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PubMed2007

Community-based screening for chronic kidney disease among populations older than 40 years in Beijing.

BACKGROUND: Chronic kidney disease (CKD) is a public health problem, while data from developing countries are limited. We sought to investigate the epidemiological features of kidney damage in metropolis-residing Chinese adults (>40 years old), and to determine the associated factors of CKD. METHODS: Two thousand three hundred and fifty-three residents in one district of Beijing were interviewed and tested for albuminuria, reduced renal function, haematuria and pyuria. The associations between demographic characteristics, health characteristics and indicators of kidney damage were examined. RESULTS: Albuminuria was detected in 6.2% of subjects; reduced renal function was found in 5.2% of subjects; haematuria was found in 0.8% and non-infective pyuria was found in 0.09%. Approximately, 11.3% (95% confidence interval: 10.0-12.8%) of subjects had at least one indicator of kidney damage. The awareness rate of CKD was only 7.2%. Systolic blood pressure and diabetes were independently associated with albuminuria. Age, diastolic blood pressure, hypercholesteraemia, hypertriglyceridaemia and hyperuricaemia were independently associated with reduced renal function. CONCLUSIONS: This is the first report on the prevalence of CKD in a community-based population within a developing country, determined using protocols recommended by kidney disease improving global outcomes (KDIGO). The prevalence of CKD in our population was close to the levels observed in developed countries, and the spectrum of CKD and associated factors were similar to developed countries. Results from this study suggest that strategies aimed at an intervention of hypertension and other metabolic disorders might prove effective in controlling the pandemic of CKD in China, as well as other developing countries.

Aged↗

PubMedDate not supplied

Comparison of the Gram-stained urethral smear and first-voided urine sediment in the diagnosis of nongonococcal urethritis.

The diagnostic sensitivity of the numbers of leukocytes in the sediment of first-voided urine and in gram-stained smears of urethral secretions was evaluated by a study of 62 men with symptoms of nongonococcal urethritis. Fifty-one patients (82.3%) had pyuria (defined as ten or more leukocytes per high-power field) in the sediment of first-voided urine, whereas 8 (45.2%) had more than four leukocytes per oil-immersion held in gram-stained urethral smears. Frequencies of positive first-voided urine sediments and urethral smears were similar in Chlamydia trachomatis--positive and -negative cases. Results of cultures, urinalyses, and urethral smears were not affected by recent micturition. Pyuria in the first-voided urine but not a positive urethral smear is a sensitive sign of urethritis whether or not urethral discharge is evident. Specimens of urethral secretions were subjected to different storage conditions to determine the effect on subsequent isolation of C. trachomatis. Equal rates of isolation were demonstrated for specimens that had been held at 4 degrees C for either four or 20-24 hr or frozen to -70 degrees C for one week prior to culture.

Chlamydia Infections↗

PubMed1985

Urinary infection in adult men: a laboratory perspective.

During a 10-week period all mid-stream urine specimens from males aged 15 years and upwards, excluding hospital in-patients, with symptoms suggesting urinary tract infection were examined by techniques capable of detecting aerobes and fastidious organisms. Five hundred and eighty-five such specimens were received; 85% were sent by general practitioners and 182 were from men aged less than 45 years, indicating that urinary symptoms are commoner in young men than is usually believed and that diagnosis and treatment are usually undertaken by general practitioners. One hundred and seventy-nine specimens yielded aerobic pathogens and 140 yielded fastidious organisms; 70% of the former and 33% of the latter showed pyuria. Only 12% of the 196 specimens showing pyuria yielded a negative culture. The possibility of prostatic infection and its relevance to treatment are discussed. Some post-treatment data are presented.

Adolescent↗

PubMed1991

Prognostic factors in the conservative treatment of ureteric stones.

A prospective study was made of 125 ureteric stones in order to detect factors which would predict the successful outcome of conservative treatment. The factors studied were the duration of pain prior to presentation, pyuria, haematuria, surface regularity of the stone and the degree of obstruction as seen radiologically. In stones less than or equal to 10 mm in size, conservative treatment was successful when the duration of pain was less than 30 days (39/45), when there was no significant pyuria (53/82), when the stones had an irregular surface (44/65) and when obstruction was only partial (55/88). Since most of these factors were interactive, further statistical analysis showed that duration of pain was the only significant factor in predicting the outcome of conservative treatment. In stones greater than 10 mm in size these factors had no predictive value and only 2/23 were passed spontaneously on conservative treatment.

