A survey regarding the use of the dipstick/pad method with elderly, incontinent patients.

OBJECTIVE: To determine if nurses and physicians would use the dipstick/pad method to test urine in elderly, incontinent patients with suspected urinary tract infection. DESIGN: A cross-sectional survey was sent to 1900 physicians and nurses. SETTING AND SUBJECTS: A convenience sample of nurses and geriatricians, family practice, and internal medicine physicians was obtained from lists on the Internet, a geriatric care conference, and a geriatric nursing journal mailing list. INSTRUMENTS: A 3-part questionnaire queried: (1) whether respondents would use the dipstick/pad method; (2) would they use results to initiate or monitor nonantibiotic interventions, antibiotic interventions, or determine further laboratory analysis; (3) would a particular combination of nitrite and leukocyte esterase results determine the need for further laboratory testing. Nurses were also asked if they had used results of dipstick urinalysis in their management of urinary tract infections. METHODS: The questionnaire was mailed to 300 geriatric physicians, 1000 internal medicine and family practice physicians, and 600 nurses. RESULTS: A total of 373 individuals (20%) responded to the survey. Sixty-five percent of the nurses responding had not used dipstick results; 90% of these nurses would consider using dipstick/pad results. Ninety-five percent of both the physician groups and the nurses who had previously used dipstick results indicated that they would consider using the dipstick/pad method. Determining the need for further laboratory analyses was the most accepted application by all groups. No combination of nitrite and leukocyte esterase dipstick results elicited greater than a 76% agreement by either physician group with regard to outcomes for further analyses. CONCLUSIONS: Although the response rate was low, the results of this survey suggest that healthcare workers would consider using the dipstick/pad method with incontinent elderly patients in the assessment of a urinary tract infection, primarily to determine further laboratory tests.     

Significance of dipstick haematuria. 1. Correlation with microscopy of the urine

The reliability of a chemical test for haematuria has been evaluated in patients referred for investigation of suspected renal or urological disease. Red blood cells in concentrations of 10/microliter or greater were found in 24% of urines giving a negative dipstick result, 82% of urines giving a trace positive result and nearly 100% of urines giving dipstick results greater than this. The accuracy of the reagent strip in predicting the presence or absence of significant haematuria was improved by testing several urines from each patient. On the basis of this study, if significant haematuria is present, reagent strip urine testing is an efficient method for its detection.     

The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy

Background  

Many studies have evaluated the accuracy of dipstick tests as rapid detectors of bacteriuria and urinary tract infections (UTI). The lack of an adequate explanation for the heterogeneity of the dipstick accuracy stimulates an ongoing debate. The objective of the present meta-analysis was to summarise the available evidence on the diagnostic accuracy of the urine dipstick test, taking into account various pre-defined potential sources of heterogeneity.     

Usefulness of dipstick test for determining leukocytes and bacteria in urine]

The value of a simple dipstick test (BMtestLN, Boehringer Mannheim-Shionogi) for determination of leukocytes and bacteria in urine was examined. This test consisted of detection of esterase, an enzyme present in leukocytes and the nitrate reduced by bacteria. A total of 666 clinical urine specimens were tested with both tests. The evaluation of leukocytes in urine was compared with microscopic examination, and the identification and measurement of strains was performed using a semiquantitative plate culture method as a reference. The leukocyte esterase test had a sensitivity of 85.3%, a specificity of 67.3%, positive predictive value of 54.7% and negative predictive value of 90.8%. The range of the sensitivity value of nitrate test was 25.7% for the detection of bacteriuria (bacteria greater than or equal to 10(4) CFU/ml). This test had a specificity of 99.6%, positive predictive value of 94.8% and negative value of 82.9%. We concluded that this dipstick test is not useful for determination of the slight change of pyuria, but sensitive for the determination of acute and untreated urinary tract infections.     

Proteinuria and renal disease: prognostic value of urine dipstick testing for leukocytes

Proteinuria is utilized to screen for underlying kidney disease and serves as a marker of disease progression. The aim of this study was to test the hypothesis that patients with proteinuria will have a higher frequency of urine dipstick positive for leukocytes as an index of noninfectious renal inflammation. In this retrospective analysis, 1,099 urine specimens were evaluated from 676 patients. Proteinuria was present in 39% of the samples and leukocyturia in 5.1%. The percentage of urines that were dipstick positive for leukocytes was similar in those specimens with or without proteinuria. However, in patients with proteinuria and concomitant leukocyturia, the mean serum creatinine concentration was higher (P=0.003) and the calculated GFR was lower (P=0.01) compared to those without this additional abnormality. These differences were noted despite similar age, gender distribution, and array of underlying diseases in these two groups. Based on these findings, urine dipstick testing for leukocytes as a primary means of screening otherwise healthy children for serious renal disease is of little value. However, in patients with established proteinuria, a positive dipstick result for leukocytes is a simple means of identifying those with more prominent noninfectious renal inflammation, a process which may promote kidney disease progression. This finding may serve as an early marker of the severity of renal injury, regardless of whether the primary process is glomerular or tubular.     

