Rhabdomyolysis: An evidence-based approach

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

Kidney Injury in Children Infected with HIV, Followed at the Teaching Hospital of Borgou (Benin)

The history of kidney disease associated with HIV infection dates back to the years of HIV breakthrough. The objective was to study kidney damage in children infected with HIV at the Teaching Hospital of Borgou (Benin) in 2019. This was a cross-sectional, descriptive, analytical, matching-type study carried out from June 1, 2019 to September 30, 2019 at the pediatrics department of Teaching Hospital of Borgou (Benin). The study included HIV-positive children, followed in consultations, and whose parents gave their consent. The biological markers were demon-strated with urine dipstick. Glomerular filtration rate was calculated using the Schwartz test and classified according to stages. The dependent variable was the presence of at least one impairment (biological or functional). Sample size was determined by Schwartz’s method on the basis of one case for two controls. Sociodemographic, clinical, biological, and therapeutic data were collected. Comparisons were made using the Chi-square test or Fisher’s exact test. The identification of associated factors was possible using a multiple logistic regression model at 5% threshold. In total, we included 117 children, including 39 HIV-positive children. The average age was 8 ± 4.81 years and the gender ratio was 1:17. The frequency of kidney damage was 76.5%. Permanent proteinuria and at least two crosses on urine dipstick were present in 20.5%, leukocyturia in 2.6%, and proximal tubular dysfunction in 5.1%. Glomerular hyperfiltration was found in 38.5%, acute kidney injury in 38.5%, and chronic kidney injury in 5.1%. Associated factors were age (P = 0.004), presence of opportunistic infections (P = 0.00), and treatment adherence (P = 0.004). Kidney damage is common in HIV-positive children. Careful follow-up is necessary to avoid complications.

Diagnostic accuracy of a urine dipstick for detecting albuminuria in hypertensive patients

Background: Screening for albuminuria is generally recommended among patients with hypertension. While the urine dipstick is commonly used for screening urine albumin, there is little evidence about its diagnostic accuracy among these patients in Thailand. This study aimed to assess the diagnostic accuracy of a dipstick in Thai hypertensive patients for detecting albuminuria. Methods: This study collected the data of 3,067 hypertensive patients, with the results of urine dipstick and urine albumin-to-creatinine ratio (ACR) from random single spot urine being examined in the same day at least once, at Lampang Hospital, Thailand, during 2018. For ACR, a reference standard of ≥ 30 mg/g was applied to indicate the presence of albuminuria. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the trace result from dipsticks were 53.6%, 94.5%, 86.5%, and 75.5%, respectively. The area under the receiver operating characteristic curve of the dipstick was 0.748. Conclusion: Using the dipstick for screening albuminuria among hypertensive patients should not be recommended for mass screening due to its low sensitivity. In response to high PPV, a trace threshold of the dipstick may be used to indicate presence of albuminuria.

Correlation of Urine Dipstick Test with Spot Urine Protein-Creatinine Ratio in Women with Preeclampsia: A Cross Sectional Study

Background: Preeclampsia is one of the leading causes for the maternal and perinatal morbidity and mortality. Increase level of proteinuria is worsening condition for the pregnant women with hypertension. Objective: Our study aimed to compare urine dipstick method with P/C ratio to know the proteinuria level in hypertensive pregnant women. Material and Methods: This Cross-sectional study was conducted on 100 antenatal women with preeclampsia in Department of obstetrics and gynecology, CAIMS Karimnagar. Antenatal cases with pre-eclampsia of more than 20 weeks gestation were included in the study and Urinary Tract Infection, Diabetic, renal function disorder were excluded from study. After getting patients consent detailed history were taken, general physical and systemic including obstetric examination was done Association between the variable analyzed by using chi-square or fisher exact test and quantitative variable compare using ANOVA and Pearson correlation coefficient. P-value<0.05 considered as significant Result: Among 100 patients admitted, there are 50 cases having mean age was 25±3.266 Years, systolic blood pressure was 156.5±21.94mmhg. Association between P/C ratio and urine dipstick was statistically significant and also correlation between urine dipstick and P/C ratio was moderately correlated (r= 0.564) and highly significant (p-value <0.05) Conclusion: Our study conclude that Urine dipstick method and P/C ratio has strong correlation between them with high accuracy, at 2+or greater level it can used to estimate significant proteinuria or spot urine P/C ratio for screening pregnant women with suspected preeclampsia. Also, this method is convenient and cost effective for patient. Keywords: Preeclampsia, Proteinuria, Urine Dipstick, Antenatal.

