Urine Analysis: Liquid biopsy of the urinary tract
By

DR. Ashraf Abdel-Basset Ass. Prof. in Pediatrics Mansoura Faculty of Medicine

• Pyuria • Hematuria • Proteinuria • Crystaluria .

000 colony-forming units (CFU) in freshly voided urine mostly used as the cutoff point between contamination and true bacteriuria. . Bacteriuria: •Bacteria in bladder urine. Growth of 100.Terminology Pyuria: •> 10 cells/HPF of centrifuged urine sample. Urinary tract infection (UTI): •Heterogeneous group of conditions in which there is growth of bacteria in the urinary tract.

• Enzymatic tests. . • Others.Diagnosis of UTI • Urine culture. • Urine analysis.

Diagnosis of UTI Urine culture Culture of properly collected specimen of urine .

. or suprapubic aspiration.Diagnosis of UTI Urine collection • No urinary control: catheterization or suprapubic aspiration. • Urinary control: midstream clean-catch. catheterization.

Catheterization Midstream clean-void Midstream clean-void . Asymptomatic patients: at least two specimens on different days with  105 CFU/mL of the same organism. 105 CFU/mL.Diagnosis of UTI Urine culture interpretation Growth of single urinary pathogen Methods of collection Suprapubic aspiration Quantitative culture: UTI present Any number (the exception is up to 23x103 CFU/mL of coagulase-negative staphylococci). Infection may be present with counts from 10 x 103 to 50 x 103 CFU/mL.  50 x 103 CFU/mL.

alkaline urine. Sensitivity: 89%. observer error. Varies with volume of sample. • Others: Hematuria. duration of centrifugation. • Bacteriuria: Gram stain. WBCs casts. volume of resuspension.Diagnosis of UTI Urine analysis • Pyuria:    > 10 cells/HPF of centrifuged urine sample. .

. • Sensitivity:   10 leukocytes/mm3  52.9%. 20 leukocytes/mm3  66.Diagnosis of UTI Enzymatic tests Leukocyte esterase test: • Principle:  Detects esterase in neutrophils  demonstrates the presence of pyuria.7%.

• Sensitivity:  29.44.2 .Diagnosis of UTI Enzymatic tests Nitrite test: • Principle:  Nitrate Bacteria 4h Nitrite + dye  Red azo.9% .

Change pH of the urine. Double or triple micturation. Complete evacuation of the bladder especially before going to bed at night:   Frequent micturation. B. C. .How to treat? General measures A. Water and fluid intake should be encouraged.

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• Microscopic:   Centrifuged sample: RBCs > 5/HPF. Uncentrifuged sample: RBCs > 5/mm3 • Addis count > 240.00 RBCs in 12 hour urine. .Hematuria Definitions • Dipstick:  Color change.

Thorough history taking. Investigation. Confirmation of the presence of hematuria. . 3. • Determination of the cause of hematuria: 1. 2.Work Up • • Exclusion of the other causes of discolored urine. Careful examination.

Confirmation of the presence of hematuria. 3. Investigation. Thorough history taking. .Work Up • • • Exclusion of other causes of discolored urine. 2. Careful examination. Determination of the cause of hematuria: 1.

Causes of discolored urine Pink. red. tea-colored Disease states Ingestion * Hemoglobinuria * Myoglobinuria * Porphyrinuria * Serratia marcescens * Bile pigments * Urates * Aminopyrine * Anthrocyans * Azathioprine * Azo dyes * Beets * Benzene * Blackberries * Chloroquine * Desferroxamine * Rhodamine B * Diphenylhydantoin * Ibuprofen * Lead * Methyldopa * Nitrofurantoin * Phenazopyridine * Phenolphthalein * Rifampin * Sulfasalazine .

black Disease states Ingestion * Alkaptonuria * Homogentisic acid * Melanin * Methemoglobinuria * Tyrosinosis * Alanine * Cascara * Resorcinol * Thymol .Causes of discolored urine Dark brown.

3. Investigation. Confirmation of the presence of hematuria. Careful examination. . Determination of the cause of hematuria: 1.Work Up • Exclusion of other causes of discolored urine. 2. • • Thorough history taking.

1%) 142 (1. J Pediatr 95:676.Confirmation of the presence of hematuria 2-3 UA over 2-3 weeks period • Studied • Hematuria: 8954 children 364 (4.. 1979 1st sample 2nd sample .6%) Vehaskari et al.

“Bubbles on the surface of the urine are a sign of disease of the kidneys….” Hippocrates .

