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Laboratory techniques for detection of urinary tract infection and assessment of value.
Manual methods for diagnosing urinary tract infection have long been under review, modification, and evaluation; thus, methods of collection and interpretation have been found to require more scrutiny. Various screening procedures include chemical, microscopic, and cultural methods, the latter two being highly reliable. In addition, examples of infections due to anaerobic bacteria and Mycoplasma have been documented, with the accompanying need to consider their role in particular situations. There has also been a need for localizing the infection, which has been accomplished with some useful methods. From the literature it is apparent that the tests all have a portion of patients' results that do not fit the true picture. These must be considered carefully in light of other information.
Evaluation of first morning urine to detect significant bacteriuria. I.
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Bacteriologic study of suprapubic bladder drainage.
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Enterocystoplasty and pregnancy.
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Bladder symptoms due to silent sigmoid disease.
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The occurrence of 2-hydroxybutyric acid in urine from patients with lactic acidosis.
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Obstructive uropathy as seen by the internist: the role of ultrasound and CT scanning.
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Renal tuberculosis in the Japanese.
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Urinary beta-glucuronidase enzyme activity in some bilharzial urinary tract diseases.
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Xanthogranulomatous pyelonephritis.
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Analgesic abuse nephropathy.
Analgesic abuse nephropathy is seldom considered as a cause in patients presenting with chronic renal disease. In a three-year period 450 patients were seen with chronic renal failure. Of these 103 had interstitial renal disease as the cause of their failure. Twenty of these 103 were due to chronic analgesic abuse, which indicates that need for a greater awareness of this problem. The spectrum of clinical and roentgenographic aspects of analgesic abuse nephropathy are discussed. What constitutes analgesic abuse, helpful clinical findings, frequency of other medical illnesses, and the low incidence of documented renal infection prior to onset of renal failure are discussed. Intravenous pyelographic findings related to visualization, renal size, corticomedullary margins and pelvicalyceal changes are also discussed and demonstrated.
Asymptomatic Chlamydia trachomatis infections in teenage males.
This study examined the prevalence of Chlamydia trachomatis infections of the urethra in asymptomatic teenage males in a juvenile detention setting. Gonorrhea cultures, chlamydia smears using the direct immunofluorescent antibody (DFA) technique, and 15-20 ml of a first-catch urine (FCU) sample were obtained. Of the 227 adolescent males screened, 205 had experienced sexual intercourse. Twenty-seven (13.2%) of the sexually active adolescents had positive DFA smears for C. trachomatis. Three (1.5%) had positive Neisseria gonorrhoeae cultures. A urine leukocyte count of greater than 10 per high-power field gave a 91% specificity but only a 26% sensitivity for a positive DFA. The high prevalence of chlamydia in this population and the relative low cost of the DFA screen for chlamydia make this a useful procedure for discovering unsuspected disease, particularly in a high-risk population. The FCU screen for leukocytes was of limited value in identifying asymptomatic infection.
Application of a leukocyte and nitrite urine test strip to the management of children with neurogenic bladder.
A urine leukocyte count of > or = 50/mm3 together with a bacterial count of > or = 10(5) colony-forming units (CFUs) per milliliter was used to define significant infection in 160 children with neurogenic bladder and evaluate the leukocyte and nitrite components of the Chemstrip 9 test. A Chemstrip 9 leukocyte reading of < or = 25 together with a negative nitrite reaction occurred in 99 children and had a sensitivity of 83.5% and a negative predictive value for infection of 97.0%. A Chemstrip 9 reading of > or = 500 leukocytes together with a positive nitrite reaction occurred in 18 children and had a sensitivity of 40% with a 100% positive predictive value for infection. Other combinations of Chemstrip 9 leukocyte and nitrite reactions were unhelpful or of uncertain value. Selection of up to three specimens from each patient increased the number of samples to 360 and provided general confirmation of the above conclusions. Nitrofurantoin may reduce the sensitivity of the nitrite strip reaction.
Clean-catch versus straight-catheter urinalysis results in women.
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Asymptomatic bacteriuria: review and discussion of the IDSA guidelines.
Asymptomatic bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.
Measurement of cystatin-C and creatinine in urine.
BACKGROUND: The concentration of serum cystatin-C (Cys-C) is highly correlated with creatinine (Cr), and is mainly determined by glomerular filtration; thus, Cys-C may be an index of the glomerular filtration rate (GFR). However, the kinetics of urinary Cys-C and Cr excretions are unclear. Thus, we investigated the kinetics of urinary Cys-C and Cr excretions, and examined whether the urinary Cys-C concentration can be used as a marker of renal function. METHODS: The urinary excretion of Cys-C and Cr was evaluated in 1670 healthy subjects and 217 patients with proteinuria. We also investigated the urinary Cys-C concentration in 52 patients with chronic renal failure. RESULTS: There was a good correlation between the urinary concentrations of Cys-C and Cr in the healthy group. This relation was also observed in patients showing persistent proteinuria without tubular cell damage. The mean urinary Cr concentration increased with age, and it was affected by the muscle mass. In contrast, the urinary Cys-C concentration was not affected by the muscle mass, and the concentration remained constant for all ages. We further found that the ratio of Cys-C to Cr (CCR) is a good index of the state of Cys-C reabsorption in the proximal tubules. CONCLUSIONS: The urinary CCR can be a marker of renal tubular dysfunction. In addition, when CCR was in the normal range, the urinary Cys-C concentration accurately reflected the glomerular filtration function.
Case report: intermittent sciatic herniation of the ureter.
Sciatic herniation is the rarest form of pelvic hernia. Herniation of the ureter into the sciatic foramen is extremely uncommon with only 11 cases reported in the literature. We describe an unusual case of intermittent herniation of the ureter during an intravenous urogram.