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Rapid processing of urine specimens by urine screening and the AutoMicrobic system.

A total of 1,500 clean-voided urine specimens were analyzed for the presence of bacteria by urine screening with the Autobac 1 system. The specimens found positive by this method were further processed on the same day for identification and for antimicrobial susceptibility testing on the AutoMicrobic system with the Enterobacteriaceae-plus Card and the General Susceptibility Card, respectively. The inocula for these tests were prepared from the centrifuged and washed growth in the eugonic broth aspirated from the Autobac cuvette chambers. Of 1,500 specimens that were analyzed, 183 contained single isolates of gram-negative bacilli. The results of these rapid procedures were compared with results for the same organisms isolated from urine specimens cultured by the conventional method. The data showed 92.3% agreement for identification and a correlation of 93.6% for antibiotic susceptibility between the two procedures. It is concluded that gram-negative bacilli can be rapidly identified and tested for antimicrobial susceptibility with a high degree of accuracy from the centrifuged eugonic broth after urine screening. These findings also suggest that the AutoMicrobic system provides a rapid and convenient method for same-day processing of positive urine cultures when combined with the urine screening procedure.

Anti-Bacterial Agents↗

Excreted urine, bladder urine, and the delay of sexual maturation in female house mice.

A series of experiments tested effects of excreted and bladder urine of group- and singly-caged female house mice (Mus musculus) on sexual maturation of young female mice caged alone or in groups of eight. Puberty was determined by vaginal smears. A maturation-delaying pheromone was present in bladder urine of all female mice and excreted urine of group-caged females, but not in excreted urine from singly-caged females. Test mice treated with bladder urine homogenized with urethras from singly-caged females matured at the same age as controls. Apparently the urethras or associated glands of singly-caged females produce a substance which deactivates the maturation-delaying pheromone contained in bladder urine.

Animals↗

Comparison of spot tests with AdultaCheck 6 and Intect 7 urine test strips for detecting the presence of adulterants in urine specimens.

BACKGROUND: Several adulterants are used to mask tests for abused drugs in urine. Adulterants such as "Klear" and "Whizzies" contain potassium nitrite while "Urine Luck" contains pyridinium chlorochromate (PCC). The presence of these adulterants cannot be detected by routine specimen integrity check (pH, specific gravity, creatinine and temperature). We previously reported the development of rapid spot tests to detect the presence of these adulterants. AdultaCheck 6 and Intect 7 urine test strips are commercially available for detecting the presence of these adulterants along with specific gravity, creatinine and pH in urine. METHODS: The performance of these two test strips for detecting adulterants was compared with the results obtained by spot tests. RESULTS: Both AdultaCheck 6 and Intect 7 effectively detected the presence of nitrite and pyridinium chlorochromate in urine. Moreover, both test strips successfully detected the presence of glutaraldehyde, for which no spot test is currently available. High amount of glucose and ascorbic acid did not cause any false positive result with AdultaCheck 6 or Intect 7. CONCLUSIONS: Both AdultaCheck 6 and Intect 7 can be used for checking the integrity of a urine specimen submitted for drugs of abuse testing.

Ascorbic Acid↗

Urine excretion of protein HC in proteinuric glomerular diseases correlates to urine IgG but not to albuminuria.

BACKGROUND: Proteinuric glomerular diseases often are associated with tubulointerstitial injury, which imposes on the progression of renal failure. Tubular damage is partly referable to toxic effects on the tubular epithelial cells induced by filtered plasma proteins. Patients with nonselective proteinuria, that is, increased urine excretion of high-molecular-weight plasma proteins such as IgG in comparison to albumin, often have poor renal outcome. The present observational study examined correlations between the degree of tubular damage, measured by urine concentration of protein HC, and the levels of urine IgG and albuminuria. METHODS: Measurements of urine concentrations of IgG, albumin, and protein HC were performed in 56 proteinuric patients (33 males and 23 females) with nondiabetic glomerular diseases at the time of the diagnostic renal biopsy and at a mean of 49 follow-up months. RESULTS: A highly significant correlation between the urine IgG excretion and the urine protein HC concentration was found both at the start and at the end of the observational time (r = 0.74 and 0.65, respectively, P < 0.001). Furthermore, alterations in the urinary excretion of the two proteins in single patients correlated significantly to each other (r = 0.84, P < 0.001). The correlation between the degree of albuminuria and the protein HC excretion was significant at the time of kidney biopsy, but ceased to exist during the follow-up time. Stepwise linear regression analysis showed that in comparison with the creatinine clearance and albuminuria, only the changes in urinary IgG excretion were related to the corresponding changes in urinary protein HC excretion (r = 0.84 and r2 = 0.7, P < 0.001). CONCLUSION: The findings of the study suggest that the urinary protein HC concentration correlates to the degree of IgG-uria but not to the degree of albuminuria during the course of proteinuric glomerular disease. Whether this correlation is to be explained by an intrinsic toxic effect on tubular cells executed by IgG or perhaps by some other high molecular weight proteins, needs to be investigated further. However, the results contribute to the understanding of the poor renal survival in patients with glomerular diseases and nonselective proteinuria.

