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