| At the outset, it may be said that in case there is | | | | by vaginal secretion/ seme~f the previous night's |
| any predisposing/ obstructive factor (like urinary | | | | intercourse. Hence the importance of proper |
| stones, benign enlargement of prostate, congenital | | | | washing of the whole area, especially in women, |
| abnormalities of urinary tract, etc.), it must be | | | | before giving the sample, is again emphasised. |
| investigated and treated according to the lines | | | | And, if still, in spite of all such precautions, traces |
| already described. | | | | of albumin in the urine persist, the albumin should |
| The various tests required for the diagnosis | | | | be measured in 24-hour urine, and normally it |
| treatment of UTI are as under: | | | | should be less than 3.0 g per day. However, |
| 1. Examination of urine | | | | presence of albumin in urine is an important finding |
| It is one of the most important tests, and it | | | | for kidney damage, not only due to pyelonephritis, |
| should not be taken casually. It indicates whether | | | | but also due to other diseases of the kidneys. It |
| the patient is suffering from UTI or not especially, | | | | tells us that the patient is passing into the chronic |
| when symptoms of cystitis/pyelonephritis are not | | | | stage, although he/she may remain |
| marked, or happen to be completely absent. | | | | asymptomatic. Hence a periodical examination of |
| The urine specimen for test in laboratory should | | | | urine is an important factor to assess the extent |
| be very carefully collected, keeping the following | | | | of kidney damage. |
| steps strictly in view: | | | | 3. Blood urea and serum creatinine tests |
| (i) The specimen should be from midstream. The | | | | Normal levels of blood urea range from 15-35 mg |
| patient must pass some urine outside, before | | | | dl with an average' of 25 mg/ dl. Normal serum |
| passing the urine in a sterilized container. | | | | creatinine leve1s range from 0.8 to 1.4 mg/ dl, the |
| (ii) Before giving the sample of urine, wash the | | | | average being 1.00 mg/ dl. Both these tests |
| whole area properly so that there is no | | | | should be carried out in order to be on the safe |
| contamination of E. coli, especially in women. | | | | side, although blood urea is a simple test and |
| (iii) The specimen should be given in laboratory as | | | | serum creatinine a little more difficult to carry out |
| urine sample often gets spoiled, on the way to | | | | - serum creatinine is more sensitive than blood |
| the laboratory. | | | | urea. If the levels of serum creatinine are 1.5 mg/ |
| (iv) Second morning sample is always preferred. | | | | dl, although the kidneys may be fairly damaged, it |
| In the first morning sample, some changes are | | | | is still considered early. When levels of serum |
| likely to occur due to overnight standing of urine, | | | | creatinine are raised to the extent of 3.5 to 5.5 |
| in the urinary bladder. | | | | mg/ dl, the kidneys may still be said to be |
| 2. Urine for culture and sensitivity | | | | moderately damaged and one should not lose |
| If the examination of urine shows the presence | | | | time in initiating the necessary tests arid |
| of pus cells, the urine should be given in the | | | | treatment. But if levels of serum creatinine rise |
| laboratory for culture and sensitivity. It may be | | | | above 8 mg/ dl, it means that the kidneys are |
| noted that 0-5 pus cells and 0-1 RBC (a little more | | | | severely affected, leading to renal failure, requiring |
| in females, and markedly if a woman is in mensis) | | | | urgent dialysis. |
| per high power field may be normally present in | | | | 4. 24-hour creatinine clearance |
| urine, especially when there is no associated/ | | | | It is much more reliable than the serum creatinine |
| contributing factor to UTI. The report of culture | | | | test. But it is somewhat cumbersome as in this |
| and sensitivity is usually available after 48-72 | | | | test, a 24-hour collection of urine is required. It |
| hours, and it guides the physician regarding the | | | | may be carried out to diagnose very early cases, |
| administration of antibiotics in a particular case. | | | | wherever facilities exist. |
| The treatment of UTI may not be possible | | | | 5. Ultrasonographic examination |
| without this test, and the entire course of | | | | It must be carried out in each and every case of |
| treatment depends upon the report of this test. | | | | UTI. It is a non-invasive test and usually gives |
| Therefore, it should be carried out by an | | | | valuable information regarding occult causes of |
| experienced laboratory technician and the urine | | | | UTI. For example, there may be an |
| must be collected under strict aseptic conditions. | | | | asymptomatic stone lying in the urinary tract, or |
| Besides the examination of pus cells, as well as of | | | | there may be some congenital abnormality of the |
| the culture and sensitivity of the urine, a complete | | | | kidneys causing obstruction in the urinary tract, or |
| detailed routine examination of the urine must be | | | | there may be an early enlargement of the |
| carried out so that any other abnormality, if | | | | prostate, in the case of males. |
| present, can also be considered while treating the | | | | 6. Plain X-ray abdomen, intravenous pyelography |
| case. Many a time one finds in the urine analysis | | | | These may be required depending upon the case. |
| report, traces of albumin, although there is no | | | | 7. Renal/kidney biopsy |
| apparent cause of passing albumin in urine in the | | | | It may be indicated to know about the exact |
| concerned case. Traces of albumin in urine could | | | | nature of pathology causing renal damage. |
| be due to the contamination of the urine sample | | | | |