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1.
Ter Arkh ; 93(1): 71-78, 2021 Jan 10.
Artigo em Russo | MEDLINE | ID: mdl-33720629

RESUMO

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.


Assuntos
Nefropatias , Médicos , Estudos de Coortes , Hematúria/diagnóstico , Hematúria/epidemiologia , Hematúria/etiologia , Humanos , Federação Russa
2.
J Pediatr Hematol Oncol ; 43(4): e478-e480, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33625095

RESUMO

A 6-week-old female presented with gross hematuria and was diagnosed with Ewing sarcoma of the bladder through ultrasound and cystoscopic biopsies, along with a negative metastatic workup. She was treated with transurethral resection, chemotherapy consisting of with vincristine, cycolphosphamide, doxorubicin, ifosfamide and etoposide, and partial cystectomy. After completing chemotherapy, the patient has been doing well with no evidence of disease. There have been 14 other cases, 4 pediatric, of Ewing sarcoma of the bladder reported. To our knowledge, our case is the youngest patient reported with this disease.


Assuntos
Neoplasias Ósseas/patologia , Sarcoma de Ewing/patologia , Neoplasias da Bexiga Urinária/secundário , Bexiga Urinária/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Hematúria/diagnóstico , Humanos , Ifosfamida/uso terapêutico , Lactente , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia , Resultado do Tratamento , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/terapia , Vincristina/uso terapêutico
3.
West Afr J Med ; 38(1): 8-14, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33463700

RESUMO

BACKGROUND: Urinary abnormalities detected on routine urinalysis in asymptomatic children may be indicators of underlying kidney diseases. OBJECTIVE: This study was conducted to determine the prevalence and risk factors for asymptomatic proteinuria and haematuria in healthy primary school children in Abuja. METHODS: Using multi-staged sampling method, early morning mid-stream urine was collected from healthy school children from urban and rural primary schools in Gwagwalada Area Council of Abuja, Nigeria for the presence of proteinuria and haematuria using urinalysis strips. Those positive for proteinuria and haematuria were retested after two weeks for persistence abnormalities. Urine microscopy was also done for the persistent haematuria subjects, and biodata collected. RESULTS: Of 861 urine samples analysed, 215 (25%) were from urban schools, and 646 (75%) from rural schools. There were 397 (46.1%) males. Their mean age was 9.5±2.1 years (range 6-12 years), with 9-10 years accounting for 36.4% of the study population. Proteinuria, haematuria, proteinuria+haematuria, persistent proteinuria, and persistent haematuria were seen in 7.0%, 10.6%, 3.6%, 4.2% and 5.5% of the subjects respectively. Microscopic haematuria was also documented in 5.2% subjects with persistent haematuria. Statistical significant association was seen between proteinuria with location of school (c2=9.529, p=0.002), and social class (c2=7.596, p=0.022). Significant association was also seen between haematuria and location of school (c2=14.218, p=0.001), social class (c2=11.290, p = 0.004). CONCLUSION: There was high prevalence of asymptomatic proteinuria and haematuria among healthy primary school children from the study area. This underscores the importance of routine urinary screening program in primary schools for early identification of affected children for intervention.


Assuntos
Hematúria , Microscopia , Proteinúria , Criança , Feminino , Hematúria/diagnóstico , Hematúria/epidemiologia , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Proteinúria/diagnóstico , Proteinúria/epidemiologia , Instituições Acadêmicas , Urinálise
5.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514619

RESUMO

We report the case of a 43-year-old man, suffering from ankylosing spondylitis and treated with Infliximab 5 mg/kg every 2 months, with an excellent disease control. During a follow-up consultation, an incipient renal insufficiency is detected. A urine analysis showed haematuria and proteinuria and a renal puncture-biopsy revealed an image of IgA nephropathy.Several cases of IgA nephropathy have been reported in the literature associated with ankylosing spondylitis. Some of them occur in patients treated with antitumour necrosis factor, but it is unclear whether this pathology is caused by the treatment or whether treatment failed to prevent its occurrence.Our clinical case highlights the importance of regular monitoring of renal function in patients with ankylosing spondylitis, as well as urinary spotting.The question of whether the disease itself, the treatment or other factors such as immune dysregulation could be held responsible for kidney disease will be addressed in the discussion.


