Microscopic Urine Analysis Research Articles

Evaluation of the DxU 850m Iris automated urine microscopy analyzer for identifying culture-negative urine samples: From a perspective of reducing urine culture number

We evaluated the DxU 850m Iris Urine Microscopy analyzer as a screening tool for excluding negative urine samples (n = 1337). At a cutoff of 103 colony counts·mL−1, sensitivity was 55.1 %, specificity 68.6 %. The DxU 850m Iris does not offer acceptable prediction of culture-negative urine samples at the tested cutoff.

Spectrophotometric and chromatographic analysis of creatine:creatinine crystals in urine

Creatinine is the end product of the catabolism of creatine and creatine phosphate. Creatine phosphate serves as a reservoir of high-energy phosphate, especially in skeletal and cardiac muscle. Besides typical known changes in serum and urinary creatinine concentrations, rare cases associated with changes in serum and urinary creatine levels have been described in the literature in humans. These cases are mostly linked to an excessive intake of creatine ethyl ester or creatine monohydrate, often resulting in increased urine creatinine concentrations. In addition, it is known that at such elevated creatinine concentrations, creatinine crystallisation may occur in the urine. Analysis of crystals and urinary concrements, often of heterogenous chemical composition, may provide diagnostic and therapeutic hints to the benefit of the patient. The aim of the present work was to analyze urine crystals of unclear composition with microscopic and spectroscopic techniques.On routine microscopic analysis of urine, a preliminary suspicion of uric acid or creatinine crystals was expressed. The crystals were of a cuboid shape and showed polarization effects in microscopy. The dried urine sample was whitish-orange in colour, odourless and dissolved well in water. Protein concentration in dry weight (DW) urine was about 0.3 mg/mg. The measured zinc content in the studied sample was approximately 660 µg/g DW sample and copper content was approximately 64 µg/g DW sample. A lead signal of around 10 µg/g DW sample was also observed. UV–Vis analysis showed a maximum creatine peak around 220 nm, compatible with the spectrum of creatinine with a maximum peak of 230 nm. Using HPLC technique, an extreme high ratio of creatine to creatinine of about 38 was measured, which led to the conclusion of the occurrence of rare creatine crystals in urine.

Evaluation of Leukocyte esterase and Nitrite dipstick tests with routine urine microscopic analysis in detecting urinary tract infections

Evaluation of Leukocyte esterase and Nitrite dipstick tests with routine urine microscopic analysis in detecting urinary tract infections

Clinical pattern and outcome of hematuria in children – A prospective follow-up study from South India

Background: Hematuria is defined by the presence of an increased number of red blood cells (RBCs) in the urine. It can be visible or apparent only on microscopic analysis of urine which many times is an incidental finding. The prevalence of microscopic hematuria is 4–5% in routine clinical practice in children of 6–12 years of age. The pediatrician is the first person who comes in contact with children having microscopic or gross hematuria. Updated knowledge of clinical patterns and their outcomes will help improve the management of children with hematuria. Aim and Objective: The aim and objectives are to study the outcome of hematuria in children attending SAT Hospital, Government Medical College, Thiruvananthapuram. Materials and Methods: This is a prospective follow-up study of 100 children admitted with hematuria in our hospital whose ages were between 1 month and 12 years. A preformed and piloted questionnaire was used. Clinical history and examinations were done. Relevant investigations and follow-up assessments were done for 1 year. Biopsy was done for 35 patients by an experienced pediatric nephrologist. Results: Among the 100 children presented with hematuria, 24 had prior renal disease whereas 76 children did not have any pre-existing renal disease. Both were followed up for 1 year. 80% (45) of those without prior renal involvement cleared of hematuria by 1 year and 20% had persistent renal impairment. In the other group with prior renal problems, 75% (15) showed persistent renal problems. School-going children (57%) were mostly affected with female preponderance (30%). The most common etiology was acute post-infectious glomerulonephritis (60%), and the next most common seems to be IgA nephropathy (23%) followed by SLE (17%) Conclusion: Eighty percent of hematuria was found to be resolved completely after 1 year. The remaining 20% has to be carefully evaluated including renal biopsy when indicated. This will help the clinician to provide better care for sick babies with hematuria.

