NITRITE

CLINIICAL SIGNIFICANCE
 Urine screening for nitrite provides an important tool to identify urinary tract infection
Cystitis- infection of the urinary bladder
Pyelonephritis- infection of the renal pelvis and tubules
Two pathways for the development of UTI are possible:
(1) The movement of bacteria from the urethra into the bladder (ascending infection)
(2) Movement of bacteria from the bloodstream into the kidneys and urinary tract
* Ascending infection is represent the more prevalent type of UTI
The most common infecting microorganism is Escherichia coli, followed by: Proteus spp., Enterobacter spp., and
Klebsiella spp.
 Urinary tract infection occur eight times more often in females than males. In addition, catheterized individuals,
regardless of gender, have high incidence of infection
 Normally the urine and the bladder are sterile due to the flushing action. UTI can begin as the result of urinary
obstruction (tumor), bladder dysfunction, or urine stasis
 Once bacteria have established a bladder infection (cystitis), ascension to the kidneys is possible but not
inevitable
 Urinary tract infection can be asymptomatic, particularly in the elderly, and the nitrite test provides a means of
identifying these patients
 Screening for urine nitrite and leukocyte esterase provides a means of identifying patients with bacteriuria
 Normally nitrates are consumed in the diet and are excreted in the urine without nitrite formation
 When nitrate reducing bacteria are infecting the urinary tract and adequate bladder time is allowed, these
bacteria convert nitrates to nitrite
 Factors that affect nitrite formation and detection include the following:
(1) The infecting microbe must be a nitrate producer
(2) Adequate time (minimum of 4 hours) must be allowed between voids for bacterial conversion of nitrate to
nitrite
(3) Adequate dietary nitrate must be consumed and available for conversion
In addition, nitrite detection can be reduced by subsequent conversion of bacteria by nitrite to nitrogen, or by
antibiotic therapy that inhibits bacterial conversion of nitrate to nitrite
 To appropriately screen for nitrite, the urine specimen of choice is a first morning void or a specimen collected
after the urine has been retained in the bladder for at least 4 hours
 The sensitivity of the reagent strip test is such that the presence of approximately 1x10 5 organism or more
produces a positive result in most cases
USE FINDINGS
Screening for UTI*  Positive test indicates possible UTI
 Bladder- cystitis
* Organisms that do not reduce nitrate to nitrite are  Kidney- pyelonephritis
not detected, such as non-nitrate reducing bacteria,  Urethra- urethritis
yeast, Trichomonads, and Chlamydia  In combination with leukocyte esterase test,
identifies urine specimens that should proceed to
urine culture

Monitor treatment effectiveness Repeat testing after antibiotic therapy to screen

for on-going presence of nitrate-reducing
bacteria
LEUKOCYTE ESTERASE
 The chemical test for leukocytes offers a more standardized means for the detection of leukocytes
 The test is not designed to measure the concentration of leukocytes
 An advantage to the chemical LE test is that it detects the presence of leukocytes that have been lysed,
particularly in dilute alkaline urine, and would not appear in the microscopic examination

CLINICAL SIGNIFICANCE
 Normal values for leukocytes based on the microscopic examination vary from 0-2 or 0-5 per hpf
 Women tend to have higher numbers as aresult of vaginal contamination
 Increased urinary leukocytes are indicators of UTI
 The LE test detects the presence of esterase in the granulocytic white blood cells (neutrophils, eosinophils,
and basophils) and monocytes
 Neutrophils are the leukocytes most frequently associated with bacterial infections
 Esterases are also present in Trichomonas, and histiocytes
 Lymphocytes, RBC, bacteria, and renal tissue cells do not contain esterases
 A positive LE result is most frequently accompanied by the presence of bacteria, which may or may not
produce a positive nitrite reaction
 Infections caused by Trichomonas, Chlamydia, yeast, and inflammation of the renal tissues (interstitial
nephritis) produce leukocyturia without bacteria
 Screening specimens using the LE and nitrite chemical reactions to determine the necessity of performing
urine cultures can be cost-effective measure
 The LE test contributes significantly more to the reliability of this practice than does the nitrite test

SUMMARY OF CLINICAL SIGNIFICANCE OF URINE LEUKOCYTES

1. Bacterial and non-bacterial UTI
2. Inflammation of the urinary tract
3. Screening of urine culture specimens