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PubMed2001

Pediatric urine testing.

Today, urinalysis is one of the most common clinical tests ordered for adult and pediatric patients. Because urine specimens are usually readily available and are obtained noninvasively, the urine testing is well suited for children. This article discusses the most common urine tests performed in children for screening purposes and also less common tests for diagnosis of specific disorders. Special considerations regarding urine specimen collection in children are discussed. Some simple tests that are underused by clinicians are mentioned, as are some exciting new molecular applications of urine testing.

Child↗
PubMedDate not supplied

Analysis of forensic specimens for cannabinoids. II. Relationship between blood delta 9-tetrahydrocannabinol and blood and urine 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid concentrations.

Data from five years of gas chromatographic/mass spectrometric (GC/MS) quantitation of blood, or blood and matched (i.e. concurrently collected) urine specimens, for cannabinoids have been used for two distinct evaluations. In the present study, we assessed the relationship of blood delta 9-tetrahydrocannabinol (THC) with blood and urine 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (COOH-THC) concentrations. Cannabinoid-containing (i.e. positive) forensic blood specimens (298, 135 with matched urines) were used to test for correlations and other relationships between these analytes. No correlation was found between blood THC and blood or urine COOH-THC concentrations. Significant correlations were found between the log blood and log urine COOH-THC concentration (r = 0.65). The correlations, however, were neither high nor consistent enough to suggest their use in extrapolations of urine to blood concentrations. Others have suggested that a urine COOH-THC concentration in excess of 100 ng/mL may indicate impairment. We observed this would result in 17% of individuals with blood THC less than 1 ng/mL being classified as impaired. The rate of inaccurate interpretations would increase if higher concentrations of blood THC were considered characteristic of impairment. It has been suggested that a ratio of blood COOH-THC/THC less than 4:1 is an indicator of impairment. In this study, the percentage of bloods with a ratio less than 4:1 increased as THC concentrations increased. However, THC concentrations in excess of 10 ng/mL were required before a majority (70%) of the specimens fell below this ratio, suggesting limitations to its use. Blood metabolic ratios (THC/COOH-THC) displayed a bimodal distribution.(ABSTRACT TRUNCATED AT 250 WORDS)

Cannabinoids↗
PubMed2002

Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco.

BACKGROUND: Because gonococcal and chlamydial infections are often asymptomatic, disease control requires population-based screening. This report describes the feasibility of home-based testing for sexually transmitted diseases (STDs) and of specimen transport via the US mail. GOAL: This project sought to establish the efficacy and acceptability to the public of screening by means of urine kits made available in public places and mailed in for STD testing. STUDY DESIGN: Self-selected community participants obtained STD test kits from local businesses, collected urine specimens at home, and mailed kits to the health department for nucleic acid amplification testing. RESULTS: Participants picked up 209 test kits and returned 80 (38%): 3 (3.8%) of 76 were positive for gonorrhea and 1 (1.3%) of 76 was positive for chlamydia. The majority (95%) of participants were white gay men. The cost of specimen collection and transport was similar to that of other population-based screening programs. CONCLUSION: Using the mail for home-based testing for gonorrhea and chlamydia was feasible and may be a useful addition to STD control efforts.

Adolescent↗
PubMed2006

Can spot urine protein/creatinine ratio replace 24 h urine protein in usual clinical nephrology?

BACKGROUND: This prospective study was designed to assess whether a single urine specimen, collected at the time of clinical assessment, could be used to estimate 24 h urinary protein excretion. METHODS: The spot urinary protein/creatinine ratio (P/Cr) and 24 h urine protein and creatinine excretion were determined from 103 patients attending a nephrology clinic. Using the spot urine P/Cr, a regression equation was derived, predicting 24 h protein excretion. The performance of the regression equation was tested on a new cohort of 85 patients. Within this new cohort, agreement between the predicted and the actual 24 h urinary protein excretion was assessed using the Bland-Altman technique. The ability of spot urine P/Cr and dipstick urinalysis to predict different threshold levels of protein excretion was assessed using a series of receiver operator curves. RESULTS: A logarithmic relationship exists between the spot P/Cr and 24 h protein excretion, with a correlation of 0.92, P < 0.0001. Agreement between the actual and predicted 24 h urine protein and between spot and 24 h urine P/Cr ratios was suboptimal at higher levels of protein excretion. Discriminant spot urine P/Cr values reliably predicted protein excretion thresholds of 0.3, 0.5, 1.0 and 3.0 g/day. Urinalysis was a poor test for quantitating protein excretion. CONCLUSION: Random spot urinary P/Cr predicts actual 24 h protein excretion with reasonable accuracy in patients with lower levels of protein excretion but is unreliable in patients with high protein excretion and should not be used in the clinical setting unless 24 h urine collection is unavailable.

