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AIM: To investigate the diagnostic test accuracy of urine collection methods for urinary tract infections in outpatient children. METHODS: A systematic literature review until April 2021 (Medline, Web of Science, Embase, Cinahl) to examine the diagnostic test accuracy of urine culture on collection methods for urinary tract infection in outpatient children below 18 years. Contamination rates were studied as secondary outcome. The risk of bias was assessed using the QUADAS-2 criteria. Two-by-two tables were extracted in duplicate to calculate sensitivities, specificities, and likelihood ratios with 95% confidence intervals. RESULTS: The search identified seven relevant studies. Clean catch compared to catheterization in children less than 90 days showed a sensitivity and specificity of 97% and 89% (95% CI: 84%-100% and 67%-99%), respectively. Adhesive bags compared to catheterization showed a sensitivity of 83% (95% CI: 75%-90%) and specificity of 91% (95% CI: 83%-96%). There was a similar diagnostic accuracy when comparing urine sampling by means of adhesive bags versus nappy pads. The contamination rate was 5% for clean catch, 30%-80% for adhesive bags and 64% for nappy pads. CONCLUSION: Nappy pads and adhesive bags are easy to use with comparable accuracy but are extremely prone to contamination. Clean-catch urine sampling might be an accurate alternative in young infants in ambulatory care. ispartof: ACTA PAEDIATRICA vol:110 issue:12 pages:3170-3179 ispartof: location:Norway status: published

AIM Accurate and precise estimation of glomerular filtration rate (GFR) is essential in kidney disease. We evaluated the usefulness of the mean of creatinine clearance (CCr ) and urea clearance (CUN ) examined over a 1-h urine collection period (1-h (CCr + CUN )/2) in a retrospective, cross-sectional study across two centres, as a relatively simple method for estimating GFR in children. METHODS Children aged ≤18 years who underwent inulin clearance (CIn ) tests were eligible. Two clearance values were obtained during a 2-h test consisting of two periods of 1 h each. The mean clearance in two periods was defined as 1-h clearance. 1-h (CCr + CUN )/2, 1-h CCr , 1-h CUN and GFR estimated by Cr-based and cystatin C (CysC)-based formulas for Japanese children were compared with CIn . Bland-Altman plots were used to evaluate correlations. The primary outcome measure was the correlation between 1-h (CCr + CUN )/2 and CIn . RESULTS Fifty-three children were analysed. Their median age was 10.9 (interquartile range [IQR] 5.3-14.2) years, and median CIn and 1-h (CCr + CUN )/2 were 77.0 (IQR: 51.5-95.1) and 81.0 (IQR: 64.1-97.7) ml/min/1.73 m2 , respectively. Percentage difference of CIn and 1-h (CCr + CUN )/2 in the Bland-Altman plot was -11.2% (95% confidence interval - 15.3% - -7.1%), with 95% lower and upper limits of agreement of -40.3% and 18.0%, respectively. Thus, 1-h (CCr + CUN )/2 was 1.12 times CIn . CONCLUSION 1 h (CCr + CUN )/2 was almost concordant with CIn . 1-h (CCr + CUN )/2 can estimate GFR accurately and precisely, making it a simple and speedy test for use in clinical practice.

OBJECTIVES Current human infant urine collection methods for the field are problematic for the researcher and potentially uncomfortable for the infant. In this study, we compared two minimally invasive methods for collecting infant urine: organic cotton balls and filter paper. MATERIALS AND METHODS We first collected urine from infants using the clean catch method. We then used those samples to compare the performance of filter paper and cotton ball collection protocols. We analyzed the clean catch and cotton samples using commercial estrone-3-glucuronide (E1G) kits and tried two different extraction methods for the filter paper. Using a paired t-test (n = 10), we compared clean catch and cotton samples. We also compared effect sizes within and between methods. RESULTS We were unable to extract enough urine from the filter paper to successfully assay the samples for E1G. The paired t-test revealed a statistically significant difference between the clean catch and cotton methods (t = 2.63, p-value = 0.03). However, the effect size was small (5.91 μg/ml, n = 10, 95% CI = 3.80, 8.02) and similar to or larger than the difference seen between duplicate wells for clean catch and cotton values. DISCUSSION While this study is limited by sample size, our results indicate that filter paper is not a field-friendly method for collecting infant urine. However, we found that organic cotton balls showed similar values to the clean catch method, and we propose this method as an alternative, minimally invasive method for study of E1G in human infant urine.

Aim Urinary tract infection is a common cause of paediatric morbidity. However, there is no consensus on the default method for urine culture collection in children. This study aimed to examine the contamination rates of different urine collection methods. Methods This was a retrospective cohort study in a paediatric emergency department. Data were collected from electronic health records on all children whose urine culture samples were obtained in the paediatric emergency department between March 2018 and March 2019. Different methods of urine collection included the midstream (MS) method, clean catch (CC), transurethral bladder catheterisation and suprapubic aspiration. Contamination rates and positive urine culture rates were calculated and compared for sex, age, and collection method. Results Urine culture samples were collected from 1507 children. There were 284 (18.8%) cultures that were positive with significant growth and 52 (3.5%) that were defined as 'contaminated'. The contamination rates for the midstream method in toilet-trained children were 1.6% (10/609), 4.9% (17/348) for CC in pre-continent children, 4.9% (25/515) for transurethral bladder catheterisation and 0% (0/35) (P = 0.006) for suprapubic aspiration. There was no significant difference in contamination rates of urine cultures collected by CC and catheterisation in the compared groups. The rates of positive cultures in the subgroup of children with high suspicion for Urinary tract infection were also found to be similar. Conclusions Our study shows that CC is non-inferior to catheterisation for collecting urine cultures in young children.

