Urinalysis, critical discipline of clinical science

Periodontal disease and emerging point-of-care technologies for its diagnosis

Periodontal disease (PD), a chronic inflammatory disorder that damages the tooth and its supporting components, is a common global oral health problem. Understanding the intricacies of these disorders, from gingivitis to severe PD, is critical for efficient treatment, diagnosis, and prevention in dental care. Periodontal biosensors and biomarkers are critical in improving oral health diagnostic skills. Clinicians may accomplish early identification, tailored therapy, and efficient tracking of periodontal diseases by using these technologies, ushering in a new age of accurate oral healthcare. Traditional periodontitis diagnostic methods frequently rely on physical probing and visual examinations, necessitating the development of point-of-care (POC) devices. As periodontal disorders necessitate more precise and rapid diagnosis, incorporating novel innovations in biosensors and biomarkers becomes increasingly crucial. These innovations improve our capacity to diagnose, monitor, and adapt periodontal therapies, bringing in the next phase of customized and effective dental healthcare. The review discusses the characteristics and stages of PD, clinical treatment techniques, prominent biomarkers and infection-associated factors that may be employed to determine PD, biomedical sensing, and POC appliances that have been created so far to diagnose stages of PD and its progression profile, as well as predicting future developments in this field.

pH and specific gravity of corrosive agents as indicators in caustic injuries

BACKGROUND

Video endoscopy, which remains the diagnostic gold standard after ingestion of a corrosive substance, is performed under general anesthesia in children, requires advanced technology, and is costly. Simple and accessible methods are therefore needed to determine the need for endoscopy. The aim of this study was to evaluate the role of the pH and specific gravity of ingested substance in determining endoscopy indications after corrosive ingestion.

METHODS

This prospective study included pediatric patients who presented after ingesting a corrosive substance from June 2018 to June 2019. Relationships between the extent of damage detected by endoscopy and the patient's age, physical examination findings, and the pH and specific gravity of the causative substance were evaluated.

RESULTS

The degree of damage detected on endoscopy was significantly milder for corrosive substances with a pH between 2 and 12 (P = 0.003). In addition, pH values between 2 and 12 were significantly more common among patients without physical examination findings (P = 0.029). Specific gravity less than 1,005 was associated with mild injury detected by video-endoscopy (P = 0.011). Patients in whom severe injury was detected by endoscopy had marked findings on physical examination (P < 0.001). There was no significant relationship between physical examination findings and the specific gravity of the substance involved (P = 0.087).

CONCLUSIONS

The results of this study suggest that conservative treatment options can be used without performing endoscopy in patients who have no physical examination finding after corrosive ingestion and where the pH of the substances is between 2 and 12 and the specific gravity of the substances is less than 1,005.

Black Tea (Camellia sinensis) Extract Induced Prenatal and Postnatal Toxicity in Experimental Albino rats

Background

Tea (Camellia sinensis) being the most widely drank beverage and despite having numerous beneficial role toward health and disease, its safety evaluation during pregnancy and prenatal, postnatal developmental period need to be monitored.

Objective

This study was to evaluate the toxicity of black tea extract (BTE) in experimental pregnant rats and on their pups during prenatal and postnatal developmental periods.

Materials and Methods

Pregnant female (120 ± 10 g) Wister albino rats were chosen for this study. Group 1 was control group where pregnant female rats were treated with saline. Group 2 and Group 3 were pregnant female rats treated with 50 mg and 100 mg BTE/kg/day, respectively, throughout prenatal and postnatal periods. All three groups of rats were provided food and drinking water ad libitum. Animals were examined through their urinary and serum parameters, histopathological studies, and biomorphometric studies in pups. All data were expressed as mean ± standard deviation with significance between the controls and the treated groups (n = 6). Collected data were subjected to the analysis of variance and Tukey test; P < 0.05 was considered as statistically significant.

Results

BTE produced significant alterations in urinary calcium, creatinine, and urea during prenatal period; exhibited proteinuria, ketonuria, and histology showed nephrotoxicity during postnatal period, and BTE also showed a significant increase in serum proinflammatory cytokines and decreased anti-inflammatory cytokines level compared to control group. BTE caused significant changes in biomorphometric parameters in the pups as compared with pups of control mothers.

Conclusion

This study confirmed the BTE-induced toxicity in pregnant rats and their pups.

