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Topics in Spinal Cord Injury... 2023To explore the association between dipstick results and urinary symptoms. (Observational Study)
Observational Study
OBJECTIVES
To explore the association between dipstick results and urinary symptoms.
METHOD
This was a prospective 12-month observational study of real-time self-administered urine dipstick results and symptoms in a community setting that included 52 spinal cord injury/disease (SCI/D) participants with neurogenic lower urinary tract dysfunction (NLUTD) who use an indwelling catheter. Symptoms were collected using the Urinary Symptom Questionnaire for Neurogenic Bladder-Indwelling Catheter (USQNB-IDC). The USQNB-IDC includes actionable (A), bladder (B1), urine quality (B2), and other (C) symptoms; analyses focused on A, B1, and B2 symptoms. Dipstick results include nitrite (NIT +/-), and leukocyte esterase (LE; negative, trace, small, moderate, or large). Dipstick outcomes were defined as strong positive (LE = moderate/large and NIT+), inflammation positive (LE = moderate/large and NIT-), negative (LE = negative/trace and NIT-), and indeterminate (all others).
RESULTS
Nitrite positive dipsticks and moderate or large LE positive dipsticks were each observed in over 50% of the sample in every week. Strong positive dipstick results were observed in 35% to 60% of participants in every week. A, B1, or B2 symptoms co-occurred less than 50% of the time with strong positive dipsticks, but they also co-occurred with negative dipsticks. Participants were asymptomatic with a strong positive dipstick an average of 30.2% of the weeks. On average, 73% of the time a person had a negative dipstick, they also had no key symptoms (95% CI, .597-.865).
CONCLUSION
No association was observed between A, B1, and B2 symptoms and positive dipstick. A negative dipstick with the absence of key symptoms may better support clinical decision-making.
Topics: Humans; Urinary Tract Infections; Nitrites; Urinary Bladder; Prospective Studies; Predictive Value of Tests; Catheters, Indwelling; Spinal Cord Injuries; Spinal Cord Diseases
PubMed: 36819928
DOI: 10.46292/sci22-00095 -
Clinical and Experimental Nephrology Dec 2021Both frailty and chronic kidney disease (CKD) increase with age and share many similarities. Many studies have demonstrated an association between frailty and chronic...
BACKGROUND
Both frailty and chronic kidney disease (CKD) increase with age and share many similarities. Many studies have demonstrated an association between frailty and chronic kidney disease (CKD), but an association with dipstick proteinuria is limited.
METHODS
This is the cross-sectional analysis of the Nambu Cohort Study at the beginning of observation. Frailty was diagnosed using Kihon Checklist. Logistic analysis was used to evaluate the association between frailty and CKD or dipstick proteinuria.
RESULTS
Among a total of 630 outpatients [age, 78 (70-84) years, men, 50%], the prevalence of patients with pre-frailty and frailty was 32% and 40%, respectively. The proportion of patients with pre-frailty and frailty increased with decreasing estimated glomerular filtration rate (eGFR) and increasing dipstick proteinuria levels. The odds ratios (95% confidence intervals) for CKD stage of 60 < eGFR ≤ 45 ml/min/1.73 m, and 45 ml/min/1.73 m < eGFR for frailty was 0.87 (0.56-1.35) and 2.54 (1.46-4.53), respectively, compared with non-CKD as a reference. Furthermore, the odds ratios for the frailty of dipstick proteinuria with ± and + or over were 1.36 (0.88-2.09) and 1.78 (1.00-3.17), respectively, when dipstick proteinuria-was used as a reference. Moreover, the combination of eGFR and dipstick proteinuria levels increased the odds ratio for pre-frailty and frailty.
CONCLUSION
Elderly patients with CKD had a higher prevalence of pre-frailty and frailty. By adding urinary protein information to eGFR, the link between CKD and frailty becomes even more robust.