Aims Nocturnal polyuria (NP) and global polyuria (GP) are not mutually exclusive. However, by rate, the common criteria for GP (40 mL/kg/24 hours [117 mL/kg/hour in a 70-kg individual] or 3000 mL/24 hours [125 mL/h]) are more stringent than those for NP (90 mL/hour during the sleep period or NP index [NPi; nocturnal volume/24-hour volume] > 0.33 [no minimum rate]). It remains unclear whether total nocturnal urine volume (NUV) may reliably delineate between NP patients with and without comorbid GP. Methods A clinical database of men with lower urinary tract symptoms was searched for voiding diaries completed by patients reporting greater than or equal to 1 nocturnal void(s). Four separate analyses were performed using all combinations of the two NP and two GP criteria listed above. For each analysis, patients were included if they met the criteria for NP, and then stratified by presence or absence of GP (ie, NP + GP vs isolated NP). Results Median NUV was greater among patients with NP + GP for all criteria combinations. Sensitivities greater than or equal to 80%/90%/100% for NP + GP were observed at 1275/1230/1085 mL for {NPi > 0.33 + 24-hour volume > 3000 mL}; 1075/1035/1035 mL for {NPi > 0.33 + 24-hour volume > 40 mL/kg}; 900/745/630 mL for {NUP > 90 mL/hour + 24-hour volume > 3000 mL}; and 1074/1035/990 mL for {NUP > 90 mL/hour + 24-hour volume > 40 mL/kg}. Conclusions An inordinate NUV among men with NP is fairly sensitive for comorbid GP. In the appropriate clinical setting, nocturnal-only diaries may suffice in the evaluation and follow-up of patients with NP, so long as outlying nocturnal volumes prompt a 24-hour diary/urine collection.

The Global Burden of Disease (GBD) 2010 study estimated national salt intake for 187 countries based on data available up to 2010. The purpose of this review was to identify studies that have measured salt intake in a nationally representative population using the 24‐hour urine collection method since 2010, with a view to updating evidence on population salt intake globally. Studies published from January 2011 to September 2018 were searched for from MEDLINE, Scopus, and Embase databases using relevant terms. Studies that provided nationally representative estimates of salt intake among the healthy adult population based on the 24‐hour urine collection were included. Measured salt intake was extracted and compared with the GBD estimates. Of the 115 identified studies assessed for eligibility, 13 studies were included: Four studies were from Europe, and one each from the United States, Canada, Benin, India, Samoa, Fiji, Barbados, Australia, and New Zealand. Mean daily salt intake ranged from 6.75 g/d in Barbados to 10.66 g/d in Portugal. Measured mean population salt intake in Italy, England, Canada, and Barbados was lower, and in Fiji, Samoa, and Benin was higher, in recent surveys compared to the GBD 2010 estimates. Despite global targets to reduce population salt intake, only 13 countries have published nationally representative salt intake data since the GBD 2010 study. In all countries, salt intake levels remain higher than the World Health Organization's recommendation, highlighting the need for additional global efforts to lower salt intake and monitor salt reduction strategies.

Many patients on hemodialysis retain significant residual renal function (RRF) but currently measurement of RRF in routine clinical practice can only be achieved using inter-dialytic urine collections to measure urea and creatinine clearances. Urine collections are difficult and inconvenient for patients and staff, and therefore RRF is not universally measured. Methods to assess RRF without reliance on urine collections are needed since RRF provides useful clinical and prognostic information and also permits the application of incremental hemodialysis techniques. Significant efforts have been made to explore the use of serum based biomarkers such as cystatin C, β-trace protein and β2 -microglobulin to estimate RRF. This article reviews blood-based biomarkers and novel methods using exogenous filtration markers which show potential in estimating RRF in hemodialysis patients without the need for urine collection.

Scope Fumonisin (FB) occurs in maize and is an inhibitor of ceramide synthase (CerS). We determined the urinary FB1 (UFB1) and sphingoid base 1-phosphate levels in blood from women consuming maize in high and low FB exposure communities in Guatemala. Methods and results FB1 intake was estimated using the UFB1. Sphinganine 1-phosphate (Sa 1-P), sphingosine 1-phosphate (So 1-P), and the Sa 1-P/So 1-P ratio were determined in blood spots collected on absorbent paper at the same time as urine collection. In the first study, blood spots and urine were collected every 3 months (March 2011 to February 2012) from women living in low (Chimaltenango and Escuintla) and high (Jutiapa) FB exposure communities (1240 total recruits). The UFB1, Sa 1-P/So 1-P ratio, and Sa 1-P/mL in blood spots were significantly higher in the high FB1 intake community compared to the low FB1 intake communities. The results were confirmed in a follow-up study (February 2013) involving 299 women living in low (Sacatepequez) and high (Santa Rosa and Chiquimula) FB exposure communities. Conclusions High levels of FB1 intake are correlated with changes in Sa 1-P and the Sa 1-P/So 1-P ratio in human blood in a manner consistent with FB1 inhibition of CerS.

Objectives To evaluate the accuracy of sonouroflowmetry in recording urinary flow parameters and voided volume. Methods A total of 25 healthy male volunteers (age 18–63 years) were included in the study. All participants were asked to carry out uroflowmetry synchronous with recording of the sound generated by the urine stream hitting the water level in the urine collection receptacle, using a dedicated cell phone. From 188 recordings, 34 were excluded, because of voided volume

Aim Guidelines recommend collecting urine with suprapubic aspiration or urethral catheterisation in infants with a suspected urinary tract infection (UTI), but the invasiveness of these methods continues to drive research on new urine collection devices. We studied children with a suspected UTI, who had not been toilet trained, to compare a new midstream urine collector and catheterisation. Method During this prospective controlled diagnosis study of 94 children, urine collection was performed using the midstream collector and then controlled via catheterisation when the urine dipstick was positive. Results When end stream samples collected by the midstream collector were compared to catheter samples, the results were inconsistent in 23.4% of cases, similar to the inconsistent results between first stream samples discarded by the device and the catheter samples (21.3%). Interestingly, the overall rate of sample contamination in the bag of the midstream collector was lower than that reported in previously published studies and there were no false positive bag results. Conclusion The midstream collector did not appear to provide additional benefits to classic collection bags. A sterile collection method, such as suprapubic aspiration, catheterisation or clean catch, is still mandatory for diagnosing urinary tract infections in children who are not toilet trained.