SUMMARY

Black tea (Camellia sinensis) is the most widely drank beverage. This study was to evaluate the toxicity BTE in experimental pregnant rats and on their pups during prenatal and postnatal developmental periods. Animals were examined through their urinary and serum parameters, histopathological studies, and biomorphometric studies in pups. BTE.induced toxicity in pregnant rats and their pups. Abbreviations used: BTE: Black tea extract, IL-1α: Interleukin 1 alpha, IL-1 β: Interleukin 1 beta, IL-6: Interleukin 6, IL-10: Interleukin 10, TNF-α: Tumor necrosis factor alpha.

Phytochemical investigation and nephroprotective potential of Sida cordata in rat

BACKGROUND

Plants are an efficient source of natural antioxidant against free radicals causing kidney damages. Sida cordata ethyl acetate fraction has been reported for strong in vitro antioxidant potency, previously. In the present study, our objective was to evaluate its in vivo antioxidant potency against CCl4 induced nephrotoxicity and investigates the bioactive phytochemicals by HPLC-DAD analysis.

METHODS

Phytochemical analysis was performed by HPLC-DAD methodology. For in vivo study, 42 male Sprague-Dawley rats were treated with alternatively managed doses for 60 days. Group I animals were remained untreated. Group II animals were treated with vehicle (1 mL of olive oil) by intragastric route on alternate days. Group III was treated with 30% CCl4 (1 mL/kg b.w.) i.p. Group IV was treated with 30% CCl4 (1 mL/kg b.w.) i.p and silymarin intragastric. Group V and VI rats were treated with 30% CCl4 and SCEE (150 and 300 mg/kg b.w., respectively) intragastric. Group VII animals were treated with SCEE (300 mg/kg b.w.) intragastrically. Blood parameters, Serum proteins and urine profile were investigated. Activities of tissue enzyme i.e. catalase, peroxidase, superoxide dismutase, glutathione-S-transferase, glutathione reductase, GSH and γ-GT were evaluated. Histopathological observations, total protein contents, lipid peroxidation, DNA damage and relative weight were also analyzed.

RESULTS

Gallic acid, catechin and caffeic acid were identified in SCEE fraction by HPLC-DAD. Decrease in the count of red blood cells, neutrophils, eosinophils and concentration of hemoglobin whereas increase in lymphocyte count and estimation of sedimentation rate (ESR) with 1 mL CCl4 (30% in Olive oil) administration (30 doses in 60 days) was restored dose dependently with co-treatment of SCEE (150 and 300 mg/kg b.w.). Treatment of rats with CCl4 markedly (P < 0.01) increased the count of urinary red blood cells and leucocytes, concentration of urea, creatinine and urobilinogen and specific gravity whereas creatinine clearance was reduced. Serum level of total protein, albumin, globulin, nitrite, creatinine and blood urea nitrogen (BUN) was significantly increased (P < 0.01) by CCl4 treatment. The activity of antioxidant enzymes; catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione reductase and content of reduced glutathione was decreased (P < 0.01) significantly. However, increased concentration (P < 0.01) of thiobarbituric acid reactive substances and histopathological injuries were noticed in the renal tissues of rats after the treatment with CCl4. Co-administration of SCEE, dose dependently, protected the alterations in the studied parameters of rats at 150 and 300 mg/kg b.w. The present study revealed that SCEE could be used as a possible remedy for renal toxicity abnormalities.

CONCLUSION

These results are an evidence of the renal protective role of S.cordat ethyl acetate fraction against CCl4 induced nephrotoxicity in rats which may be due to its antioxidant compounds.

Protective effects of fraction 4a of polysaccharides isolated from Lycium barbarum against KBrO3-induced renal damage in rats

LBP-4a exhibits protective effects on KBrO₃-induced renal damage, and the mechanism correlates with the increase of oxidation resistance in renal cells.

Phytochemical screening and protective effects of Trifolium alexandrinum (L.) against free radical-induced stress in rats

Trifolium alexandrinum is traditionally used in various human ailments, including renal dysfunctions. The present experiment was designed to investigate antioxidant and nephroprotective effect of T. alexandrinum methanolic extract (TAME) against CCl4-induced oxidative stress in albino rats. Results of in vitro study revealed significant (P < 0.05) antioxidant effects. The ameliorative role of TAME was also examined by investigating the level of antioxidant enzymes catalase (CAT), peroxidase (POD), glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST), nonenzymatic antioxidant viz; reduced glutathione contents (GSH) and lipid peroxidation products (TBARS) in the renal tissue homogenate in CCl4-treated rats. The intraperitoneal injection of 1 mL/kg b.w. CCl4 caused a significant depletion in the activity antioxidant enzymes and increased the TBARS contents. Supplementation of TAME at 200 mg/kg b.w. for 2 weeks significantly improved activities of antioxidant enzymes and reduced TBARS formation. Co-treatment of TAME also presented significant protection in maintaining renal urine and serum markers. Antioxidant and nephroprotective effects of TAME are associated with its polyphenolic constituents.