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Female; Frail Elderly; Frailty; Geriatric Assessment; Glomerular Filtration Rate; Humans; Japan; Kidney; Male; Prevalence; Prospective Studies; Proteinuria; Reagent Strips; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Urinalysis
PubMed: 34244892
DOI: 10.1007/s10157-021-02110-y -
Journal of Nephrology Apr 2021Urine samples can be readily obtained from patients in everyday clinical practice. Therefore, the availability of urine allows physicians to obtain relevant clinical... (Review)
Review
Urine samples can be readily obtained from patients in everyday clinical practice. Therefore, the availability of urine allows physicians to obtain relevant clinical information in a timely manner. Since the measurement of urinary protein levels is essential in diagnosing and treating a host of diseases, the potential detection of urinary proteins by urinary strips in an easy, quick, and cheap way is very attractive. However, to ensure optimal use of urinary strips, one needs to be aware of their characteristics and their limitations. In this review, we discuss the characteristics of the urinary strips available for testing urinary protein levels and for detecting urinary albumin. We then consider their analytical performances in their most widely used clinical applications (e.g., in pregnancy, chronic kidney disease, diabetes, and screening of the general population).
Topics: Albuminuria; Female; Humans; Mass Screening; Pregnancy; Proteinuria; Reagent Strips; Urinalysis
PubMed: 32328900
DOI: 10.1007/s40620-020-00735-y -
Clinical and Experimental Nephrology Feb 2020Urine dipstick tests are often used to evaluate proteinuria during health checkups. We examined the dipstick's accuracy in assessing the proteinuria levels among...
BACKGROUND
Urine dipstick tests are often used to evaluate proteinuria during health checkups. We examined the dipstick's accuracy in assessing the proteinuria levels among Japanese workers.
METHODS
We assessed subjects aged ≥ 18 years who had a health checkup at the University of Tokyo in 2016 or 2017 (n = 5383). Proteinuria was stratified by urine protein-to-creatinine ratio (PCR): A1, < 150 mg/gCre; A2, 150-499 mg/gCre; and A3, ≥ 500 mg/gCre. The accuracy of a dipstick result of ± or higher to detect a PCR level of ≥ A2 was examined. We compared changes in dipstick results and PCR level in 136 subjects evaluated twice with a median interval of 119 days.
RESULTS
The subjects' mean age was 40 years, and half were women. The dipstick results were - in 94.9%, ± in 4.1%, and ≥ 1 + in 1.0%. The PCR level was A1, A2, A3 in 98.6%, 1.2%, and 0.2% of the subjects, respectively. The sensitivity, specificity, and positive and negative predictive values of a ± or higher dipstick result to detect A2 or higher were 66.2%, 95.6%, 17.5%, and 99.5%, respectively. Among the 136 subjects examined twice, 134 (98.5%) had no change in PCR level (A1 in all cases) despite a decrease or increase in dipstick results.
CONCLUSION
Urine dipstick results of ± or above had a high specificity but low sensitivity and positive predictive value to detect PCR proteinuria of A2 or higher. Confirmation by quantitative protein measurement should be recommended for individuals at high risk of chronic kidney disease.
Topics: Biomarkers; Creatinine; Humans; Occupational Health; Predictive Value of Tests; Proteinuria; Reagent Strips; Renal Insufficiency, Chronic; Reproducibility of Results; Tokyo; Urinalysis
PubMed: 31734818
DOI: 10.1007/s10157-019-01809-3 -
Lancet (London, England) Sep 2023Chronic kidney disease (CKD) has a rising global prevalence and is expected to become the fifth leading cause of death by 2030. Increased albuminuria defines the early... (Randomized Controlled Trial)
Randomized Controlled Trial
Participation rate and yield of two home-based screening methods to detect increased albuminuria in the general population in the Netherlands (THOMAS): a prospective, randomised, open-label implementation study.
