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