Nowadays, pharmaceuticals are present in surface waters as well as in groundwaters of developed countries. In the middle of Lake Geneva, for example, one of the largest European lakes, 14 pharmaceuticals are regularly detected in concentrations up to 0.37 µg/L. This pollution is due to the human consumption of drugs and also veterinary use and industrial releases during production. In the case of Lake Geneva, this latter pollution is significant for some specific compounds. But, as shown in this overview, environmental toxicity data are lacking for most of the pharmaceuticals detected in the aquatic environment. For example, the ecotoxicity of metformin, one of the main compounds detected in Lake Geneva, is mostly unknown for the moment. Furthermore, specific effects like endocrine disruption, genotoxicity, or antibioresistance induction, which may be expected because of the mode of action of some drugs, have not yet been investigated for aquatic species. Ecological risk assessment of pharmaceuticals is therefore tricky and most of the time is not feasible. Owing to this lack of knowledge, also due to high biological potency of the pharmaceuticals, it is critical to reduce the release of these compounds to the aquatic system. This may be achieved by ‘at source’ (e.g., urine collection) methods or ‘end of pipe’ (e.g., wastewater treatment) solutions. WIREs Water 2014, 1:69–86. doi: 10.1002/wat2.1006 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website.

Aim The aim of this study was to underscore problems associated with the dipstick test and determination of protein concentration alone in spot-urine (P-test) compared with spot-urine protein-to-creatinine ratio (P/Cr test) and to determine whether urine collection for 24-h test was complete. Material and Methods Dipstick and P/Cr tests were performed simultaneously in 357 random spot-urine specimens from 145 pregnant women, including 35 with pre-eclampsia. Positive results were defined as ≥1+ on dipstick test, protein concentration ≥30 mg/dL on P-test, and P/Cr ratio ≥ 0.27 (mg/mg) on P/Cr test. Sixty-four 24-h urine tests (quantification of protein in urine collected during 24 h) were performed in 27 of the 145 women. We assumed that P/Cr ratio ≥ 0.27 predicted significant proteinuria (urinary protein ≥ 0.3 g/day). The 24-h urine collection was considered incomplete when urinary creatinine excretion was 25.0 mg/kg/day. Results Forty-four percent (69/156) of specimens with a positive test result on dipstick test contained protein

Background Due to high nuclease activity and complex contents in urine, urinary cell-free DNA (ucfDNA) was prone to degrade. So, we developed standardized urine collection tube (UCT) to prevent ucfDNA degradation and simultaneously maintain urinary cells in their original form during the sample collection process, ensuring stabilization of the original proportion and integrity of ucfDNA. Methods Urine samples were collected from bladder cancer patients and divided into 10-mL normal tubes and 10-mL UCTs, respectively, and kept at ambient temperature. Urine supernatant was separated by centrifuging, and ucfDNA was extracted. Then ucfDNA was quantified by quantitative real-time polymerase chain reaction. UcfDNA fragments distribution was analyzed by Agilent 2200, and the frequency of specific mutations of urinary system disease was detected by next-generation sequencing method. Results Urine collected into UCTs showed no statistically significant changes in their original proportion and integrity of ucfDNA up to 7 days at ambient temperature and also ucfDNA fragments were maintained well. Conversely, urine collected into normal tubes was observed an obviously decline in their original proportion of ucfDNA and ucfDNA fragments changed greatly. The △% of allele fraction (AF) for specific genes of ucfDNA from UCTs was lower than from normal tubes by 3.7-fold. Conclusion Using UCTs, they can maximally keep the original proportion and integrity of ucfDNA and stabilize urinary cells and minimize the background noise caused by urinary cellular DNA releasing, it will be help to open the door of next-generation noninvasive liquid biopsy applications utilizing urine.

Purpose In vivo animal cystometry represents an accepted methodology for the study of lower urinary tract physiology. A particular advantage of the mouse model is the availability of genetically modified strains, offering the possibility of linking individual genes to relevant physiological events. However, small voided volumes complicate the ability to obtain reliable pressure-flow data by gravimetric methods, due to non-continuous drop formation and release during voiding. We investigated the feasibility of a simple non-gravimetric continuous urine collection system during cystometry under urethane anesthesia, and compared urethane-anesthetized with awake cystometry. Methods Cystometry was performed in awake and urethane-anesthetized female mice using a suprapubic tube. A simple, novel non-gravimetric method of urine collection was used in urethane-anesthetized animals to assess voided volume and permit flow rate calculations. Pressure and time-related variables were compared between groups. Results Voided urine collection appears to be complete and continuous in this model. Mean voided volume was 0.09 ± 0.020 ml, with an average flow rate of 0.029 ± 0.007 ml/sec. Urethane anesthesia delayed cystometric pressure/volume responses. However, micturition reflexes were intact and otherwise comparable between groups. Female mice void with pulsatile pressurization previously described in rats. Conclusion Suprapubic voiding cystometry using a simple and reliable urine collection method under urethane anesthesia is feasible in mice, permitting the integration of voided volumes with pressure and time data. The inclusion of volume and flow data enhances the usefulness of the mouse model for in vivo assessment of detrusor and potentially sphincteric performance. Neurourol. Urodynam. 29:1344–1349, 2010. © 2010 Wiley-Liss, Inc.

OBJECTIVE To develop a relational database (Cancer Research Uro-Oncology Database, CRUD©) to enable automatic data collection on all urological malignancies within our region, as there is increasing emphasis on good data collection for surgical patients with cancer, and numerous overlapping systems that are amassing data on the same patients. METHODS Links have been established between pathological databases, multidisciplinary team data-collection systems and patient-survival monitoring facilities, providing accurate pathology, treatment and survival data on all of uro-oncology patients. We are also developing individual modules for the oncological surgeons within our unit that are compatible with the British Association of Urological Surgeons (Section of Oncology), and have plans to connect to the Medical and Clinical Oncology data systems in the future. RESULTS Pre-existing protocols for fresh tissue, plasma and urine collection have been incorporated within CRUD via a tissue-tracking system, to comply with the Human Tissue Act 2004, and link these samples to accurate clinical, pathological and survival data. Many research and audit projects have already used these data, including the construction of a 274-case tissue microarray for renal cell carcinoma, microRNA hybridization arrays and analysis of 900 nephrectomy cases from the past three decades. CONCLUSIONS Our work over the past 3 years in Oxford has established numerous links with organizations collecting data on our uro-oncological patients, and we are now able to collect this excellent combined data on all of these patients, in an automated manner.