BACKGROUND
Chronic kidney disease (CKD) has a rising global prevalence and is expected to become the fifth leading cause of death by 2030. Increased albuminuria defines the early stages of CKD and is among the strongest risk factors for progressive CKD and cardiovascular disease. The value of population screening for albuminuria to detect CKD in an early phase has yet to be studied. We aimed to evaluate the effectiveness of two home-based albuminuria population screening methods.
METHODS
Towards Home-based Albuminuria Screening (THOMAS) was a prospective, randomised, open-label implementation study that invited Dutch adults aged 45-80 years for albuminuria screening. Individuals were randomly assigned (1:1) to screening by applying either a urine collection device (UCD) that was sent by post to a central laboratory for measurement of the albumin-to-creatinine ratio (ACR) by immunoturbidimetry or to screening via a smartphone application that measures the ACR with a dipstick method at home. Randomisation was done with a four-block method via a web-based system and was stratified by age, sex, and socioeconomic status. If two or more individuals per household were invited to participate, these individuals were randomly assigned to the same group. In case of confirmed increased albuminuria at home, participants were invited for an elaborate screening in a regional hospital (Amphia Hospital, Breda, Netherlands) for CKD and cardiovascular risk factors. When abnormalities were found, participants were referred to their general practitioner for treatment. The primary outcomes were the participation rate and yield of the home-based screening and elaborate screening. Participation rate was assessed in the intention-to-screen population (ie, all participants who were invited for the home-based screening or elaborate screening). Yield was assessed in the per-protocol population (ie, all individuals who participated in the home-based screening or elaborate screening). An exploratory analysis assessed the sensitivity and specificity of both home-based screening methods. To this end, an additional quantitative ACR test was performed among people participating in the elaborate screening, and a substudy was performed among participants with a first negative home-based screening test, who were invited for an additional test. The study is registered with ClinicalTrials.gov, NCT04295889.
FINDINGS
15 074 participants were enrolled between Nov 14, 2019, and March 19, 2021. 7552 (50·1%) were randomly assigned to home-based albuminuria screening by the UCD method and 7522 (49·9%) were assigned to albuminuria screening by the smartphone application method. The participation rate of the home-based screening was 4484 (59·4% [95% CI 58·3-60·5]) of the 7552 invited individuals for the UCD method and 3336 (44·3% [43·2-45·5]) of 7522 invited individuals for the smartphone application method (p<0·0001). Increased ACR was confirmed by home-based testing in 150 (3·3% [95% CI 2·9-3·9]) of 4484 individuals for the UCD method and 171 (5·1% [4·4-5·9]) of 3336 indivduals for the smartphone application method. 124 (82·7% [95% CI 75·8-87·9]) of 150 individuals assigned to the UCD method and 142 (83·0% [76·7-87·9]) of 171 participants assigned to the smartphone application method attended the elaborate screening. Sensitivity to detect increased ACR was 96·6% (95% CI 91·5-99·1) for the UCD method and 98·1% (89·9-99·9) for the smartphone application method, and specificity was 97·3% (94·7-98·8) for the UCD method and 67·9% (62·0-73·3) for the smartphone application method, indicating that the test characteristics of only the UCD method were sufficient for screening. Albuminuria, hypertension, hypercholesterolaemia, and decreased kidney function were newly diagnosed in 77 (62·1%), 44 (35·5%), 30 (24·2%), and 27 (21·8%) of 124 participants for the UCD method, respectively. Of the 124 participants assigned to the UCD method who completed elaborate screening, 111 (89·5%) were referred to their general practitioner for treatment because of newly diagnosed CKD or cardiovascular disease risk factors or known risk factors outside the target range.
INTERPRETATION
Home-based screening of the general population for increased ACR using a UCD had a high participation rate and correctly identified individuals with increased albuminuria and yet unknown or known but outside target range CKD and cardiovascular risk factors. By contrast, the smartphone application method had a lower at-home participation rate than the UCD method and the test specificity was too low to accurately assess individuals for risk factors during the elaborate screening. The UCD screening strategy could allow for an early start of treatment to prevent progressive kidney function loss and cardiovascular disease in patients with CKD.