Hematuria↗

PubMed1988

Detection of urinary tract infections by rapid methods.

A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory.

Bacterial Infections↗

PubMed1986

Aetiology of urinary symptoms in sexually active women.

Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.

Adolescent↗

PubMed1999

Screening tests for urinary tract infection in children: A meta-analysis.

OBJECTIVE: To review systematically and to summarize the existing literature regarding performance of rapid diagnostic tests for urinary tract infection (UTI) in children. DESIGN: Systematic review and meta-analysis. METHODS: Published articles reporting the performance of urine dipstick tests (leukocyte esterase [LE] and/or nitrite), Gram stain, or microscopic analysis of spun or unspun urine in the diagnosis of UTI in children </=12 years of age. Articles were identified through a comprehensive MEDLINE search, and those articles meeting a priori inclusion criteria were selected. Eligibility criteria included the use of urine culture as the reference standard, independent comparison of urine culture with the results of one of the screening tests, definition of positive screening test results provided, only pediatric patients included or evaluable separately, and both gold standard and screening test performed on all patients. For each test, heterogeneity of reported sensitivity and specificity of all studies was determined. The subgroups of studies with similar definitions of UTI and age of study subjects were analyzed separately to account for some of the differences in reported results. When significant unexplained heterogeneity among studies precluded simple combining of results, a summary receiver-operator characteristic curve was fitted for each screening test, from which pooled estimates of true-positive rate (TPR; ie, sensitivity) and false-positive rate (FPR; 1-specificity) were calculated. PRIMARY RESULTS: A total of 1489 titles were identified by the MEDLINE search; 26 articles met all criteria for inclusion. There was significant heterogeneity among studies for nearly all tests for both TPR and FPR, which was explained only partially by the stringency of the definition of UTI or age of subjects studied. Based on the pooled estimates, the presence of any bacteria on Gram stain on an uncentrifuged urine specimen had the best combination of sensitivity (0.93) and FPR (0.05). Urine dipstick tests performed nearly as well, with a sensitivity of 0.88 for the the presence of either LE or nitrite and an FPR of 0.04 for the presence of both LE and nitrite. Pyuria had lower TPR and higher FPR: for presence of >5 white blood cells/high-power field in a centrifuged urine sample, the TPR was 0.67 and the FPR was 0.21, whereas for >10 white blood cells per mm(3) in uncentrifuged urine, the TPR was 0.77 and the FPR was 0.11. CONCLUSIONS: Both Gram stain and dipstick analysis for nitrite and LE perform similarly in detecting UTI in children and are superior to microscopic analysis for pyuria.

Bacteriuria↗

PubMed1977

Urinary tract infections in childhood: the place of the nitrite test.

The effectiveness of the nitrite test available on the N-Multistix (Ames Co.) was compared with that of the microscopic examination of urine as a screening test for the detection of urinary tract infections in children presenting to a general paediatric clinic. The nitrite test gave a positive result in 59% of children with urinary infections, while microscopic pyuria (more than 50 white blood cells per cubic millimetre of uncentrifuged urine) was found in 72% of the same group. Of children who did not have a urinary tract infection, 2.8% had microscopic pyuria compared with only 0.2% who showed a false-positive nitrite test result. The ease and rapidity of the nitrite test make it a useful screening test for the presumptive diagnosis of urinary tract infections, and in certain circumstances it is preferable to the conventional microscopic examination of urine. However, as in the case of microscopic examination, urine culture must always be performed to avoid missing the urinary infections that are not detected by the screening test.

Bacteriuria↗

PubMed1986

Urinalysis and urine culture in women with dysuria.

In caring for women with acute dysuria, clinicians traditionally have relied on clinical findings to distinguish between acute pyelonephritis and "cystitis"; they have ordered urinalysis and urine culture regularly for patients with suspected acute pyelonephritis and ordered these tests inconsistently for patients with suspected "cystitis." Recent evidence indicates that "cystitis" may actually be any of six different clinical conditions, each of which is managed differently; subclinical pyelonephritis, lower urinary tract bacterial infection, chlamydial urethritis, other forms of urethritis, vaginitis, or dysuria without any urinary tract or vaginal infection. The distinction between these entities is made primarily from clinical findings. Urinalysis is also of great value in symptomatic patients; the presence of pyuria (and possibly indirect quantitation of pyuria by the leukocyte esterase test) is a reliable indicator of treatable infection, and its absence indicates infection is not present. In contrast, urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis.

