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Jimenez M, Callahan K, Sakai-Bizmark R, Estevez D, Neman S, Greiner MV. Assessing the Need for Routine Urinalysis in Foster Care Exams. Clin Pediatr (Phila) 2024; 63:1343-1347. [PMID: 38269571 DOI: 10.1177/00099228241226496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Melissa Jimenez
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kelly Callahan
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Rie Sakai-Bizmark
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sophia Neman
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mary V Greiner
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Soriano-Martín A, Alonso R, Machado M, Reigadas E, Muñoz P, Bouza E. Candida spp.: the burden of a microorganism in a microbiology department. Microbiol Spectr 2024; 12:e0386023. [PMID: 38980031 PMCID: PMC11302065 DOI: 10.1128/spectrum.03860-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 06/04/2024] [Indexed: 07/10/2024] Open
Abstract
There is no precise information available on the entire workload of isolating a specific microorganism in a clinical microbiology laboratory, and the costs associated with it have not been specifically estimated. In this descriptive retrospective study conducted at the microbiology department of a general teaching hospital from January 2021 to December 2022, we assessed the workload associated with identifying Candida species in all types of clinical samples and patients. Costs were estimated from data obtained from the hospital's finance department and microbiology laboratory cost records. In 2 years, 1,008,231 samples were processed at our microbiology department, of which 8,775 had one or more Candida spp. isolates (9,683 total isolates). Overall, 5,151 samples with Candida spp. were identified from 2,383 inpatients. We isolated Candida spp. from 515.3 samples/100,000 population/year and from 92 samples/1,000 hospital admissions/year. By sample type, 90.8% were superficial, mainly mucosal. Only 9.1% Candida spp. were isolated from deep, usually sterile, samples, being mostly from ordinarily sterile fluids. Candida albicans was the main species (58.5%) identified, followed by C. parapsilosis complex, C. glabrata, C. tropicalis, and C. krusei. In admitted patients, the incidences of samples with Candida spp. isolates were 302.7 samples/100,000 population/year and 54 samples/1,000 admissions/year. The average cost of isolating and identifying Candida spp. was estimated at 25€ per culture-positive sample. To our knowledge, this is the first attempt to gage the workload and costs of Candida spp. isolation at a hospital microbiology department. These data can help assess the burden and significance of Candida isolation at other institutions and also help design measures for streamlining. IMPORTANCE We believe that this work is of interest because at present, there is no really accurate information available on the total workload involved in isolating a specific microorganism in a clinical microbiology laboratory. The costs related to this have also not been described. We have described the unrestricted workload of Candida spp. in all types of samples for all types of species and patients. We believe that this information would be necessary to collect and share this information as well as to collect it in a standardized way to know the current situation of Candida spp. workload in all clinical microbiology laboratories.
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Affiliation(s)
- Ana Soriano-Martín
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Alonso
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
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Honda K, Akune Y, Goto R. Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan. JAMA Netw Open 2024; 7:e2356412. [PMID: 38363568 PMCID: PMC10873767 DOI: 10.1001/jamanetworkopen.2023.56412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Importance The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease. Objectives To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program. Design, Setting, and Participants This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer's perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2% per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1). Interventions School urinary screening for IgA nephropathy was compared with no screening. Main Outcomes and Measures Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093). Results In the base case analysis, the ICER was ¥4 186 642 (US $39 127)/QALY, which was less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Cost-effectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, -¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY). Conclusions and Relevance This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.
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Affiliation(s)
- Kimiko Honda
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Yoko Akune
- Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Rei Goto
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
- Graduate School of Health Management, Keio University, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Tokyo, Japan
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Imam AA, Saadeh SA. Evaluation of Proteinuria and Hematuria in Ambulatory Setting. Pediatr Clin North Am 2022; 69:1037-1049. [PMID: 36880921 DOI: 10.1016/j.pcl.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Proteinuria and/or hematuria are common findings in ambulatory settings. Proteinuria can be glomerular and/or tubular in origin and it may be transient, orthostatic, or persistent. Persistent proteinuria may be indicative of a serious kidney pathology. Hematuria, which denotes the presence of an increased number of red blood cells in the urine, can be gross or microscopic. Hematuria can originate from the glomeruli or other sites of the urinary tract. Asymptomatic microscopic hematuria or mild proteinuria in an otherwise healthy child is less likely to be of clinical significance. However, the presence of both requires further workup and careful monitoring.