FUNDING
Dutch Kidney Foundation, Top Sector Life Sciences & Health of the Dutch Ministry of Economic Affairs.
Topics: Humans; Albuminuria; Cardiovascular Diseases; Creatinine; Netherlands; Prospective Studies; Renal Insufficiency, Chronic; Middle Aged; Aged; Aged, 80 and over
PubMed: 37597522
DOI: 10.1016/S0140-6736(23)00876-0 -
European Journal of Clinical... Mar 2021Sensitivity and specificity of rapid antigen detection tests (RADTs) for detection of group A hemolytic streptococcus (GAS) vary. The purpose is to present the first...
Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care.
Sensitivity and specificity of rapid antigen detection tests (RADTs) for detection of group A hemolytic streptococcus (GAS) vary. The purpose is to present the first SKUP (Scandinavian evaluation of laboratory equipment for point of care testing) evaluations concerning the assessment of the diagnostic performance and user-friendliness of two RADTs for detection of GAS when used under real-life conditions in primary health care. Throat samples were collected in duplicates at primary health care centers (PHCCs) from patients with symptoms of pharyngitis. The performance of QuickVue Dipstick Strep A test (307 samples) and DIAQUICK Strep A Blue Dipstick (348 samples) was evaluated using culture results at a clinical microbiology laboratory as comparison. The user-friendliness was evaluated using a questionnaire. The diagnostic sensitivity was 92% (90% confidence interval (CI) 87-96%) and 72% (90% CI 65-79%), while the diagnostic specificity was 86% (90% CI 81-90%) and 98% (90% CI 96-99%) for QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick, respectively. Both RADTs obtained acceptable assessments for user-friendliness and fulfilled SKUP's quality goal for user-friendliness. The diagnostic sensitivity for QuickVue Dipstick Strep A test and the diagnostic specificity for DIAQUICK Strep A Blue Dipstick in this objective and supplier-independent evaluation were higher compared with previous meta-analyses of RADTs. However, the diagnostic specificity for QuickVue Dipstick Strep A test and the diagnostic sensitivity for DIAQUICK Strep A Blue Dipstick were lower compared with previous meta-analyses of RADTs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antigens, Bacterial; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Pharyngitis; Point-of-Care Testing; Primary Health Care; Prospective Studies; Reagent Kits, Diagnostic; Sensitivity and Specificity; Serologic Tests; Streptococcal Infections; Streptococcus pyogenes; Young Adult
PubMed: 32996031
DOI: 10.1007/s10096-020-04034-z -
Infectious Diseases (London, England) Oct 2019Urine cultures are usually obtained from 0- to 2-month-old febrile infants, while in older children they are obtained more selectively. In 3- to 23-month-old children,...
Urine cultures are usually obtained from 0- to 2-month-old febrile infants, while in older children they are obtained more selectively. In 3- to 23-month-old children, urinary tract infection (UTI) diagnosis requires both positive culture and dipstick, but data are scarce regarding 0- to 2-month-old infants. We assessed dipstick performance for UTI diagnosis in 0-2 vs. 3- to 23-month-old children. A case-control study, conducted between 2015 and 2016, in southern Israel. Sensitivity and specificity of urine dipstick for diagnosing UTI were assessed. We compared dipstick false-negative (FN) and true-positive (TP) groups; high FN rate indicates low sensitivity. Overall, 434 positive and 571 sterile urine culture episodes were included. Dipstick sensitivity was 63% in 0-2 month old children; 93% for supra-pubic aspiration (SPA), and ∼50% for non-SPA sampling method. However, sensitivity was >90% for 3-5 and 6- to 23-month-old children. In univariate analysis, younger age, hospitalization, lower temperature, short fever duration, lower leukocyte blood levels, neutrophils, stabs and C-reactive protein, and absent future UTI within <1 year were associated with FN compared with TP. In multivariate analysis, among positive culture episodes, age 0-2 months (odds ratio, OR = 6.60) and non-SPA sampling method (OR = 8.39) were associated with FN episodes. Dipstick lower sensitivity for diagnosing UTI in febrile infants 0-2 months old vs. their older counterparts, was associated with non-SPA sampling method, lower inflammatory markers, lower temperature and low risk for future UTI. This suggests that positive culture in negative dipstick episodes may not reflect a true UTI.