Bacteriological Techniques↗

PubMedDate not supplied

Use of urinary gram stain for detection of urinary tract infection in childhood.

In this study, urinary culture, urinary Gram stain, and four tests within the urinalysis, leukocyte esterase, nitrite, microscopyfor bacteria, and microscopyforpyuria, were examined in 100 children with symptoms suggesting urinary tract infection. Our purpose was to determine the validity of the urinary Gram stain compared with a combination of pyuria plus Gram stain and overall urinalysis (positiveness of nitrite, leukocyte esterase, microscopy for bacteria, or microscopy for white blood cell). Of 100 children, aged two days to 15 years, 70 (70 percent) had a positive urinary culture: 40 girls (57 percent) and 30 boys (43 percent). Escherichia coli was the most common isolated agent. The sensitivity and specificity of the urinary Gram stain were 80 percent and 83 percent, and that of the combination of pyuria plus Gram stain 42 percent and 90 percent, and that of the overall urinalysis 74 percent and 3.5 percent respectively. Our findings revealed that neither method of urine screen should substitute for a urine culture in the symptomatic patients in childhood.

Adolescent↗

PubMed2003

Predicting urine culture results by dipstick testing and phase contrast microscopy.

AIMS: Urine is the most frequently received clinical specimen for bacterial culture. To determine whether dipstick or microscopy results reliably predicted the presence or absence of a reportable urinary pathogen we performed dipstick testing and phase contrast microscopy on unspun urine from 500 specimens. We also investigated the relationship between the presence of squamous epithelial cells (SECs) and mixed growth on culture. METHODS: For each specimen, the presence of leukocyte esterase and urinary nitrite was recorded as well as the quantity of leukocytes (WBC), SECs, and erythrocytes. All cultures had the number and type of each organism recorded. Pyuria was defined as > or =10 WBC/mm(3). RESULTS: Specimens with <10 SEC/mm(3) had fewer isolates (0.9 isolate per culture) than specimens with > or =10 SEC/mm(3) (two isolates per culture); therefore, SEC contamination was defined as > or =10 SEC/mm(3). Of 500 specimens, 266 (53%) had no growth and 136 (27%) had mixed growth. A total of 288 (58%) specimens had negative dipstick results and completely normal microscopy. Of these, 11 (4%) had a pure growth of a urinary pathogen but the pathogen was present in only three (1%) at > or =10(5) CFU/mL. Of 413 urine specimens without SEC contamination, 323 (78%) had either no detectable growth or pure growth compared with only 41 of 87 (47%) with SEC contamination (P<0.001). Of the 413 urine specimens without SEC contamination, 90 (22%) had > or =2 organisms compared with 46 of 87 (53%) with contamination (P<0.01). Pyuria was present in only 21 of 266 (8%) urine specimens without growth but was present in 60 of 95 (64%) specimens containing a reportable pathogen (P<0.01). CONCLUSIONS: SEC contamination does not reliably predict cultures with mixed growth, urine specimens with negative dipstick results and microscopy rarely contain a reportable urinary pathogen, and screening algorithms are warranted and justified.

Adolescent↗

PubMedDate not supplied

A study for the improvement of the cytological urine examination performances in upper tract infection diagnosis.

Diagnosis of the location of upper and lower urinary tract infection (UTI) is necessary in defining the therapeutic conduct that has a different period and intensity according to the infection location and in prognosis. Many studies show the lack of clinical criteria peculiarity in revealing the different location of UTI. As a result, the correct location of the level in which UTI develops is the necessity of paraclinical investigations. Urinary sample examination, in which urinary sediment microscopy is essential, is a reliable technique in fast detection and localization of UTI. Finding, in pyuria context, the classic significant bacteriuria (> or = 10(5) CFU/ml) or lower value bacteriuria (< or = 10(4) CFU/ml) confirms the UTI diagnosis. The upper tract infection prognosis increases when leukocyte cylinders, characteristic for pyelonephritis, appear together with intact or degraded leukocytes, single or grouped. We settled an algorithm to examine the urine samples in order to: Concentrate and preserve the structural integrity of leukocytes and cylinders, examining the conventional urinary sediment Precisely identify and differentiate these elements by vital coloration (leukocyte peroxidase coloration and Sternheimer - Malbin coloration) to establish more accurate the UTI level. The vital coloration for leukocyte peroxidase has cytological specificity, confirming the pyuria and the cylinders that contain leukocytes (leukocytary, granular, mixed) and obviously ameliorates the reliability and reproducibility of the urinary sediment cytological exam.