Homologation of results of manual and automated urine microscopic analysis: a review of the bibliography

Introduction: urinalysis represents one of the most requested laboratory tests for the diagnosis and follow-up of urinary and renal system diseases. Although manual microscopy has been the traditional method, its process is characterized by being laborious and time-consuming. For this reason, automated systems have been introduced with the aim of improving the accuracy of the results. Objective: to establish the relevance of the homologation of manual and automated urine microscopic analysis results through a literature review.Methods: this study is based on descriptive research of bibliographic documents with a retrospective analysis. For the collection of information, various databases such as PudMED, Scielo, Google Scholar, Scopus, Elsevier were consulted. During the bibliographic search, 25 articles related to the subject of the study were found, for which the PRISMA methodology was used.Results: by analyzing the different investigations, it was found that the automated analyzers showed an adequate concordance with manual microscopy for red blood cells, white blood cells and epithelial cells. However, in the case of bacteria and casts, a lower concordance was evidenced. Conclusion: urine microscopic analysis is crucial in medical diagnosis. The transition from manual methods to automated equipment has improved the efficiency and accuracy of the results. The comparison between both methods is fundamental to ensure the reliability of the results, which contributes to provide safe and appropriate treatments for patients

Positive predictive value of urine analysis with reflex criteria at a large community hospital.

Urine analysis with reflex to culture (URTC) is employed as a diagnostic aid for urinary tract infections (UTIs). Criteria utilized to determine whether a urine analysis (UA) will reflex varies owing to a lack of evidence-based guidance. Positive predictive value (PPV) of URTC varies across studies. The URTC criteria in this study included moderate or more white blood cells (> 5 high-power field [HPF]), few or more bacteria (> 1 HPF), and few or no epithelial cells (< 3 HPF). The purpose of this study was to determine the extent to which URTC predicts culture positivity. This study was a single-center, retrospective evaluation at a large community hospital. A report of URTC ordered in adults in October 2020 was generated from the hospital's electronic database. The primary outcome was to determine the PPV of URTC criteria. The secondary outcome was to examine the differences in microscopic UA results between culture-positive and culture-negative urine. A total of 350 patients were included for analysis. The data was analyzed through descriptive statistics, Mann-Whitney U test, and multivariate logistic regression. The results showed a PPV of 58%. Variables predicting negative culture included younger patients, males, and a reason for the visit to the emergency department of a fall/syncope or other. Further optimization is needed for URTC criteria and the appropriateness of ordering UAs to reduce operational laboratory costs and inappropriate antibiotic treatment.

Intravesical liposomal tacrolimus for hemorrhagic cystitis: a phase 2a multicenter dose-escalation study

BackgroundHemorrhagic cystitis (HC) is an inflammatory disease of the bladder with sustained hematuria for which there is currently no approved drug treatment. We evaluated a liposomal tacrolimus preparation (LP-10) in patients with refractory moderate to severe sterile HC.MethodsThis phase 2a dose-escalation study assessed the safety and efficacy of up to 2 intravesical instillations of LP-10 (2, 4, or 8 mg tacrolimus) in 13 patients with HC. Primary efficacy outcomes were changes from baseline in the number of bleeding sites on cystoscopy, microscopic urine analysis for red blood cells (RBCs), and hematuria on dipstick. Additional efficacy measures included urinary incontinence, frequency, and urgency on a 3-day diary and cystoscopy global response assessment (GRA). Blood samples for pharmacokinetic (PK) assessment were obtained in all patients.ResultsIntravesical LP-10 was well tolerated, with no treatment-related severe or serious adverse events (AEs) and only 3 drug-related AEs (artificial urinary sphincter malfunction, dysuria, and bladder spasms). LP-10 blood levels showed short durations of minimal systemic uptake. Treatment resulted in significant improvements in bleeding on cystoscopy, RBC counts in urine, hematuria on dipstick, and urinary incontinence. Bleeding on cystoscopy and urinary incontinence showed dose-dependent improvements that were more pronounced in the 4 mg and 8 mg dose groups. All dose groups showed a significant improvement in cystoscopy GRA.ConclusionLP-10 was well tolerated, with clinically relevant efficacy seen in improvements in cystoscopic bleeding, hematuria, and urinary incontinence. The benefit-risk profile supports the further clinical development of LP-10 at a tacrolimus dose of 4 mg.

