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Iranian Journal of Kidney Diseases Mar 2017Renal involvement is a rare complication of β-thalassemia. Both tubular and glomerular dysfunction might occur in these patients. The aim of this study was to evaluate... (Comparative Study)
Comparative Study
INTRODUCTION
Renal involvement is a rare complication of β-thalassemia. Both tubular and glomerular dysfunction might occur in these patients. The aim of this study was to evaluate and compare kidney function in the major, intermedia, and minor variants of β-thalassemia.
MATERIALS AND METHODS
Renal tubular and glomerular function of 72 patients with β-thalassemia (25 major, 23 intermedia, and 24 minor) were evaluated. Patients older than 40 years and those with chronic kidney disease, diabetes mellitus, congestive heart failure, associated infections, congenital anomalies of the kidney and urinary tract were excluded. Blood and urine samples were collected electrolytes and markers of kidney function.
RESULTS
Mean age at the time of study was significantly higher in the minor group. The majority of patients with thalassemia major were males. Hematuria and pyuria occurred in 4% to 8% of the patients. Serum level of all variables were within normal limits, with no significant difference between the three groups. Glomerular filtration rate was nonsignificantly higher in the major and intermedia groups, compared to the minor variant. A significantly lower urine phosphorus and uric acid excretion was noted with the minor variant. Urine phosphorus and uric acid excretion increased more frequently in the major and intermedia groups.
CONCLUSIONS
Tubular and glomerular functions appear to be well preserved in all variants of β-thalassemia.
Topics: Adolescent; Adult; Child; Creatinine; Cross-Sectional Studies; Female; Glomerular Filtration Rate; Hematuria; Humans; Iran; Male; Middle Aged; Nephrons; Pyuria; Uric Acid; Young Adult; beta-Thalassemia
PubMed: 28270645
DOI: No ID Found -
Journal of Microbiology, Immunology,... May 2024Urine leukocyte count under microscopy is one of the most frequently used routine screening tests for urinary tract infection (UTI). Nevertheless, it is observed that...
BACKGROUND
Urine leukocyte count under microscopy is one of the most frequently used routine screening tests for urinary tract infection (UTI). Nevertheless, it is observed that pyuria is lacking in 10-25% of children with UTI. This study aims to determine the factors related to pyuria-negative UTI in young infants aged under four months old.
METHOD
This retrospective cross-sectional study was conducted on 157 patients aged under 4 months old with UTI. All subjects had paired urinalysis and urine culture, which were collected via transurethral catheterization. According to the results of their urinalysis, the patients were then classified as UTI cases with pyuria and UTI cases without pyuria. The clinical characteristics and outcomes of both groups were analyzed.
RESULT
Among the 157 UTI patients, the prevalence of pyuria-negative UTI was 44%. Significant risk factors associated with pyuria-negative UTI included non-E.coli pathogens, younger age, shorter duration of fever prior to hospital visit, lower white blood cell (WBC) count upon hospital visit, and absence of microscopic hematuria.
CONCLUSIONS
We found that non-E.coli uropathogens were the strongest factor related to pyuria-negative UTI. The absence of pyuria cannot exclude the diagnosis of UTI in young infants, and it's reasonable to perform both urinalysis and urine culture as a part of the assessment of febrile or ill-looking young infants.
PubMed: 38845335
DOI: 10.1016/j.jmii.2024.05.008 -
International Journal of Preventive... 2019Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of...
BACKGROUND
Urinary tract infection (UTI) is a common reason for referral to the emergency department (ED) especially in unwell infants. Upper UTIs are particularly at risk of significant complications later in life. Rapid dipstick urinalysis and microscopy are often used in unwell children as a screening tool to guide early diagnosis and treatment. This study aims to evaluate the sensitivity of dipstick urinalysis and microscopy in the diagnosis of UTI.
METHODS
A retrospective review of children aged 16 years and below with positive urine culture (UC) over a 3-year period was done. The results of urine dipstick and microscopy were compared with the positive UC and sensitivities calculated.
RESULTS
Dipstick urinalysis and microscopy of 262 children were studied. Female-to -male ratio of 1.8:1. Median age was 0.79 (range: 0.02-15.95) years. The sensitivity of nitrite, blood, and leukocyte esterase (LE) were 0.54, 0.74, and 0.86 (95% confidence interval [CI] = 0.46-0.62, 0.68-0.80, and 0.82-0.91), respectively. The sensitivity of pyuria of ≥100 cells/mm was 0.92 (95% CI = 0.89-0.95). The presence of any of the 3 dipstick parameters increased the sensitivity to 0.97 (95% CI = 0.95-0.99). The lowest sensitivity 0.49 (95% CI = 0.40-0.58) was found with combined positive LE and nitrite. There was a significant comparison between positive LE dipstick test and pyuria ( = 0.000004).