Assuntos
Antirreumáticos/uso terapêutico , Glomerulonefrite por IGA/patologia , Infliximab/uso terapêutico , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Antirreumáticos/administração & dosagem , Biópsia , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/urina , Hematúria/diagnóstico , Humanos , Infliximab/administração & dosagem , Rim/patologia , Testes de Função Renal/normas , Masculino , Monitorização Fisiológica/normas , Proteinúria/diagnóstico , Remissão Espontânea , Espondilite Anquilosante/tratamento farmacológico
6.
Zhonghua Nan Ke Xue ; 26(9): 815-819, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33377706

RESUMO

Objective: To summarize and analyze the experience in the diagnosis and treatment of sexual activity-related hematuria. METHODS: A retrospective analysis was conducted on 12 cases of sexual activity-related hematuria treated in Changhai Hospital from October 2015 to April 2019. The patients ranged in age between 31 and 59 years, with a disease course of 2 weeks to 25 years, 6 complaining of urethral bleeding at penile erection and another 6 hematuria immediately after ejaculation, including 2 accompanied by hemospermia. All the patients underwent urethroscopy and cauterization of the lesioned urethral mucosa with the electric excision ring or holmium laser. In addition, one of the patients received seminal tract endoscopic exploration and seminal vesicle irrigation, and another one seminal tract endoscopy and transurethral resection of the prostate. RESULTS: All the patients were diagnosed with posterior urethral varicosity, one accompanied with bulbar and posterior urethral varicosity, one with seminal vesiculitis, and still another with BPH. The patients were followed up for 3-45 (mean 23.5) months, during which the symptoms of sexual activity-related hematuria disappeared in 11 cases, with smooth urination and no recurrence, and post-ejaculation hematuria developed in one case at 2 and 10 months postoperatively but never again thereafter. No complications, such as epididymitis, urethral stricture and ED, were observed in any of the patients. CONCLUSIONS: Urethral varicosity should be first considered in patients with painless hematuria immediately after penile erection or sexual activity though other conditions such as seminal vesicle bleeding can also be taken into account. Urethroscopy combined with seminal tract endoscopy is effective in the diagnosis and treatment of sexual activity-related hematuria.


Assuntos
Hematúria/diagnóstico , Hematúria/terapia , Comportamento Sexual , Adulto , Hematúria/etiologia , Hemospermia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ressecção Transuretral da Próstata , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370975

RESUMO

A 52-year-old man presented with lower urinary tract symptoms and intermittent haematuria for the last 6 months. He had undergone totally extraperitoneal right inguinal hernia repair a decade ago. The ultrasonography and an X-ray of the pelvis suggested a large radio-opaque shadow in the bladder. However, CT revealed an encrusted intravesical extension of the migrated mesh along the right anterolateral wall. The entire intravesical part of the migrated mesh with encrustations was successfully retrieved by endourological approach using holmium laser. The patient symptomatically improved and at follow-up, cystoscopy showed a complete re-epithelisation of the bladder mucosa. The intravesical extension of migrated mesh is a rare but challenging complication following mesh hernioplasty and can be successfully managed with a complete endoscopic approach.


Assuntos
Remoção de Dispositivo/métodos , Migração de Corpo Estranho/cirurgia , Herniorrafia/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Falha de Prótese , Telas Cirúrgicas/efeitos adversos , Cistoscopia , Remoção de Dispositivo/instrumentação , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
8.
Medicine (Baltimore) ; 99(43): e22926, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120848

RESUMO

RATIONALE: Acquired hemophilia A (AHA) is a rare autoimmune disease caused by autoantibodies directed against the activity of factor VIII (FVIII) and presents with prolonged bleeding. 5.7% of systemic lupus erythematosus (SLE) patients are affected by AHA. PATIENT CONCERNS: A 51-year-old female patient with SLE presenting with the fatigue and spontaneous clinical bleeding symptoms such as hematuria and ecchymoses for 1 week. DIAGNOSIS: Laboratory examinations revealed prolongation of the activated partial thromboplastin time (APTT) (65.7 s), decreased FVIII activity (1.4%), and a titer of FVIII inhibitors of 8.5 Bethesda units/mL. INTERVENTIONS: Transfusion of recombinant human FVIII (ADVATE) in combination with intravenous methylprednisolone, cyclophosphamide, plasmapheresis, and fresh frozen plasma successfully stopped the bleeding and reduced the level of FVIII inhibitor. OUTCOMES: The size of the hematoma slowly decreased. The skin ecchymosis was gradually absorbed, the hemoglobin count increased, and the coagulation index gradually improved. There was no new bleeding or bleeding site. The patient was discharged and transferred to a local hospital for hospice care. LESSONS: AHA in a patient with SLE is rare. Once it occurs, it can be life-threatening. Clinicians should remain aware that because some cases of AHA may have features of SLE, appropriate distinction and diagnosis of these different but associated diseases is necessary.