URINALYSIS AS A PREDICTOR FOR URINARY TRACT INFECTION: AN OBSERVATIONAL STUDY

Aims and Objectives: The aims and objectives of the study are to find the usefulness of urine dipstick and urinalysis in children with an intention to identify the parameters which most likely point toward the presence of urinary tract infection (UTI), whether a combination of the parameters analyzed rather than single parameter is useful in suggesting the presence or absence of UTI. Methods: The study was a prospective observational study done in 401 children below 16 years of age with clinically suspected UTI. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of dipstick leukocyte esterase (LE) and nitrite were 85%, 93.1%, 75.6%, 96.1% and 51.2%, 99.1%, 93.2%, 89.1%, respectively. In urine microscopic analysis, the sensitivity, specificity, PPV, NPV of bacteria were 68.5%, 96.9%, 84.6%, and 92.6% and those of pus cells were 80%, 93.1%, 74.4%, and 94.9%. Conclusion: Combination of parameters, i.e., LE, nitrite, and bacteria or LE, nitrite, and pus cells are good screening tools to predict and rule out UTI. Of the individual parameters analyzed, negative nitrites in dipstick and absence of bacteria in urine microscopy almost rule out UTI caused by most uropathogens.

Prevalence of urinary tract infection and sensitivity pattern in febrile children less than 5 years of age

Background: Fever has long been considered as an important clinical finding in children with urinary tract infections (UTIs), it is often ignored in children in whom the symptoms are fuzzy. UTI in children is alarming because of the acute and chronic complications not seen routinely in adults. The study emphasizes that UTI should be strongly suspected in febrile children to prevent future complications. This study was undertaken to determine the prevalence of UTI and sensitivity pattern in febrile children and to assess the validity of microscopic urine analysis against urine culture in the diagnosis of UTI.Methods: A descriptive study was undertaken in the department of pediatrics, NMCTH, Birgunj. Data related to age, sex, nutritional status, socioeconomic status were noted. Physical examinations with relevant investigations were carried out in all those patients.Results: Out of 1074 children 147 showed significant pyuria (13.7%) and 44 showed significant bacterial growth making an overall prevalence of 4.1%. Urine cultures were done in all the cases and showed positive culture in 29.93%. Among culture positive cases gram negative organisms were commonly isolated. E. coli (70.45%) commonly isolated in the culture was found highly sensitive to cefotaxime and sulphamethoxazole /trimethoprim (32.14%) and was highly resistance to cefepime, cefuroxime, cefixime.Conclusions: Overall prevalence of UTI in our study was low (4.1%). The &gt;5 pus cells/hpf in centrifuged sample should be considered as significant pyuria and further evaluation should be done promptly to initiate treatment and to prevent long term sequalae.

Prevalence of urinary tract infection in febrile children of less than five years of age

To determine the prevalence of urinary tract infection in febrile children, less than 5 years of age. To assess the validity of microscopic urine analysis and urine culture in the diagnosis of urinary tract infection.Prospective study. Children attending the department of paediatrics, Dr.V.R.K. Women’s Medical College, Teaching Hospital &amp; Research Centre, with febrile illness during June 2019-June 2020.370 children between 1 month to 5 years of age.Data related to age, sex, nutritional status, socioeconomic status and predisposing risk factors like urethral instrumentation, bowel habits etc, were noted. A thorough physical examination with relevant investigations were carried out in all these patients. Routine urinary microscopy was done in all patients and urine culture was done in those who showed pyuria of &amp;#62;5 pus cells/HPF in centrifuged urine sample.In our study, overall prevalence of UTI was 3.5% in children between 1 month to 5 yrs and 4.1% in children &amp;#60;2yrs and 7% in Children &amp;#60;1 year of age with M:F ratio of 1:1in children &amp;#60;2yrs. Prevalence of culture positivity was 44% in those who showed &amp;#62;10 pus cells/HPF in centrifuged sample of urine and 2.5% in those who showed &amp;#62;5pus cells/HPF.The presence of obvious source of fever such as upper respiratory tract infection or otitis media is not reliable in excluding urinary tract infection. Overall prevalence of UTI in our study was low (3.5%) and prevalence among children &amp;#60;2yrs was 4.1% and &amp;#60;1 year of age was 7%. Pyuria of &amp;#62;5pus cells/HPF (centrifuged urine sample) should be considered as significant and further evaluation should be done to initiate prompt treatment.

