Central Ethiopia: a cross-sectional study

BackgroundSchistosoma spp. and other intestinal parasites are common in Ethiopia. During pregnancy, SCH increases the risk of adverse birth outcomes. However, its epidemiology among pregnant women and awareness level about the disease are not well addressed in Ethiopia. This study was conducted to address this gap.MethodsA cross-sectional study was conducted from April to June 2023 among 422 pregnant women who attended Shewa Robit Health Center. Pregnant women who came to the health center for antenatal care services were enrolled in the study following systematic random sampling technique. Questionnaire data was collected on socio-demographic characteristics, KAP towards SCH, and associated factors. Stool samples were processed using the Kato–Katz technique, while urine samples were tested with urine test strips for hematuria, and filtration and centrifugation methods for detection of S. haematobium. Data were entered and analyzed using SPSS software version 25. Descriptive statistics and logistic regression were performed at a 95% confidence level.ResultsAmong 422 pregnant women, 38 (9.0%) were positive for hematuria, but none were infected by S. haematobium. Schistosoma mansoni was detected in 40 (9.5%; 95% confidence interval (CI): 6.6–12.6) participants. Habit of swimming or bathing (adjusted odds ratio (AOR) = 4.896; 95% CI: 2.193–10.933, p < 0.001) and habit of crossing freshwater on barefoot (AOR = 5.113; 95% CI: 1.171–22.324, p = 0.030) were significantly associated with S. mansoni infection. Of the participants, only 74 (17.5%) had previously heard of SCH. Out of 74 aware participants, 49 (66.2%) and 14 (18.9%) were unaware of the causative agent and possibility of a cure for SCH, respectively. Sixty-one (82.4%) were aware that SCH is preventable. Fifty-three (71.6%) and 4 (5.4%) participants believed that SCH is preventable and serious disease, respectively. Eight (10.8%) and 9 (12.2%) participants avoided contact with freshwater and used clean water for drinking and washing, respectively.ConclusionsThere is nearly moderate prevalence of S. mansoni infection in the study area. Pregnant women who often had freshwater contact were more likely to contract S. mansoni. Most pregnant women in the study area had low KAP levels towards SCH. Therefore, women of reproductive age groups should be the focus of SCH control programs.

Early Detection of Proteinuria in the Third Trimester of Pregnancy Using Visual and Automated Urine Dipstick Analysis at Great Baby Clinic

Proteinuria merupakan salah satu komplikasi kehamilan yang dapat berdampak serius pada ibu dan janin. Deteksi dini sangat penting untuk mencegah terjadinya komplikasi lebih lanjut. Penelitian ini dilakukan untuk membandingkan keefektifan metode carak celup visual dan otomatis dalam mendeteksi proteinuria pada ibu hamil trimester III di Klinik Great Baby. Sampel urine dari sejumlah ibu hamil trimester III diperiksa menggunakan kedua metode tersebut. Hasil penelitian menunjukkan [secara visual dan otomatis, yaitu sama didapatkan hasil 30 sampel negatif (50%), 7 sampel ± (12%), 14 sampel +1 (23%), 7 sampel +2 (12%), dan 2 sampel +3 (3%).. Disimpulkan bahwa [tidak terdapat perbedaan hasil pada pemeriksaan protein urine metode carik celup secara visual dan otomatis.

Utility of Urine Dipstick Testing in Pediatric Appendicitis: Assessing its Role in Identifying Complicated Cases and Retrocecal Appendicitis.

Diagnosing appendicitis in children remains a challenge, and the role of urine dipstick is controversial. This study aimed to evaluate the association between abnormal urine dipstick results and appendicitis, particularly appendicitis severity and appendix position. A prospective cohort study was conducted from 2017 to 2021 at a tertiary hospital in Sweden. Children aged ≤ 15 years with suspected appendicitis were included. Logistic regression was used to assess associations between abnormal urine dipstick results and sex, age, peritonitis, body temperature, C-reactive protein, complicated appendicitis, and appendix position. A total of 311 children with suspected appendicitis were included, with 193 (62%) diagnosed with appendicitis. Among these, 80 (41%) had complicated appendicitis. There was no difference in appendicitis rate between children with positive and normal urine dipstick results. Among children with appendicitis, 119 (62%) had positive urine dipstick results: 49% ketones, 29% erythrocytes, 23% protein, 19% leukocytes, and 2% nitrite. Multivariable analysis revealed that female sex (adjusted odds ratio: 2.41 [95% confidence interval, CI: 1.21-4.80], p = 0.013), retrocecal appendicitis (aOR: 2.39 [95% CI: 1.18-4.84], p = 0.015), and complicated appendicitis (aOR: 2.27 [1.01-5.13], p = 0.015) were significantly associated with abnormal urine dipstick results. Sensitivity and specificity of positive urine dipstick for complicated appendicitis was 56% (95% CI: 45-67%) and 64% (95% CI: 54-73%), respectively, with an area under the curve of 0.62 (95% CI: 0.54-0.70). Limitations in this study include potential unmeasured confounders such as hydration status and urinary tract infections. Abnormal urine dipstick results are common in children with appendicitis. Urine dipstick might help identify cases of complicated and retrocecal appendicitis.