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Affiliation(s)
- Abubakr A Imam
- Nephrology & Hypertension, Department of Pediatrics, Sidra Medicine, College of Medicine, Qatar University, Weill Cornell Medicine-Qatar, PO Box 26999, Doha, Qatar.
| | - Sermin A Saadeh
- Department of Pediatrics - MBC 58, Pediatric Nephrology, King Faisal Specialist Hospital and Research Center, (KFSH&RC), King Faisal University, PO Box 3354, Riyadh 11211, KSA
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Malaga-Dieguez L, Trachtman H, Giusti R. Pulmonary Manifestations of Renal Disorders in Children. Pediatr Clin North Am 2021; 68:209-222. [PMID: 33228933 DOI: 10.1016/j.pcl.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.
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Affiliation(s)
- Laura Malaga-Dieguez
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA.
| | - Howard Trachtman
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
| | - Robert Giusti
- Division of Pediatric Pulmonology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
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Fortin K, Wood JN. Utility of screening urinalysis to detect abdominal injuries in suspected victims of child physical abuse. CHILD ABUSE & NEGLECT 2020; 109:104714. [PMID: 32979848 DOI: 10.1016/j.chiabu.2020.104714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Urinalysis, liver enzymes (LE) and lipase are used to screen for abdominal injuries in children with suspected physical abuse (SPA). However, data on the utility of urinalysis is limited. OBJECTIVES Describe the prevalence of hematuria in evaluations for SPA. Determine test characteristics of hematuria, LE and lipase to identify kidney and other abdominal injuries among children with SPA. PARTICIPANTS AND SETTING Children < 7 years receiving a urinalysis during evaluation for SPA by a hospital child protection team. METHODS Demographic, clinical, and laboratory data including presence of hematuria (blood on urine dipstick), elevated LE (> 80 U/L) and elevated lipase (> 100 U/L) were abstracted retrospectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the overall study population and for patients without abdominal symptoms. RESULTS Ten percent of patients had hematuria (N = 237). Prevalence of abdominal and kidney injuries was 7 % and 1 % respectively. Of 3 patients with kidney injury, 2 had hematuria and all had elevated LE. Sensitivity (67 %) and NPV (99 %) of hematuria to detect kidney injuries were lower than LE and the same as lipase. Specificity (91 %) and PPV (8%) of hematuria to detect kidney injury were greater than LE and similar to lipase. Sensitivity of hematuria to detect any abdominal injury (50 %) was lower than LE (81 %). Sensitivity of hematuria to detect occult abdominal injury was 0 %. CONCLUSIONS Hematuria alone did not lead to detection of kidney injury. Test characteristics of hematuria were largely similar or inferior to LE and lipase.
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Affiliation(s)
- Kristine Fortin
- Perelman School of Medicine at the University of Pennsylvania, Division of General Pediatrics, Children's Hospital of Philadelphia, United States.
| | - Joanne N Wood
- Perelman School of Medicine at the University of Pennsylvania, Division of General Pediatrics, Children's Hospital of Philadelphia, United States; Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, United States
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Kouri T, Fogazzi G, Gant V, Hallander H, Hofmann W, Guder WG. European Urinalysis Guidelines. Scandinavian Journal of Clinical and Laboratory Investigation 2019. [DOI: 10.1080/00365513.2000.12056993] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
'Urine dipstick', the commonly used point-of-care test, is an extremely sensitive investigation. Results of this test affected by numerous factors, if not meticulously linked with detailed history and examination, can lead a well-meaning clinician down the wrong clinical pathway. The aim of this article is to provide an overview of this every day test, touching on the physiological and technological basis initially, but mainly focusing on common questions like when to request the dipstick test, the correlation of dipstick results with urine specimen collected by different method and complexities of interpretation of dipstick results in everyday clinical scenarios.