Proteinuria Definitions: < 4mg/m2/h < day > night Normal Proteinuria mg/24h 40% alb. 15% Igs.H prt. 5% others . 40% T.

+2: 100 mg/dl • Sulphosalicylic acid:  5ml of urine + 3 drops of 20% of the acid  turbidity Non-nephrotic: < 2 years: > 0.Proteinuria Definitions Significant • Dipistick:   Trace: 10 mg/dl +3: 300 mg/dl +1: 30 mg/dl +4: >1 g/dl.5 >2 years: > 0.2 Nephrotic: 3 Non-nephrotic Nephrotic 4-40 mg/m2/h > 40 mg/m2/h • Protein / creatinine ratio:   • Quantitative:   .

. • Confirmation of the presence of proteinuria.Work Up • Exclusion of the other causes of +ve tests. • Differentiation between different types of proteinuria. • Determination of the cause of proteinuria.

Work Up • Exclusion of other causes of +ve tests. • Determination of the cause of proteinuria. . • Confirmation of the presence of proteinuria. • Differentiation between different types of proteinuria.

cephalosporins Metabolites of sulfonamide Tolbutamide Tolemtin .False +ve Tests for Proteinuria Dipstick Highly concentrated urine Highly alkaline buffered urine (pH>8) Gross hematuria Pyuria Skin cleanser chlorhexidine Quarternary ammonium compounds Phenazopyridine Sulfosalicylic acid Highly concentrated urine Gross hematuria Pyuria Radiologic contrast media High levels of penicillin.

• Determination of the cause of proteinuria. • Confirmation of the presence of proteinuria. .Work Up • Exclusion of other causes of +ve tests. • Differentiation between different types of proteinuria.

Drugs 5. congestive heart failure. emotional stress. 2. exposure to cold. ect….Acquired.Infection 3. II.Primary or idiopathic.Multisystem 4.Glomerular: 1.Tubular: C. III. exercise-induced. 2.Secondary: 1.Neoplasm B. b.Transient: Fever.Orthostatic.Congenital or hereditary. seizures. epinephrine infusion.Acquired: a. 2.Overload: * Light chains * Myoglobin * Lysozyme * Hemoglobin .Congenital or hereditary.Persistent: A.Causes of Proteinuria I.Miscellaneous 1.

+ve -ve • Mild glomerular abnormalities in 50% of cases. • Prognosis is good. • Diagnosis: 7am-10pm 10pm-7am • Rarely >1g/24h urine. . • ? Hemodynamic changes.Orthostatic Proteinuria • 2-5% of adolescents.

Ur prt electrophoresis Alb/B2 microglobulin (ng/mg) Tubular functions Mild severe +ve Mainly albumin 1000-15.000 Normal <1 g/day -ve LMW band <300 Abnormal .Glomerular vs tubular Glomerular Tubular Quantity Dipsticks for prt.

Routine medical follow-up Initial positive dipstick test for urinary protein Obtain two additional urines Two of three urines positive Identifiable non-renal cause? No Additional evidence for renal disease Yes No Symptomatic Specific evaluation .BUN.ASO. chol. Anti-Dnase B .C3.Evaluation of isolated proteinuria Negative .Renal imaging . electr.Streptozyme . C4..ANA. .Urine culture .Renal biopsy (consider) Asymptomatic Orthostatic test Persistent nonorthostatic proteinuria Orthostatic proteinuria Repeat test in one year Absent or intermittent proteinuria Repeat urinalysis in one month Negative No further evaluation Positive Continue follow up . total prt.Reassure . alb.CBC. anti-DNA . C3 .Measurement of GFR . ESR . Cr.

3 • All children with 1st documented UTI should be evaluated by renal sonography .UTI • Urine culture is the golden standard method 1 for the diagnosis of UTI • Acute pyelonephritis usually presents with 2 extrarenal manifestations especially in young infants.

Hematuria 1 2 • Exclude other causes of discolored urine • Confirm the presence of hematuria • Serious sings:  Hypertension and or edema  Proteinuria  RBCs casts  +ve family history of progressive renal disease 3 .

Proteinuria 1 2 • Exclude causes of false positive test • Confirm the presence of proteinuria • Serious sings:  Hypertension and or edema  Hematuria  +ve family history of progressive renal disease 3 .

Crystaluria 1 • Many of the crystals found in urine are of limited clinical significance except in:   Metabolic disorders Calculus formation .

Urine analysis is the liquid biopsy of the urinary tract .

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