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PubMed1985

Use of clinical findings in the diagnosis of urinary tract infection in women.

To develop a decision rule for predicting urinary culture results in patients suspected of having urinary tract infection, we used discriminant analysis to identify the optimum combination of clinical findings. Thirty variables identified in a pilot study were recorded from 248 patients in a second study. Five findings were independent predictors of positive urinary culture: history of urinary tract infection, back pain, microscopic pyuria, hematuria, and bacteriuria. An additive decision rule that assigned one point for each of the five variables was tested in a third group of 258 patients. These scores stratified patients into subsets with increasing likelihood of positive culture. Higher scores identified patients who can confidently be treated without documentation of bacteriuria. If the rule applies successfully to other populations, cost savings could result from identification of patients who do not require quantitative urinary culture to demonstrate significant bacteriuria.

Adolescent↗

PubMed1987

A multicenter comparative trial of three-day norfloxacin vs ten-day sulfamethoxazole and trimethoprim for the treatment of uncomplicated urinary tract infections.

Two-hundred nine patients with symptoms of acute urinary tract infection and pyuria were randomized to 400 mg of administered norfloxacin twice daily for three days, or 800 mg of sulfamethoxazole and 160 mg of trimethoprim administered twice daily for ten days. Therapeutic outcome was assessed five to nine days and four to six weeks after treatment. The cure rates were 71/74 (96%) with norfloxacin and 81/81 (100%) with sulfamethoxazole and trimethoprim five to nine days after treatment. Only seven patients had a recurrence at the second follow-up visit; four in the norfloxacin group and three in the sulfamethoxazole and trimethoprim group. No isolates were resistant to norfloxacin, but three Escherichia coli were resistant to sulfamethoxazole and trimethoprim. Fifteen patients in each group reported a side effect during treatment. Two patients in the norfloxacin group and four patients in the sulfamethoxazole and trimethoprim group discontinued therapy due to an adverse effect. In this multicenter study, a three-day course of norfloxacin was as effective and safe as a ten-day regimen of sulfamethoxazole and trimethoprim in the treatment of acute uncomplicated urinary tract infections.

Acute Disease↗

PubMed1987

[Practical approach in an isolated abnormality of urinalysis].

The three major abnormalities found in urinalysis (proteinuria, hematuria and pyuria) usually lead on to invasive investigations. It emerges that the general practitioner is able, with only a few simple non-invasive diagnostic methods, to establish a wide range of differential diagnoses with precise etiology and prognosis.

Diagnosis, Differential↗

PubMedDate not supplied

Detection of leukocyte esterase in urine: a new screening test for nongonococcal urethritis compared with two microscopic methods.

First-catch urine samples of 130 men attending a clinic for genitourinary medicine were screened with the leukocyte esterase dipstick test. Conventional microscopy of centrifuged sediment and inverted microscopy of unspun urine samples were performed 2-4 hr later. The leukocyte esterase test had sensitivities of 100% and 96.6% and specificities of 55% and 52.8%, respectively, when compared with the two microscopic methods. The apparently low predictive value of the positive leukocyte esterase test was probably linked to its ability to detect lysed cells and the limitations of the microscopic methods, which were used as the absolute indicator of nongonococcal urethritis. Of the 42 patients with microscopic pyuria, 45.2% had positive cultures for Chlamydia trachomatis, and the leukocyte esterase test was positive in every case. Twenty-one per cent of the C. trachomatis-positive patients were asymptomatic, and 42% had fewer than five polymorphonuclear leukocytes per high-power field (X1000) of the gram-stained urethral smear. The leukocyte esterase test appears to be a simple, practical, and sensitive test that is useful in screening for nongonococcal urethritis, especially asymptomatic nongonococcal urethritis.

Esterases↗

PubMedDate not supplied

[Bacteria and leukocyte count in the urine in the diagnosis of urinary tract infections].