Cohort Studies↗
PubMed1988

Drugs in sport. The first 5 years of testing in South Africa.

Since 1983 screening procedures have been developed to detect prohibited substances in urine specimens collected from competitors in sport. Gas chromatography is used for the detection of stimulant drugs and gas chromatography/mass spectrometry for the detection of anabolic steroids. Of 679 urine samples analysed, a positive result was obtained for 45 (6.6%). Fencamfamine was the stimulant most frequently detected, while the ephedrines as a group accounted for 18 positive samples. These findings indicate the necessity to continue the monitoring of drug use and abuse in sport.

Anabolic Agents↗
PubMedDate not supplied

Analysis of forensic specimens for cannabinoids. I. Comparison of RIA and GC/MS analysis of blood.

Data from five years of radioimmunoassay (RIA) screens and gas chromatographic/mass spectrometric (GC/MS) quantitation of blood, or blood and matched (i.e. concurrently collected) urine specimens for cannabinoids have been used for two distinct evaluations. The first part, which is the subject of this study, considers comparative results from RIA and GC/MS analysis of the specimens. RIA analysis (Abuscreen urine cannabinoids kit) of methanol extracts of blood with extracted blood calibrators (122 specimens) was compared to analysis of nonextracted blood with urine calibrators (108 specimens). RIA of methanol extracts of blood was a reliable assay (limit of detection = 17 ng/mL; interassay coefficients of variation of 2-10%). RIA of nonextracted GC/MS negative blood gave significant displacement of labeled antigen, which precluded accurate quantitation using the urine-based calibrators. Comparison of RIA cannabinoid concentrations to 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (COOH-THC) concentrations measured by GC/MS yielded correlation coefficients of 0.68 and 0.23 for the methanol extract and nonextract procedures, respectively. Comparison of the qualitative accuracy of the two techniques, however, resulted in similar discrimination of GC/MS positive and negative specimens when the 20-ng/mL extracted blood calibrator was used as the cutoff for methanol-extracted blood specimens, and the 100-ng/mL urine calibrator was used as the cutoff for nonextracted blood specimens. Although qualitatively similar, the methanol extract procedure resulted in quantitatively superior analysis.

Cannabinoids↗
PubMed2002

Performance evaluation of three on-site adulterant detection devices for urine specimens.

The performance of three on-site adulterant detection devices that assess the integrity of urine specimens collected for drug-of-abuse testing was evaluated: the Intect 7, MASK Ultra Screen, and Adultacheck 4. Intect 7 simultaneously tests creatinine, nitrite, glutaraldehyde, pH, specific gravity, and the presence of bleach and pyridinium chlorochromate (PCC). Mask Ultra Screen tests creatinine, nitrite, pH, specific gravity, and oxidants, and Adultacheck 4 tests creatinine, nitrite, glutaraldehyde, and pH. Urine specimens were prepared with the Substance Abuse and Mental Health Administration regulated analytes at 50% above the cut-off concentrations. Stealth, Urine Luck, Instant Clean ADD-IT-ive, and KLEAR were added individually to the drug-added urine specimens so that their concentrations reflected the "optimum" usage reported in their package inserts and 25% above and below that optimum. Stealth is reported to be peroxidase; Urine Luck is believed to be PCC; Instant Clean ADD-it-ive reportedly contains glutaraldehyde, and Klear is a nitrite. The following diluents/adulterants were added at 25%, 33%, and 50% of the volume of drug-added urine: distilled water, bleach, ammonia, and vinegar. Of the devices tested, Intect 7 proved to be the most sensitive, and it correctly indicated the presence of adulterant or diluent in all samples tested. In order to do so, all indication pads had to be assessed in concert. Adultacheck 4 specifically assesses four characteristics of urine integrity and is therefore very limited in detecting the use of several popular adulterants that are commercially available. Although it correctly assessed the four characteristics, it did not detect the use of Stealth, Urine Luck, or Instant Clean ADD-it-ive. Mask Ultra Screen can potentially detect a broader range of adulterants than Adultacheck 4. However, in practice, it only detected them at levels well above their optimum usage, making it less efficacious than Intect 7. Clearly, the specific identification of an adulterant is a trade-off for sensitive detection of several adulterants.