Frequency and Antibiotic Resistance Profile of Uropathogens Associated With Community Acquired Urinary Tract Infections

Abstract Background Community acquired urinary tract infections (CAUTIs) are among the most common bacterial infections diagnosed in community health practice resulting in high rates of morbidity and high economic costs associated with its treatment. CAUTIs are usually treated empirically. Geographical variations in etiologic agents and their antibiotic sensitivity patterns are common. Knowledge of antibiotic resistance trends is important for improving evidence-based recommendations for empirical treatment of UTIs. Adequate empirical treatment can cause decrease in unnecessary hospital stays, treatment cost, antibiotic side effects as well as reducing antimicrobial resistance spread. Aim of the Work To determine the implicated uropathogens associated with community-acquired UTIs and their respective antimicrobial resistance pattern to improve the efficacy of empirical treatment of this infection. Patients and Methods This a cross-sectional descriptive study conducted from November 2018 to November 2019 at the main Microbiology Lab in Clinical Pathology Department, Ain Shams University Hospitals. Samples were received from patients attending different outpatient clinics in Ain Shams University Hospitals having UTI symptoms and whose urine samples showed significant bacterial growth (≥105 CFU/mL) associated with pyuria (more than 8–10 pus cells by microscopic urine analysis) and nitrite and leukocyte esterase positive by chemical analysis of urine strip. Results A total of 1600 patients who fulfilled our inclusion criteria were sampled. Of these, 1058 patients had urine samples that showed significant bacterial growth while about 34% of the samples were contaminated and excluded . Of the 1058 significant samples, 764 (72.21%) were from females and 294 (27.79%) from males with female to male ratio 2.6:1. Escherichia coli was found the dominant bacteria among a with the prevalence rate of 24.4% followed by Klebsiella pneumoniae (13.8%). Tetracycline was found the most resistant antibiotic 929 (95.4%) followed by Ampicillin, Tazobactam-piperacillin, and Ampicillin- sulbactam by 90.1%, 81.7% and 77.7% respectively; however, the most sensitive antibiotics against all uropathogens were Carbapenems (Ertapenem 72.9% fol Imipenem 66.5% and Meropenem 66.4%) followed by Nitrofurantoin and Amikacin showing 64.3% and 58.01% sensitivity respectively . However, For gram positive uropathogens, Linezolid showed the highest sensitivity in 84% of the isolates. Conclusion The present study reveals a familiar pattern with respect to the species of uropathogens involved in community acquired urinary tract infections, however with considerable bacterial resistance to common empirically prescribed antibiotics.

Modified Atkins diet for drug-resistant epilepsy and the risk of urolithiasis.

Ketogenic diet (KD) is widely used for drug-resistant epilepsy (DRE). The study was designed to evaluate one of the risk factors for development of renal calculi with KD. Twenty patients with DRE on Modified Atkins diet (MAD) were subjected to full history and laboratory investigations, including microscopic urine analysis, urinary calcium after overnight fasting, and calcium/creatinine ratio, as well as pelviabdominal ultrasound. Frequency and severity of seizures assessed by Chalfont severity score were recorded. All assessment measures were repeated after 3 and 6 months of KD therapy. There were significant reductions in both frequency and severity of seizures, yet 2 patients (10%) developed renal stones after 6 months on KD. Gross hematuria was reported in 1 of those 2 patients (50%), but microscopic hematuria was detected in both patients. The urine calcium and the urine calcium/creatinine ratio were elevated in both patients having renal calculi after 6 months. KD increases the risk of renal stones with hypercalciuria among the causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with regular urinary studies including calcium/creatinine ratio and renal ultrasound for patients with symptoms. KD has been increasingly used in epilepsy management and beyond. The potential side effects of such diet should be highlighted while valuing the merits. KD increases the risk of renal stones because of hypercalciuria among other causes. We recommend initiation of prophylactic measures once KD is commenced by maximizing fluid intake and urine alkalinization with estimation of urinary calcium/creatinine ratio and renal ultrasound in patients with relevant symptoms.