The count of bacteria in fresh, unstained, uncentrifuged urine specimens, using a phase-contrast microscope, magnification X400, and a hemocytometer chamber, is a simple method to exclude urinary tract infection. The specificity of this method is 94%, while the sensibility is 66%. We exclude an urinary infection when the count is less than 5 bacteria/0.1 ml. If we add to bacteria the evaluation of pyuria, the sensibility of this method does not change. On the contrary what we observe is an increase of the false positives. Bacteria more easily identified in urine specimens are E. Coli and Klebsiellae; the bacterioscopy has confirmed respectively 82% and 100% of positive urinecultures. The corresponding values for Protei and Streptococci are 23% and 20% respectively. This method is very simple also for teaching; it requires only a few minutes and is inexpensive. Its most useful utilization is the exclusion of urinary tract infection when the concentration of bacteria in the urine is less than 5 bacteria/0.1 ml.

Adolescent↗

PubMed1972

Renal disease due to analgesics. I. Recognition of the problem of analgesic nephropathy.

The incidence of renal impairment secondary to the abuse of analgesic compounds now accounts for a significant proportion of patients requiring renal replacement therapy. The clinical features of 100 cases of analgesic nephropathy are described; essentially these consist of otherwise unexplained renal impairment, urinary tract symptoms, radiological changes and sterile pyuria, often associated with dyspepsia, anemia and psychiatric disturbances. The classical pathological changes consist of interstitial nephritis and progressive reduction in renal size, secondary to repeated episodes of papillary necrosis. Cessation of analgesic abuse usually arrests the deterioration in renal function, and indeed some recovery of function may occur.

Analgesics↗

PubMed1977

[Vaginal reflux during miction-cystourethrography in girls (author's transl)].

The cases of 57 girls with reflux of radioopaque iodin solution into the vagina during mictioncystourethrography are reported. In 52.6% (30 cases) no signs of anomalies of the urinary tract or of pyelonephritis were found. For this group of 30 girls pyuria (leucocyturia) was typical (in 86.6%). In contrast, a urinarty-tract infection was found only in a few cases (16.6%). The authors discuss the clinical importance of vaginal reflux and its role in the pathogenesis of urinary-tract infections.

Adolescent↗

PubMedDate not supplied

[Urinary tract infections in premature infants: considerations on the reliability of bladder catheterization and other methods of urine collection for bacteriological study].

The collection of urine by the use of adhesive plastic bags even if simple is not unfailing procedure for making diagnosis of urinary tract infection (U.T.I.) because of contamination with bacteria located on the external genitals. This is particularly true in the case of the premature baby. Therefore this method of urine's collection has been considered not enough satisfactory in symptomless cases since an early diagnosis of U.T.I. in this premature babies is extremely important. The Authors suggest that after a first positive test response by urine's collection with adhesive plastic bags is extremely important to collect the urine with a catheter specimen in the females and with sterile test tube in the males. Using these criteria, satisfactory results have been obtained. To prevent possible bladder urine contamination by catheter use, antibiotic treatment had been applied for few days after specimen collection. The non catheter specimen collection of the urine remains of course, one of the most important test to detect pyuria during U.T.I.

Bacteriological Techniques↗

PubMed1978

The microbial flora of the urogenital tract in women with symptoms of recurrent urinary tract infection. The non-influence of methenaminehippurate treatment on the idigenous flora.

Recurrent urinary tract infections are known to occur among 5 per cent of all females. These women frequently have episodes of symptoms of lower urinary tract infection even between periods of bacteriuria. In the present study, 25 women with a history of recurrent urinary tract infections, found to lack signs of obstructive uropathy, were subjected to an extensive urological and microbiological survey. The investigation showed that (i) "pyuria" was common (9/12) but usually of urethral origin, (ii) introital and/or urethral colonization with Enterobacteriaceae often (11/25) occurred, (iii) apart from Escherichia coli found in three patients, a Bacteroides species was isolated in two and ureaplasmas in one patient from suprapubically aspirated urine, and (iv) chlamydia, gonococci, and trichomonads were not found. The patients were given methenaminehippurate for 1 week and then reexamined. The treatment did not seem to influence the indigenous flora of the lower urogenital tract.

Adult↗

PubMed1984

Fistulas of the bladder in Crohn's disease.

Fourteen patients with fistulas of the bladder complicating Crohn's disease are reported. In one-half of the patients, the presence of Crohn's disease was known before; in the other one-half, the appearance of urinary symptoms led to the diagnosis of Crohn's disease. The symptom most commonly encountered was chronic pyuria, while pneumaturia as an early sign was found in only three patients. Cystoscopy proved to be the most useful diagnostic procedure. The results of this examination demonstrated lesions in 11 of 13 patients investigated and was instrumental in arriving at the correct diagnosis in four patients. Treatment should be surgical and consist of intestinal resection and suturing of the usually small defect in the bladder. The results of the operation are good with respect to the complication of the urinary tract.

Adolescent↗

PubMed1978

[Acute hemorrhagic leucoencephalitis during tuberculosis (author's transl)].

The authors report a fairly typical clinico-pathological case of acute hemorragic leucoencephalitis (A.H.L.E.). Both clinical and histological features appeared particularly acute. At autopsy a visceral evolving tuberculosis was diagnosed. Such an etiological circumstance has not been, apparently, reported in cases of A.H.L.E. published as such. Three other etiological circumstances were noticed: pyuria, treatment by cephalotin and treatment by gentamycine. The physiopathogenesis of A.H.L.E. remains obscure and will not be clarified before detailed immunological studies can be performed. But the disease is rare and brisk and diagnosis usually post-mortem.

Brain↗

PubMed1980

Granulomatous sarcoid nephritis: a cause of multiple renal tubular abnormalities.

We report the eleventh case of granulomatous sarcoid nephritis and review the previous literature. Although not as commonly recognized as calcium nephropath, granulomatous nephritis may be an important cause of morbidity and mortality in patients with sarcoidosis. Its characteristics are similar to other tubulo-interstitial diseases. Mild to moderate albuminuria, microscopic hematuria and sterile pyuria predominate. Hypertension is usually absent and renal size is well preserved. Urinary concentration defects (including nephrogenic diabetes insipidus), renal tubular acidosis and inappropriate glucosuria may also be seen. Interstitial inflammation with non-caseating granulomas, epithelioid and multinucleated giant cells is the usual histologic picture. Intimal thickening is not infrequent and granulomas may occasionally involve the small arteries. Immunofluorescence and electron microscopic findings are non-specific.

Adolescent↗

PubMed1994

Eosinophils in urine revisited.

The finding of eosinophils in the urine has been suggested to be useful in establishing the diagnosis of acute interstitial nephritis (AIN). The diagnostic accuracy of this test has not yet been defined. It is the purpose of this study to define the specificity, sensitivity, and the predictive positive and negative values for the presence of eosinophils in the urine. One hundred forty-eight patients with pyuria were tested for the presence or absence of urinary eosinophils. In this group consecutively admitted to the hospital with WBC in the urine, 4% of patients had urinary eosinophilia of greater than 1 eosinophil per 100 cells. Since none of this group had the diagnosis of AIN, the false positive rate was 4% and the specificity was 96%. In a selected group of patients in which the diagnosis of AIN was suspected by a nephrology consultant, urinary eosinophils were found in 6 of 15 patients with a confirmed diagnosis of AIN but were also found in 10 of 36 patients with another renal diagnosis. The sensitivity for eosinophiluria was 40% and the specificity was 72% with a positive predictive value of only 38%. We conclude that eosinophiluria is not an accurate test for the diagnosis of AIN. The false positive and negative rates are too high to confirm an AIN diagnosis.

Acute Disease↗

PubMed1996

Urological abnormalities in 1,328 patients with nocturnal enuresis.

OBJECTIVES: Evaluation of the incidence of urological abnormalities as revealed by urological examinations of a large number of patients with enuresis. METHODS: Patients with the chief complaint of nocturnal enuresis were examined urologically. RESULTS: The incidence of urological abnormalities was 1.8% of 940 patients on intravenous pyelography (IVP), 7.1% of 695 patients on voiding cystourethrography (VCG) and 11.5% of 487 patients on cystometry (CM). No abnormal findings were observed in 58 patients on renal ultrasonography (US). 92.1% of reflux cases detected by VCG were low grade and only 8.9% of patients with reflux had pyuria. 20.2% of 446 patients who were submitted to all these examinations had some urological abnormality. Only pollakisuria was statistically more frequent in patients with urological abnormalities than in patients without them. CONCLUSION: These data suggest that the incidence of urological abnormalities was rather low when compared with the past literature. In particular, IVP was though to be unnecessary.

Child↗

PubMed1995

[Fluconazole in treatment of urinary candidiasis. Experience with 24 patients].

Since fluconazole achieves high urine concentrations, we assessed its usefulness in the treatment of urinary candidiasis. We studied 24 patients (8 male) aged 23 to 97 years old, that presented pyuria with a negative urine culture for bacteria and fungal colony counts in urine of 10(4) CFU/ml or more. Isolated strains were Candida albicans in 20 cases, Candida kefyr in one case, Candida glabrata in one case and Candida spp in two cases. All patients were treated with fluconazole in doses of 50 to 100 mg/day for 2 to 4 weeks. The fungus was eradicated in 21 patients (88%), the infection persisted in two (8.5%) and one had a relapse (4.2%). Two patients had transient elevations of transaminases, one had abdominal pain and one, a purpuric syndrome without thrombocytopenia in whom the drug was discontinued. It is concluded that fluconazole is efficacious and safe in the treatment of urinary candidiasis.

Adult↗

PubMed1976

Abnormalities of urinary sediment and renal failure following sulfinpyrazone therapy.

A patient with recurrent thrompophlebitis had sterile pyuria with white blood cell casts and transient, mild renal failure during therapy with sulfinpyrazone. These abnormalities resolved on cessation of therapy, but similar changes in the urinary sediment recurred during therapy with sulfinpyrazone. These abnormalities resolved on cessation of therapy, but similar changes in the urinary sediment recurred during a second course of sulfinpyrazone therapy.

Acute Kidney Injury↗

PubMed1998

[Pathological horseshoe kidney. 30 case reports].

The authors report a series of 30 horseshoe kidneys observed over a 20-year period. This series consisted of 20 men (66.6%) and 10 women (33.4%) with a mean age of 35 years (20-65 years). The clinical features were dominated by abdominolumbar pain (22 cases), haematuria (12 cases) and pyuria (2 cases). Horseshoe kidney was associated with renal stones (20 cases), ureteropelvic junction syndrome (8 cases), upper urinary tract tumour (1 case). Treatment was surgical depending on the aetiology. The objective of this study was to analyse the epidemiological and diagnostic features of this disease, as well as the therapeutic features specific to each uropathy associated with horseshoe kidney.

Abdominal Pain↗

PubMed1981

Clinical analgesic nephropathy.

Analgesic nephropathy is recognized worldwide, but the differences in incidence in various countries, or regions, remain unexplained. Analgesic compounds may cause both functional and structural renal damage. This damage may be related to depletion of glutathione and renal vasoconstriction (probably mediated through prostaglandin depletion) and to the fact that the concentrations of glutathione and prostaglandins and their metabolites in the kidneys are manyfold their concentrations in plasma. Most patients with analgesic nephropathy are middle-aged women with histories of peptic ulcer, anemia, psychiatric disorders, headaches, and arthralgias. Investigations often show pyuria, some bacteriuria, and impaired concentrating ability, as well as other abnormalities of tubular function; caliceal abnormalities on intravenous pyelography are also frequent. It is important to discover these patients; evidence exists that with cessation of drug ingestion, renal function may stabilize and, in some cases, may improve.

Analgesics↗