Adolescent↗

Normal chromium levels in urine and blood of Japanese subjects determined by direct flameless atomic absorption spectrophotometry, and valency of chromium in urine after exposure to hexavalent chromium.

Two hundred and thirty one urine and 20 blood samples of Japanese subjects from 4 geographic areas without known chromium pollution were assayed for chromium by direct flameless atomic absorption spectrophotometry. Normal chromium level in urine of Japanese subjects was 0.41 microg/L on an average. Urine level was less than 0.8 microg/L for all age and sex groups. Chromium levels in 2 hour urines did not correlate with those in 24 hours urine. Blood level of chromium was 2.9 ng/mL. A rabbit given an oral administration of 100 mg hexavalent chromium excreted 8.2 mg in 15 days after administration. No hexavalent chromium could be detected in urine. Ninety percent of the urinary excretion occurred within 2 days of administration.

Adolescent↗

Abnormalities of urine urobilinogen and urine bilirubin assays and their relation to abnormal results of serum liver function tests.

A prospective observational study of 324 cases was conducted in a busy ambulatory care setting to evaluate the sensitivity, specificity, predictive values, and accuracy of spot urine urobilinogen and urine bilirubin assays as screening tests for serum liver function test (LFT) abnormalities. High positive predictive values (88% for at least one abnormal LFT) make the evaluation of positive urine screens detected during routine health care maintenance examinations imperative. Because extraneous factors may influence both urine and serum test results, however, urine assays obtained as a screening parameter in clinical presentations (abdominal pain, jaundice, constitutional symptoms, etc) have only limited clinical utility. The high proportion of false-negative results for both urine assays renders their statistical properties unacceptable as screens in these clinical situations.

Adolescent↗

Electrolyte excretion in 12-hour urine and in spot urine. Relationship to plasma renin activity and aldosterone concentration in older children.

Plasma renin activity (PRA) and urinary electrolyte excretion were measured in 137 healthy children aged 6 to 14 years. Plasma aldosterone concentration (PAC) was measured in 52 of the children. Nocturnal 12-hour urine was collected in 110 of the children. Spot urine was collected on two occasions, once just before lying down, once after 90-min supine rest in another 27. Na/K ratio and fractional Na excretion rate (FENa) in 12-hour urine showed a significant inverse correlation with PRA or PAC. Na excretion (mmol/min, mmol/mmol creatinine), Na/K ratio and FENa in the spot urine following 90 min in a supine position showed a significant inverse correlation with PRA or PAC, but they failed to show a significant relationship to PRA or PAC in the spot urine preceding supine rest. A spot urine after 90 min in the supine position is collected easily and hence most appropriate to study the relationship between Na excretion and PRA or PAC clinically.

Adolescent↗

Effects of urinary tract inflammation and sample blood contamination on urine albumin and total protein concentrations in canine urine samples.

BACKGROUND: Urinary tract inflammation and hemorrhage are believed to be common causes of proteinuria in dogs based on results of studies that measured total urine protein concentration. A method to quantify urine albumin (UAlb) concentration in dogs recently has become available; however, the effect of inflammation on albuminuria is unknown. OBJECTIVES: The goals of this study were to determine the effects of urinary tract inflammation, as indicated by pyuria and sample blood contamination, on UAlb concentration and on urine protein:creatinine (UPC) ratio in dogs. METHODS: Urine samples were obtained from dogs with pyuria that were presented to a veterinary teaching hospital or were part of a laboratory colony. To mimic the effects of hematuria, canine whole blood was added to a microscopically normal canine urine sample that had baseline albumin and total protein concentrations below the limits of detection. UAlb concentration was measured using a canine albumin-specific competitive ELISA. UPC ratio was determined using routine methods. RESULTS: Of 70 samples with pyuria, 67% had negligible UAlb concentrations and 81% had normal UPC ratios. UAlb concentration but not UPC ratio was significantly higher (P < 0.05) in samples with concurrent hematuria or bacteriuria. When whole blood was added to normal urine, UAlb concentration did not exceed 1 mg/dL until the sample became visibly pink; the UPC did not exceed 0.4 at any dilution. CONCLUSIONS: Many dogs with pyuria do not have albuminuria or proteinuria; however, albuminuria may be more likely in dogs with pyuria and concurrent hematuria or bacteriuria. Hematuria may not cause an increase in UAlb concentration until it becomes macroscopic and even then may not increase the UPC ratio.