BK Virus Associated Nephropathy (BKVAN) in a Lung Transplant Recipient in the Setting of Augmented Immunosuppression

Introduction Acute kidney injury (AKI) and chronic kidney disease (CKD) are common amongst lung transplant recipients due to calcineurin inhibitor (CNI) use. We describe a case of acute BK virus associated nephropathy (BKVAN) in a lung transplant recipient with baseline CKD stage 4. Case Report A 73-year-old male status post right single lung transplant eight years prior for tobacco-induced emphysema presented for admission for acute cellular rejection (ACR). He was treated with methylprednisolone 10 mg/kg x three days per protocol. His renal function was within normal range pre-transplant, but had gradually progressed to CKD 4 with a new baseline creatinine of 2.4 at time of admission. Progressive CKD was attributed to CNIs. He had been placed on a CNI sparing regimen with everolimus more than one year prior to index admission with continued progression of renal dysfunction. Upon initiation of methylprednisolone, creatinine began to rise and eventually peaked to 4.3. UA showed trace protein but was otherwise bland, urine microscopy with muddy brown granular casts and renal tubular epithelial (RTE) cells. Renal ultrasound was poor quality showing possible small right kidney, left kidney not imaged. As part of his work-up, a BK virus PCR from his urine was sent and positive, with greater than 162 million IU/mL: serum BK PCR returned at 146,000 IU/mL. Microscopic urine analysis demonstrated RTE cells consistent with decoy cells, supportive of viral injury. A kidney biopsy was considered, however not performed because of chronic anticoagulation for a recent history of venous thromboembolism. Over the next several days, creatinine decreased minimally to 3.76. Patient was discharged home with outpatient nephrology follow up and had serial serum BK PCR tests for disease monitoring.In the setting of declining pulmonary function testing and ACR, we were unable to decrease immunosuppression without risking further deterioration of the lung allograft. Summary To our knowledge, this is the ninth reported case of BKVAN after lung transplant. BK viremia and BKVAN are likely an under-diagnosed etiology of CKD and AKI in the lung transplant population. We speculate that our patient had undiagnosed low level BK viremia that was affecting his renal function chronically, but when treated with high dose steroids, led to an acute BK nephropathy.

Evaluation of the detection ability of uropathogen morphology and vaginal contamination by the Atellica UAS800 automated urine microscopy analyzer and its effectiveness.

BackgroundTo help combat the worldwide spread of multidrug‐resistant Enterobacterales, which are responsible for many causes of urinary tract infection (UTI), we evaluated the ability of the Atellica UAS800 automated microscopy system, the only one offering the capability of bacterial morphological differentiation, to determine its effectiveness.MethodsWe examined 118 outpatient spot urine samples in which pyuria and bacteriuria were observed using flow cytometry (training set: 81; cross‐validation set: 37). The ability of the Atellica UAS800 to differentiate between bacilli and cocci was verified. To improve its ability, multiple logistic regression analysis was used to construct a prediction formula.ResultsThis instrument's detection sensitivity was 106 CFU/ml, and reproducibility in that range was good, but data reliability for the number of cocci was low. Multiple logistic regression analysis with each explanatory variable (14 items from the Atellica UAS800, age and sex) showed the best prediction formula for discrimination of uropathogen morphology was a model with 5 explanatory variables: number of bacilli (p < 0.001), squamous epithelial cells (p = 0.004), age (p = 0.039), number of cocci (p = 0.107), and erythrocytes (p = 0.111). For a predicted cutoff value of 0.449, sensitivity was 0.879 and specificity was 0.854. In the cross‐validation set, sensitivity was 0.813 and specificity was 0.857.ConclusionsThe Atellica UAS800 could detect squamous epithelial cells, an indicator of vaginal contamination, with high sensitivity, which further improved performance. Simultaneous use of this probability prediction formula with urinalysis results may facilitate real‐time prediction of uropathogens and vaginal contamination, thus providing helpful information for empiric therapy.