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Affiliation(s)
- J Cyriac
- Department of Paediatrics, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Chelmsford, UK
| | - Katy Holden
- Department of Paediatrics, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Chelmsford, UK
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital, London, UK
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9
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Ramirez MD, Mertens A, Esiashvili N, Meacham LR, Wasilewski-Masker K. Yield of Urinalysis Screening in Pediatric Cancer Survivors. Pediatr Blood Cancer 2016; 63:893-900. [PMID: 26797960 PMCID: PMC4801680 DOI: 10.1002/pbc.25897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/30/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Children's Oncology Group (COG) publishes consensus guidelines with screening recommendations for early identification of treatment-related morbidities among childhood cancer survivors. We sought to estimate the yield of recommended yearly urinalysis screening for genitourinary complications as per Version 3.0 of the COG Long-Term Follow-Up Guidelines and identify possible risk factors for abnormal screening in a survivor population. PROCEDURE A database of pediatric cancer survivors evaluated between January 2008 and March 2012 at Children's Healthcare of Atlanta was queried for survivors at risk for genitourinary late effects. The frequency of abnormal urinalyses (protein ≥1+ and/or presence of glucose and/or ≥5 red blood cells per high power field) was estimated. Risk factors associated with abnormal screening were identified. RESULTS Chart review identified 773 survivors (57% male; 67% Caucasian; 60% leukemia/lymphoma survivors; mean age at diagnosis, 5.7 years [range: birth to 17.7 years]; time from diagnosis to initial screening, 7.6 years [range: 2.3 to 21.5 years]) who underwent urinalysis. Abnormal results were found in 78 (5.3%) of 1,484 total urinalyses. Multivariable analysis revealed higher dose ifosfamide (odds ratio [OR] = 6.8, 95% confidence interval [CI] 2.9-16.0) and total body irradiation (TBI, OR = 3.0, 95% CI 1.0-8.4) as significant risk factors for abnormal initial urinalysis screening. CONCLUSIONS Pediatric cancer survivors exposed to higher dose ifosfamide or TBI may be at higher risk of abnormal findings on urinalysis screening. Targeted screening of these higher risk patients should be considered.
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Affiliation(s)
- Matthew D. Ramirez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Ann Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Lillian R. Meacham
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Karen Wasilewski-Masker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA,Correspondence to: Karen Wasilewski-Masker, MD, MSc, The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 5455 Meridian Mark Road, Suite 400, Atlanta, GA 30342, Tel.: (404)785-3240, Fax: (404)785-3600,
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Utsch B, Klaus G. Urinalysis in children and adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:617-25; quiz 626. [PMID: 25283761 DOI: 10.3238/arztebl.2014.0617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urinalysis is the most commonly performed biochemical test in infancy and early childhood. The urine sample should be correctly obtained, age-specific aspects should be considered, and age-dependent reference values should be used. METHOD This review is based on a selective literature search in electronic databases, textbooks, and guidelines from Germany and abroad on the acquisition of urine samples and the performance of urinalysis in infancy and early childhood. RESULTS The timing and mode of acquisition of the urine sample affect the assessment of hematuria, proteinuria, leukocyturia, nitrituria, and the uropathogenic bacterial colony count in the urine culture. Dipstick tests can be used for targeted screening for these features. The test results should be interpreted together with the findings of urine microscopy, the medical history, and the physical examination. Proteinuria should be quantified and differentiated; both of these things can be done either from collected urine or (especially in infants and young children) from a spontaneously voided urine sample, by determination of the protein/creatinine quotient. Orthostatic proteinuria in an adolescent requires no further evaluation or treatment. Hematuria should be characterized as either glomerular or non-glomerular erythrocyturia. Asymptomatic, isolated microhematuria in childhood is not uncommon and often transient; in the absence of a family history, it usually does not require an extensive work-up. Proteinuria combined with hematuria should arouse the suspicion of glomerulonephritis. CONCLUSION Urinalysis in infancy and early childhood is a simple and informative diagnostic test as long as the urine sample has been obtained properly and the results are interpreted appropriately for this age group.