Significance of urine dipstick test for occult blood in patients with diabetes mellitus

OBJECTIVE: Hematuria is the usual urinary finding in patients with diabetic nephropathy. In this study, prevalence and significance of microhematuria in patients with diabetes mellitus were investigated. MATERIAL AND METHODS: Five hundred and forty-two samples from outpatients, who consulted the Department of Diabetes and Metabolism, were categorized into 4 groups according to the results of the urine dipstick test. Group I :258 samples, urinary protein(u-P) 1+ and occult blood (OB) negative, group II: 95 samples: u-P 1+, OB 1+ approximately 3+, group III: 89 samples: u-P 2+ approximately 3+, OB negative, group IV 100 samples u-P 2+ approximately 3+, OB 1+ approximately 3+. RESULTS: Serum concentrations of creatinine and highly sensitive CRP were both significantly higher in group II than in group I . Those parameters were also significantly higher in group IV than in group III. CONCLUSIONS: These results indicate that a positive dipstick test for OB may occur in many patients with diabetes mellitus and suggest the progress of renal damage.     

A method for forming a large-intestine reservoir for the urine

Eighteen patients with cancer of the urinary bladder underwent cystectomy with formation of a large intestinal reservoir for urine. The terminal large intestinal portion, 15-20 cm, the cecum, the ascending colon, and the hepatic angle of the colon were excluded to produce a reservoir from the intestinal tube. Appendectomy was performed. The continuity of the intestinal tube was restored via ileotransversostomy. The ureters were retroperitoneally grafted into the cecum by using antireflux and antistricture techniques. The ileocecal valve was clinico-anatomically examined. A device restraining urine was formed on an individual basis in relation to the function of Bauhin's valve. Cutaneous urinostoma ("dry") was formed epicutaneously in the right iliac region below the umbilicus. Three patients died in the postoperative period. Complete urine keeping was observed in 14 of 15 patients. The maximal capacity of the reservoir is 500 ml, the pressure is 30-40 cm H2O. Homeostasis and intestinal function were found to be normal.     

Ultrasound assessment of residual urine. A quantitative method

A method of measuring residual urine volume using ultrasound is described. The volume is computed from serial parallel sections of the bladder. This method is found to be significantly more accurate than previously reported techniques and is quick and easy to perform.     

A modification of the urine osmolal gap: an improved method for estimating urine ammonium

A modification of the urine osmolal gap was evaluated as an estimate of urine [NH4+]. We proposed that: Urine [NH4+] = Urine osmolality - [2(Na+ + K+) + urea + glucose]/2 Spot urine samples were collected from normal volunteers and from individuals with ketonuria; the modified urine osmolal gap as well as two other previously described estimates of urine [NH4+] were compared with measured urine [NH4+]. There was a significant positive linear correlation between the urine [NH4+] and the modified urine osmolal gap in normal volunteers (r = 0.81; p less than 0.01) and in individuals with ketonuria (r = 0.93; p less than 0.001). The originally described urine osmolal gap greatly overestimated the urine [NH4+] but also showed a significant correlation. The urine anion gap was not a valid estimate of urine [NH4+] within the range of values measured in our subjects. The modified urine osmolal gap is an improvement over previously described estimates of urine [NH4+] and can be used as a single calculation in place of the other two.     

A comparison of BTA stat, hemoglobin dipstick, telomerase and Vysis UroVysion assays for the detection of urothelial carcinoma in urine

PURPOSE: We determine the sensitivity and specificity of various assays for the detection of urothelial carcinoma. MATERIALS AND METHODS: A total of 280 voided urine specimens from 265 patients were obtained immediately before cystoscopy for BTA stat, (Bard Diagnostic, Redmond, Washington) hemoglobin dipstick, (Bayer, Elkhart, Indiana) telomerase and UroVysion (Vysis, a wholly owned subsidiary of Abbott Laboratories, Abbott Park, Illinois) analysis. RESULTS: Of the 265 patients 75 had biopsy proven urothelial carcinoma, and the sensitivity of the assays was determined from these patients. From most sensitive to least sensitive, the overall sensitivity of UroVysion (73 cases), BTA stat (72), hemoglobin dipstick (73) and telomerase (70) was 81%, 78%, 74%, and 46%, respectively. Each of the first 3 tests was statistically significantly more sensitive than the telomerase assay (p <0.05). However, the differences in overall sensitivity of UroVysion, BTA stat and hemoglobin dipstick were not statistically significant. The specificity of the tests was calculated for 80 of the 265 patients in this study who had no history of urothelial carcinoma and negative cystoscopy findings despite common urological complaints. From most specific to least specific, the specificity of UroVysion, telomerase, BTA stat and hemoglobin dipstick was 96%, 91%, 74% and 51%, respectively. UroVysion and telomerase were statistically significantly (p <0.01) more specific than the BTA stat and hemoglobin dipstick assays, and all of the assays were more specific than hemoglobin dipstick testing (p <0.001). CONCLUSIONS: Our study reveals that UroVysion is the most sensitive and specific assay among those tested for the detection of urothelial carcinoma. Telomerase testing had good specificity but poor sensitivity. The BTA stat and hemoglobin dipstick tests had good sensitivity but relatively poor specificity. UroVysion is a promising new assay for the detection of urothelial carcinoma in urine specimens. However, further studies are needed to explore the role of the various assays in the treatment of patients with superficial urothelial carcinoma.     