Artificial Intelligence in Diagnostics: Enhancing Urine Test Accuracy Using a Mobile Phone-Based Reading System.

Urinalysis, an essential diagnostic tool, faces challenges in terms of standardization and accuracy. The use of artificial intelligence (AI) with mobile technology can potentially solve these challenges. Therefore, we investigated the effectiveness and accuracy of an AI-based program in automatically interpreting urine test strips using mobile phone cameras, an approach that may revolutionize point-of-care testing. We developed novel urine test strips and an AI algorithm for image capture. Sample images from the Chungnam National University Sejong Hospital were collected to train a k-nearest neighbor classification algorithm to read the strips. A mobile application was developed for image capturing and processing. We assessed the accuracy, sensitivity, specificity, and ROC area under the curve for 10 parameters. In total, 2,612 urine test strip images were collected. The AI algorithm demonstrated 98.7% accuracy in detecting urinary nitrite and 97.3% accuracy in detecting urinary glucose. The sensitivity and specificity were high for most parameters. However, this system could not reliably determine the specific gravity. The optimal time for capturing the test strip results was 75 secs after dipping. The AI-based program accurately interpreted urine test strips using smartphone cameras, offering an accessible and efficient method for urinalysis. This system can be used for immediate analysis and remote testing. Further research is warranted to refine test parameters such as specific gravity to enhance accuracy and reliability.

Morbidity associated with schistosomiasis in adult population of Chókwè district, Mozambique.

Mozambique is one of the countries with the highest prevalence of schistosomiasis, although there is little data on the prevalence of disease and associated morbidity in the adult population. This study aimed to describe and characterize the morbidity associated with schistosomiasis in the adult population of Chókwè district and to explore the use of anamnestic questionnaires and urine dipsticks, as well as point-of-care ultrasound for urinary related findings, to better characterize disease prevalence and morbidity. Between April and October 2018, we conducted a cross-sectional study embedded within the Chókwè Health Research and Training Centre. Data were collected on sociodemographic variables, signs and symptoms for schistosomiasis and water related activities. Infection status was determined by urine filtration, Kato-Katz thick smear and DNA detection. Point-of care urinary tract ultrasonography was performed to assess structural morbidity associated with Schistosoma haematobium infection. Multivariate logistic regression was used to search for associations between risk factors, signs and symptoms, infection status and ultrasound abnormalities. Our study included 1033 participants with a mean age of 32 years old. The prevalence of Schistosoma haematobium, Schistosoma mansoni and ultrasound detected urinary tract abnormalities were 11.3% (95% CI 9.5%-13.4%), 5.7% (95% CI 4.3%-7.5%) and 37.9% (95% CI 34.8%-41.2%), respectively. Of the 37.9% with urinary tract abnormalities, 14.5% were positive for Schistosoma haematobium. Reported hematuria in the last month (p = 0.004, aOR 4.385) and blood in the urine dipstick (p = 0.004, aOR 3.958) were markers of Schistosoma haematobium infection. Reporting lower abdominal pain (p = 0.017, aOR 1.599) was associated with ultrasound abnormalities. Using microscopy and DNA analysis for both Schistosoma haematobium and Schistosoma mansoni in conjunction with urinary ultrasound abnormalities gives us several insights into correlations between disease prevalence (microscopic and anatomical) and demographic details in a high-risk population.