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Affiliation(s)
- Boris Utsch
- Center for Pediatric and Adolescent Medicine, Justus Liebig University, Gießen, KfH Pediatric Kidney Center, Marburg
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Filice CE, Green JC, Rosenthal MS, Ross JS. Pediatric screening urinalysis: a difference-in-differences analysis of how a 2007 change in guidelines impacted use. BMC Pediatr 2014; 14:260. [PMID: 25303836 PMCID: PMC4287447 DOI: 10.1186/1471-2431-14-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/19/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Practice guidelines can promote higher-quality care, yet they are inconsistently adopted. The purpose of this study is to evaluate the impact of a 2007 American Academy of Pediatrics recommendation to discontinue routine screening urinalysis in children. METHODS Using data from the National Ambulatory Medical Care Survey, we used a difference-in-differences approach to estimate visit-level screening urinalysis proportions before (2005-2006, n = 1,247) and after (2008-2009, n = 1,772) the 2007 AAP recommendation. We compared visits by children 4-18 years old to visits by young adults aged 19-32. Analyses were adjusted for continuous patient age, patient race/ethnicity, physician specialty, and stratified by patient gender and visit setting. RESULTS The 2007 recommendation was associated with no significant change in adjusted visit-level screening urinalysis proportions in child visits (20.4% to 22.5%) compared to an increase in young adult visits (20.1% to 27.0%) - a differential impact of -4.8 percentage points (95% Confidence Interval [CI] -9.0, -0.5). In private practices, visit proportions differentially decreased by 7.6 percentage points (95% CI -13.7, -1.5) in female children and by 0.5 percentage points (95% CI -10.6, 9.6) in male children. In community health centers, visit proportions differentially decreased by 17.4 percentage points (95% CI -27.9, -6.8) in female children and by 33.5 percentage points (95% CI -47.4, -19.7) in male children. CONCLUSIONS A 2007 recommendation to discontinue routine screening urinalysis in children was associated with no change in use in child visits relative to an increase in use in adult visits. Overall, nearly one-quarter of child visits still included screening urinalysis.
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Affiliation(s)
- Clara E Filice
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
| | - Jeremy C Green
- />Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO USA
| | - Marjorie S Rosenthal
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
- />Department of Pediatrics, Yale School of Medicine, New Haven, CT USA
| | - Joseph S Ross
- />Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, PO Box 208088, New Haven, CT 06520 USA
- />Department of Internal Medicine, Yale School of Medicine, New Haven, CT USA
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Van Biljon G. A practical approach to urine dipstick test abnormalities in relation to kidney and urinary tract disorders in children. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- G Van Biljon
- Department of Paediatrics, Faculty of Health Sciences, University of Pretoria
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13
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Gallieni M, Aiello A, Tucci B, Sala V, Brahmochary Mandal SK, Doneda A, Genovesi S. The burden of hypertension and kidney disease in Northeast India: the Institute for Indian Mother and Child noncommunicable diseases project. ScientificWorldJournal 2014; 2014:320869. [PMID: 24616621 PMCID: PMC3927758 DOI: 10.1155/2014/320869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/27/2013] [Indexed: 11/17/2022] Open
Abstract
Chronic noncommunicable diseases (NCDs) such as hypertension, atherosclerosis, acute myocardial infarction, stroke, diabetes, obesity, and chronic kidney disease are the major cause of death not only in high income, but also in medium and low income countries. Hypertension and diabetes, the most common causes of chronic kidney disease, are particularly common in southeast Asian Countries. Because early intervention can markedly slow the progression of these two killer diseases, assessment of their presence through screening and intervention program is a priority. We summarize here results of the screening activities and the perspectives of a noncommunicable diseases project started in West Bengal, India, in collaboration with the Institute for Indian Mother and Child (IIMC), a nongovernmental voluntary organization committed to promoting child and maternal health. We started investigating hypertension and chronic kidney disease with screen in school-age children and in adults >30 years old. We found a remarkable prevalence of hypertension, even in underweight subjects, in both children and adult populations. A glomerular filtration rate <60 mL/min was found in 4.1% of adult subjects significantly higher than that of 0.8% to 1.4% reported 10 years ago. Increased awareness and intervention projects to identify NCDs and block their progression are necessary in all countries.