21 % of 228 tests for vitamin B12 absorption were unsatisfactory because of a discrepancy between the result obtained by the urinary excretion method and by the measurement of plasma radioactivity. The usual error was recording a too low value for the urinary excretion because of incomplete urine collection or impaired renal function. In all these cases the plasma radioactivity was within the normal range. In 4 patients plasma radioactivity was too low but urinary excretion normal.

Orange RN (monosodium salt of l–phenylazo–2–naphthol–6–sulphonic acid) was administered to female pigs either by intraveneous injection or by stomach tube. After intravenous injection of Orange RN, 7.8 mg/kg, the following metabolites were indentified in 24–hour urines: Orange RN (31 %), l–(4–hydroxyphenylazo)–2–naphthol–6–sulphonic acid (3 %), p–aminophenol and o–aminophenol (34 % and 4 % of the theoretical yield, respectively). l–Amino–2–naphthol–6–sulphonic acid was present, but not determined. When the urine collection was extended to 72 hours the excretion of p–aminophenol accounted for the remainder of the phenylazo moiety. The excretion pattern for p–aminophenol suggests that Orange RN is partly excreted in the bile and thereafter undergoes azo reduction in the gut. After administration of Orange RN, 78 mg/kg, by stomach tube the following metabolites were identified in the urine: Total coloured metabolites (Orange RN and l–(4–hydroxyphenylazo)–2–naphthol–6–sulphonic acid) (0.4 % of the theoretical yield), p–aminophenol and o–aminophenol (52 % and 6 % of the theoretical yield, respectively) and aniline (0.3 % of the theoretical yield). 1–Amino–2–naphthol–6–sulphonic acid was present, but not determined.

SUMMARY Twenty incontinent female patients with spina bifida have been treated with an indwelling Foley catheter. Four, whose abdominal deformity prevented urinary diversion, have remained dry for periods between 11 and three years. So far there have been no serious late complications. 12 patients have been catheterised as an alternative to ileal loop diversion, and four to improve bladder drainage. Eight of these have tolerated a catheter and remain dry. Late results have not yet been assessed. Further trial is suggested. RESUME 20 filles incontinentes en raison d'un spina bifida ont ete traitees par un catheter de Foley a demeure. Quatre d'entre elles, dont les deformations abdominales avaient empeche une diversion urinaire, sont restees continentes durant des periodes de trois a 11 ans. Il n'y a pas eu de complications tardives graves. Chez douze malades, le traitement par catheter a demeure a ete associea une diversion dans une boucle ileale et dans quatre autres cas, le traitement a ete entrepris pour ameliorer le drainage vesical. Dans huit de ces seize cas, la tolerance du catheter aete bonne, avec continence, bien que les resultats tardifs aient encore besoin d'une appreciation. ZUSAMMENFASSUNG 20 inkontinente weibliche Patienten mit Spina bifida sind mit einem Foley Dauerkatheter behandelt worden. Vier dieser Kinder, bei denen durch eine abdominelle Misbildung die Urinableitung behindert war, sind uber Zeitraume zwischen drei und elf Jahren trocken geblieben. Es sind keine spateren ernsthaften Komplikationen beobachtet worden. 12 Patienten sind mit einem Dauerkatheter als Alternative zu einer Ileumschlingenableitung behandelt worden und weitere vier Falle zur Verbesserung der Blasendrainage. Acht dieser 16 Falle haben den Katheter toleriert und sind trocken, obwohl spatere Ergebnisse noch abzuwarten sind. RESUMEN Se trato a 20 ninas incontinentes con espina bifida con el cateter interno de Foley. Cuatro, cuya deformacion abdominal impidio la derivacion urinaria, permanecieron continentes por periodos de 3 a 11 anos. No hubo ninguna complicacion grave posterior. Doce fueron tratadas con el cateter interno, como alternativa a la derivacion ileal, y otros cuatro casos para mejorar el drenaje vesical. Ocho de estas 16 pacientes han tolerado el cateter y han permanecido continentes, si bien aun no se conocen los resultados a largo plazo.

Glomerular filtration rate (GFR) is a direct measurement of renal function. Although clearance tests using 24-h urine collection or blood sample series are gold standards for measuring GFR, serum-based prediction of GFR based upon the Modification of Diet in Renal Disease (MDRD) Study equation is acceptable for routine use in human adults. The purpose of our study was to assess the ability for a modified MDRD Study equation to predict expected changes in GFR in bottlenose dolphins (Tursiops truncatus) using a healthy dolphin population represented by 1,103 routine serum samples collected from 50 dolphins of all age groups, years 1998-2005. Predicted GFR was also calculated from serum collected from a 32-yr-old male dolphin with end-stage renal disease. The dolphin-adjusted MDRD equation predicted GFR changes in our population that paralleled what has previously been reported in other mammals, including decreasing predicted GFR with age (P < 0.01), higher predicted GFR in dolphins that had recently eaten (P < 0.01), and rapidly decreasing predicted GFR in the animal with end-stage renal disease. We conclude that a serum-based GFR prediction equation may be a feasible means of detecting and tracking renal function in bottlenose dolphins.

In recent years products containing 6alpha-methylandrost-4-ene-3,17-dione have appeared on the sport supplement market. Scientific studies have proven aromatase inhibition and anabolic and mild androgenic properties; however, no preparation has been approved for medical use up to now. In sports 6alpha-methylandrost-4-ene-3,17-dione has to be classified as a prohibited substance according to the regulations of the World Anti-Doping Agency (WADA). For the detection of its misuse the metabolism was studied following the administration of two preparations obtained from the Internet (Formadrol and Methyl-1-Pro). Several metabolites as well as the parent compounds were synthesized and the structures of 3alpha-hydroxy-6alpha-methyl-5beta-androstan-17-one, 6alpha-methylandrost-4-ene-3,17-dione, and 5beta-dihydromedroxyprogesterone were confirmed by nuclear magnetic resonance (NMR) spectroscopy. The main metabolite, 3alpha-hydroxy-6alpha-methyl-5beta-androstan-17-one, was found to be excreted as glucuronide and was still detectable in microg/mL amounts until urine collection was terminated (after 25 h). Additionally, samples from routine human sports doping control had already tested positive for the presence of metabolites of 6alpha-methylandrost-4-ene-3,17-dione. Screening analysis can be easily performed by the existing screening procedure for anabolic steroids using 3alpha-hydroxy-6alpha-methyl-5beta-androstan-17-one as target substance (limit of detection