CONCLUSIONS
Dipstick urinalysis may not be reliable in ruling out UTI in children. However, considering both positive dipstick and pyuria will be more useful in making the diagnosis.
PubMed: 31198497
DOI: 10.4103/ijpvm.IJPVM_353_17 -
Archives of Disease in Childhood Apr 1992Over a period of 33 months in a paediatric accident and emergency department, the clinical pattern and possible causes of vulvovaginitis were studied prospectively in...
Over a period of 33 months in a paediatric accident and emergency department, the clinical pattern and possible causes of vulvovaginitis were studied prospectively in 200 girls presenting with genital discharge, irritation, pain, or redness. The major causes were poor hygiene and threadworms. The suspicion of sexual abuse arose in a few girls but no organisms of sexually transmitted disease were found. Urinary symptoms were common but only 20 patients had a significant bacteriuria and 40 had sterile pyuria. Specific skin problems occurred in 28 cases. Simple measures to improve hygiene and treatment of threadworms gave effective relief. Genital irritation caused urinary symptoms with no clinical evidence of infection, and it is advised that antibiotic treatment should await urine culture. Specific skin problems require help from a dermatologist. The possibility of sexual abuse must be considered especially if the vulvovaginitis is persistent or recurrent after adequate treatment.
Topics: Adolescent; Bacteriuria; Child; Child Abuse, Sexual; Child, Preschool; Female; Humans; Hygiene; Infant; Oxyuriasis; Prospective Studies; Skin Diseases; Vulvovaginitis
PubMed: 1580682
DOI: 10.1136/adc.67.4.509 -
BMC Nephrology Jan 2013Urinary tract infection (UTI) occurs in 30%-50% of individuals with autosomal dominant polycystic kidney disease (ADPKD). However, the clinical relevance of asymptomatic...
BACKGROUND
Urinary tract infection (UTI) occurs in 30%-50% of individuals with autosomal dominant polycystic kidney disease (ADPKD). However, the clinical relevance of asymptomatic pyuria in ADPKD patients remains unknown.
METHODS
We retrospectively reviewed medical records of 256 ADPKD patients who registered to the ADPKD clinic at Seoul National University Hospital from Aug 1999 to Aug 2010. We defined the asymptomatic pyuria as more than 5-9 white blood cells in high-power field with no related symptoms or signs of overt UTI. Patients were categorized into 2 groups depending on its duration and frequency: Group A included non-pyuria and transient pyuria patients; Group B included recurrent and persistent pyuria patients. The association between asymptomatic pyuria and both the development of overt UTI and the deterioration of renal function were examined.
RESULTS
With a mean follow-up duration of 65.3 months, 176 (68.8%) out of 256 patients experienced 681 episodes of asymptomatic pyuria and 50 episodes of UTI. The annual incidence of asymptomatic pyuria was 0.492 episodes/patient/year. The patients in group B showed female predominance (58.5% vs. 42.0%, P=0.01) and experienced an upper UTI more frequently (hazard ratio: 4.612, 95% confidence interval: 1.735-12.258; P=0.002, adjusted for gender and hypertension). The annual change in estimated glomerular filtration rate (ΔeGFR) was significantly larger in magnitude in group B than in group A (-2.7±4.56 vs. -1.17±5.8, respectively; P=0.01). Age and Group B found to be the independent variables for ΔeGFR and developing end-stage renal disease (16.0% vs. 4.3%, respectively; P=0.001).
CONCLUSIONS
Chronic asymptomatic pyuria may increase the risk of developing overt UTI and may contribute to declining renal function in ADPKD.
Topics: Causality; Chronic Disease; Comorbidity; Female; Humans; Male; Middle Aged; Polycystic Kidney, Autosomal Dominant; Prevalence; Pyuria; Renal Insufficiency, Chronic; Republic of Korea; Risk Factors; Sex Distribution; Urinary Tract Infections
PubMed: 23295127
DOI: 10.1186/1471-2369-14-1 -
Anaesthesiology Intensive Therapy 2017Pre-emptive screening of urine for patients admitted to an intensive care unit can result in the misinterpretation of data and over- or under-treatment of urinary tract...
BACKGROUND
Pre-emptive screening of urine for patients admitted to an intensive care unit can result in the misinterpretation of data and over- or under-treatment of urinary tract infection.
METHODS
Data were studied from 169 consecutive patients admitted to the neurologic or burn intensive care unit at Shands Hospital at the University of Florida. All patients had a urinary catheter in place at the time of admission. Urinalysis and urine culture were sent for analysis. Data included leukocyte esterase, urine nitrate, urine protein, pyuria or urine white blood cell count, and culture.