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Affiliation(s)
- Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Graduate School of Nephrology, University of Milan, Via Pio II, 3-20153 Milano, Italy
| | - Angela Aiello
- Dialysis Unit, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Benedetta Tucci
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | - Valeria Sala
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | | | | | - Simonetta Genovesi
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
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Bereket G, Bozdogan G, Saribeyoglu E, Arapoglu M, Serteser M, Celiker A. Use of urinalysis as a screening tool for asymptomatic infants. J Paediatr Child Health 2013; 49:458-61. [PMID: 23614754 DOI: 10.1111/jpc.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 11/29/2022]
Abstract
AIM The utility of screening urinalysis in asymptomatic children has been questioned based on studies done in school-age children or adolescents. The American Academy of Pediatrics (AAP) recommended to abandon this screening in 2007 but many paediatricians perform it at some point during childhood. Thus, we aimed to investigate usefulness of screening urinalysis during infancy. METHODS We retrospectively reviewed results of screening urinalysis done in infants at 6-18 months of age who had regular care since birth at our centre. Infants with an ICD-10 (International Classification of Diseases, Tenth Revision) diagnostic code for routine child health exam (Z00.1) and a urinalysis requested with this code on the same date were included. RESULTS A total of 683 infants met the inclusion criteria. 44 (6%) had an abnormal urinalysis. The most common abnormality (n = 39, 5,7%) was pyuria. Of these 39 babies, 5 had a repeat urinalysis only, 18 had a repeat urinalysis with urine culture, and 16 had a urine culture alone. Six patients had positive culture results and were given antibiotic treatment. All six babies who received treatment had normal ultrasound and two patients had a voiding cystourethrography, which were also normal. The other abnormalities (n = 5) detected were microscopic hematuria and proteinuria. Repeat urinalyses of these patients were normal. CONCLUSION Screening urinalysis results were abnormal in 6% of the babies, but in 86% of those, abnormalities were transient. Only <1% had positive culture results. These data add to the evidence that screening urinalysis during infancy is unjustified supporting the AAP 2007 recommendations.
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Affiliation(s)
- Gamze Bereket
- Department of Pediatrics, Acibadem University, School of Medicine, Istanbul, Turkey.
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Johnson DW, Jones GRD, Mathew TH, Ludlow MJ, Doogue MP, Jose MD, Langham RG, Lawton PD, McTaggart SJ, Peake MJ, Polkinghorne K, Usherwood T. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations. Med J Aust 2012; 197:224-5. [PMID: 22900871 DOI: 10.5694/mja11.11329] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The publication of the Australasian Creatinine Consensus Working Group's position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to individualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.
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Affiliation(s)
- David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Braverman J, Samsonov DV. A study of online consultations for paediatric renal patients in Russia. J Telemed Telecare 2010; 17:99-104. [PMID: 21163814 DOI: 10.1258/jtt.2010.100410] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We developed an educational website for parents of paediatric patients with kidney diseases in Russia. Parents could ask questions regarding their child's illness and submit information, including medical summaries and scanned or electronic images. A US-trained specialist in paediatric nephrology reviewed the information provided and advised about further evaluation or referral, as well as discussing possible treatment plans. In the first nine months, 141 distinct users communicated through the website. Fifty-eight percent of patients were female. An analysis of 70 cases suggested that in 45% there had been overdiagnosis of common paediatric problems, such as urinary tract infection and pyelonephritis. Users completed an anonymous satisfaction survey. The response rate was 84% (n = 59/70). The majority of respondents found the consultation useful (mean = 4.6 on a 5-point scale). The online consultation answered the questions of most respondents, provided useful information and relieved uncertainty regarding a follow-up. The majority of the respondents (>90%) confirmed that they trusted the online consultation and would recommend the technique to other parents. Online consultation for parents can provide reliable information that results in improved parental satisfaction and education. This approach may be useful in improving care and providing patient education in underserved areas in the USA and elsewhere.