Drug Contamination↗
PubMed2006

Risk factors for bacteriuria due to Pseudomonas aeruginosa or Enterococcus spp in patients hospitalized via the emergency department.

To determine the incidence and risk factors related to isolation of Pseudomonas aeruginosa or Enterococcus spp from urine cultures obtained from patients in the emergency department (ED), a 1-year prospective study was conducted of all urine specimens collected in the ED of a general hospital. Specimens from which one of these organisms was isolated at a concentration of >or=10(5) cfu/ml were included. Of 744 positive urine cultures, 39 (5%) were P. aeruginosa and 28 (4%) Enterococcus spp. Comparison with a control cohort of 80 patients with Escherichia coli bacteriuria revealed several univariate indicators for P. aeruginosa bacteriuria, including male sex, indwelling catheter, past prostatectomy, hospitalization in the previous 2 months and pregnancy; multivariate indicators were indwelling catheter (p<0.001) and male sex (p<0.001). Enterococcus and P. aeruginosa were significantly more often associated with asymptomatic bacteriuria. These data will help clinicians select appropriate antibiotic treatment for patients with urinary tract infections.

Bacteriuria↗
PubMed2001

A 6-year experience with urine drug testing by family service agencies in Nova Scotia, Canada.

The objective of this study is to describe a urine drug-testing program implemented for parents with a history of substance abuse by family service agencies in the province of Nova Scotia, Canada. Nurse collectors went to the parents' home to obtain urine specimens under direct observation and then delivered the specimens to the toxicology laboratory or arranged shipment by courier under chain of custody. Each urine specimen was screened for cannabinoids, cocaine metabolite, opiates, amphetamines and benzodiazepines, ethyl alcohol and creatinine. All positive screening tests were confirmed by another method such as gas chromatography-mass spectrometry (GC-MS). In 15,979 urine specimens collected from 1994 to 1999, the percent positive rate for one (or more) drugs/metabolites ranged from 45.6% (1994-1996) to 30.0% (1998, 1999). A total of 575 specimens (3.7%) were dilute (urine creatinine <25mg/dl). Positive rates in 15,404 non-dilute specimens from 1994 to 1999 were as follows: cannabinoids - 11.7%, benzodiazepines - 11.3%, cocaine metabolite - 3.7%, and ethyl alcohol - 2.6%. Most clients provided less than 20 urine specimens for testing but some individuals submitted urine specimens more than 100 times in a 12-15-month period. Urine drug screening in parents with a history of substance abuse provided an objective and reliable indication of recent drug use in this population.

Adult↗
PubMed1992

Asymptomatic bacteriuria, urinary antibody, and survival in the institutionalized elderly.