Validity of dipstick urinalysis for predicting urinary tract infection in febrile children aged 2-12 years in a tertiary care centre, South Kerala

Background: Urinary tract infection (UTI) warrants an early accurate diagnosis in children. Use of rapid diagnostic tests like urine dipstick and microscopy was found to be economical and effective. There is lack of sufficient studies on rapid diagnostic tests in developing countries like India. This study looked at the single as well as combination of parameters that provided maximum sensitivity and specificity, providing a better diagnostic criterion in detecting UTI. The objective was to assess the diagnostic validity of urinary dipstick in the diagnosis of UTI in comparison with urinary culture.Methods: This cross-sectional diagnostic evaluation study was conducted in a tertiary care centre in Southern Kerala. Total of 75 children between the age group of 2 years to 12 years who attended the paediatric OPD with the clinical features of UTI were included in this study. Two urine samples were obtained in sterile containers. The first urine sample was assessed with dipstick and the second sample was sent for culture to confirm the UTI. The results obtained were analysed using SPSS software.Results: Using culture as gold standard, the results for nitrate alone had lower sensitivity at 69.69%, specificity at 90.4%. The results for LE (LE) alone had higher sensitivity at 81.8%, specificity at 80.95% and the results for combined urine dipstick had higher sensitivity at 84.8% than individual nitrite and LE. The combined positive predictive value (PPV) was lower than individual nitrite and LE 75.6%. The combined negative predictive value (NPV) was higher than individual LE and nitrite at 86.8%.Conclusions: Dipstick urinalysis alone may not be a completely adequate screening tool for UTI. Since urine dipstick test has high sensitivity it can be used as a bedside tool in detecting UTI in children.

Semiquantitative assessed proteinuria and risk of heart failure: Analysis of a nationwide epidemiological database

Background Heart failure (HF) is increasing in prevalence worldwide. We explored whether adults with trace and positive proteinuria were at a high risk for incident HF compared with those with negative proteinuria using a nationwide epidemiological database. Methods This is an obserevational cohort study using the JMDC Claims Database collected between 2005 and 2020. This is a population-based sample (n = 1,021,943; median age [interquartile range], 44 [37-52] years; 54.8% men). No participants had a known history of cardiovascular disease. Each participant was categorized into three groups according to the urine dipstick test results: negative proteinuria (n = 902,273), trace proteinuria (n = 89,599), and positive proteinuria (≥1+) (n = 30,071). The primary outcome was HF. The secondary outcomes were myocardial infarction, stroke, and atrial fibrillation. We performed multivariable Cox regression analyses to identify the association between the proteinuria category and incient HF and other cardiovascular disease events. Results Over a mean follow-up of 1,150 ± 920 days, 17,182 incident HF events occurred. After multivariable adjustment, hazard ratios (HRs) for HF events were 1.09 (95% confidence interval [CI], 1.03-1.15) and 1.59 (95% CI, 1.49-1.70) for trace proteinuria and positive proteinuria vs. negative proteinuria, respectively. This association was present irrespective of clinical characteristics. A stepwise increase in the risk of myocardial infarction, stroke, and atrial fibrillation with proteinuria category was also observed. Our primary results were confirmed in participants after multiple imputation for missing values and in those having no medications for hypertension, diabetes mellitus, and dyslipidemia. Discriminative predictive value for HF events improved by adding the results of urine dipstick test to traditional risk factors (net reclassification improvement 0.0497, 95% CI 0.0346-0.0648, p &lt; 0.001). Conclusions Not only positive proteinuria but also trace proteinuria was associated with a greater incidence of HF in the general population. Semiquantitative assessment of proteinuria would be informative for the risk stratification of HF.