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Affiliation(s)
- Julia Braverman
- Division on Addictions, Cambridge Health Alliance, 101 Station Lnd, 2 floor, Boston MA 02155, USA.
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Sekhar DL, Wang L, Hollenbeak CS, Widome MD, Paul IM. A cost-effectiveness analysis of screening urine dipsticks in well-child care. Pediatrics 2010; 125:660-3. [PMID: 20231188 DOI: 10.1542/peds.2009-1980] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Despite data suggesting that routine urine screening for chronic kidney disease (CKD) has low diagnostic yield and the American Academy of Pediatrics 2007 recommendation to discontinue this screening, pediatricians may not have recognized this change. Because the new recommendation marks a major alteration in the practice guidelines, we sought to evaluate the cost-effectiveness of dipstick urinalysis for detection of CKD from the primary care practitioner's perspective. METHODS Decision analysis was used to model a screening dipstick urinalysis strategy relative to a no-screening strategy. Data on the incidence of hematuria and proteinuria in children were derived from published reports of large cohorts of school-aged children. Direct costs were estimated from the perspective of the primary care practitioner. The measure of effectiveness was the rate of diagnoses of CKD. Cost-effectiveness was evaluated by using an incremental cost-effectiveness ratio. RESULTS Expected costs and effectiveness for the no-screening strategy were 0 dollars because no resources were used and no cases of CKD were diagnosed. The screening strategy involved a cost per dipstick of 3.05 dollars. Accounting for both true-positive and false-positive initial screens, 14.2% of the patients required a second dipstick as per typical clinical care, bringing the expected cost of the screening strategy to 3.47 dollars per patient. In the screening strategy, 1 case of CKD was diagnosed per 800 screened, and the incremental cost-effectiveness ratio was 2779.50 dollars per case diagnosed. CONCLUSIONS Urine dipstick is inexpensive, but it is a poor screening test for CKD and a cost-ineffective procedure for the primary care provider. These data support the change in the American Academy of Pediatrics guidelines on the use of screening dipstick urinalysis. Clinicians must consider the cost-effectiveness of preventive care procedures to make better use of available resources.
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Affiliation(s)
- Deepa L Sekhar
- Penn State Hershey Children's Hospital, Department of Pediatrics, HS83, 500 University Dr, Hershey, PA 17033, USA.
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Shajari A, Shajari H, Zade MHF, Kamali K, Kadivar MR, Nourani F. Benefit of urinalysis. Indian J Pediatr 2009; 76:639-41. [PMID: 19390814 DOI: 10.1007/s12098-009-0068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 07/24/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the pilot Iran school screening programme, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. METHODS The cost of screening dipstick urinalysis was calculated by reviewing the literature for the prevalence of asymptomatic proteinuria, hematuria, bacteriuria, and glucosuria determined by an initial dipstick urinalysis. The minimal cost utilizing data of 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. RESULTS 4.7% (76/1601) of patients were calculated to have an initial abnormal urinalysis. Upon retesting 1.37% (22/1601) of patients were calculated to have a persistent abnormality. The calculated cost was $167 to initially screen all 1601 patients with a dipstick urinalysis or $0.092 per patient. The calculated cost to evaluates the 22 patients with any persistent abnormality on repeat dipstick urinalysis was $0.02 or $0.001 per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. CONCLUSION Multiple screening dipstick urinalysis in asymptomatic pediatric is costly and should be discontinued. We propose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years, in all asymptomatic children.
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Affiliation(s)
- Ahmad Shajari
- Department of Pediatric Nephrology, Shahid Sadoughi Hospital, School of Medicine, Yazd, Iran.