Purpose: To compare efficacy and cost of conventional and alternative sampling methods concerning urine cultures. Design and Methods: An experimental study with two replications was carried out in a 900-bed university hospital in Ankara, Turkey. The sample was 160 hospitalized female patients, who were asked to give urine specimens, September 10, 2000 and September 1, 2001. They were patients on urology and obstetrics and gynaecology wards. The authors informed the patients about the study first and then obtained two samples from each patient under their observation. The number of specimens was 320. Statistical methods were descriptive. Findings: The rates of contamination and significant growth, respectively, were 4.4% and 7.5% for the conventional method and 5.6% and 10% for the alternative method. The cost per culture was 2.588.257 TL (2.10 USD) for the conventional method and 57.021TL (0.05 USD) for the alternative method. The cost difference was statistically significant. Conclusions: The two methods yielded similar results but the alternative method was less expensive.

To establish adequacy of urine collection times shorter than 24h in the metabolic monitoring of low birthweight infants, we collected urine for 24 h in 39 LBW infants during the third and fourth week of life. All urine voidings over the 24-h period were separately collected, the volume of each sampling and the time of voiding were recorded, and 20% of the volume was removed for pooling. All individual and pooled samples were analysed for total nitrogen, urea and ammonia, alpha-amino nitrogen, creatinine, sodium, potassium, calcium and phosphorus, and for each compound the ratio to 1 mol creatinine was established. Individual sample results were "pooled" to obtain 3-, 6- and 12-h period excretion and than related to the 24-h excretion as measured in the pooled 24-h sample. As the volume of urine obtained in any 6-h collecting period depended on the time of sampling (06:00-12:00 h, 17.5+/-3.1% of total; 12:00-18:00 h, 31.6+/-5.1% of total; 18:00-24:00 h, 25.6+/-3.1% of total; and 0:00-06:00h, 25.3+/-2.9% of total), calculations were based on samples obtained from 18:00 to 06:00 h. The correlation between results of 3- and 24 h-collection periods was weakest, while results of the 6-h collection correlated highly with the total daily excretion (r = between 0.82 and 0.93 for the different compounds) and the correlation was only slightly better when the 12-h collection period was considered. The correlation between the mean molar substrate/creatinine ratio of all individual samples of a 24-h collecting period and the and total daily excretion of the respective substrate was weaker (r = between 0.46 and 0.76 for the different compounds) than the correlation between the results of a 6-h collecting period and the daily excretion is not as stable than in later life. The data indicate that 6-h urine sampling may be sufficient for metabolic monitoring of LBW infants. By contrast, urinary substrate/creatinine ratios are not good markers of the daily excretions of the respective substrate during the first weeks of life.

OBJECTIVES To test the ability of a sensor developed to signal infection by the organisms that generate the crystalline biofilms that encrust catheters, to give an early warning that encrustation was occurring on patients' catheters, as the care of many patients undergoing long-term bladder catheterization is complicated by the encrustation and blockage of their catheters PATIENTS AND METHODS Twenty patients were followed prospectively for the lifetime of one of their catheters. Sensors based on cellulose acetate/bromothymol blue were placed in the urine-collection bags, which were changed as usual at weekly intervals. The bacteriology was assessed and pH determined weekly on urine samples. Photographic records were made of the sensors twice weekly. On removal, each catheter was examined for encrustation and blockage. RESULTS Proteus mirabilis was not isolated from five patients and in these cases the sensor colour remained golden-yellow to brown. The catheters drained for the scheduled period and showed no signs of encrustation. By contrast, the sensors turned dark blue/black in the urine of all 15 patients infected with P. mirabilis. All these patients' catheters were encrusted and in 12 the catheters blocked. The mean interval between the sensor signalling and the catheter blocking was 12 days. CONCLUSION The cellulose acetate/bromothymol blue sensors placed in the urine collection bags are capable of signalling infection by P. mirabilis. They also signal the early stages of catheter encrustation and allow catheter replacement in ample time to avoid the clinical crises and emergency referrals caused by catheter blockage.

Background: The clinical effect of phototherapy for neonatal hyperbilirubinemia is based on the production and elimination of cyclobilirubin. Generally, the clinical effect of light sources is estimated by the reduction in the total serum bilirubin level. One procedure with less invasiveness than blood collecting is urine collection. Whether the effectiveness of light sources used for phototherapy could be assessed using measurements of bilirubin photoisomers in urine was studied. Methods: This study was a retrospective analysis of 38 term infants with hyperbilirubinemia who underwent phototherapy. Bilirubin fractions in serum and urine before and 24 h after the phototherapy were measured by high-performance liquid chromatography. The light sources used for the phototherapy were blue-white light (n = 11), Biliblanket plus high output (n = 13) or green light (n = 14). The relationships between serum and urine bilirubin photoisomers after phototherapy and whether the levels of urine bilirubin photoisomer are affected by the light sources with different wavelength characteristic were analyzed. Results: There was no correlation between serum (ZE)-bilirubin and urine configurational isomers, but a weak positive correlation between serum (EZ)-cyclobilirubin and urine structural isomers after phototherapy. Although serum (ZE)-bilirubin levels depended on the wavelength characteristic of each light source during phototherapy, the urine configurational isomer levels did not depend on it. The increase in serum (EZ)-cyclobilirubin levels and the urine structural isomer levels were mostly in agreement. Conclusions: The urine bilirubin structural isomers may be used to estimate the serum (EZ)-cyclobilirubin levels and to evaluate the clinical effects of light sources.