RESULTS
Leukocyte esterase and pyuria were the most sensitive indicators of a positive urine culture at 87.5% (95% CI: 71.3-100%) and 73.3% (95% CI: 51.0-95.7%), respectively; urine nitrate was specific at 100%. More than half of the patients (56.3%) with positive cultures did not initially receive antibiotics.
CONCLUSION
The combination of leukocyte esterase and urine nitrate provides the best indicator for the initiation of antibiotic coverage for urinary tract infection prior to culture availability.
Topics: Adult; Aged; Carboxylic Ester Hydrolases; Cohort Studies; Critical Illness; Female; Humans; Intensive Care Units; Male; Mass Screening; Medical Overuse; Middle Aged; Pyuria; Retrospective Studies; Sensitivity and Specificity; Urinalysis; Urinary Catheterization; Urinary Tract Infections
PubMed: 28712106
DOI: 10.5603/AIT.a2017.0036 -
Ghana Medical Journal Jan 2023This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks,...
OBJECTIVES
This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks).
DESIGN
A cross-sectional study with stratified simple random sampling.
SETTING
Urology Unit, Korle Bu Teaching Hospital.
PARTICIPANTS
One hundred and thirty-seven male patients with long-term urinary catheters.
INTERVENTIONS
Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements.
PRIMARY OUTCOMES MEASURES
Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed.
RESULTS
Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065.
CONCLUSIONS
In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.
FUNDING
Enterprise Computing Limited.
Topics: Humans; Male; Catheters, Indwelling; Urinary Tract Infections; Silicon; Urethral Stricture; Cross-Sectional Studies; Prostatic Hyperplasia
PubMed: 37576373
DOI: 10.4314/gmj.v57i1.10 -
Cureus Jun 2021A 69-year-old man presented to the ED of our hospital with fever, loss of appetite, malaise, and pyuria and was admitted. He was diagnosed as having urinary infection....
A 69-year-old man presented to the ED of our hospital with fever, loss of appetite, malaise, and pyuria and was admitted. He was diagnosed as having urinary infection. We instituted treatment with cefmetazole, and he was discharged on hospital day 7. is a rare infection in adults in Japan. urinary infection usually occurs as an opportunistic infection in immunocompromised adults or older adults. This patient was not immunocompromised, so spp. should be recognized as potential pathogens in non-diabetic, non-immunocompromised adults.
PubMed: 34295590
DOI: 10.7759/cureus.15780 -
Italian Journal of Pediatrics Nov 2018Kawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present... (Comparative Study)
Comparative Study
BACKGROUND
Kawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present study investigated the clinical and laboratory findings that can differentiate KD from UTI in febrile children with pyuria and CRP elevation.
METHODS
Medical records were retrospectively reviewed for children with KD and those with UTI. The clinical and laboratory findings between the KD with pyuria group (n = 48) and the UTI group (n = 118) were compared.
RESULTS
The KD with pyuria group had older age (P < 0.001) and longer duration of fever (P < 0.001) than the UTI group. In blood tests, both groups showed increased CRP level, but the value of CRP was higher in the KD with pyuria group than in the UTI group (P < 0.001). The KD with pyuria group also showed higher values for liver enzymes than the UTI group (P < 0.001); > 70.0% of children in the KD with pyuria group, but < 20.0% of children in the UTI group possessed elevated liver enzymes (P < 0.001). On urinalysis, 40.7% of the UTI group had a positive nitrite test, but 0.0% of the KD with pyuria group had a positive nitrite test (P < 0.001).
CONCLUSIONS
Elevated liver enzymes are more specific to KD than to UTI, whereas a positive nitrite test is more specific to UTI than to KD. Our findings can be used as diagnostic clues to differentiate KD from UTI in febrile children with pyuria and CRP elevation.
Topics: Alanine Transaminase; Aspartate Aminotransferases; Biomarkers; C-Reactive Protein; Child, Preschool; Female; Fever; Hematuria; Humans; Infant; Male; Mucocutaneous Lymph Node Syndrome; Nitrites; Pyuria; Retrospective Studies; Urinary Tract Infections
PubMed: 30454066
DOI: 10.1186/s13052-018-0585-7 -
BMC Medicine May 2015Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure.
METHODS
From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group). The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days.
RESULTS
Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0-14.0] vs. 10.0 [IQR, 7.0-16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different.
CONCLUSIONS
A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.
Topics: Adult; Aged; Aged, 80 and over; Algorithms; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Protein Precursors; Pyuria; Switzerland; Urinary Tract Infections
PubMed: 25934044
DOI: 10.1186/s12916-015-0347-y