Assuntos
Coagulantes/uso terapêutico , Fator VIII/uso terapêutico , Hemofilia A/etiologia , Lúpus Eritematoso Sistêmico/complicações , Administração Intravenosa , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Testes de Coagulação Sanguínea/métodos , Coagulantes/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Equimose/diagnóstico , Equimose/etiologia , Fator VIII/administração & dosagem , Feminino , Hematúria/diagnóstico , Hematúria/etiologia , Hemofilia A/terapia , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial/métodos , Tempo de Tromboplastina Parcial/estatística & dados numéricos , Plasma , Plasmaferese/métodos , Resultado do Tratamento
10.
Pediatr. aten. prim ; 22(87): 291-294, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-194300

RESUMO

La hematuria es un motivo de consulta frecuente. Una adecuada historia clínica y exploración física permiten una aproximación diagnóstica inicial en la mayoría de los casos. Lo primero es reconocer y confirmar la hematuria, descartando otras circunstancias que pueden teñir falsamente la orina. El análisis del aspecto macroscópico de la orina es clave para determinar el origen glomerular o extraglomerular de la hematuria. Presentamos el caso de una niña con falsa hematuria por agente externo, efectuándose el diagnóstico a través de una exhaustiva historia clínica


Hematuria is a frequent reason for consultation. An adequate medical history and physical examination allow an initial diagnostic approach in most cases. The first thing is to recognize and confirm hematuria, ruling out other circumstances that can falsely stain urine. The analysis of the macroscopic appearance of urine is key to determine the glomerular or extraglomerular origin of hematuria. In this paper, the case of a girl with false hematuria from an external agent in which the diagnosis is reached through an exhaustive medical history


Assuntos
Humanos , Feminino , Pré-Escolar , Lixívia/uso terapêutico , Hematúria/diagnóstico , Urinálise/métodos , Saneantes , Diagnóstico Diferencial , Coleta de Urina/normas
11.
J Urol ; 204(4): 778-786, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32698717

RESUMO

PURPOSE: Patients presenting with microhematuria represent a heterogeneous population with a broad spectrum of risk for genitourinary malignancy. Recognizing that patient-specific characteristics modify the risk of underlying malignant etiologies, this guideline sought to provide a personalized diagnostic testing strategy. MATERIALS AND METHODS: The systematic review incorporated evidence published from January 2010 through February 2019, with an updated literature search to include studies published up to December 2019. Evidence-based statements were developed by the expert Panel, with statement type linked to evidence strength, level of certainty, and the Panel's judgment regarding the balance between benefits and risks/burdens. RESULTS: Microhematuria should be defined as ≥ 3 red blood cells per high power field on microscopic evaluation of a single specimen. In patients diagnosed with gynecologic or non-malignant genitourinary sources of microhematuria, clinicians should repeat urinalysis following resolution of the gynecologic or non-malignant genitourinary cause. The Panel created a risk classification system for patients with microhematuria, stratified as low-, intermediate-, or high-risk for genitourinary malignancy. Risk groups were based on factors including age, sex, smoking and other urothelial cancer risk factors, degree and persistence of microhematuria, as well as prior gross hematuria. Diagnostic evaluation with cystoscopy and upper tract imaging was recommended according to patient risk and involving shared decision-making. Statements also inform follow-up after a negative microhematuria evaluation. CONCLUSIONS: Patients with microhematuria should be classified based on their risk of genitourinary malignancy and evaluated with a risk-based strategy. Future high-quality studies are required to improve the care of these patients.


Assuntos
Hematúria/diagnóstico , Algoritmos , Hematúria/etiologia , Humanos , Medição de Risco
13.
Ann R Coll Surg Engl ; 102(8): e196-e197, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436735

RESUMO

Bladder cancer is a rare disease in childhood; however, it is one of great clinical significance. Investigation and management follow a tailored approach, which is largely driven by clinical practice patterns in adult patients with the disease. We present the case of bladder cancer in a boy who presented to the primary care practitioner with visible haematuria. This case highlights the need for clinicians to consider malignancy as a possible cause for haematuria when assessing and investigating children with this presenting complaint.


Assuntos
Hematúria , Neoplasias da Bexiga Urinária , Adolescente , Cistoscopia , Hematúria/diagnóstico , Hematúria/etiologia , Hematúria/cirurgia , Humanos , Masculino , Atenção Primária à Saúde , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia
15.
Medicine (Baltimore) ; 99(16): e19853, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312008

RESUMO

RATIONALE: Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT. PATIENT CONCERNS: A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank. DIAGNOSIS: Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib. INTERVENTIONS: An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively. OUTCOMES: The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications. LESSONS: We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.