SUMMARY: The objective of this study was to establish an appropriate formula for the estimation of creatinine clearance (CCr) in sick Thai children, and to evaluate the accuracy of using the Schwartz formula. Children aged between 0 and 19 years with various diseases and varying levels of renal function (but remained stable) were studied. Height in centimetres (L) and weight in kilograms (W), time of urine collection and urine volume were measured to provide urine flow (mL/min (V)) measurements. Body surface area (m2; SA) was also assessed. Quantitative urinary and plasma creatinine concentration (UCr and PCr, respectively) were determined. Creatinine clearance was calculated by using the following formula: UCr × V × 1.73/(PCr × SA). The linear association between CCr and L/PCr derived from these data was compared with the Schwartz formula by using bootstrap statistics. One-hundred and sixty children were studied. A least squares straight-line regression through the origin of CCr against L/PCr provided a good fit to the data. Our dataset revealed no evidence of an age or sex affect on the relationship. Creatinine clearance was estimated by using the following formula: 0.465 × (L/PCr), in which the calculated 95% confidence interval of the coefficient was 0.44–0.49. A comparison of this coefficient with that for the Schwartz formula for children aged ≥1 year (0.55), using 1000 bootstrapped resamples, showed an incompatibility between the two coefficients (P

The self-retaining catheter was developed in the 1930s without recognising the need to preserve the antibacterial mechanisms of the bladder. Professor Feneley discusses how future research should be seeking a urine collection system that enables the bladder to fill and empty regularly and completely, thus mimicking the wash-out effect of the healthy bladder. He provides an example of the way in which new technologies can improve the quality of life for the catheter user.

Objectives: This study evaluates how often the self-report of a low sodium (Na) intake is reflected by a low 24-h urinary sodium excretion and examines the influence of incomplete urinary collections on this comparison. Methods: In a study in which 24-h urine collections were obtained for measurement of Na and creatinine excretion, 120 participants were asked whether their Na intake was low, medium, or high. A 24-h urine collection was considered complete if creatinine excretion was ≥20 mg/kg in men or ≥15 mg/kg in women, and incomplete if below those amounts. The kappa statistic was computed to assess the level of agreement between 24-h Na excretion, dichotomized at 100 meq and self-report responses. Results: Agreement between self-reported and actual Na excretion was poor. The kappa statistic was 0.18 for the total sample, 0.04 for complete collectors, and 0.51 for incomplete collectors, respectively. Overall, 24-h Na excretion exceeded 100 meq among 75% of those reporting an average or high Na intake, but it also exceeded 100 meq among 57% of those reporting a low sodium intake. Further, among those reporting a low sodium intake, Na excretion exceeded 100 meq in 80% of those who submitted a complete collection, but in only 29% of those who submitted an incomplete collection. Conclusions: These findings suggest that many individuals who report a low salt diet actually excrete ≥100 meq/day. Na intake is also frequently underestimated because many 24-h urine collections are incomplete. Am. J. Hum. Biol., 2012. © 2012 Wiley Periodicals, Inc.

cope : Knowledge on the influence of current diet on TMAO levels in humans is still inconsistent. Thus, we aimed to investigate associations of current diet with urine and plasma TMAO levels and to determine the effect of different foods on TMAO variation. Methods and results : TMAO concentrations of 297 healthy individuals were assessed using 1H-NMR spectroscopy for 24h urine collection and spot urine, and LC-MS for plasma. Of 35 assessed food groups, those with a correlation of ρ >|0.15| with plasma or urine TMAO levels were further investigated in multivariate linear regression models showing current fish and (red) meat consumption as plausible dietary sources of TMAO. Overall, explained variance of TMAO levels by current diet and co-variates (age, sex, lean body mass, glomerular filtration rate) was small. Associations with urine and plasma concentrations differed depending on the TMAO source. Fish consumption was associated with urine and plasma TMAO concentrations, whereas meat consumption was only associated with TMAO concentrations in plasma. Furthermore, associations of plasma TMAO concentration with fish consumption were two times stronger than with meat consumption. Conclusions : Meat and fish consumption differentially affects TMAO concentrations in body fluids. Only a small fraction of variance is explained by current diet. This article is protected by copyright. All rights reserved

Objective: To audit practice in diagnosis of urinary tract infection (UTI) and implement a protocol to reduce the number of falsely diagnosed or missed UTI in febrile children. Methodology: Data were obtained from the microbiology database on the number of urine samples collected for culture, the methods of collection and the culture results over a 3 month period. Using these data and published evidence, a protocol was developed for the collection of urine in febrile children. An education program was instituted which included the adoption of the protocol. Further data were collected and compared with those obtained before the program. Results: Total urine samples sent for culture decreased from 219 in 1998 to 143 in 1999. The percentage collected by bag fell from 60% (n = 132) to 14% (n = 20). The number of definite UTI diagnosed was 15 in both time periods. The number of children given antibiotics before an appropriate sample could be collected fell from nine to two for the respective 3-month periods. Conclusions: Through the development of a new protocol, its introduction and an education program, a change in management was effected and a reduction in the chance of missed or mistaken diagnosis of UTI occurred.

Objective: We sought to determine if 2-h urine collection for the assessment of urine protein excretion and creatinine clearance correlates with 24-h urine collection in pregnant patients with renal disease.Methods: We enrolled patients of gestational ages ranging from 8–41 weeks, admitted as inpatients and having undergone evaluation for renal function (n = 59). We obtained the following samples: 1) 2-h urine, and 2) 24-h urine. We measured serum creatinine concentration, urinary protein, creatinine concentration, and creatinine clearance. The data was analyzed using descriptive analysis, two-way ANOVA, univariate linear regression analysis, and Bland-Altman plot comparing the efficacy of 2-h urine results with 24-h urine results.Results: We analyzed the data on 51 patients. Total proteinuria calculated by protein/creatinine (P:C) ratio in the 2-h group correlated with the total protein measured in the 24-h group (1,840.8 ± 786 and 1,944 ± 1,060 mg [mean ± SE], respectively, r2 = 0.95, P < 0.0001). Creat...