Albuminuria↗

The estimation of 24-hour urine urea nitrogen excretion from urine collections of shorter duration in continuously alimented patients.

Urine urea nitrogen excreted in 24 hr is used to estimate nitrogen balance in patients. Normal diurnal variation of urea excretion may be less pronounced in patients alimented continuously, and a urine collection of shorter duration may be representative of the 24-hr excretion. Five stabilized trauma center patients on continuous enteral or parenteral alimentation were studied with six consecutive 4-hr urine collections analyzed for urine urea nitrogen content. Excretion rates for various lengths of urine collection were compared with the 24-hr excretion rate. Urine collections spanning 4 or 8 hr frequently exceeded an error of 10% in predicting 24-hr urea nitrogen excretion, while collections of 12 hr or more had small errors. A comparison of three consecutive 8-hr collections was suggestive of diurnal variation existing under these conditions.

Blood Urea Nitrogen↗

Comparison of volumetric urine collection versus single-sample urine collection in horses consuming diets varying in cation-anion balance.

OBJECTIVE: To determine daily variation in urinary clearance and fractional excretion (FE) of electrolytes and minerals within and between horses and to compare volumetric and single-sample urine collection for determining FE values of diets with a range of dietary cation-anion balance (DCAB). ANIMALS: 5 Thoroughbred and 6 mixed-breed mares. PROCEDURE: 3 isocaloric diets with low, medium, and high DCAB values (85, 190, and 380 mEq/kg of dry matter, respectively) were each fed for 14 days. Daily blood samples, single urine samples collected by using a urinary catheter (5 mares), and volumetric urine collections (6 mares) were obtained during the last 72 hours of each diet. RESULTS: Urine and plasma pH values, plasma concentrations, and FE values of sodium, chloride, potassium, magnesium, phosphorus, and calcium were altered by varying the DCAB. Noticeable variation in clearance and FE values was detected within horses from day-to-day on the same diet as well as between horses. Fractional excretion values were not significantly different between single-sample and volumetric methods, except for magnesium in the high DCAB diet. Volumetric and single-sample collections revealed similar patterns of change in urinary FE values with varying DCAB, except for calcium and magnesium. CONCLUSIONS AND CLINICAL RELEVANCE: Substantial variation in clearance and FE of electrolytes and minerals are evident within horses between 24-hour periods as well as between horses fed a specific diet. Three daily urine samples provide similar information regarding dietary-induced changes in clearance and FE values (excluding calcium and magnesium) as that obtained by volumetric urine collection.

Animals↗

Relationship between urine flow, glomerular filtration, and urine solute concentrations during prolonged heavy exercise.

Serum and urine electrolytes, creatinine, and urea were determined in 21 well-trained men, aged 21-56 years, in connection with a 70-km cross-country ski race, lasting 4.39-6.52 h, leading to slight dehydration. Although the race urine flow was low, averaging 0.41 (0.1-0.9) ml/min, the average urine concentrations of urea, Na, Ca, Mg, Cl and P were markedly lower than during the preceding night, while the concentrations of K and creatinine were higher, the total of measured solutes being 621 nmol/l, compared with 911 nmol/l during the preceding night. Decreasing urine flow and endogenous creatinine clearance were accompanied by a falling urine solute concentration, particularly when the race creatinine clearance decreased to below 70 ml/min, mainly due to a fall in the urea, Na, and Cl concentrations. Thus, a decrease in the glomerular filtration rate was accompanied by a progressive decline in the urine concentrating ability.

Adult↗

Rapid screening of high-risk patients for disorders of purine and pyrimidine metabolism using HPLC-electrospray tandem mass spectrometry of liquid urine or urine-soaked filter paper strips.