Topics: Aged; Case-Control Studies; Diagnostic Tests, Routine; Female; Fever; Humans; Infant; Infant, Newborn; Israel; Male; Sensitivity and Specificity; Urinary Tract Infections; Urine
PubMed: 31418615
DOI: 10.1080/23744235.2019.1652339 -
Clinical Microbiology and Infection :... Feb 2022Cholera is an acute diarrheal disease caused by Vibrio cholerae O1 or O139. Cholera rapid diagnostic tests (RDTs) are widely used to screen for cholera cases. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cholera is an acute diarrheal disease caused by Vibrio cholerae O1 or O139. Cholera rapid diagnostic tests (RDTs) are widely used to screen for cholera cases. However, their accuracy has not been systematically reviewed.
OBJECTIVES
To evaluate the diagnostic accuracy of cholera RDTs.
METHODS
Systematic review and meta-analysis.
DATA SOURCES
Medline, EMBASE and Web of science through to November 2020; references of included studies and a technical guidance on cholera RDTs. This review is registered with PROSPERO (CRD42021233124).
STUDY ELIGIBILITY CRITERIA
Cross-sectional studies comparing the performance of cholera RDTs either to stool culture or PCR.
PARTICIPANTS
Individuals with clinically suspected cholera.
DATA EXTRACTION
Two authors independently extracted data and assessed the quality using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria.
RESULTS
Eighteen studies were included in the systematic review of which 17 were used for meta-analysis. Crystal VC was the most frequently used RDT (13 studies), followed by Cholkit and Institut Pasteur cholera dipstick (three studies each), SD Bioline (two studies), Artron (one study) and Smart (one study). Using direct testing (n = 12 627 specimens), the bivariate random-effects model yielded a pooled sensitivity and specificity of 91% (95% CI 87%-94%) and 80% (95% CI 74%-84%), respectively. However, through alkaline peptone water (APW) enrichment (n = 3403 specimens), the pooled sensitivity and specificity were 89% (95% CI 79%-95%) and 98% (95% CI 95%-99%), respectively.
CONCLUSION
Cholera RDTs, especially when enriched with APW, have moderate sensitivity and specificity. Although less useful for clinical management, the current generation of RDTs have clear utility for surveillance efforts if used in a principled manner. Enrichment of stool specimens in APW before using cholera RDTs reduces the possibility of obtaining false-positive results, despite the few cholera cases that go undetected. It is noteworthy that APW-enriched cholera RDTs are not necessarily rapid tests, and are not listed in the Global Task Force on Cholera Control/WHO target product profile.
Topics: Cholera; Cross-Sectional Studies; Humans; Reagent Kits, Diagnostic; Sensitivity and Specificity; Vibrio cholerae O1
PubMed: 34506946
DOI: 10.1016/j.cmi.2021.08.027 -
The Journal of Antimicrobial... Aug 2023Given the lack of accurate rapid diagnostics for urinary tract infection (UTI) in women, many countries have developed guidelines aiming to support appropriate... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Given the lack of accurate rapid diagnostics for urinary tract infection (UTI) in women, many countries have developed guidelines aiming to support appropriate antibiotic prescribing, but some guidelines have not been validated. We performed a diagnostic accuracy validation study of two guidelines: Public Health England (GW-1263) and Scottish Intercollegiate Guidelines Network (SIGN160).