OBJECTIVE: To compare clinical status of elderly institutionalized subjects with asymptomatic bacteriuria and normal urinary antibody to those with elevated urinary antibody to the major outer membrane of Escherichia coli. DESIGN: Retrospective review. SETTING: Long term facility for the elderly. PARTICIPANTS: Convenience sample of 63 elderly subjects, 26% of those resident in the institution, aged 78.8 +/- 8.4 years with urine specimens collected and stored in 1987. MAIN OUTCOME MEASURES: Differences in clinical or functional status, demographic features, and outcome during 3-years follow-up between bacteriuric subjects with normal and elevated urine antibody. RESULTS: Thirteen subjects had no bacteriuria, and 12 had infrequent, intermittent bacteriuria; 38 (60%) had persistent bacteriuria, including four with frequent, intermittent infections. In the persistently bacteriuric group, 18 (47%) had persistently elevated urine antibody. There was no significant differences between bacteriuric residents with normal vs elevated urine antibody in clinical or functional status, age, duration of residence, or infecting organisms. However, 11 of 20 in the cohort with normal urine antibody were alive at 3 years compared to 3 of 18 with elevated urine antibody (P = 0.014). CONCLUSIONS: Elderly institutionalized subjects with persistent bacteriuria and elevated urine antibody have decreased survival compared to those with normal urine antibody. No differences in underlying illness or clinical course to explain this survival difference were identified.

Aged↗
PubMed1982

The diagnosis of 21-hydroxylase deficiency in a prematurely born infant on the basis of the urinary steroid excretion pattern.

The urine of a 6-day-old prematurely born female infant (birth weight 1060 g) suspected of having a 21-OH-deficiency showed no steroid abnormalities on capillary GLC analysis. Using GC-MS tetrahydrocortisone (THE) and also 3 alpha, 17 alpha-dihydroxy-5 beta-pregnane-20-one (17-OH-Polone) were absent, but two androstanetriolone peaks were observed. In the urine collected on day 9 THE was absent, but a large amount of 3 alpha, 11 beta-dihydroxy-5-alpha-androstane-17-one (11-HA) was found by GC-MS to be contaminated by a small amount of 17-OH-Polone. The next urine specimen collected on the 22nd day while the child received cortisol therapeutically showed the characteristic steroid profile for the diagnosis 21-OH deficiency, large peaks of 17-OH-Polone, pregnanetriol (P3) and 11-keto-pregnanetriol (11-keto-P3). Over the next few weeks two other compounds were found to have been excreted in relatively large amounts, 3 xi, 16 xi, 17 xi, 20 xi-pregnanetetrol (16-OH-P3) and surprisingly also a 21-hydroxylated compound, namely 3 xi, 20 alpha, 21-trihydroxy-5-pregnene. These same two compounds were also found in the urine of another infant with suspected 21-OH deficiency. The urinary steroid excretion patterns characteristic for 21-OH deficiency are dependent on the maturity and age of the infant. In the prematurely born infant androstanetriolones appear in the urine before 17-OH-Polone. The occurrence of these different steroid excretion patterns is tentatively explained.

Adrenal Hyperplasia, Congenital↗
PubMed1987

[Study of spontaneous crystalluria in patients with calcium oxalate calculi].

We studied crystalluria in healthy subjects and in calcium oxalate stone formers using polarization microscopy and infrared spectroscopy, in freshly voided urine and after 48 h urine storage at +4 degrees C. 412 urine specimens from 39 normal subjects and from 172 stone formers were examined. In the latter, 90 voidings were obtained while on free diet, 61 on moderately calcium restricted diet, 34 in the fasting state and 136 while on thiazide therapy. In the normal subjects, all 91 voidings were obtained while on free diet. Crystalluria was more frequent in urine specimens collected on free diet in stone formers (48.9%) than in normal subjects (13.9%, p less than 0.001) and slightly decreased in patients on thiazide therapy (41.2%). Crystalluria increased following +4 degrees C urine storage in all groups. The most frequent crystalline phase was weddellite. Comparison of crystalline phases of calcium oxalate observed before and after +4 degrees C storage showed that crystallization spontaneously progressed to weddellite whatever the calcium oxalate phase initially present. On thiazide therapy we observed, in addition to lower calcium content, a decreased frequency of urate crystallization especially in +4 degrees C stored urine, in parallel with a decrease in urate concentration.

Calcium Oxalate↗
PubMed1981

Evaluation of a new sensitive nitrite test as a reliable screening tool for bacteriuria.