Usefulness and limitations of rapid urine dipstick testing for joint-fluid analysis. Prospective single-center study of 98 specimens

ObjectiveTo evaluate the diagnostic performance of rapid urine reagent strip testing of joint fluid in separating mechanical from inflammatory disease.MethodsIn a prospective single-center 12-month study of joint fluid specimens, leukocyte esterase reagent strip testing (LERST) was compared to leukocyte counts used as the reference standard. Leukocyte counts greater than 2000/mm³ were taken to indicate inflammation. Reproducibility of LERST was evaluated by testing 73 specimens twice and computing Cohen's kappa coefficient.ResultsNinety-eight joint fluid specimens (26 with mechanical and 72 with inflammatory characteristics) were evaluated. LERST had 79.2% sensitivity, 92.3% specificity, 96.6% positive predictive value, 61.5% negative predictive value, a positive likelihood ratio of 10.3, and a negative likelihood ratio of 0.23. The kappa coefficient was 0.70 (0.53–0.87). Two negative LERSTs a few minutes apart had 80% negative predictive value and a negative likelihood ratio of 0.08.ConclusionLERST of joint fluid is a rapid means of satisfactorily separating mechanical from inflammatory joint fluids.     

A method for studying inhibitory activity in whole urine

Summary A method has been developed for inducing and quantifying calcium oxalate crystallisation in whole human urine. The propensity of a given urine to induce crystal formation was described in two ways: 1) its ability to resist spontaneous nucleation of calcium oxalate crystals was assessed by titrating 20 mls of the urine with increasing quantities of sodium oxalate (0–150 mol) to determine its practical metastable limit. This limit was inversely related to the endogenous calcium concentration. 2) its capacity to inhibit crystal growth was quantified by determining the rate of growth of calcium oxalate crystals precipitated in response to a fixed oxalate load (30 mol) above its metastable limit. The crystals produced were predominantly calcium oxalate dihydrate and were morphologically identical to those occurring naturally in urine. Citrate had no effect on the metastable limits of 3 urines examined, but markedly inhibited crystal growth. Pyrophosphate had a similar effect on crystal growth, and in addition, raised the metastable limit of one of the urine samples.     

尿干化学分析与尿液沉渣检查对尿路感染诊断价值的比较

目的:探讨尿路感染(UTI)检验的较好方法。方法:以UTI诊断的金标准为参照,对124例UTI住院患者中段尿进行尿干化学分析和尿沉渣WBC计数检验,并作对比分析。结果:尿沉渣镜检的灵敏度、阴性预计值、准确率分别为79.6%、88.5%、81.7%,而尿液干化学分析亚硝酸盐(NIT)或WBC的灵敏度、阴性预计值、准确率分别为63.3%、81.2%、76.8%。结论:在UTI的尿筛查试验中,尿沉渣镜检WBC计数比尿干化学分析NIT、WBC的诊断价值为优。     

A simple method for quantitating the propensity for calcium oxalate crystallization in urine

To assess the propensity for spontaneous crystallization of calcium oxalate in urine, the permissible increment in oxalate is calculated. The previous method required visual observation of crystallization with the addition of oxalate, this warranted the need for a large volume of urine and a sacrifice in accuracy in defining differences between small incremental changes of added oxalate. Therefore, this method has been miniaturized and spontaneous crystallization is detected from the depletion of radioactive oxalate. The new "micro" method demonstrated a marked decrease (p < 0.001) in the permissible increment in oxalate in urine of stone formers versus normal subjects. Moreover, crystallization inhibitors added to urine, in vitro (heparin or diphosphonate) or in vivo (potassium citrate administration), substantially increased the permissible increment in oxalate. Thus, the "micro" method has proven reliable and accurate in discriminating stone forming from control urine and in distinguishing changes of inhibitory activity.