The performance of the urine strip test for predicting microscopic urine analysis

The performance of the urine strip test for predicting microscopic urine analysis

Bacteriological Profile and Antibiogram of Uropathogens in Pediatric Age Group Population from a Tertiary Care Hospital in Western Nepal

INTRODUCTION&#x0D; Urinary tract infection (UTI) is one of the most common bacterial infections encountered in day to day pediatrics practices. It has been a significant cause of acute morbidity and is also a significant cause of hospital attendance among children. In children, despite the presence of simple and reliable methods of preliminary screening of children's urine, UTI continues to be under-diagnosed.&#x0D; AIMS &amp; OBJECTIVE&#x0D; The study aimed to know the clinical and bacteriological profile of urinary tract infection and to find out the drug resistance of bacterial isolates in pediatric age group population attending Universal College of Medical Sciences Teaching Hospital, Bhairahawa.&#x0D; MATERIALS &amp; METHODOLOGY&#x0D; Three hundred and seven non-repetitive urine samples from UTI suspected pediatric patients were included in the study and subjected for microscopic urine analysis followed by semi- quantitative culture by calibrated loop method for estimation of significant bacteriuria.&#x0D; RESULTS&#x0D; Present study showed that UTIs are more common in girls (54.07%) than in boys (45.92%). In terms of urine culture, 98 (31.92%) subjects had positive urine culture. There was no consistent symptom common to all patients with UTI other than fever. E. coli was the commonest uropathogens isolated. E. coli was the principal isolates showing high susceptibility to Imipenem (90.5%).

Degree of Portal and Systemic Hemodynamic Alterations Predict Recurrent AKI and Chronic Kidney Disease in Patients With Cirrhosis.

The relevance of hemodynamic derangements on the incidence of recurrent acute kidney injury (AKI) and chronic kidney disease (CKD) in patients with cirrhosis is largely unknown. Consecutive patients with cirrhosis with a complete record of baseline hemodynamics were followed for identifying risk factors for the development of recurrent AKI and CKD by using negative binomial regression and competing risk analysis, respectively. Consecutive patients with cirrhosis (n = 2013, age 50.1 ± 11.8 years, 80% male, Child A:B:C percentage 13.7:52.9:33.4, and mean Child‐Turcotte‐Pugh score 8.6 ± 1.8) were enrolled, 893 (44.3%) of whom received beta‐blockers, with 44.2% responders. Prior AKI was noted in 12.4% at enrollment. At a median follow‐up of 379 (interquartile range: 68‐869) days, AKI developed at a rate of 0.37 episodes per person‐year, and 26% patients developed CKD. A lower mean number of AKI episodes (0.05 ± 0.25 vs. 0.42 ± 0.868; P < 0.001), CKD (subdistribution hazard ratio 0.74 [0.54‐1.02]), and mortality (hazard ratio 0.21 [0.06‐0.73]) were observed in beta‐blocker responders. Albuminuria was an independent risk factor for recurrent AKI, CKD, and mortality (P < 0.05). Lower systemic vascular resistance index predicted hemodynamic response (odds ratio 2.04 [1.29‐3.22]), cumulative AKI episodes (ratio of means 0.10 [0.08‐0.14]), and development of CKD (subdistribution hazard ratio 0.70 [0.58‐0.83]). Higher hepatic venous pressure gradient (≥17 mm Hg) predicted AKI episodes (ratio of means 1.76 [1.32‐2.35]) but not CKD. Conclusion: High portal pressure and severe vasodilatation predispose patients with cirrhosis to repeated AKI episodes and development of CKD. Response to beta‐blockers and therapies targeting the vasodilatory state could prevent frequent AKI and the risk of CKD development. Albuminuria could serve as an early marker of renal dysfunction in patients with cirrhosis.

Delving into the Antiurolithiatic Potential of Tribulus terrestris Extract Through \u2013In Vivo Efficacy and Preclinical Safety Investigations in Wistar Rats

