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Kidney360 Mar 2022Autosomal dominant polycystic kidney disease (ADPKD) has phenotypic variability only partially explained by established biomarkers that do not readily assess...
BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) has phenotypic variability only partially explained by established biomarkers that do not readily assess pathologically important factors of inflammation and kidney fibrosis. We evaluated asymptomatic pyuria (AP), a surrogate marker of inflammation, as a biomarker for disease progression.
METHODS
We performed a retrospective cohort study of adult patients with ADPKD. Patients were divided into AP and no pyuria (NP) groups. We evaluated the effect of pyuria on kidney function and kidney volume. Longitudinal models evaluating kidney function and kidney volume rate of change with respect to incidences of AP were created.
RESULTS
There were 687 included patients (347 AP, 340 NP). The AP group had more women (65% versus 49%). Median ages at kidney failure were 86 and 80 years in the NP and AP groups (log rank, =0.49), respectively, for patients in Mayo Imaging Class (MIC) 1A-1B as compared with 59 and 55 years for patients in MIC 1C-1D-1E (log rank, =0.02), respectively. Compared with the NP group, the rate of kidney function (ml/min per 1.73 m per year) decline shifted significantly after detection of AP in the models, including all patients (-1.48; <0.001), patients in MIC 1A-1B (-1.79; <0.001), patients in MIC 1C-1D-1E (-1.18; <0.001), and patients with (-1.04; <0.001). Models evaluating kidney volume rate of growth showed no change after incidence of AP as compared with the NP group.
CONCLUSIONS
AP is associated with kidney failure and faster kidney function decline irrespective of the ADPKD gene, cystic burden, and cystic growth. These results support AP as an enriching prognostic biomarker for the rate of disease progression.
Topics: Adult; Biomarkers; Disease Progression; Female; Glomerular Filtration Rate; Humans; Inflammation; Kidney Failure, Chronic; Polycystic Kidney, Autosomal Dominant; Prognosis; Pyuria; Retrospective Studies
PubMed: 35582184
DOI: 10.34067/KID.0004292021 -
The American Journal of Emergency... Jan 2024Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence.
DISCUSSION
Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care.
CONCLUSIONS
An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
Topics: Humans; Prevalence; Urinary Tract Infections; Pyuria; Pyelonephritis; Urolithiasis
PubMed: 37950981
DOI: 10.1016/j.ajem.2023.10.049 -
Pediatrics Jul 2024Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis...
OBJECTIVES
Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida.
METHODS
Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI.
RESULTS
We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others.
CONCLUSIONS
Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.
Topics: Humans; Retrospective Studies; Cross-Sectional Studies; Urinary Tract Infections; Urinalysis; Female; Male; Child; Spinal Dysraphism; Child, Preschool; Adolescent; Infant; Carboxylic Ester Hydrolases; Sensitivity and Specificity; Pyuria; Nitrites; Meningomyelocele; ROC Curve
PubMed: 38845550
DOI: 10.1542/peds.2023-065192 -
The Western Journal of Emergency... Jul 2019Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal... (Review)
Review
INTRODUCTION
Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects.
METHODS
We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin.
RESULTS
Serum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness.
CONCLUSION
In the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.
Topics: Aged; Asymptomatic Diseases; Bacteriuria; Biomarkers; Emergency Service, Hospital; Humans; Procalcitonin; Urinary Tract Infections
PubMed: 31316695
DOI: 10.5811/westjem.2019.5.42096 -
Journal of Personalized Medicine Aug 2021Chronic kidney disease (CKD) is considered a major health problem, which poses a burden for health care systems worldwide. It has been estimated that 10% of the...
Chronic kidney disease (CKD) is considered a major health problem, which poses a burden for health care systems worldwide. It has been estimated that 10% of the population worldwide have CKD; however, most of the cases are undiagnosed. If left untreated, CKD could lead to kidney failure, which highlights the importance of early diagnosis and treatment. Pyuria has been reported in CKD patients, and could be the result of several comorbidities, such as diabetes, or urinary tract infections (UTIs). A few studies have shown that pyuria is associated with the late stages of CKD. However, there are limited data on the prevalence of non-UTI (sterile) and UTI-pyuria in different CKD patient populations, and its association with the decline in kidney function and progression of CKD. In this retrospective study, we report the prevalence of pyuria (sterile and UTI) in 754 CKD patients of King Fahd Specialist Hospital, Buraydah, Saudi Arabia. Our data showed that 164/754 CKD patients (21.8%) had pyuria, whereas 590 patients (78.2%) presented with no pyuria. There was a significantly higher percentage of late-stage (stage 4) CKD patients in the pyuric group compared to the non-pyuric group (36.6% vs. 11.9%). In line with the previous data, proteinuria was detected in a significantly higher percentage of pyuric patients, in addition to significantly higher levels of serum creatinine and urea, compared to non-pyuric patients. Furthermore, 13.4% of the pyuric CKD patients had UTI, whereas 86.6% presented with sterile pyuria. was indicated as the causative agent in 45.5% of UTI patients. Our patient data analysis showed that a significantly higher percentage of UTI-pyuric CKD patients, than sterile pyuric patients (63.6% vs. 19.7%), had higher numbers of urinary white blood cells (>50/HPF, WBCs). The data also showed that a higher percentage of UTI-pyuric patients were late-stage CKD patients, compared to sterile pyuric patients (50% vs. 34.5%). Our findings indicate that a high level of pyuria could be considered as a marker for late-stage CKD, and that UTI is an important risk factor for the decline in kidney function and the progression to late-stage CKD. We believe that further studies are needed to correlate pyuria to kidney function, which could be helpful in monitoring the progression of CKD. Moreover, the management of comorbidities, such as diabetes and UTIs, which are risk factors for CKD and associated pyuria, could help to control the progression of CKD to the late stages.