We were interested in the study undertaken by Farrell and colleagues on the methodology comparison of collecting urine samples from children published in your journal recently (Farrell et al. 2002). The paper surprised us mainly because after addressing the shortcomings of all previous studies in this field, these authors undertook a study whose design failed to satisfy their own minimum criteria. These authors were so concerned to ensure that the urine collections were contemporaneous that they decided to use both the bag and the pad collection techniques literally at the same time. In order to do this they had to modify the way they were done, that is they performed them incorrectly. All that was necessary was to collect a pad or bag sample correctly, and then repeat the collection with the other technique, ensuring that this sequence was randomized. That is indeed the method that we used when we tested approximately twice as many patients as Farrell used (Liaw et al. 2000). As the purpose of this study was to evaluate the extent of contamination of urine collections it would also be preferable for such a study to be on children thought unlikely to have an infection, as we did. Finally, it should be tested in an appropriate (often challenging) clinical environment. That is why we asked our parents to make these collections at home rather than them being undertaken in a variety of different clinical settings, as Farrell did. We also note that these authors are very concerned about the precise white blood cell numbers in the urine samples. This seems misplaced. It is well established that urinary tract infection should be defined by the presence of minimum numbers of a single species of bacteria. The white cell numbers are poor markers of urinary tract infection. The numbers may fall extremely rapidly in some urine samples after collection, but not in others (Stansfeld 1962, Vickers et al. 1991), or may be significantly raised by febrile illnesses in the absence of a urine infection (Turner & Coulthard 1995), or from vaginal contamination. Children that are immunosuppressed or extremely sick may be simply unable to generate urinary white blood cells (Kumar et al. 1996). We would suggest that any future urine collection methodology testing these authors undertake should include them applying the techniques correctly, ideally in a consistent and appropriate setting, and then evaluating bacterial culture only, as it is that alone which determines whether the child has a urine infection.

The success of a low-iodine diet (LID) is best determined by measurement of 24-h urine iodine (U-I) excretion. The aim of this study was to determine reliable estimates for 24-h U-I based on spot-urine samples and to provide cut-offs to determine the effectiveness of LID preparation.We prospectively measured iodine levels in 193 patients based on 24-h- and spot-urine samples before radioactive iodine therapy. The iodine was expressed as the 24-h U-I excretion (microg/day) and as two different indices from spot urine, simple iodine concentration (simple I) and the iodine/creatinine (I/Cr) ratio. Poor LID preparation was defined as I excretion of150 microg/day according to the 24-h U-I measurement.The measured 24-h U-I was significantly higher than the two indices from spot urine (P0.001). However, there were statistically significant correlations between the 24-h U-I values and the two spot-urine-based indices; the correlation coefficient was 0.539 for simple I and 0.773 for I/Cr ratio (P0.001). The cut-off of I/Cr ratio for poor LID preparation was66.2 microg/g Cr (sensitivity 96.4%, specificity 83.6%, positive predictive value 50.0% and negative predictive value 99.3%).We demonstrated that the I/Cr ratio from spot urine could serve as a useful and reliable alternative to 24-h urine collection as it has acceptable diagnostic values for detecting poor LID preparation.

Endogenous creatinine clearance was determined in 5 healthy female pigs of different body weight simultaneously to the clearance of inulin. The average creatinine clearance (3.74 +/- 0.57 mg/min/kg) has been found to be 7% higher than inulin clearance indicating some tubular secretion of creatinine. However, since this difference was not significant, the endogenous creatinine clearance is a practicable method for the measurement of glomerular filtration rate in swine. Data of creatinine concentration in plasma and of creatinine excretion showed close relationships to the body weight. It is discussed, whether the glomerular filtration rate can be predicted from the creatinine concentration in plasma and creatinine excretion, which might be estimated from the body weight without quantitative urine collection.

A study based on 55 hospital patients (age groups 40–59, 60–69, 70–79) demonstrated a significant correlation between the glomerular filtration rate (as expressed by endogenous creatinine clearance) and the mean urinary calcium concentration. Excluded were patients with thyroidal or hypophyseal disorders, osteoporosis, renal stones, immobilizing conditions, or those treated with corticosteroids. The study patients had a normal fluid intake and did not receive any diuretics. The urinary calcium concentration test is less laborious and less liable to laboratory errors than the creatinine clearance test, which requires a 24-hour urine collection. Because of the gradual decrease in the glomerular filtration rate in the elderly, this test should be of value in geriatric practice.

The diurnal variation in urinary oxalate concentration and output was measured in 10 catheterised males. There was an increase in urinary oxalate concentration and output during the day and evening and an early morning decrease. It is thought that the daytime increase is related to dietary oxalate. These data suggest an elevated urinary oxalate excretion is more likely to occur during the day and a 24-hour urine collection may mask this effect.

Channel catfish, Ictalurus punctatus Rafinesque, injected intraperitoneally with 2-methyl-quinoline sulphate (QdSO4) or 3-trifluoromethyl-4-nitrophenol (TFM) eliminate most of the dose of these compounds by extra-renal routes. Patterns of renal excretion of Na+, K+, Ca2+, Mg2+, and Cl− (ρEq kg−1 h−1) appeared to be associated with the ‘stress’ of the urine collection technique rather than with the elimination of either compound. Concentrations of Na+, K+, Ca2+, Mg2+, and Cl− (mEq/1) were determined in urine, plasma and gall bladder bile.

Thirty-one medically stable, elderly males (age 75 +/- 8.3 yrs) participated in a prospective study evaluating the accuracy of 16 methods of estimating creatinine clearance. Serum creatinine values were determined on the mornings of days 1, 4, and 5 to assure stable renal function. On the morning of day 3, a 24-hour urine collection was initiated. A statistically significant correlation existed between the measured and estimated clearance values for all 16 formulas. The correlation (r less than 0.65) was lower than that in previously published studies, however. Five of the formulas (1A, 5A, 5B, 7A, 7B) demonstrated no statistical difference between mean measured and estimated values. In this population, formula 2B was the least biased and formula 9B the most accurate. For all 16 methods, the bias was minimal and the relative accuracy of the estimated methods was comparable. The results support using methods to estimate creatinine clearance only as a rough bedside prediction of renal function in elderly males.

This study compares urinary E1-3G and serum E2 measurements in monitoring ovulation induction in an in vitro fertilization programme (FIVET). We used an RIA kit, ESTR.CTK2 (Sorin, Italy), for the daily determination of serum E2, and an LA kit, Fertilux (Bouty, Milan), for the determination of E1-3G in early morning urine samples using a timed and measured volume urine collection procedure. A significant correlation was found between serum E2 as measured by RIA and urinary E1-3G as measured by LIA. Considering the RIA disadvantages (the short half-life of the reagents, the hazards of handling radioactive materials, the inconvenience of frequent venepuncture for the patients) the LIA measurement seems to be a useful method in a FIVET programme.