Modern treatment interventions for kidney stones are wrought with side-effects, hence the need for alternative therapies such as plant-based medicines. We have previously documented through in vitro studies that statistically optimized aqueous extract of Tribulus terrestris (Zygophyllaceae family) possesses antiurolithic and antioxidant potential. This provides strong scientific foundation to conduct in vivo efficacy and preclinical safety studies to corroborate and lend further proof to its ability to prevent and cure kidney stones. The preventive and curative urolithiatic efficacy in experimentally induced nephrolithiatic Wistar rats, along with preclinical toxicity was evaluated following oral administration of statistically optimized aqueous extract of T. terrestris. Treatment showed augmented renal function, restoration of normal renal architecture and increase in body weight. Microscopic analysis of urine revealed excretion of small sized urinary crystals, demonstrating that treatment potentially modulated the morphology of renal stones. Tissue enzymatic estimation affirmed the antioxidant efficacy of treatment with reduced free radical generation. Significant upregulation of p38MAPK at both the gene and protein level was noted in hyperoxaluric group and interestingly treatment reversed it. Acute oral toxicity study established the Median Lethal Dose (LD50) to be greater than 2000 mg/kg body weight (b.wt.) No observed adverse effect level (NOAEL) by repeated oral toxicity for 28 days at 750 mg/kg b.wt. was noted. This study lends scientific evidence to the safe, preventive and curative potential of statistically optimized aqueous extract of T. terrestris at a dose of 750 mg/kg b.wt. and suggests that the extract shows promise as a therapeutic antiurolithic agent.

Sensitivity of Automated Urine Chemstrip Analysis for Detecting Microscopic Abnormalities

Abstract Objectives Urinalysis (UA) is used to screen for multiple medical abnormalities. Microscopic analysis of urine requires trained morphologists and can be time-consuming; therefore, a reflex strategy where microscopic analysis is only performed when the chemstrip is positive is an attractive strategy. We previously described the retrospective performance of the iChem VELOCITY (Beckman Coulter, CA, USA) and CLINITEK Novus strip cassettes (Siemens, Munich, DE) for detecting microscopic abnormalities. The iRICELL is iQ microscopic and is now paired with the AX-4030 (Arkray, JP). During our validation of the new workcell, we tested the sensitivity and specificity of the chemstrip results for microscopic abnormalities. Methods A total of 60 samples were analyzed on both the VELOCITY and AX-4030. Microscopic evaluation was performed by centrifuging the urine and examining by light microscope. Sensitivity and specificity for each chemstrip result were calculated and compared. Results Looking at sensitivity of any chemistry abnormality for any microscopic abnormality, the AX-4030 was 90.2% sensitive compared to 80.5% on the VELOCITY. The AX-4030 leukocyte esterase result was slightly less sensitive but more specific than the VELOCITY for presence of leukocytes (94.7% sensitivity and 95.1% specificity compared to 100% sensitivity and 87.8% specificity). The AX-4030 blood results were slightly more sensitive for detection of RBC (77.8% vs 72.2%) and more specific (100% vs 92.9%), perhaps related to the known interference of ascorbic acid with the VELOCITY strips. Conclusion Overall, the AX-4030 chemstrip results were more sensitive for microscopic abnormalities than the VELOCITY, although 10% of cases would still be missed. For a general population, a reflex methodology may be adequate. However, in patients with a higher likelihood of microscopic abnormalities, performing routine microscopic analysis may still be prudent.

Screening for Asymptomatic Urine Abnormalities among Primary School Children in Qallin City of Kafr El-Sheikh Governorate,Egypt

Abstract: Background: Chronic kidney disease is cause of death and disability. Urine dipstick is a simple, non-invasive cost effective method with high ability to detect urine abnormalities in earlier stages for proper management and prevention. Objectives: 1-To assess prevalence of urine abnormalities. 2- To compare positive results of urine dipstick test with microscopic examination of urine.Methods: A sample of 320 students was randomly selected from two primary schools in Qallin city in Kafr El- sheikh governorate by simple random sampling technique. Students were assessed through a predesigned questionnaire to determine socioeconomic status of studied group. Urine dipstick was performed for each studied child to examine the morning urine sample. Another urine sample was taken from children who had abnormal urine dipstick results for complete microscopic urine analysis. Results: There was 15% from all the studied children having urine abnormalities during screening by dipstick test. The most prevalent abnormalities were hematuria, lecocyturia, nituria and lastly proteinuria 9.7%, 7.5%, 2.2% and 0.9% respectively. The most common abnormality in microscopic urine examination was crystaluria. Cases were +ve for urinary tract infection by dipstick confirmed by 67% were +ve for pus by microscopic analysis, while 9.6% of cases who were +ve for hematuria by dipstick screening confirmed by 100% +ve for blood by microscopic analysis.Conclusion: Prevalence of urine abnormalities was 15% among studied group. The most prevalent abnormalities were hematuria in dipstick test and crystalluria in microscopic examination.