PubMed: 34575608
DOI: 10.3390/jpm11090831 -
Saudi Journal of Kidney Diseases and... 2021Since the initial times of renal transplantation in the 1950s, understanding various aspects influencing graft survival and outcome have been progressively improving.... (Review)
Review
Since the initial times of renal transplantation in the 1950s, understanding various aspects influencing graft survival and outcome have been progressively improving. However, infections especially urinary tract infections (UTIs), are an important factor leading to an increase in morbidity and graft failure. UTI degrades the health-related quality of life and can potentially impair graft function. UTI occurs in 25% of kidney transplant recipients within one year of transplant and accounts for 45% of infectious complications. Asymptomatic bacteriuria (ASB), uncomplicated UTI, and complicated UTI comprise 44%, 32%, and 24% of cases, respectively. This article reviews important aspects regarding posttransplant UTI, including definition, incidence, predisposing factors, recommendations, ASB, and controversies in management. UTI after renal transplantation is still an under-estimated aspect, despite its degrading effects on allograft and recipient health.
Topics: Bacteriuria; Humans; Kidney Transplantation; Postoperative Complications; Pyuria; Quality of Life; Risk Factors; Transplant Recipients; Urinary Tract Infections
PubMed: 35017323
DOI: 10.4103/1319-2442.335441 -
Annals of Coloproctology Jul 2021Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and...
Meckel diverticulum is a common congenital malformation of the gastrointestinal tract and can cause complications such as ulceration, hemorrhage, intussusception, and perforation. This report describes a very rare complication of an enterovesical fistula associated with chronic Meckel diverticulum. A 51-year-old male presented with over 10 years of persistent pyuria. Tests were performed to rule out malignancy, including serum prostate-specific antigen level, urine cytology, bacterial culture, cystoscopy, and bladder computed tomography. An enterovesical fistula was identified, and laparoscopic exploration was performed. The findings suggested enterovesical fistula formation caused by chronic inflammation at the tip of a Meckel diverticulum. Segmental resection of the small bowel including the diverticulum and primary repair of the urinary bladder along with partial cystectomy were performed. The postoperative clinical course was uneventful. An enterovesical fistula is a very rare complication resulting from chronic inflammation of a Meckel diverticulum.
PubMed: 32178494
DOI: 10.3393/ac.2019.01.18 -
Australian Journal of General Practice Apr 2021Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
BACKGROUND
Recurrent urinary tract infections (rUTIs) and recurrent cystitis symptoms without infection occur commonly in women and present frequently in general practice.
OBJECTIVE
The aim of this article is to provide a management approach to the assessment and treatment of recurrent cystitis symptoms in women with rUTIs as well as women who have negative urine cultures.
DISCUSSION
Five common clinical scenarios are discussed with different approaches to treatment: true rUTIs with positive urine cultures, women with variable urine cultures (some positive and some negative), women with negative urine cultures who have pyuria +/- haematuria, women with completely normal urine cultures and women with ongoing symptoms after a definite UTI. Red flags signalling the need for early referral to a urologist for further assessment are discussed. Both non-antibiotic and antibiotic-related strategies to treat women with rUTIs are available.
Topics: Anti-Bacterial Agents; Cystitis; Female; Humans; Recurrence; Urinalysis; Urinary Tract Infections
PubMed: 33786541
DOI: 10.31128/AJGP-11-20-5728 -
Infection Control and Hospital... Feb 2023Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance...
BACKGROUND
Clinicians and laboratories routinely use urinalysis (UA) parameters to determine whether antimicrobial treatment and/or urine cultures are needed. Yet the performance of individual UA parameters and common thresholds for action are not well defined and may vary across different patient populations.
METHODS
In this retrospective cohort study, we included all encounters with UAs ordered 24 hours prior to a urine culture between 2015 and 2020 at 3 North Carolina hospitals. We evaluated the performance of relevant UA parameters as potential outcome predictors, including sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria and used receiver operating curves to identify the 5 best-performing models for predicting significant bacteriuria (≥100,000 colony-forming units of bacteria/mL).
RESULTS
In 221,933 encounters during the 6-year study period, no single UA parameter had both high sensitivity and high specificity in predicting bacteriuria. Absence of leukocyte esterase and pyuria had a high NPV for significant bacteriuria. Combined UA parameters did not perform better than pyuria alone with regard to NPV. The high NPV ≥0.90 of pyuria was maintained among most patient subgroups except females aged ≥65 years and patients with indwelling catheters.
CONCLUSION
When used as a part of a diagnostic workup, UA parameters should be leveraged for their NPV instead of sensitivity. Because many laboratories and hospitals use reflex urine culture algorithms, their workflow should include clinical decision support and or education to target symptomatic patients and focus on populations where absence of pyuria has high NPV.
Topics: Female; Humans; Pyuria; Bacteriuria; Urinary Tract Infections; Retrospective Studies; Urinalysis; Reflex; Urine
PubMed: 36625063
DOI: 10.1017/ice.2022.315