BACKGROUND: A rapid and specific screening method for patients at risk of inherited disorders of purine and pyrimidine metabolism is desirable because symptoms are varied and nonspecific. The aim of this study was to develop a rapid and specific method for screening with use of liquid urine samples or urine-soaked filter paper strips. METHODS: Reverse-phase HPLC was combined with electrospray ionization (ESI), tandem mass spectrometry (MS/MS), and detection performed by multiple reaction monitoring. Transitions and instrument settings were established for 17 purines or pyrimidines. Stable-isotope-labeled reference compounds were used as internal standards when available. RESULTS: Total analysis time of this method was 15 min, approximately one-third that of conventional HPLC with ultraviolet detection. Recoveries were 96-107% in urine with added analyte, with two exceptions (hypoxanthine, 64%; xanthine, 79%), and 89-110% in urine-soaked filter paper strips, with three exceptions (hypoxanthine, 65%; xanthine, 77%; 5-hydroxymethyluracil, 80%). The expected abnormalities were easily found in samples from patients with purine nucleoside phosphorylase deficiency, ornithine transcarbamylase deficiency, molybdenum cofactor deficiency, adenylosuccinase deficiency, or dihydropyrimidine dehydrogenase deficiency. CONCLUSIONS: HPLC-ESI MS/MS of urine allows rapid screening for disorders of purine and pyrimidine metabolism. The filter paper strips offer the advantage of easy collection, transport, and storage of the urine samples.

Chromatography, High Pressure Liquid↗

Failure of prediction of liver function test abnormalities with the urine urobilinogen and urine bilirubin assays.

A prospective observational study of 229 cases was conducted in a busy ambulatory care setting to evaluate the sensitivity, specificity, predictive values, and accuracy of spot urine urobilinogen and urine bilirubin assays as screening tests for serum liver function test (LFT) abnormalities. Both urine tests exhibited remarkably similar characteristics overall once they were adjusted to maximize accuracy and predictive values (occurring at a normal or abnormal "threshold," respectively, of 3.4 or 5.07 mumol/d for urobilinogen and 0 or 1+ for urine bilirubin). The percentage of cases correctly identified were 81% to 83% for serum bilirubin assays, 68% to 72% for other LFTs, but only 62% to 63% for screens for cases with at least one abnormal LFT finding. Poor sensitivities (47% to 49%) limited the detection of abnormal findings by the screen; both screens were reasonably specific (79% to 89%), but negative predictive values were suitable (89%) for serum bilirubin results only and were prohibitively lower (49% to 50%) in predicting all patients without LFT abnormalities. We conclude that spot urine urobilinogen and urine bilirubin determinations, although good screens for isolated serum bilirubin elevations, have unacceptable statistical properties as predictors of other LFT results due to a high proportion of false-negative results.

Bilirubin↗

[Detection of bacteria in urine using dip-slides (1). Possible occurrence of false-negative results when dip-slides are used for urine containing antibacterial agents].

Dip-slides are used as semiquantitative microbial sampling devices that are simple to use in routine testing of urine to detect the presence of bacteria, and are recommended for use in "Standard evaluation of drug efficacy in UTI". Bacterial growth on currently available dip-slides, however, may conceivably be influenced by the presence of antibacterial agents in urine. We studied clinical performance of, and effects of antibacterial agents on, such dip-slides, using two types of dip-slides, URICULTE and DIASLIDE, both of which are newly developed urine culture devices. The quantitative conventional culture method was also used as the control. 1. When single species of bacteria are present in urine specimens of patients, results obtained using URICULTE and DIASLIDE agreed very well, and they, in turn agreed well with results obtained using the quantitative, conventional culture method, also. 2. When urine specimens were spiked with Gram-negative rods and Gram-positive cocci together, URICULTE fail to provide quantitative results because colonies were not well separated and confluent growth often resulted because of a large sample volume this device employs. DIASLIDE which used a smaller amount of sample, on the other hand, provided quantitative results with adequate separation of colonies. 3. When three antibacterial agents were added to urine specimens that were spiked with bacteria, DIASLIDE produced significantly higher numbers of colonies than URICULTE. The difference probably are due to the difference in volumes of specimens used in the two devices, the former device employs approximately 1/100 as much volume of specimen as the latter.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

[Study on urine ALb, serum and urine beta 2-m, IgG, and THP].

The urine ALb, serum and urine beta 2-m, IgG, and THP were serially determined with radioimmunoassay to assess the renal functions during various stages of burn in 52 patients with TBSA over 30% (mean +/- s 58.4% +/- 18.88%). It was found that the urine levels of ALb, IgG, and THP and the serum and urine levels of beta 2-m were remarkably increased and that the serum levels of IgG were decreased after burns. Our study suggested that the measurements of urine ALb, serum and urine beta 2-m, IgG, and THP using radioimmunoassay were sensitive in assessing renal glomerular permeability and tubular functions after burn. It is presumed that such methods might be used to help identify the location, the extent, and the severity of the renal abnormalities and provide valuable information about the differential diagnosis and the prognosis of the renal damage in patients with extensive burns.

Adolescent↗