The bentiromide test, a test of pancreatic exocrine function, has recently been approved for clinical use by the Food and Drug Administration. The test has been studied in adult patients with chronic pancreatic disease and in children with cystic fibrosis. The 500-mg dose and 6-hour urine collection period appear optimal for separating patients with chronic pancreatic disease from control subjects. Side effects with the 500-mg dose are virtually nonexistent. This simply performed outpatient test of chymotrypsin function appears to be an excellent means of confirming the diagnosis of pancreatic exocrine insufficiency.

Analysis of sulfamethazine (SMZ) kinetics in man has revealed complexities including wide intersubject variability. In our study, an attempt was made to assess the potential influence of changes in nonmetabolic parameters (absorption and urinary elimination rate constants) on the markers of acetylation capacity normally used in clinical screening procedures to determine phenotype. Seven normal subjects were classified as slow (SA) or fast acetylators (FA) according to their metabolic rate constant for SMZ (Km), plasma SMZ half-life, and percentage of N-acetyl SMZ in a 6-hr blood sample (PI6), a 5- to 6-hr urine collection (UI5--6), or a 6-hr total urine collection (UI6). Computer simulations were applied to baseline SMZ kinetic data from these subjects, varying nonmetabolic kinetic parameters over experimentally defined ranges singly, or in parallel with 1 or more of the other parameters. The simulations indicate that all the usual phenotyping procedures were sensitive to changes in absorption and urinary elimination rate constants. While these predictions require experimental confirmation, results show that the PI6 method is least sensitive to such changes, suggesting this method may minimize errors in phenotyping screening.

1. The principles devised by the authors [1949] for the determination of the renal clearance of inulin have been applied to the determination of the renal clearance of diodone and the tubular excretory capacity for diodone. 2. Following the intravenous injection of diodone in amounts suitable for the measurement of both renal clearance and tubular excretory capacity, the volume of distribution of diodone continues to increase for the duration of the experiments. It is concluded that equilibration of diodone between the plasma and the extravascular component of the volume of distribution does not occur under the conditions of the experiment. 3. Formulae are derived for the renal clearance of diodone and the maximal tubular excretory capacity for diodone incorporating functions which are demanded by the failure of the establishment of equilibration. 4. The formula for the renal clearance of diodone is applied to fourteen subjects possessing widely different clearance values, and the formula for the maximal tubular excretory capacity for diodone is applied to twelve of these subjects. The values calculated by the formulae agree closely in every case with the average values experimentally determined, following intravenous injections of diodone. 5. The calculative errors introduced into the formulae by the simplifying assumption that the volume of distribution of diodone is linearly related to time, between defined limits of time, are shown to be of similar magnitude to the limits of the error in the chemical determination of diodone in the plasma. 6. The formulae can be applied without the need for accurate urine collection over short clearance periods. They necessitate the passage of urine approximately 25 and 120 minutes (for the maximal tubular excretory capacity for diodone) and 20 and 60 minutes (for the renal clearance of diodone) after the injection of known amounts of diodone, and a minimum of two blood samples for each determination taken at the time of urine passage. 7. The errors introduced in the determinations of inulin and diodone clearance and the maximal tubular excretory capacity for diodone by sampling venous blood are discussed briefly. 8. The results of a further five estimations of inulin clearance employing the authors' method (loc. cit.), and their comparison with average values experimentally determined, are also included.

SUMMARY Urinary lactate dehydrogenase activity was determined in 114 persons. An eight–hour urine collection was reliable and convenient. Raised U.L.D. levels were obtained in 76 per cent, of cases with malignant disease. It is of no value in differentiating benign from malignant conditions. Raised U.L.D. levels indicated severe urinary tract disease and could be used as a screening test.

The possibility of simplifying the regimen for the collection of urine samples in the determination of the debrisoquine metabolic ratio (DMR) was explored in 15 normal subjects. In the extensive metaboliser subgroup (EM; n = 11), there was a close correlation between the DMR as determined by an 8 h urine collection and the debrisoquine/4-hydroxydebrisoquine ratio (D/4-OHD) in the hourly samples (excluding the first hour). In the poor metabolisers (PM; n = 4) the phenotype could be identified, but it was not possible to estimate the DMR reliably.

EDITORIAL COMMENT: These authors previously reported that a first morning urinary oestrogen to creatinine ratio correlates well with 24-hour urinary oestrogen excretion (13). This paper reports the successful application of this assay in monitoring the ovarian response to gonadotrophin therapy. Summary: Efficient gonadotrophin therapy requires both biochemical and ultrasonic measurements of ovarian response. Biochemical monitoring can take the form of measurement of plasma oestradiol levels or urinary oestrogen excretion. Levels of first morning urinary oestrogen to creatinine ratio have been shown to correlate well with 24-hour total urinary oestrogen excretion. Such urine collection is not cumbersome and is less invasive than daily venepuncture. Eighty gonadotrophin treatment cycles were evaluated by first morning urinary oestrogen to creatinine ratio and ultrasound scanning of follicles. Analysis confirmed that the ratio correlated significantly both with plasma oestradiol and 24-hour urinary oestrogen levels. The administration of the ovulating dose of human chorionic gonadotrophin depended primarily on ultrasonic demonstration of the presence of mature follicles in the ovaries. There was no increased incidence of multiple gestation or hypersti-mulation syndrome in 135 treatment cycles. It is concluded that first morning urinary oestrogen to creatinine ratio is a convenient and cheap method of efficient biochemical monitoring of ovarian response to gonadotrophin therapy.

The present study was designed to examine methods of urine sugar testing by comparing the traditional 'tablet' test requiring urine collection and water availability (Clinitest) with a 'dipstick' method (Diabur-Test 5000). Seventy-nine patients participated in the study. The patients used each test for three months and the order in which the tests were used was randomly assigned. There was no evidence that either method was used more frequently, or was associated with increased sensitivity for detection of glycosuria, or with improved diabetic control. However, 53 of the 79 patients expressed a preference for use of Diabur-Test 5000 in the future. The frequent surveillance employed in this study may have obscured a possible benefit of the dipstick method which may operate under routine conditions.