Assuntos
Dor no Flanco/etiologia , Rim/lesões , Ferimentos Penetrantes/complicações , Adulto , Dor no Flanco/diagnóstico , Hematoma , Hematúria/diagnóstico , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Laparotomia/métodos , Masculino , Nefrectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/patologia
16.
Am J Kidney Dis ; 76(1): 90-99, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32197881

RESUMO

RATIONALE & OBJECTIVE: Hematuria is the most typical presentation of immunoglobulin A nephropathy (IgAN); however, its role in disease progression is still controversial. This study aimed to evaluate the association of hematuria and progression of IgAN. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A cohort of 1,333 patients with IgAN treated at a Chinese referral hospital with a median follow-up of 45 months. PREDICTORS: Microhematuria was evaluated in fresh urine using a fully automated urine particle analyzer (automated method) and urine sediment examination by a skilled examiner (manual method). Hematuria was characterized as a time-varying attribute; namely, average hematuria level was calculated for every 6-month period for each patient during follow-up. Remission was defined as average red blood cell count ≤5/high-power field (manual method) or ≤28 red blood cells/µL (automated method) during the first 6 months of follow-up. OUTCOMES: Composite event of 50% decline in estimated glomerular filtration rate or development of kidney failure. ANALYTICAL APPROACH: Multivariable cause-specific hazards models to analyze the relationship between hematuria and the composite kidney disease progression event. RESULTS: Time-varying hematuria during follow-up was an independent risk factor for the composite kidney disease progression event (HR, 1.46; 95% CI, 1.13-1.87; P = 0.003). Hematuria remission during the 6 months after diagnosis was associated with a significantly lower rate of the composite kidney disease progression event (HR, 0.41; 95% CI, 0.28-0.61; P < 0.001). A significant interaction was detected between remission of proteinuria and remission of hematuria during the first 6 months (P < 0.001). The association between remission of hematuria and kidney disease progression was detectable (HR, 0.46; 95% CI, 0.32-0.68) within the subpopulation with persistent proteinuria (protein excretion > 1.0 g/d during the first 6 months), but not among patients whose proteinuria had remitted (HR, 0.64; 95% CI, 0.31-1.29; P = 0.2). The 2 techniques for hematuria evaluation were strongly and significantly linearly correlated (r = 0.948; P < 0.001), and results using these 2 methods were consistent. LIMITATIONS: A single-center retrospective study. Proportional hazards regression incorporating time-varying covariates may create time-varying confounding. The predictive value of reductions in hematuria was not directly evaluated. CONCLUSIONS: Level of hematuria was independently associated with kidney disease progression, whereas hematuria remission was associated with improved kidney outcomes in IgAN among patients with persistent proteinuria. Additionally, to monitor IgAN progression, automated methods to evaluate hematuria hold promise as a replacement for manual evaluation of urinary sediment.


Assuntos
Progressão da Doença , Glomerulonefrite por IGA/diagnóstico , Glomerulonefrite por IGA/epidemiologia , Hematúria/diagnóstico , Hematúria/epidemiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Glomerulonefrite por IGA/sangue , Hematúria/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal/sangue , Insuficiência Renal/diagnóstico , Insuficiência Renal/epidemiologia , Estudos Retrospectivos
17.
Dtsch Med Wochenschr ; 145(1): 56-61, 2020 01.
Artigo em Alemão | MEDLINE | ID: mdl-31914470

RESUMO

Hematuria is a common clinical finding and has a wide spectrum of possible causes. Erythrocytes can originate from any part of the genitourinary tract. An urine dipstick test is the first step in diagnostic approach. Medical history may help to narrow down the range of causes: arterial hypertension or a family history of renal disease may indicate a renal disease. Risk factors for an urinary tract malignoma point to an urological origin. If the microscopy shows more than 5 % acanthocytes in the urine sediment, a glomerular cause can be assumed. Normal erythrocytes suggest a non-glomerular cause. A nephrologist should be consulted if urine sediment microscopy and other clinical features (e. g. clinically relevant proteinuria, elevated serum creatinine) indicate a renal disease. In this case, a renal biopsy should be considered to confirm the diagnosis of glomerulopathy and to develop a treatment plan. If an urological pathology is suspected, sonography should be complemented by a multi-phasic computed tomography. Based on the imaging results, a retrograde ureteroscopy should be considered. Repeated urinalysis on an annual basis for two consecutive years is recommended, if no diagnosis can be established.