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Abstract
This review addresses the relevance of urinary screening for chronic kidney disease (CKD) in children. Ambiguity about screening children exists because of the uncertainty as to whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who subsequently progress to ESRD. A related concern is whether the adoption of urinary screening programs is cost effective. The most common method that is used for screening children for CKD involves the measurement of spot samples of urine for hematuria and or proteinuria. Although mass screening is now well established in Japan, Taiwan, and Korea, there appears to be movement away from mass screening to detect CKD in children and adolescents in North America and Europe. In December 2007, the American Academy of Pediatrics published their latest recommendations, in which no urinalyses were recommended at any age during childhood. The second issue addressed in this review is the reporting of estimated glomerular filtration rates (GFR) in children by clinical laboratories.
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Affiliation(s)
- Ronald J Hogg
- The Children's Hospital at Scott & White, 2401 South 31st Street, Temple, TX 76508, USA.
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Gai M, Motta D, Giunti S, Fop F, Masini S, Mezza E, Segoloni GP, Lanfranco G. Comparison between 24-h proteinuria, urinary protein/creatinine ratio and dipstick test in patients with nephropathy: patterns of proteinuria in dipstick-negative patients. Scandinavian Journal of Clinical and Laboratory Investigation 2006; 66:299-307. [PMID: 16777758 DOI: 10.1080/00365510600608563] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Three main tests are commonly employed for the measurement of proteinuria: the dipstick test, the urinary protein/creatinine ratio (P/C) and the 24-h urine collection. The aim of this study was to evaluate the correlation between these methods, comparing linear regression and ROC curve data. MATERIAL AND METHODS A total of 297 consecutive outpatients with different renal diseases were included in the study. Twenty-four-hour proteinuria was considered the reference test. RESULTS A high degree of correlation was observed between all the tests (p<0.0001), the highest regression coefficient being between 24-h proteinuria and P/C (R=0.82), and the lowest between P/C and the dipstick test (R=0.72). The dipstick test failed to detect pathological proteinuria in 94 patients (31.6%). Therefore, in these subjects, the patterns of proteinuria were assessed by immunofixation and sodium dodecyl sulphate (SDS) electrophoresis. CONCLUSIONS Our data strongly support the use of urinary P/C for the detection of proteinuria, at least in nephrology units, where the prevalence of proteinuria is likely to be high.
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Affiliation(s)
- M Gai
- Laboratory of Nephrology, Nephrology Unit, Department of Internal Medicine, University of Turin - Molinette Hospital, Turin, Italy.
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Abstract
Gross hematuria in children is a common complaint that often leads patients to seek urgent care. The diagnostic evaluation can be chosen based on specific patient history and physical examination. When a patient is asymptomatic, hypercalciuria and mild forms of glomerulonephritis are common causes of gross hematuria. Although they are less common in children, special care should be taken to investigate for renal and bladder tumors.
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Affiliation(s)
- Cynthia G Pan
- Division of Pediatric Nephrology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Suite 510, Children's Corporate Center, PO Box 1997, Milwaukee, WI 53201-1997, USA.
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Abstract
The urinalysis is one of the most commonly performed tests in pediatrics, and whether expected or incidental, abnormal findings are common. Understanding the strengths and limitations of the urinalysis allows one to maximize its use as a screening tool while avoiding expensive and unnecessary evaluations. This article reviews the significance of abnormal results on urine dipstick testing and urine microscopy. Causes of false positive and false negative results are summarized. Initial diagnostic considerations of abnormal urinalysis findings are provided where appropriate.
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Affiliation(s)
- Hiren P Patel
- Department of Pediatrics, Section of Nephrology, Columbus Children's Hospital, The Ohio State University College of Medicine and Public Health, 700 Children's Drive, Columbus, OH 43205, USA.