Protective effects of rutin against potassium bromate induced nephrotoxicity in rats

BACKGROUND

Rutin, a polyphenolic flavonoid, was investigated for its protective effects against the KBrO(3) induced renal injuries in rat.

METHODS

Group I was control (untreated), group II was given saline 0.5 ml/kg bw (0.9% NaCl), group III was administered KBrO(3) (20 mg/kg bw) intragastric twice a week for four weeks. Rutin was administered to group VI (50 mg/kg bw) and Group V (70 mg/kg bw) along with KBrO(3) (20 mg/kg bw) while group VI was given rutin (70 mg/kg bw) alone twice a week for four weeks. Protective effects of rutin on KBrO(3)-induced nephrotoxicity in rats were determined for biochemical parameter of urine, and serum, various antioxidant enzymes, DNA and histopathological damages in kidneys.

RESULTS

The level of urinary red blood cells, leucocytes count, specific gravity, urea, creatinine and urobilinogen was increased (P<0.01) whereas creatinine clearance was reduced. Serum level of protein, albumin, globulin, nitrite, creatinine and blood urea nitrogen (BUN) was significantly increased (P<0.01) by KBrO(3). Marked histopathological lesions, elevated DNA fragmentation and AgNORs count in renal tissues was determined. Activity of antioxidant enzymes; catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase, glutathione reductase, and reduced glutathione contents were decreased (P<0.01) while thiobarbituric acid reactive substances were increased (P<0.01) with KBrO(3) treatment in kidneys. DNA ladder assay was intimately related with the DNA fragmentation assay. Telomerase activity was found positive in the KBrO(3) treated kidneys. Treatment with rutin effectively ameliorated the alterations in the studied parameters of rat. Rutin administration alone to rats did not exhibit any significant change in any of the parameters studied.

CONCLUSION

These results suggest that rutin works as an antioxidant in vivo by scavenging reactive oxygen species and this serves to prevent oxidative renal damage in rat treated with KBrO(3).

Amelioration of CCl(4)-induced nephrotoxicity by Oxalis corniculata in rat

CCl(4) induces oxidative stress in various tissues by altering antioxidant enzymes defense system. In this study we investigated the chemical composition and protective role of Oxalis corniculata methanol extract (OCME) on CCl(4)-induced nephrotoxicity in rat. Presence of flavonoids, alkaloids, terpenoids, saponins, cardiac glycosides, phlobatannins and steroids was determined in OCME while tannins were absent. Total phenolic contents estimated were 7.76 ± 0.36 (mg gallic acid equivalents/g extract) while total flavonoid contents recorded were 6.92 ± 0.52 (mg rutin equivalents/g extract). Intraperitoneal injection of CCl(4) (1 ml/kg b.w., 20% in olive oil) once a day for seven days caused nephrotoxicity as evident by elevated levels of urinary specific gravity, RBCs, WBCs, creatinine, protein, urobilinogen and nitrite. Serum level of creatinine, urea, blood urea nitrogen were significantly increased while protein and creatinine clearance was decreased by CCl(4) treatment in kidney samples. Activity of antioxidant enzymes; catalase, peroxidase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase, glutathione reductase and glutathione concentration was decreased whereas lipid peroxidation and protein contents were increased along with histopathological injuries. Treatment with OCME caused significant recovery in changed parameters. It could be concluded that OCME has a protective role against CCl(4)-induced oxidative stress in rat, due to antioxidant effects of phenolics.

Evaluation of Launaea procumbens use in renal disorders: a rat model

INTRODUCTION

Carbon tetrachloride exerts its toxicity in rat kidneys through oxidative stress. Launaea procumbens is used ethnopharmacologically in renal disorders. Its methanolic, chloroform, ethyl acetate, and n-hexane fractions were evaluated against CCl(4)-induced nephrotoxicity in rat.

