Urine abnormalities predict acute kidney injury in COVID-19 patients: An analysis of 110 cases in Chennai, South India

BACKGROUND AND AIMS

Renal involvement in Covid-19 infection is varied and can affect glomeruli, tubules, interstitium and can cause acute kidney injury (AKI). AKI is a strong predictor of mortality. Routine urinalysis gives an insight into the renal pathology of the patient. We studied the incidence of urinary abnormalities in hospitalised Covid-19 patients and analysed their impact on development of AKI and mortality.

METHODS

Information on 110 hospitalised patients with confirmed Covid-19 was retrospectively collected and analysed. The demographic data such as age, gender, comorbid conditions such as diabetes mellitus, the need for dialysis and laboratory data such as urine for albumin, glucose, RBC and WBC, and serum creatinine were collected. The diagnosis of AKI was based on the KDIGO criteria. The outcomes studied were development of AKI and hospital mortality.

RESULTS

Urine abnormalities were seen in 71% of the patients. Proteinuria in 58.2%, haematuria in 17.3%, pyuria in 8.2% of patients and concurrent proteinuria and haematuria was seen in 13.6% of patients. AKI was seen in 28.2% of patients and hospital mortality was 24.5%. AKI was strongly associated with mortality. Proteinuria and haematuria were good predictors of development of AKI, more strongly when they occurred concurrently (p < 0.01).

CONCLUSION

Our results suggest that urine analysis is a simple test, which can be used to predict development of AKI and mortality and may be used for risk stratification of Covid-19 patients, especially in low resource settings.

Evaluation of Trends of Near-Real-Time Urine Drug Test Results for Methamphetamine, Cocaine, Heroin, and Fentanyl

This cross-sectional study uses nationally representative urine drug test data to analyze changes in positivity rates for methamphetamine, cocaine, heroin, and fentanyl.

Diagnostic Advances in Urine Cytology

The utility of urine cytology has shifted from the identification of red blood cells, crystals, or parasites to its currently used role of detection of cancer cells exfoliated in urine samples. A variety of ancillary tests have been developed to complement the diagnostic ability of urine cytology. Furthermore, urine testing will continue to evolve as the pathogenesis of genitourinary tract diseases in depth is understood. This article focuses on the diagnostic advances in urine cytology from the cytomorphological perspective, past and current reporting schemes, and the application of ancillary testing in urine samples.

New and developing diagnostic technologies for urinary tract infections

Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2-3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health.

Urinary markers in the detection of bladder cancer: what's new?

PURPOSE OF REVIEW

Bladder cancer is one of the most common genitourinary malignancies and is a potentially life-threatening diagnosis. For many patients, however, the diagnosis of bladder cancer entails a lifetime of vigilant, costly, and invasive surveillance for recurrent and/or progressive disease. In the context of relative limitations of the current standard of cystoscopy and cytology, there has been burgeoning activity in the development of novel molecular urine-based markers for bladder cancer detection.

RECENT FINDINGS

A large number of candidate bladder cancer biomarkers have emerged as our understanding of the molecular pathogenesis of the disease has evolved. Many of these are in the relatively earlier phases of development but several have received the approval of the United States Food and Drug Administration for clinical use and are already being applied to patients in clinical practice.

SUMMARY

Urine-based markers for bladder cancer detection represent an area of substantial innovation and discovery with potentially profound scientific, clinical, and economic implications. As more of these tests become standardized and undergo evaluation in large multicenter trials, it is conceivable that a novel marker or panel of markers will emerge as a major enhancement to the current standard of care.

Medical applications of electronic nose technology

Electronic nose technology has been developed over the past 15 years in the field of chemistry as an electronic equivalent of the biologic mechanism of smell. Since its inception, it has been well recognized that there is great potential in applying this technology to the field of medicine. This review discusses those areas of medicine in which electronic nose technology has been applied. For each area, this review addresses the scope of the medical problem that has been studied, how the electronic nose technology may help address the medical problem, and the results of such studies to date. Next generation electronic noses will be refined to better analyze specific disease states. This will require further evaluation of the specific volatiles to be tested. This information may then be brought to bear on refinement of the chemistry of the electronic nose sensors, making them more sensitive and specific for the particular disease of interest. The ultimate goal of work in this arena is to make an electronic nose that is portable, fast, inexpensive and, therefore, suitable for use in the examination room or at the bedside, making it facile as a diagnostic tool.

PROCORAD's international intercomparisons highlight the evolution of techniques used to determine uranium in urine

Inter-laboratory tests are a means of assessing the analytical coherence of medical laboratories. In radiotoxicology, this kind of exercise makes it possible to keep up with laboratory know-how and with the evolution and relative performances of analytical techniques. The intercomparison exercises organised by PROCORAD (Association for the Promotion of Quality Controls in Radiotoxicological Bioassays) provide an opportunity to compare and contrast radiochemistry and metrology for the in vitro analysis of urine and faeces. For uranium compounds, the development of new techniques such as inductively coupled plasma-mass spectrometry (ICP-MS), alpha spectrometry, and laser spectrofluorimetry makes it possible to compare the effectiveness of these protocols with respect to radiation protection monitoring, both in routine and special situations. Detection limits, flexibility, repeatability, reproducibility and isotopic quantification are the criteria considered in this study. The authors present the evolution of performances for the analysis of uranium in urine over the years. However, the goal of the laboratories taking part in these annual exercises is not only to check the accuracy of their results but also to have analytical discussions and the opportunity to exchange experiences that will enrich the group's general competence.

[Recent advances on routine urinalysis]

Urine qualitative/semiquantitative tests with reagent-strip and microscopic examination(sediments) are most popular and basic clinical laboratory tests. However, the accuracy and precision of those tests have not been more reliable than that of clinical chemistry or hematology, mainly due to the instability of urine specimen and subjective analysis procedure. Automated analyzer with compact size and high quality of both reagent-strip method and sediments(formed elements or particles) have been commonly used in many laboratories and guidelines on urinalysis of JCCLS(Japan), NCCLS(USA) and ECLM(EU) are publishing in succession recently. These advances are expected to lead to a solution for those problems in the urinalysis field.

Urinalysis: current status and prospects for the future

More than 300 million routine clinical analyses are performed annually in the United States. Methods for routine clinical urine examination, including detection of bacteriuria, are briefly reviewed. Prospects of some newer, better techniques to carry out such analyses are introduced. A preliminary report is presented on the use of supravital microscopic fluorescence technique (SMFT), employing acridine orange as a non-specific staining fluorochrome. Results of examining 218 unspun urine specimens by SMFT are compared to traditional bacteriologic culture at a large pediatric hospital reference laboratory.