Diagnostic Role of Urinary Nitrites and Leukocyte Esterase in Detection of UTI in Children

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Urinary tract infections (UTI) are common in children and pose a significant public health concern, particularly in low-resource settings like Bangladesh. Rapid, cost-effective diagnostic tools such as urinary nitrite and leukocyte esterase dipstick tests offer an alternative to traditional urine culture, which is often time-consuming and resource-intensive. This study aimed to evaluate the diagnostic accuracy of urinary nitrite and leukocyte esterase tests in detecting UTI in children. &amp;lt;i&amp;gt;Methods:&amp;lt;/i&amp;gt; This cross-sectional study was conducted at Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh, from July 2019 to December 2019. A total of 200 children, including 100 cases with proven UTI by culture or microscopy and 100 controls, were enrolled. Urinary nitrite and leukocyte esterase tests were performed on urine samples, with urine culture used as the gold standard. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess diagnostic performance. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; The urinary nitrite test demonstrated a sensitivity of 75.56% and a specificity of 97.00%, with an overall accuracy of 90.34%. The PPV was 91.89%, and the NPV was 89.81%. The leukocyte esterase test showed a sensitivity of 88.89% and a specificity of 82.00%, with an accuracy of 84.14%, PPV of 68.97%, and NPV of 94.25%. Compared with urine R/E, the urinary nitrate test had strong specificity (97.00%) but moderate sensitivity (47.78%), while the leukocyte esterase test maintained high sensitivity (86.67%) and reliable NPV (87.23%). &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Both urinary nitrite and leukocyte esterase dipstick tests are effective rapid screening tools for diagnosing UTI in children, with high specificity and sensitivity, respectively. Their combined use can enhance diagnostic accuracy, particularly in settings where access to culture testing is limited. These findings support the implementation of dipstick tests as a reliable first-line diagnostic method for pediatric UTI.

Rapid and accurate testing for urinary tract infection: new clothes for the emperor.

SUMMARYUrinary tract infection (UTI) is among the most common infections in clinical practice. In some cases, if left untreated, it can lead to pyelonephritis and urosepsis. In other cases, UTI resolves without treatment. Clinical diagnosis is typically based on patient symptoms and/or urinalysis, including urine dipsticks. The standard urine culture method is sometimes employed to identify the suspected urinary pathogen (uropathogen) and/or guide antimicrobial choice, but results are rarely available before 24 h. The standard urine culture method also misses fastidious, anaerobic, and slow-growing uropathogens and rarely reports polymicrobial infections. The unexplained combination of negative urine cultures with persistent urinary tract symptoms is distressing to both patients and clinicians. Given the broad appreciation of the advantages provided by rapid testing (e.g., for COVID-19 or influenza A), a rapid, accurate diagnostic test is needed to deliver timely treatment to patients seeking care for UTI that optimizes antibiotic stewardship. Herein, we discuss progress being made toward an accessible, timely (i.e., within hours), accurate assay with results that are clinically useful for the treating clinician within the timeframe of the infection (i.e., the growth rate of the pathogen(s)). New and emerging uropathogens often overlooked by current diagnostic techniques are also reviewed.

Assessment of proteinuria by urine dipstick as a predictive marker for dengue hemorrhagic fever in pediatric patients

Objective: To investigate whether urinary dipstick proteinuria or urine protein creatinine ratio (UPCR) could predict leakage in children with dengue virus infection. Methods: This was a prospective cross-sectional study. A total of 141 hospitalized patients with confirmed dengue virus infection were enrolled from three hospitals in Thailand. Once daily, complete blood count, serum albumin, and random morning urine dipstick protein were collected from the day of admission to the day after defervescence. Morning UPCR was only measured in patients from one hospital due to logistic reasons. Results: There were 81 and 60 patients in the dengue fever (DF) and DHF groups, respectively. The proportion of patients with proteinuria detected using urine dipstick in the DHF group was higher than that in the DF group from Day-1 (one day before defervescence) to Day +1 (one day after defervescence). Urine dipstick for proteinuria of ≥1+ had sensitivity and specificity of 12.8% and 94.4% on Day-1, and 18.9% and 98.6% on Day 0 (the day of defervescence) to differentiate DHF from DF. For UPCR, cut-off values of approximately 0.2 g/g from Day-2 to Day+1 yielded a sensitivity of 71.6%-94.4% and a specificity of 55.6%-100% in differentiating between DF and DHF. Conclusions: Dipstick proteinuria of ≥1+ on Day-1 to Day+1 after defervescence had poor sensitivity but good specificity in differentiating DHF from DF. UPCR performed better but was less convenient and more expensive than urine dipsticks.

Utilisation and trends of laboratory testing and point-of-care testing in primary care in Germany: an analysis of claims data

ObjectivesGerman general practitioners (GPs) either order laboratory tests from external laboratories (initiated laboratory services (ILS)) or perform point-of-care tests (POCTs) within the GP practice. This study investigated the current use...