MATERIALS AND METHODS

Among 16 groups, one was given CCl(4) of 3ml/kg body weight (30% in olive oil i.p.) twice a week for 4 weeks. Others were orally fed with extracts (100, 200mg/kg b.w.) or rutin (50mg/kg b.w.) after 48h of CCl(4) or 200mg/kg b.w. of extracts without CCl(4)-treatment twice a week for 4 weeks.

RESULTS

CCl(4) exposure led to a significant oxidative stress in kidneys which was remarkably attenuated with co-administration of various fractions and rutin thereby increased the level of CAT, POD, SOD, GSH, GSR, GST, GSH-Px, quinone reductase, while reduced the xanthine oxidase, gamma-GT, TBARS, H(2)O(2), nitrite, tissue proteins and DNA fragmentation%. Ameliorated effects of fractions and rutin were also recorded for the function of kidneys and the level of urobilinogen, urea, albumin, creatinine, RBC and WBC in urine were decreased. Serum level of creatinine, urobilinogen, BUN, direct bilirubin, total bilirubin and globulin were decreased while total proteins, albumin and creatinine clearance were increased with fractions and rutin. Protective effects of rutin and fractions were also evident on histopathology by reducing glomerular atrophy, tubular degeneration, congestion of blood capillaries, necrosis of epithelium and edema. Similarly body weight was increased while kidney and relative kidney weight was decreased with co-administration of fractions and rutin.

CONCLUSION

It is suggested that Launaea procumbens effectively protect kidneys against the CCl(4)-induced oxidative damage in rats, through antioxidant and free radical scavenging effects of flavonoids and saponins present in the fractions.

Carbon tetrachloride-induced nephrotoxicity in rats: protective role of Digera muricata

Digera muricata is used in renal disorders in folk medicine. Generation of reactive radicals has been implicated in carbon tetrachloride-induced nephrotoxicity, which are involved in lipid peroxidation, accumulation of dysfunctional proteins, leading to injuries in kidneys. The present study was aimed to evaluate the efficacy of Digera muricata on the kidney function in CCl(4)-induced injuries. CCl(4) treatment (5 ml/kg body wt., i.p. CCl(4):olive oil; 1:9) significantly increased the level of urine creatinine, protein, nitrite, urobilinogen, red blood cells (RBCs), leucocytes count, and levels of blood urea nitrogen (BUN). Level of proteins and DNA fragmentation %, argyrophilic nucleolar organizer regions (AgNORs) count in renal tissues was also significantly increased. Activity of antioxidant enzymes; catalase, peroxidase, superoxide dismutase and reduced glutathione (GSH) were decreased while thiobarbituric acid reactive substances (TBARSs) were increased with CCl(4) treatment. DNA ladder assay was intimately related with the DNA fragmentation assay. Telomerase activity was determined in the CCl(4)-treated renal tissue homogenate. Treatment with n-hexane (HDMP) and methanolic (MDMP) extracts of Digera muricata (200 and 250 mg/kg body wt., oral, respectively) effectively attenuated the alterations in the biochemical markers, telomerase activity was inhibited and confirms the restoration of normalcy and accredits the protective role of Digera muricata against CCl(4)-induced nephrotoxicity.

Measurement of urine pH for epidemiological studies on bladder cancer

Methods for efficiently identifying subjects with constantly acidic pH in epidemiological and clinical studies have not been assessed. We recruited 30 volunteers to estimate the minimum number of urine pH measurements using pH strips needed to identify subjects with "constantly acidic urine pH". Spearman's correlation coefficients between urine pH measured with a pH meter and with the four pH strips ranged from 0.94 to 0.95 (p < 0.001 for all four strips). Overall agreement within +/-0.5 pH units between the four strips and the pH meter ranged from 62.2% to 74.4%. When using a spot urine sample from a single morning to classify participants with respect to their urine pH, 80% of individuals fell into the acidic urine pH (pH equal to or lower than 6.0) group. When we required subjects to have urine pH equal to or lower than 6.0 in six consecutive AM spot urine samples and seven spot PM urine samples, only 20% of participants fulfilled this criterion. Measuring urine pH twice a day (early in the morning and early in the evening) during four consecutive days classified individuals in the same way as two daily measurements for one week. A single pH measurement from a spot urine sample is not reliable to identify individuals with constantly acidic pH. Morning and evening urine pH measurements with pH strips during four consecutive days identify individuals with constantly acidic urine pH individuals as well as one week of measurements, and thus might be useful to identify subjects with constantly acidic urine pH in epidemiological and clinical studies.