Assuntos
Hematúria/diagnóstico , Hematúria/etiologia , Urinálise/métodos , Humanos , Nefropatias/diagnóstico , Anamnese , Microscopia , Proteinúria/diagnóstico
18.
Am J Emerg Med ; 38(7): 1384-1388, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31843330

RESUMO

BACKGROUND: Diagnostic value of urinalysis specimens contaminated with squamous epithelial cells (SEC) from the genital surfaces is assumed to be limited compared to clean-catch samples. However, no studies have quantified the change in predictive value in the presence of SECs for individual urinalysis markers. METHODS: In a retrospective, single center cohort study, we analyzed all urine cultures sent from the ED over a 26-month period with corresponding urinalysis results. Cultures were classified as positive with growth of >104 colony forming units of pathogenic bacteria, negative if no growth, or contaminated for all other results. UA specimens were classified as contaminated or clean based on SEC presence. Accuracy of urinalysis markers for prediction of positive cultures was calculated as an area under the curve (AUC) and was compared between contaminated and clean UA specimens. RESULTS: 6490 paired UA and urine cultures were analyzed, consisting of 3949 clean and 2541 contaminated samples. SEC presence was less common with male gender, older age, and smaller BMI. Urine cultures were 19.2% positive overall, and SECs were more common in contaminated cultures. AUCs for individual markers ranged from 0.557 to 0.796, with pyuria, bacteriuria, and leukocyte esterase having higher AUC in clean samples over contaminated. CONCLUSION: Analysis of AUC for individual urinalysis markers showed reduced diagnostic accuracy in the presence of SECs. SEC presence also reflected much higher rates of contaminated cultures. These results support the reduced reliance on contaminated UA specimens for ruling in UTI in ED patients.


Assuntos
Células Epiteliais , Hematúria/diagnóstico , Piúria/diagnóstico , Infecções Urinárias/diagnóstico , Urina/citologia , Adulto , Idoso , Área Sob a Curva , Índice de Massa Corporal , Hidrolases de Éster Carboxílico/urina , Estudos de Coortes , Técnicas de Cultura , Feminino , Hematúria/urina , Humanos , Masculino , Pessoa de Meia-Idade , Nitritos/urina , Valor Preditivo dos Testes , Piúria/urina , Estudos Retrospectivos , Urinálise , Infecções Urinárias/urina , Coleta de Urina/métodos
19.
Eur Radiol ; 30(3): 1664-1670, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31748856

RESUMO

BACKGROUND: Three-phase CT urography (CTU) is the gold standard for evaluating the upper urinary tract in patients with hematuria. We aimed to evaluate the accuracy of CTU for detecting upper urothelial cell carcinomas (UCC) in patients with hematuria and negative cystoscopy. Secondly, we aimed to determine the tumor visibility on each CTU phase. MATERIAL AND METHODS: This retrospective study included all patients with hematuria referred to CTU after a negative cystoscopy during 2016 and 2017. The original CTU reports were dichotomized as negative or positive. All patient charts were reviewed after a minimum of 18-month follow-up in order to register missed cancers. The results of biopsies and clinical follow-up were used as the reference standard. Two reviewers retrospectively evaluated the tumor visibility of each CT sequence in all true-positive CTUs. RESULTS: We included 376 patients with hematuria who underwent CTU after a negative cystoscopy. Macroscopic and microscopic hematuria occurred in 87% (327) and 13% (49), respectively. The incidence of upper urothelial cell carcinoma was 1.9% (7), and the sensitivity of CTU was 100% (95% CI, 59-100), specificity was 99% (95% CI, 98-100), positive predictive value was 88% (95% CI, 47-99), and negative predictive value was 100% (95% CI, 99-100). The accuracy was 99% (95% CI, 90-100). All UCCs were visible on the nephrographic phase for both reviewers. CONCLUSION: CTU is highly accurate for detecting upper UCCs. All cases were seen on the nephrographic phase. This suggests that the CTU protocol can be simplified. KEY POINTS: • CT urography is highly accurate for detecting upper urothelial cell carcinomas. • All cancers were seen on the nephrographic phase. • All cancers were detected in patients with macroscopic hematuria.


Assuntos
Carcinoma de Células de Transição/complicações , Hematúria/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Neoplasias da Bexiga Urinária/complicações , Sistema Urinário/diagnóstico por imagem , Urografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/diagnóstico , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/diagnóstico , Sistema Urinário/irrigação sanguínea , