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PubMed1990

Assessment of proteinuria by using the protein/creatinine ratio of single-voided urine.

Quantitative 24-hour urine protein excretion is used in the diagnosis, the monitoring of therapeutic effects and the prognosis of renal disease. However, this method is time-consuming, cumbersome and often inaccurate. Many studies have shown that the single voided urine protein/creatinine (Pr/Cr) ratio relates well with 24-hour urine protein excretion and can be substituted for evaluating some conditions. In our study, 41 patient with renal disease (25 men, 16 women) with a mean age of 43 years (range, 20-79 years), not only collected 24-hour urine, but also collected single voided urine at four different times. There was an excellent correlation between 24-hour urine protein excretion and the single voided urine Pr/Cr ratio at various degrees of creatinine clearance and ranges of proteinuria. The highest correlation was found in urine specimens collected at 16:00 hours with a correlation coefficient (r) of 0.91. Other urine specimens also showed a good relation with a correlation coefficient of above 0.80. The creatinine clearance (Ccr) greater than or equal to 70 ml/min group showed a better relationship than the Ccr less than 70 ml/min group. The proteinuria more than 1.0 g/day group also showed a better relationship than the group with proteinuria of less than 1.0 g/day. However, these differences were not statistically significant. No significant differences between the different age groups or sexes, using the single voided urine Pr/Cr ratio to estimate the 24-hour urine protein excretion were found. It is concluded that the single voided urine Pr/Cr ratio correlates highly with 24-hour urine protein excretion and could be an alternative means for disease monitoring and screening.

Adult↗
PubMed1998

Urinary excretion of d-amphetamine following oral doses in humans: implications for urine drug testing.

Seven healthy male volunteers received a single oral dose of 5 mg, 10 mg, or 20 mg of d-amphetamine. Urine was collected at 2, 4, 8, 12, 18, and 24 h post-dose. Total urine volume was measured, and pH and creatinine were determined. All specimens were analyzed by TDx Amphetamine/Methamphetamine II (TDx), Emit-d.a.u. Monoclonal Amphetamine/Methamphetamine (EM), and Emit II Amphetamine/Methamphetamine (EII) immunoassays at a cutoff value of 1000-ng/mL amphetamine. Quantitation of urinary amphetamine in all specimens was performed by gas chromatography-mass spectrometry. All urine testing results by the three immunoassays, EM, EII, and TDx, were in agreement; there were no discordant findings. Of the 42 total urine specimens collected following a 5-mg dose of amphetamine, only 8 (19%) screened positive by immunoassay. Twenty-four of 36 (67%) urine specimens yielded positive responses following a 10-mg dose, and 37 of 42 (88%) were positive by immunoassay following a 20-mg dose. These data demonstrate the present guideline for regulated forensic urine drug testing (FUDT) for amphetamine with a screening cutoff of 1000 ng/mL is too high to consistently detect the administration of a single 5-mg oral dose of d-amphetamine. There was considerable overlap of amphetamine concentrations in individual specimens following the various doses. Peak urinary amphetamine ranged from 620 to 3160 ng/mL following 5-mg doses. The time to peak concentration also varied widely at each dose, occurring in urines collected 2 to 18 h post-administration. The mean percent of dose excreted as unchanged amphetamine over 24 h at each dose ranged from 35 to 44%. The data demonstrated that amphetamine excretion increases with increasing urine flow and decreasing urine pH. Thus, a positive FUDT result for amphetamine means only that the individual was administered or self-administered amphetamine at some time prior to collection of the specimen.

Administration, Oral↗
PubMedDate not supplied

GHB urine concentrations after single-dose administration in humans.

Gamma-hydroxybutyric acid (GHB) is used as an illicit drug and is implicated in drug-facilitated sexual assault, but it also has some therapeutic uses. Detection of GHB in urine is important for forensic testing and could be of clinical benefit in overdose management. Urine GHB concentration-time profiles have not been well-characterized or correlated with doses used therapeutically. GHB levels were measured by gas chromatography-mass spectrometry in urine collected over 24 h from 16 adults administered single doses of 50 mg/kg GHB (Xyrem) alone and combined with 0.6 g/kg ethanol. Peak GHB urine concentrations averaged 150-200 mg/L and occurred in the 0-3 h urine collection. Significant variability in GHB urine levels between individuals was observed. Caucasians had lower urine concentrations than other races/ethnicities (p = 0.03). Men had lower GHB levels than women in the first 3 h after dosing (p = 0.038). Coingestion of ethanol did not significantly affect renal clearance of GHB, but urine GHB concentrations were lower in the first 3 h when ethanol and GHB were coingested (p = 0.039). At a proposed cut-off of 10 mg/L to distinguish endogenous versus exogenous GHB levels, 12.5% of the samples collected from 3 to 6 h, 81.3% of samples collected from 6 to 12 h, and 100% of urine specimens collected from 12 to 24 h were below this level. We conclude that the detection time for GHB in urine may be shorter than the previously reported 12-h window in some people taking therapeutic doses of GHB.

Administration, Oral↗
PubMed1997

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

BACKGROUND: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. METHODS: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested for Chlamydia trachomatis using ligase and polymerase chain reaction tests. RESULTS: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive for C. trachomatis. CONCLUSIONS: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Adolescent↗
PubMed2005

Random urine calcium/osmolality in the assessment of calciuria in children with decreased muscle mass.

BACKGROUND: Random urine Ca/creatinine (UCa/Cr) is used to estimate 24-hour Ca excretion. However, due to decreased urine creatinine excretion in children with decreased muscle mass (DMM), UCa/Cr overestimates their Ca excretion. OBJECTIVE: To evaluate whether in children with DMM random urine Ca/osmolality (UCa/Osm) can accurately predict hypercalciuria (24-hour urine Ca > 4.0 mg/kg) and at which "cutoff" value. METHODS: 19 children with DMM and 29 with normal muscle mass (NMM), ages 6 - 17 years, were studied. DMM was diagnosed based on clinical findings and decreased serum creatinine, and confirmed by low urine creatinine excretion. Over 24 hours, subjects collected each void separately. After each sample was analyzed, samples of each participant were combined to form a 24-hour specimen from which an aliquot (AL) was obtained; 24-hour urine Ca was first correlated with the corresponding AL Ca/Cr and Ca/Osm. As an internal control, a similar assessment ofproteinuria was conducted. In the next step, AL data were compared with individual urine samples to identify the time of day when a random sample best correlates with AL. RESULTS: The correlation coefficient between 24-hour Ca and AL Ca/Cr in all children was 0.61, in NMM 0.96, and in DMM 0.69 (in all p < 0.001). The correlation coefficient between 24-hour urine Ca and AL Ca/Osm in all children was 0.90, in NMM 0.90, and in DMM 0.91 (in all p < 0.001). In children with DMM, the correlation coefficient of 24-hour protein with AL protein/Cr was 0.75, and with protein/Osm 0.98 (both p < 0.001). Receiver operating characteristic curves showed UCa/Cr as a better predictor of 24-hour Ca > 4.0 mg/kg in NMM, whereas UCa/Osm was a better predictor of hypercalciuria in DMM patients. In NMM, UCa/Cr ratio > 0.20 had sensitivity of 88% and specificity of 96% in detecting 24-hour Ca > 4.0 mg/kg, whereas in those with DMM UCa/Osm (x 10) ratio of > 0.25 had sensitivity of 100% and specificity of 93% in detecting hypercalciuria. It was further found that random urine specimens collected between 9:00 a.m. and 2:00 p.m. best represented 24-hour urine data. CONCLUSION: In children with DMM, UCa/Osm can successfully replace UCa/Cr as a screening tool for hypercalciuria.

Adolescent↗
PubMedDate not supplied

Oxaprozin cross-reactivity in three commercial immunoassays for benzodiazepines in urine.

Immunoassay methods are commonly used to screen for drugs of abuse and some prescription drug classes as part of drug-testing programs in clinical and forensic toxicology. Oxaprozin (Daypro) is a new nonsteroidal anti-inflammatory drug that is widely prescribed in North America and has been reported to cross-react for benzodiazepines in several different immunoassay methods. The first objective of this study was to characterize the immunoreactivity of oxaprozin standards over a wide concentration range when analyzed by the EMIT dau, Abbott FPIA, and BMC CEDIA urine benzodiazepine assays. The second objective was to measure the immunoreactivity of urine specimens obtained from 12 subjects after receiving a single oral dose (1200 mg) of oxaprozin. Urine oxaprozin standards were prepared in drug-free urine at seven concentrations ranging from 500 to 100,000 ng/mL. The standards gave presumptive positive benzodiazepine results between 5000 and 10,000 ng/mL (EMIT dau) and approximately 10,000 ng/mL (FPIA, CEDIA). With a 200-ng/mL cutoff for benzodiazepines in these assays, all 36 urine specimens collected from the 12 subjects gave positive results by EMIT and CEDIA, and 35 of 36 urine specimens were positive by FPIA. It was concluded that presumptive positive benzodiazepine results by these immunoassays may be due to the presence of oxaprozin or oxaprozin metabolites. It is recommended that all positive immunoassay screening tests for benzodiazepines be confirmed by another technique based upon a different principle of analysis.

Administration, Oral↗
PubMedDate not supplied

A positive cannabinoids workplace drug test following the ingestion of commercially available hemp seed oil.

A commercially available health food product of cold-pressed hemp seed oil ingested by one volunteer twice a day for 4 1/2 days (135 mL total). Urine specimens collected from the volunteer were subjected to standard workplace urine drug testing procedures, and the following concentrations of 11-nor-delta9- tetrahydrocannabinol carboxylic acid (9-THCA) were detected: 41 ng/mL 9-THCA at 45 h, 49 ng/mL at 69 h, and 55 ng/mL at 93 h. Ingestion was discontinued after 93 h, and the following concentrations were detected: 68 ng/mL at 108 h, 57 ng/mL at 117 h, 31 ng/mL at 126 h, and 20 ng/mL at 142 h. The first specimen that tested negative (50 ng/mL initial immunoassay test, 15 ng/mL confirmatory gas chromatographic-mass spectrometric test) was at 146 h, which was 53 h after the last hemp seed oil ingestion. Four subsequent specimens taken to 177 h were also negative. This study indicates that a workplace urine drug test positive for cannabinoids may arise from the consumption of commercially available cold-pressed hemp seed oil.

Artifacts↗
PubMed1988

Time-dependence of urinary neopterin, a marker of cellular immune activity.

Neopterin, a marker of cellular immune system activation, is produced by human macrophages after induction by interferon gamma (secreted by T-lymphocytes) and is eliminated mostly in urine. We have documented the circadian rhythm of urinary neopterin in five healthy young men (about 25 years old), using voidings collected during 48 h at fixed 4-h intervals. We repeated the experiment three times, one week apart. Neopterin was measured by high-performance liquid chromatography (HPLC). We clearly show a peak of the excretion of neopterin in the early morning (around 0630 hours +/- 2 h), with total variability (peak-trough difference) reaching 51%. Neopterin is commonly assayed in urinary fractions, so it is imperative to use urine specimens collected at the same time of day--e.g., the first morning urines--to avoid misinterpretation in follow-up of patients.

Adult↗
PubMed2001

[The determination of lorazepam in human urine by gas chromatography/nitrogen-phosphorus detector].

A method to assay lorazepam in human urine has been developed. After addition of hydroxyethylflurazepam (internal standard) and hydrolysis with beta-glucuronidase, the lorazepam and hydroxyethylflurazepam were extracted with ethyl ether at pH 10.8. The analysis was performed on an HP-5 capillary column with nitrogen-phosphorus detector(NPD). The detection limit and recovery of analytes in urine were 5 micrograms/L and (83.4 +/- 3.1)% respectively. The method was successfully applied to urine specimens collected from healthy human volunteers who have ingested 2 mg of lorazepam. The method was sensitive enough to assay urine specimen excreted at 32 h after taking the medicine by volunteers.

Anti-Anxiety Agents↗
PubMed1986

Screening for urinary tract infection using Bac-T-Screen bacteriuria device.

The Bac-T-Screen was used to process 795 urine specimens. Tests for urine specimens took slightly more than two minutes. The Bac-T-Screen predicted with 99 per cent accuracy if a specimen was negative for bacteriuria or pyuria. Thus, approximately one half of all carefully collected urine specimens need no further laboratory culture. In addition, the Bac-T-Screen detected bacteriuria with a sensitivity of 96 per cent at the 10(5) CFU/ml level of probability. Pyuria (1 +) was detected with a sensitivity of 98 per cent. The Bac-T-Screen can be used in an office practice as well as in the clinical laboratory.

Bacteriuria↗
PubMedDate not supplied

Determination of chromate adulteration of human urine by automated colorimetric and capillary ion electrophoretic analyses.

Various chemicals can be added to urine specimens collected for drug analysis to abnormally elevate ionic concentrations and/or interfere with either immunoassay urine drug-screening procedures or gas chromatographic-mass spectrometric confirmation techniques. One such adulterant, "Urine Luck" (formula 5.3), has been identified in our previous research to contain potassium dichromate. Screening of suspected adulterated specimens and confirmation of the adulterant are important for forensic drug screening. The application and comparison of automated colorimetric and capillary ion electrophoretic techniques for the detection, confirmation, and quantitation of chromate adulteration of urine specimens were the purpose of this investigation. Thirty-six urine specimens suspected of adulteration were analyzed for chromate by colorimetric analysis with diphenylcarbazide. Duplicate aliquots were analyzed for chromate by capillary ion electrophoresis. Results of the colorimetric chromate analyses revealed a mean chromate concentration of 929 microg/mL with a standard error of 177 microg/mL and a range of 30 to 5634 microg/mL. Results of the capillary ion electrophoresis chromate analyses revealed a mean chromate concentration of 1009 microg/mL with a standard error of 218 microg/mL and a range of 20 to 7501 microg/mL. The correlation coefficient between the capillary ion electrophoretic and colorimetric chromate results was r = 0.9669. Application of the automated diphenylcarbazide colorimetric technique provides rapid determination of chromate adulteration of a urine specimen. Capillary ion electrophoresis offers a separation technique to confirm the presence of chromate in suspected adulterated specimens. The excellent correlation between these methods substantiates their application to forensic testing as screening and/or confirmation techniques.

Colorimetry↗
PubMed2001

Comparison of urine to sweat patch test results in court ordered testing.

A former cocaine and methamphetamine abuser was continuously monitored with both sweat patch and urine testing for approximately 6 months. Thirteen sweat patches were applied and collected, five were positive for cocaine and/or methamphetamine, but all the urine specimens collected were negative at the analytical cut-off levels. The high incidence of false positive sweat patch tests in relation to the sensitivity, specificity, and efficiency of the sweat patch assay is discussed. Possible mechanisms, which can lead to false positive results, are presented. The results of our study raise further questions about the preferential use of the sweat patch in detecting new episodes of drug use in formerly chronic drug users.

Adult↗
PubMed1997

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

The interference of buflomedil with the monoclonal and polyclonal EMIT d.a.u. amphetamine immunoassays was investigated. Urine samples collected from 20 patients taking 600 mg of buflomedil daily gave false positive results with the monoclonal EMIT d.a.u. assay, as did urine specimens collected 2 hours after the first oral dose of buflomedil. Conversely, no false positive results occurred with the polyclonal EMIT d.a.u. amphetamine assay. Urine samples with buflomedil added at concentrations greater than 100 mg/l gave false positive results with the monoclonal immunoassay. Buflomedil concentrations found in the patient urines (56-400 mg/l) failed to correlate to EMIT assay responses: this result suggests that one or more buflomedil metabolites, besides the unchanged drug, probably interfere in the monoclonal EMIT d.a.u. assay.

Adult↗
PubMed2006

Urinary excretion of morphine and codeine following the administration of single and multiple doses of opium preparations prescribed in Taiwan as "brown mixture".

Parallel to the "poppy-seed defense" strategy commonly reported in the United States, donors of urine samples tested positive for opiates in Taiwan often claimed the consumption of Brown Mixture (BM) as the source of the observed morphine and codeine. Because BM contains opium powder (10.0-10.5% morphine), opium tincture (0.9-1.1% morphine), or camphorated opium tincture (0.045-0.055% morphine) and is a popular remedy, and heroin use is considered a serious criminal act, the claim of BM use has to be adequately addressed. In this study, BM from seven different manufacturers (5 tablets and 2 solutions) and urine samples from alleged heroin users and volunteers with various ingestion patterns and were analyzed for their morphine and codeine contents. The analytical procedure included hydrolysis, trimethylsilylation, and gas chromatography-mass spectrometry analysis. The contents of morphine and codeine in the tablets were found to be very consistent, but with significant differences in the two BM solutions. Morphine concentrations found in urine specimens collected from volunteers ingesting BM tablets (or solutions) were always < 4000 ng/mL. The following morphine-to-codeine ([M]/[C]) ratios were observed for urine specimens with morphine concentration > or = 300 ng/mL: (A) < 3.0 for volunteers ingesting BM solution and (B) > 3.0 (mostly > 5.0) for volunteers ingesting BM tablets and alleged heroin users. It appeared that (A) BM ingestion (tablet or solution) was unlikely to result in a morphine concentration > 4000 ng/mL; and (B) [M]/[C] ratio might not be an effective parameter to differentiate heroin use from BM tablet ingestion.

Codeine↗
PubMed1997

[Detection of Chlamydia trachomatis from urine sediment by PCR diagnostic reagent kit].

Chlamydia trachomatis detection by both swab CHLAMYDIAZYME and urine sediment AMPLICOR were performed on 61 males and 54 females who were suspected to have C. trachomatis genital infection (CTGI). Positive agreement between swab CHLAMYDIAZYME and urine sediment AMPLICOR was good, 96.9% in males and 96.6% in females. Negative agreement was 100% in males and 84.0% in females. "Swab CHLAMYDIAZYME positive-Urine sediment AMPLICOR negative specimen" were not obtained. "Swab CHLAMYDIAZYME negative-urine sediment AMPLICOR positive" resulted in four females who were finally diagnosed to have CTGI by repeated specimens on CHLAMYDIAZYME. Positive result by AMPLICOR was obtained on un-spun urine specimen that was in agreement with the laboratory result that the sensitivity of AMPLICOR reaches one thousand fold of CHLAMYDIAZYME. Detection on every separately collected urine specimen of one urination showed AMPLICOR positive all through the last cup specimen in both male and female. Those results seem to certify the reliability of C. trachomatis detection by urine sediment AMPLICOR. False negative by interference substance in urine and false positive by contamination were not experienced. On asymptomatic young male and female, positive rates of urine sediment AMPLICOR were 7.5% in male and 12.1% in female which are far more than the positive rate obtained by CHLAMYDIAZYME. Non invasive C. trachomatis detection method applicable to asymptomatic female is needed for control of CTGI. C. trachomatis detection could be facilitated by non invasive urine sediment AMPLICOR.

Adult↗
PubMed2000

Can urine clarity exclude the diagnosis of urinary tract infection?

OBJECTIVES: To determine the association of clear urine by visual inspection with the absence of significant bacteruria, and to compare it with standard urinalysis. METHODS: The study was performed in the emergency department of Children's Hospital Medical Center, Cincinnati, Ohio. It was a prospective, convenience sample of children <21 years of age who had catheterized or midstream clean-catch urine specimen collected for culture. Clinical findings including the presence or absence of fever, abdominal pain, dysuria, frequency, and urgency were collected for each patient. Urine was visually assessed for clarity by 2 independent observers using a standardized technique. Standard laboratory urinalysis and microscopy were also performed on all specimens. A positive urine culture was defined as >/=10(4) colony-forming unit (CFU)/mL of a urinary pathogen if obtained by catheterization and >/=10(5) CFU/mL if obtained by midstream. RESULTS: Samples were obtained from 159 patients ranging in age from 4 weeks to 19 years. Females comprised 77% of the patients. One hundred ten of the samples (69%) were clear to visual inspection. There were a total of 29 positive cultures; however, 3 were in children with clear urine. The finding of clear urine on visual inspection had a negative predictive value of 97.3%. These results were similar to those obtained with standard urinalysis. CONCLUSION: Clear urine on visual inspection cannot completely eliminate the possibility that a child has a urinary tract infection. However, it is a reproducible test that offers the advantages of being simple, fast, and inexpensive. The finding of clear urine should be considered a reasonable and relatively effective bedside screen for the presence of a urinary tract infection.

Adult↗