What Tests Are Necessary For Urinary Tract Infection (UTI)?

At the outset, it may be said that in case there isby vaginal secretion/ seme~f the previous night's
any predisposing/ obstructive factor (like urinaryintercourse. Hence the importance of proper
stones, benign enlargement of prostate, congenitalwashing of the whole area, especially in women,
abnormalities of urinary tract, etc.), it must bebefore giving the sample, is again emphasised.
investigated and treated according to the linesAnd, if still, in spite of all such precautions, traces
already described. The various tests required forof albumin in the urine persist, the albumin should
the diagnosis/treatment of UTI are as under: 1.be measured in 24-hour urine, and normally it
Examination of urine It is one of the mostshould be less than 3.0 g per day. However,
important tests, and it should not be takenpresence of albumin in urine is an important finding
casually. It indicates whether the patient isfor kidney damage, not only due to pyelonephritis,
suffering from UTI or not especially, whenbut also due to other diseases of the kidneys. It
symptoms of cystitis/pyelonephritis are nottells us that the patient is passing into the chronic
marked, or happen to be completely absent. Thestage, although he/she may remain
urine specimen for test in laboratory should beasymptomatic. Hence a periodical examination of
very carefully collected, keeping the followingurine is an important factor to assess the extent
steps strictly in view: (i) The specimen should beof kidney damage. 3. Blood urea and serum
from midstream. The patient must pass somecreatinine tests Normal levels of blood urea range
urine outside, before passing the urine in afrom 15-35 mg/ dl with an average' of 25 mg/ dl.
sterilized container. (ii) Before giving the sample ofNormal serum creatinine leve1s range from 0.8 to
urine, wash the whole area properly so that there1.4 mg/ dl, the average being 1.00 mg/ dl. Both
is no contamination of E. coli, especially in women.these tests should be carried out in order to be
(iii) The specimen should be given in laboratory ason the safe side, although blood urea is a simple
urine sample often gets spoiled, on the way totest and serum creatinine a little more difficult to
the laboratory. (iv) Second morning sample iscarry out - serum creatinine is more sensitive
always preferred. In the first morning sample,than blood urea. If the levels of serum creatinine
some changes are likely to occur due to overnightare 1.5 mg/ dl, although the kidneys may be fairly
standing of urine, in the urinary bladder. 2. Urinedamaged, it is still considered early. When levels of
for culture and sensitivity If the examination ofserum creatinine are raised to the extent of 3.5
urine shows the presence of pus cells, the urineto 5.5 mg/ dl, the kidneys may still be said to be
should be given in the laboratory for culture andmoderately damaged and one should not lose
sensitivity. It may be noted that 0-5 pus cells andtime in initiating the necessary tests arid
0-1 RBC (a little more in females, and markedly iftreatment. But if levels of serum creatinine rise
a woman is in mensis) per high power field mayabove 8 mg/ dl, it means that the kidneys are
be normally present in urine, especially when thereseverely affected, leading to renal failure, requiring
is no associated/ contributing factor to UTI. Theurgent dialysis. 4. 24-hour creatinine clearance It is
report of culture and sensitivity is usually availablemuch more reliable than the serum creatinine test.
after 48-72 hours, and it guides the physicianBut it is somewhat cumbersome as in this test, a
regarding the administration of antibiotics in a24-hour collection of urine is required. It may be
particular case. The treatment of UTI may not becarried out to diagnose very early cases,
possible without this test, and the entire course ofwherever facilities exist. 5. Ultrasonographic
treatment depends upon the report of this test.examination It must be carried out in each and
Therefore, it should be carried out by anevery case of UTI. It is a non-invasive test and
experienced laboratory technician and the urineusually gives valuable information regarding occult
must be collected under strict aseptic conditions.causes of UTI. For example, there may be an
Besides the examination of pus cells, as well as ofasymptomatic stone lying in the urinary tract, or
the culture and sensitivity of the urine, a completethere may be some congenital abnormality of the
detailed routine examination of the urine must bekidneys causing obstruction in the urinary tract, or
carried out so that any other abnormality, ifthere may be an early enlargement of the
present, can also be considered while treating theprostate, in the case of males. 6. Plain X-ray
case. Many a time one finds in the urine analysisabdomen, intravenous pyelography These may be
report, traces of albumin, although there is norequired depending upon the case. 7. Renal/kidney
apparent cause of passing albumin in urine in thebiopsy It may be indicated to know about the
concerned case. Traces of albumin in urine couldexact nature of pathology causing renal damage.
be due to the contamination of the urine sample