A new sensitive nitrite test, the SRN test, was evaluated for its suitability as a reliable screening technique for the detection of bacteriuria. The SRN test was compared to a currently available nitrite test, the Microstix nitrite test, and the results obtained with both nitrite tests were assessed in comparison with the results of the quantitative culture method. Of 158 cases of significant bacteriuria found among 1060 randomly collected specimens, the SRN test detected 90% and the Microstix nitrite test, 30%. The higher reliability of the SRN test reflects its high capability of nitrite detection (greater than or equal to 0.1 ppm), and its ability to overcome interference by various factors, such as dark colour of the urine, presence of phenazopyridine, urobilinogen, blood, high concentration of ascorbate, and high urinary pH, all of which do interfere with the Microstix nitrite test. The high sensitivity of the SRN test allows detection of bacteriuria in urine specimens collected at random throughout the day; the test is therefore not restricted to the use of first-morning samples as are other nitrite tests. Since the SRN test was found to give a quantitative indication of the size of the bacterial population, the possibility of its use as an exact quantitative test under controlled conditions its discussed.

Bacteriuria↗
PubMed1994

Urine drug screening and the family physician.

Urine screening for drugs is increasingly employed in the United States in an effort to reduce illegal drug use and its consequent morbidity, mortality and economic burden. The family physician may choose to ensure proper urine specimen collection or may choose to develop expertise as a medical review officer; training courses and materials are available. In addition, certification is available from several organizations. The physician who becomes a medical review officer is responsible for interpreting positive tests and may also become involved in drug rehabilitation programs. It is prudent to follow federal guidelines for occupational urine drug screening, even when these guidelines are not mandatory, to protect against a possible challenge to a positive specimen on the grounds of improper processing. In all cases, care should be taken to correctly identify the patient, to label all specimens and to document that the specimen has been secured against tampering.

Family Practice↗
PubMedDate not supplied

Ranitidine interference with the monoclonal EMIT d.a.u. amphetamine/methamphetamine immunoassay.

The interference of ranitidine with the monoclonal EMIT d.a.u. amphetamine/methamphetamine immunoassay (ME) was investigated. Urine specimens collected from 23 patients receiving 150-300 mg of ranitidine daily were found to contain 7-271 mg/L of the drug when analyzed by Remedi automated high pressure liquid chromatography. Only patient specimens and urine samples with ranitidine added at concentrations greater than 91 mg/L gave false positive ME results. Of the 63 patient urine samples analyzed by ME, 12 gave false positive results. All false positive results occurred in the first or second void after ingestion. No false positive results occurred with the polyclonal EMIT d.a.u. amphetamine or TDx amphetamine/methamphetamine II assays.

Amphetamine↗
PubMed1994

Cytologic detection of urinary bladder involvement in cervical cancer.

One-hundred and four patients with advanced carcinoma of the cervix had their urine specimens collected, at the time of cystoscopy, for cytologic detection of the presence of malignant cells. Forty-eight (46%) of the patients had evidence of bladder mucosal involvement at cystoscopy. The overall sensitivity of urine cytology in detecting bladder mucosal involvement was 56%, with a specificity of 93%. The predictive value for a positive result was 87% and the accuracy of the test was 76%. The findings indicate that urine cytology is a useful test for detecting bladder mucosal involvement in cervical cancer where cystoscopy is not available.

Journal Article↗
PubMed2003

Urinary tract infection in febrile children with sickle cell anaemia in Ibadan, Nigeria.

A prospective study to determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia (SCA) was carried out at University College Hospital, Ibadan. Altogether, 171 febrile children (aged 1-15 years) with SCA and 171 age- and sex-matched controls were studied. After obtaining a history of the illness from the parents or guardians, each child was physically examined and a mid-stream urine specimen collected and subjected to microscopy and culture. The prevalence of bacteriuria in children with SCA was 21.6% compared with 15.8% in the controls. Escherichia coli and Klebsiella species were the predominant isolates from the urine, accounting for 64.9% and 18.9%, respectively, of the isolates from the SCA group and 63% and 22.2%, respectively, in the controls. In the SCA group, significant bacteriuria also occurred with other conditions such as pneumonia and osteomyelitis. Urinary tract infection (UTI) is common in children with SCA. Routine screening for it is therefore recommended during febrile illnesses. Children with fever from other overt causes, however, should not be exempted from the urine screening procedure in case there might be concomitant UTI.

Adolescent↗