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Sox CM, Christakis DA. Pediatricians' screening urinalysis practices. J Pediatr 2005; 147:362-5. [PMID: 16182676 DOI: 10.1016/j.jpeds.2005.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Revised: 02/15/2005] [Accepted: 05/05/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine pediatricians' routine screening urinalysis practices. STUDY DESIGN This was a survey of a nationally representative sample of pediatricians practicing in the U.S. regarding their screening urinalysis practices in childhood. RESULTS Of the 1502 pediatricians sampled, 653 eligible subjects participated, for an estimated response rate of 49.5%. The vast majority of participants (78%) routinely screen asymptomatic children with urinalysis in at least 1 age group. Pediatricians' screening urinalysis practice varies based on age group: 9% screen during infancy (<1 year), 60% screen during early childhood (1 up to 5 years), 55% screen during late childhood (5 to 12 years), and 58% screen during adolescence (13 to 20 years). The majority of pediatricians (58%) routinely screen more than 1 age group. Some 38% of the pediatricians surveyed believe that the overall health of children is improved by screening all asymptomatic children with urinalysis. CONCLUSIONS Many pediatricians routinely conduct screening urinalysis during childhood, frequently at ages not recommended by the American Academy of Pediatrics.
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Affiliation(s)
- Colin M Sox
- Department of Ambulatory Care and Prevention, Center for Child Health Care Studies, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02115, USA.
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Chandar J, Gómez-Marín O, del Pozo R, Sanders L, Montane B, Abitbol C, Strauss J, Zilleruelo G. Role of routine urinalysis in asymptomatic pediatric patients. Clin Pediatr (Phila) 2005; 44:43-8. [PMID: 15678230 DOI: 10.1177/000992280504400105] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was done to evaluate the spectrum of diagnoses and identify risk factors for significant kidney disease in asymptomatic children with proteinuria and/or microhematuria detected by routine urinalysis. Clinical and laboratory data were obtained by retrospective chart review of 239 patients referred to a tertiary care center. The predominant diagnosis in children with isolated microhematuria was hypercalciuria and with isolated proteinuria, orthostatic proteinuria. When microhematuria and proteinuria were present in combination, kidney disease was the predominant diagnosis. Urinalysis is a valuable tool to identify patients with kidney disease. The combination of microhematuria and proteinuria increases the risk of having significant kidney disease.
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Affiliation(s)
- Jayanthi Chandar
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Jackson Children's Hospital, Miami, Florida 33101, USA
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Delanghe JR, Kouri TT, Huber AR, Hannemann-Pohl K, Guder WG, Lun A, Sinha P, Stamminger G, Beier L. The role of automated urine particle flow cytometry in clinical practice. Clin Chim Acta 2000; 301:1-18. [PMID: 11020458 DOI: 10.1016/s0009-8981(00)00342-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urine particle flow cytometers (UFC) have improved count precision and accuracy compared to visual microscopy and offer significant labor saving. The absence of an internationally recognized reference measurement procedure, however, is a serious drawback to their validation. Chamber counting by phase contrast microscopy of supravitally-stained uncentrifuged urine is considered the best candidate for reference. The UF-100 (Sysmex Corporation, Japan) identifies RBC, WBC, squamous epithelial cells, transitional epithelial and renal tubular cells (SRC), bacteria, hyaline and inclusional casts, yeast-like cells, crystals and spermatozoa, using argon laser flow cytometry. Evaluations have established acceptable linearity over useful working ranges, with an imprecision that is consistently and significantly less than microscopy, and with negligible carry-over. Comparisons of UFC with chamber counts, quantitative urine microscopy, sediment counts, test strips, bacterial culture and urine density are reviewed. Clinical studies include diagnosis and monitoring of urinary tract infection; localization of the sites of hematuria; and diagnosis, monitoring and exclusion of renal disease. The most popular approach is to combine test strips with UFC for primary screening either always by both methods or by using test strips for analytes unrelated to particles analyzed by UFC. Expert systems now exist combining both test modalities based on user definable decision rules. The implementation of such a strategy significantly reduces microscopy review and saves time and expense without diminishing clinical utility.
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Affiliation(s)
- J R Delanghe
- Department of Clinical Chemistry, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgium.
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Affiliation(s)
- B S Arant
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga 37403, USA
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Affiliation(s)
- M A Linshaw
- Division of Pediatric Nephrology, Floating Hospital/New England Medical Center, Boston, MA 02111, USA
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