Urine as a Biological Specimen for Forensic Analysis of Alcohol and Variability in the Urine-to-Blood Relationship

This article concerns the use of urine as a biological specimen for determination of alcohol in clinical and forensic toxicology and discusses factors that might influence variability in the urine/blood concentration ratio of alcohol. A large number of human drinking experiments were conducted to determine the time course of urine-alcohol concentrations (UAC) in relation to blood-alcohol concentrations (BAC). The UAC and BAC curves were shifted in time and the BAC curve always began to decrease before the UAC started to decline. During the early absorption phase the UAC/BAC ratio was less than unity, whereas in the late absorption/distribution period the ratio was between 1.0-1.2. On reaching the post-absorptive phase, the UAC always exceeded BAC and UAC/BAC ratios averaged 1.3-1.4, increasing appreciably as BAC decreased towards zero. Alcohol-induced diuresis was most pronounced during the rising portion of the BAC curve and near to the peak value. After about 2 hours post-drinking, the production rate of urine diminished to the pre-drinking rate of about 0.5-1 mL/min. Drinking water during the post-absorptive phase of the alcohol curve produced dilute urine, as reflected in lower creatinine content and osmolality, although the concentration of ethanol remained unchanged. After subjects drank a moderate dose of ethanol (0.54-0.85 g/kg) about 2% of the dose was recoverable in the urine after 7 hours. Ethyl glucuronide, a minor metabolite of ethanol, was measured in urine samples from drunk drivers. The UAC/BAC ratio of ethanol in drunk drivers did not depend on the creatinine content of the urine and therefore the relative dilution of the specimens. When alcohol-free urine was spiked with glucose and infected with the yeast species Candida albicans, ethanol was produced by fermentation after approximately 24 hours storage at room temperature. This post-sampling synthesis of ethanol was prevented by sodium fluoride (1% weight by volume) in the urine tubes or by keeping the specimens in the cold (4 degrees C). The UAC and BAC were highly correlated (r > 0.95) in drunk drivers and in autopsy cases, although the residual standard deviations were appreciable. This speaks against attempting to estimate BAC indirectly from UAC in any individual case. The UAC/BAC ratio and the change in UAC between two successive voids can help to resolve whether a large amount of alcohol had recently been consumed. This information is useful to support or challenge allegations of drinking alcohol after driving, which has become known as the hip-flask defence.

Normal and abnormal aspects of proteinuria. Part I: Mechanisms, characteristics and analyses of urinary protein. Part II: Clinical considerations

Part I highlights the mechanisms of glomerular filtration and tubular reabsorption of plasma proteins, selected characteristics of urinary proteins based upon electrophoretic properties and recent advances in clinical laboratory analysis of proteinuria. Both structural characteristic of the glomerular capillary wall and molecular properties of plasma proteins are important determinants of glomerular filtration. Proteins filtered by the glomerulus subsequently appear in urine only after escaping the efficient mechanisms of tubular reabsorption. Albumin is one such protein and constitutes the major protein in normal urine although trace amounts of alpha, beta, and gamma globulins are also detectable. Several techniques of protein analysis have thus been developed to specifically measure albumin as well as other plasma proteins. Other methods have been adapted to measure total urinary protein content enabling the clinician to readily monitor renal function in health and disease. The second part of this review will consider conditions associated with proteinuria in both asymptomatic individuals and patients with renal disease. Asymptomatic proteinuria encompasses states of excess protein excretion during conditions of orthostasis, exercise, travel to high altitude of fever. Proteinuria during renal disease has received considerable interest as a means to monitor kidney function. It is therefore classified according to the type of damage incurred: (1) glomerular-type where large molecular weight proteins are excreted (2) tubular-type where small molecular weight proteins are excreted and (3) mixed-type characterized by both large and small molecular weight proteinuria.

Urine proteins after burn injury

Two-dimensional immunoelectrophoresis was used to examine the proteins present in urine during the first week following burn injury. Of the "serum" proteins present in the urine some glycoproteins were found to be in different relative proportions from those observed in serum. In patients sustaining severe burns the amount of protein excreted was increased compared to patients with mild burns and to controls. alpha 1-Antichymotrypsin detected in the urine of patients with severe burns was at times seen as a twin peak. This altered peak was of slower electrophoretic mobility and may represent a polymer of the protein or a complex of the protein with some other, possibly tissue-derived, protein.