How a skilful and motivated urinary sediment examination can save the kidneys

Verdesca, Simona; Brambilla, Claudia; Garigali, Giuseppe; Croci, Maria Daniela; Fogazzi, Giovanni B.

doi:10.1093/ndt/gfm142

Cited by 21 publications

(11 citation statements)

References 10 publications

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“…Non-infectious diseases of the urinary system such as interstitial cystitis, chronic prostatitis, tubulointerstitial nephritis, and kidney stone formation can mimic UTIs. Urine analysis (UA) tests for proteinuria and hematuria and microscopic evaluation of renal cell and erythrocyte casts can be useful for the diagnosis of kidney diseases including nephrolithiasis [ 7 , 8 ], but are not sufficiently specific. Potassium sensitivity testing and cystoscopy are diagnostic methods used for patients with symptoms of chronic cystitis and prostatitis [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing inflammation and infection in the urinary system via proteomics

et al. 2015

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BackgroundCurrent methodology for the diagnosis of diseases in the urinary system includes patient symptomology, urine analysis and urine culture. Asymptomatic bacteriuria from urethral colonization or indwelling catheters, sample contamination from perineal or vaginal sources, and non-infectious inflammatory conditions can mimic UTIs, leading to uncertainty on medical treatment decisions.MethodsInnovative shotgun metaproteomic methods were used to analyze urine sediments from 120 patients also subjected to conventional urinalysis for various clinical reasons including suspected UTIs. The proteomic data were simultaneously searched for the presence of microbial agents, inflammation, immune responses against pathogens, and evidence of urothelial tissue injury. Hierarchical clustering analysis was performed to identify host protein patterns discerning UTI from urethral colonization and vaginal contamination of urine samples.ResultsOrganisms causing more than 98% of all UTIs and commensal microbes of the urogenital and perineal area were identified from 76 urine sediments with detection sensitivities estimated to be similar to urine culture. Proteomic data permitted a thorough evaluation of inflammatory and antimicrobial immune responses. Hierarchical clustering of the data revealed that high abundances of proteins from activated neutrophils were associated with pathogens in most cases, and correlated well with leukocyte esterase activities and leukocyte counts via microscopy. Proteomic data also allowed assessments of urothelial injury, by quantifying proteins highly expressed in red blood cells and contributing to the acute phase response. Lactobacillus and Gardnerella vaginalis were frequently identified suggesting urethral colonization and/or vaginal contamination of urine.ConclusionsA metaproteomic approach of interest for routine urine clinical diagnostics is presented. As compared to urinalysis and urine culture methods, the data are derived from a single experiment for a given sample and provide additional insights into presence or absence of inflammatory responses and vaginal contamination of urine specimens.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0475-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Diagnosing inflammation and infection in the urinary system via proteomics

et al. 2015

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“…These aspects are all very important because there is now evidence that the examination of the urine sediment by nephrologists has and added value when compared to the examination carried out by clinical pathologists working in central laboratories, far from bedside and with an inadequate knowledge of clinical correlates of urinary findings [20,21,22]. …”

Section: Discussionmentioning

confidence: 99%

A Theoretical and Practical Course on Urine Microscopy in Nigeria: A Model for Nephrological Skill Transfer

et al. 2010

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Background: In the developing world, the diagnostic power of nephrologists is heavily limited by financial, technical and human resource constraints. Urine microscopy (UM) is a basic, inexpensive and relatively simple diagnostic tool, which supplies irreplaceable information. Recently, a theoretical and practical course on UM was organized during the 22nd annual meeting of the Nigerian Society of Nephrology. Methods: The 2-day course was based on power point presentations and on examination of true urine samples by means of a microscope equipped with phase contrast, polarized light and a video camera for projection of the findings. Results: The presentations described were the methodology, the particles of the urine sediment and their clinical interpretation, the urine sediment in different clinical conditions, and 12 clinical cases, which demonstrated the value of UM in clinical practice. Practical sessions showed the most important urine particles, and how they could be identified and combined into urine profiles. More than 97% of the participants found the course to be useful and practicable and a UM program was actually started in 1 Nigerian center a few days after the course. Conclusion: This course demonstrated that nephrological skills can be transferred from the developed to the developing world without large financial investments.

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“…In the case of vasculitis, positive dipsticks for haemoglobin and protein with a urine sediment containing glomerular erythrocytes associated with erythrocytic casts can be diagnostic and permit to start the adequate therapy in shorter time. With this simple and inexpensive approach, as suggested by others [ 6 ], it is possible to favour a prompt diagnosis and save the patient from a progressive renal disease.…”

Section: Discussionmentioning

confidence: 99%

Urinanalysis (UA): a neglected but easy and inexpensive diagnostic tool

Györik

Jandus

Marone³

2009

Clinical Kidney Journal

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The case history of a 75-year-old woman, who was hospitalized with the diagnosis of an acute erosive colitis, is presented. The patient was treated with hysterectomy for an endometrial cancer in 2000 and had suffered from multiple sclerosis for 15 years. A persistent non-productive cough with fever requested a pneumological consultation. Multiple small alveolar opacities and cavitating lesions were found at chest imaging, but no precise diagnosis was possible. Only 3 weeks after hospitalization, we noticed that a urine analysis had been forgotten. This additional test clearly demonstrated a nephritic sediment and further analysis confirmed the diagnosis of a ANCA-positive microscopic polyangiitis, which promptly responded to immunosuppressive therapy. The necessity of a routine urine analysis in the majority of internal medicine patients and the possible link between small vessel vasculitis and multiple sclerosis are discussed.

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How a skilful and motivated urinary sediment examination can save the kidneys

Cited by 21 publications

References 10 publications

Diagnosing inflammation and infection in the urinary system via proteomics

Diagnosing inflammation and infection in the urinary system via proteomics

A Theoretical and Practical Course on Urine Microscopy in Nigeria: A Model for Nephrological Skill Transfer

Urinanalysis (UA): a neglected but easy and inexpensive diagnostic tool

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