Foamy Urine: Is This a Sign of Kidney Disease?

Superior selectivity of high-frequency ultrasound toward chorine containing-pharmaceuticals elimination in urine: A comparative study with other oxidation processes through the elucidation of the degradation pathways

This work considered the sonochemical degradation (using a bath-type reactor, at 375 kHz and 106.3 W L^-1, 250 mL of sample) of three representative halogenated pharmaceuticals (cloxacillin, diclofenac, and losartan) in urine matrices. The action route of the process was initially established. Then, the selectivity of the sonochemical system, to degrade the target pharmaceuticals in simulated fresh urine was compared with electrochemical oxidation (using a BDD anode, at 1.88 mA cm^-2), and UVC/H₂O₂ (at 60 W of light and 500 mol L^-1 of H₂O₂). Also, the treatment of cloxacillin in an actual urine sample by ultrasound and UVC/H₂O₂ was evaluated. More than 90% of the target compounds concentration, in the simulated matrix, was removed after 60 min of sonication. However, the sono-treatment of cloxacillin in the real sample was less efficient than in the synthetic urine. The ultrasonic process achieved 43% of degradation after 90 min of treatment in the actual matrix. In the sonochemical system, hydroxyl radicals in the interfacial zone were the main degrading agents. Meanwhile, in the electrochemical process, electrogenerated HOCl was responsible for the elimination of pharmaceuticals. In turn, in UVC/H₂O₂ both direct photolysis and hydroxyl radicals degraded the target pollutants. Interestingly, the degradation by ultrasound of the pharmaceuticals in synthetic fresh urine was very close to the observed in distilled water. Indeed, the sonodegradation had a higher selectivity than the other two processes. Despite the sono-treatment of cloxacillin was affected by the actual matrix components, this contrasts with the UVC/H₂O₂, which was completely inhibited in the real urine. The sonochemical process led to 100% of antimicrobial activity (AA) elimination after 75 min sonication in the synthetic urine, and ∼ 20% of AA was diminished after 90 min of treatment in the real matrix. The AA decreasing was linked to the transformations of the penicillin nucleus on cloxacillin, the region most prone to electrophilic attacks by radicals according to a density theory functional analysis. Finally, predictions of biological activity confirmed that the sono-treatment decreased the activity associated with cloxacillin, diclofenac, and losartan, highlighting the positive environmental impact of degradation of chlorinated pharmaceuticals in urine.

The urine foaming test in COVID-19 as a useful tool in diagnosis, prognosis and follow-up: Preliminary results

OBJECTIVE

We aimed to develop a simple, rapid urine test based on the level of foaming that occurs in the urine sample due to the excretion of peptide structures containing amino acids specific to the antigenic structure of COVID-19. In this study, we present the preliminary results of the first clinical study with a newly developed urine foaming test (UFT).

METHODS

This study was conducted in a tertiary hospital in Istanbul. After obtaining the approval of the ethics committee, urine samples were taken from three groups of patients whose informed consent was obtained. The groups were created according to the COVID-19 Diagnostic Guide of Ministry of Health: A: outpatients with suspected COVID-19, B: inpatients for follow-up and treatment, C: patients treated in intensive care unit (ICU). Also, 30 healthy volunteers were included as the control group D. Urine samples taken from all groups were delivered to the laboratory. 2.5 ml urine sample was added to the test tube and shaken for 15 seconds and the level of foam formed was visually evaluated according to the color scale. Other data of the patients were obtained from the hospital information management system and the physician caring for the patient. The clinical status, PCR test results, computed tomography (CT), if any, laboratory tests, and UFT results were compared and the level of statistical significance was expressed as p≤0.05 in the 95% confidence intervals (CI). Performance characteristics, such as sensitivity, specificity, positive and negative predictive value of the UFT, were statistically calculated according to the RT-PCR result and/or CT.

RESULTS

A statistically significant difference was observed between UFT distributions of the control, outpatient, inpatient and ICU patients (p=0.0001). The results of UFT orange and red in inpatients and ICU patients were statistically significantly higher than in the control and outpatient groups. The diagnostic accuracy of UFT was detected in all group, the pooled sensitivity was 92% (95% CI: 87-95%) and specificity was 89% (95% CI: 80-98%).

CONCLUSION

Our preliminary results suggest that the UFT is useful, particularly in predicting the clinical severity of COVID-19. The UFT could be recommended as a point of care test, rapid and non-invasive method in the diagnosis and follow-up of COVID-19.