METHODS
We used data from women with symptoms suggestive of uncomplicated UTI from a randomized controlled trial comparing urine collection devices. Symptom information was recorded via baseline questionnaire and primary care assessment. Women provided urine samples for dipstick testing and culture. We calculated the number within each risk category of diagnostic flowcharts who had positive/mixed growth/no significant growth urine culture. Results were presented as positive/negative predictive values, with 95% CIs.
RESULTS
Of women aged under 65 years, 311/509 (61.1%, 95% CI 56.7%-65.3%) classified to the highest risk category (recommended to consider immediate antibiotic prescribing) and 80/199 (40.2%, 95% CI 33.4%-47.4%) classified to the lowest risk category (recommended to reassure that UTI is less likely) by the GW-1263 guideline (n = 810) had positive culture. For the SIGN160 guideline (n = 814), the proportion with positive culture ranged from 60/82 (73.2%, 95% CI 62.1%-82.1%) in those for whom immediate treatment was indicated to 33/76 (43.4%, 95% CI 32.3%-55.3%) in those recommended a self-care/waiting strategy.
CONCLUSIONS
Clinicians should be aware of the potential for diagnostic error when using diagnostic guidelines for managing uncomplicated UTI and making antimicrobial prescribing decisions. Infection cannot be excluded on the basis of symptoms and dipstick testing alone.
Topics: Humans; Female; Urinalysis; Urinary Tract Infections; Anti-Bacterial Agents; Predictive Value of Tests; Primary Health Care
PubMed: 37401673
DOI: 10.1093/jac/dkad212 -
Nephrologie & Therapeutique Dec 2022Peritoneal dialysis is the treatment of choice for end-stage renal disease. Peritoneal dialysis related peritonitis is of great importance for patient and technical...
Automated complete blood counter, urine analyzer and urine dipstick test results are correlated with thoma cell counting chamber counts in the diagnosis of dialysis related peritonitis in children.
INTRODUCTION
Peritoneal dialysis is the treatment of choice for end-stage renal disease. Peritoneal dialysis related peritonitis is of great importance for patient and technical survival. The aim of our study was to evaluate the accuracy and the correlation between the three methods (complete blood count, urinalysis device, urine dipstick test) and with the reference manual method (Thoma Cell Counter Chamber).
MATERIALS AND METHODS
We retrospectively analyzed 167 peritoneal fluid samples taken from 25 patients receiving peritoneal dialysis treatment. Leukocyte counts were evaluated with Thoma Cell Counter Chamber, complete blood count, urinalysis device and urine dipstick test.
RESULTS
There was a significant positive correlation between Thoma Cell Counter Chamber and complete blood count results (Spearman's rho=0.70), between Thoma Cell Counter Chamber and urinalysis device (Spearman's rho=0.73), and between Thoma Cell Counter Chamber and urine dipstick test (Spearman's rho=0.71). Area under curve for complete blood count, urinalysis device and urine dipstick test were 0.93, 0.94 and 0.89 respectively, indicating good accuracy. Sensitivity and specificity were 89.7% and 86.7% in the complete blood count analysis (associated criterion: 130 cells/mm). Sensitivity and specificity were 89.7% and 86.7% in the urinalysis device (associated criterion: 10 cells/HPF). Sensitivity and specificity were 79.6% and 91.4% when in the urine dipstick test analysis (associated criterion: +1 positivity). The Bland-Altman plot showed good agreement.
CONCLUSION
Automatic complete blood count and urinalysis devices have good correlation and agreement with manual method in the diagnosis of peritonitis in the pediatric age group. Urine dipstick test in the home setting can be useful for screening patients with suspected peritonitis.
Topics: Child; Humans; Retrospective Studies; Urinalysis; Peritonitis; Leukocyte Count; Sensitivity and Specificity
PubMed: 36435740
DOI: 10.1016/j.nephro.2022.10.001