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Urinalysis in urinary tract infection
1Masonic Medical Centre for Children, Coimbatore.
Insights
Routine urinalysis effectively diagnoses urinary tract infections (UTI) in children when urine culture is unavailable. Key indicators like proteinuria, bacteriuria, and pyuria significantly aid in UTI diagnosis.
Area of Science:
- Pediatric Nephrology
- Clinical Microbiology
- Diagnostic Pathology
Background:
- Urinary tract infections (UTI) are common in children, necessitating accurate diagnostic methods.
- Routine urine examination is often the first diagnostic step, but its correlation with definitive culture results requires further elucidation.
Purpose of the Study:
- To correlate routine urinalysis parameters with urine culture results in children suspected of UTI.
- To determine the diagnostic accuracy of proteinuria, bacteriuria, and pyuria in identifying UTI in pediatric patients.
Main Methods:
- A study involving 376 children aged 6 months to 5 years with suspected UTI.
- Correlation analysis of four routine urine examination parameters against urine culture reports.
Main Results:
- Proteinuria (79% sensitivity, 80% specificity), bacteriuria (78% sensitivity, 96% specificity), and pyuria > 10 wbc/hpf (80% sensitivity, 82% specificity) showed significant diagnostic value.
- The combination of bacteriuria with either proteinuria or pyuria > 10 wbc/hpf achieved 98% specificity.
- Pyuria > 10 wbc/hpf was more specific (82%) than the conventional > 5 wbc/hpf (66.6%) for UTI diagnosis.
Conclusions:
- Routine urinalysis, particularly when interpreting proteinuria, bacteriuria, and pyuria > 10 wbc/hpf together, can reliably diagnose UTI in children, especially when urine culture facilities are limited.
- Isolated findings of proteinuria, pyuria, bacteriuria, or microscopic hematuria are not definitive indicators of UTI in this age group.
Abstract:
In 376 children, between 6 months and 5 years of age, with suspected urinary tract infection, 4 parameters of a routine urine examination were correlated with culture reports. In diagnosing urinary infection, the sensitivity and specificity of proteinuria was 79 and 80% respectively, that of bacteriuria 78 and 96% and that of pyuria > 10 wbc/hpf 80 and 82% respectively. 61% among the culture positive groups had all these three parameter present, as against only 0.5% in the culture negative group (P < 0.001). All these 3 parameters were absent in 70% in the culture negative group, as against 8% in the culture positive group (P < 0.001). Bacteriuria in association with either proteinuria or Pyuria > 10 Wbc/hpf had 98% specialty is diagnosis. In diagnosis UTI, Pyuria > 10 wbc/hpf was significantly more specific (82:66.6) than the conventional > 5 wbc/hpf. Isolated proteinuria, isolated pyuria, isolated bacteriuria and microscopic haematuria were not features of urinary tract infection in children. Urine culture can be more selectively done if the routine urinalysis is well interpreted. In the absence of dependable culture facilities, a routine urine examination can be reliably used in the diagnosis of UTI in children.