Bacteriuria↗

PubMedDate not supplied

Urinary tract infections in young infants with prolonged jaundice.

The incidence of urinary tract infections (UTIs) in young infants with jaundice is low, and prolonged jaundice in that setting is even rarer. In this study, we retrospectively reviewed the clinical features of 50 infants (seen from 1984 through 2004) 1 week to 3 months of age who had UTIs and prolonged jaundice and compared them with those of infants with UTIs in a similar age range at our hospital from a published study. The infants in our study had a lower incidence of high fever (12%), were less likely to have pyuria (29%), had fewer Escherichia coli but more Enterococcus species infections, and had more mixed infections (32%) than did the historical control. Klebsiella pneumoniae or Enterococcus species dominated in mixed infections (15/16) but the frequency of E. coli isolates did not differ significantly between mixed and single infections. We conclude that high fever and pyuria are unreliable criteria for screening for UTIs in young infants presenting with prolonged jaundice. Urine cultures should be obtained in such patients to determine whether a UTI is present. Mixed urinary infections, particularly K. pneumoniae and Enterococcus species, may play a key role in this entity.

Adult↗

PubMed1990

[Asymptomatic bacteriuria in patients with diabetes mellitus].

The prevalence of asymptomatic bacteriuria and the relation of bacteriuria to pyuria, glycosuria and HbA1c in patients with diabetes mellitus were investigated. The study population included 110 diabetic patients and 100 healthy persons (control group). The ratio of bacteriuria was found as 25.5% (31.3% in women, 17.4% in men) in the diabetic group and as 9% (16% in women, 0% in men) in the control group. The prevalence of asymptomatic bacteriuria was significantly higher in the diabetic patients than in the control group (p less than 0.05). There was a significant relation between bacteriuria, pyuria and HbA1c levels (p less than 0.05). But, there wasn't any important correlation between bacteriuria and glycosuria.

Bacteriuria↗

PubMed1989

[Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi].

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.

Adult↗

PubMed1986

[Recurrence of acute uncomplicated cystitis--criteria for the evaluation of recurrence after antimicrobial chemotherapy].

UNLABELLED: The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; PATIENTS: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.

Acute Disease↗

PubMed1979

Urine microscopy and infection in general practice.

To test the value of urine microscopy 100 consecutive specimens were examined in the surgery and the results correlated with the subsequent laboratory culture reports.An assessment of the degree of pyuria was made by low power microscopy of a thick drop of fresh urine. A second specimen was examined under high power for the presence or absence of motile bacilli. The techniques used are described and quantified.The laboratory report was definitive in 88 of the 100 cultures. All the 33 specimens with 10(5) bacteriuria had some degree of pyuria and in 27 (82 per cent) motile bacilli had been found. In the 50 with no significant bacteriuria no motile bacilli had been seen in 38 (76 per cent).In these 88 specimens a diagnosis made in the surgery based entirely on bacterial microscopy would have been correct in 80 per cent, combined with cytological microscopy in 87 per cent, and with the addition of clinical features in 92 per cent.In the remaining 12 cases the laboratory report was inconclusive and would have made no difference to my conclusions.

Bacteriuria↗

PubMed1995

Interrater agreement in the interpretation of microscopic urinalysis.

To determine the reliability of specimen interpretation by outpatient laboratories, 150 consecutive specimens from three family practice centers were analyzed by either two laboratory technicians (n = 99) or two family physicians (n = 51). The results showed good to excellent agreement for contamination (defined as five or more epithelial cells per high-power field) or significant pyuria (five or more white blood cells per high-power field) or hematuria (five or more red blood cells per high-power field). Agreement between laboratory technicians did not differ significantly from agreement between physicians for the interpretation of contamination or pyuria, but for hematuria, agreement was higher between technicians (P = .02). These results suggest that outpatient interpretation of microscopic urine specimens shows levels of interrater agreement similar to or better than other tests that have been evaluated.

Humans↗