| 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. The various tests required for | | | | of 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 most | | | | should be less than 3.0 g per day. However, |
| important tests, and it should not be taken | | | | presence of albumin in urine is an important finding |
| casually. It indicates whether the patient is | | | | for kidney damage, not only due to pyelonephritis, |
| suffering from UTI or not especially, when | | | | but also due to other diseases of the kidneys. It |
| symptoms of cystitis/pyelonephritis are not | | | | tells us that the patient is passing into the chronic |
| marked, or happen to be completely absent. The | | | | stage, although he/she may remain |
| urine specimen for test in laboratory should be | | | | asymptomatic. Hence a periodical examination of |
| very carefully collected, keeping the following | | | | urine is an important factor to assess the extent |
| steps strictly in view: (i) The specimen should be | | | | of kidney damage. 3. Blood urea and serum |
| from midstream. The patient must pass some | | | | creatinine tests Normal levels of blood urea range |
| urine outside, before passing the urine in a | | | | from 15-35 mg/ dl with an average' of 25 mg/ dl. |
| sterilized container. (ii) Before giving the sample of | | | | Normal serum creatinine leve1s range from 0.8 to |
| urine, wash the whole area properly so that there | | | | 1.4 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 as | | | | on the safe side, although blood urea is a simple |
| urine sample often gets spoiled, on the way to | | | | test and serum creatinine a little more difficult to |
| the laboratory. (iv) Second morning sample is | | | | carry 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 overnight | | | | are 1.5 mg/ dl, although the kidneys may be fairly |
| standing of urine, in the urinary bladder. 2. Urine | | | | damaged, it is still considered early. When levels of |
| for culture and sensitivity If the examination of | | | | serum creatinine are raised to the extent of 3.5 |
| urine shows the presence of pus cells, the urine | | | | to 5.5 mg/ dl, the kidneys may still be said to be |
| should be given in the laboratory for culture and | | | | moderately damaged and one should not lose |
| sensitivity. It may be noted that 0-5 pus cells and | | | | time in initiating the necessary tests arid |
| 0-1 RBC (a little more in females, and markedly if | | | | treatment. But if levels of serum creatinine rise |
| a woman is in mensis) per high power field may | | | | above 8 mg/ dl, it means that the kidneys are |
| be normally present in urine, especially when there | | | | severely affected, leading to renal failure, requiring |
| is no associated/ contributing factor to UTI. The | | | | urgent dialysis. 4. 24-hour creatinine clearance It is |
| report of culture and sensitivity is usually available | | | | much more reliable than the serum creatinine test. |
| after 48-72 hours, and it guides the physician | | | | But it is somewhat cumbersome as in this test, a |
| regarding the administration of antibiotics in a | | | | 24-hour collection of urine is required. It may be |
| particular case. The treatment of UTI may not be | | | | carried out to diagnose very early cases, |
| possible without this test, and the entire course of | | | | wherever 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 an | | | | every case of UTI. It is a non-invasive test and |
| experienced laboratory technician and the urine | | | | usually 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 of | | | | asymptomatic stone lying in the urinary tract, or |
| the culture and sensitivity of the urine, a complete | | | | there may be some congenital abnormality of the |
| detailed routine examination of the urine must be | | | | kidneys causing obstruction in the urinary tract, or |
| carried out so that any other abnormality, if | | | | there may be an early enlargement of the |
| present, can also be considered while treating the | | | | prostate, in the case of males. 6. Plain X-ray |
| case. Many a time one finds in the urine analysis | | | | abdomen, intravenous pyelography These may be |
| report, traces of albumin, although there is no | | | | required depending upon the case. 7. Renal/kidney |
| apparent cause of passing albumin in urine in the | | | | biopsy It may be indicated to know about the |
| concerned case. Traces of albumin in urine could | | | | exact nature of pathology causing renal damage. |
| be due to the contamination of the urine sample | | | | |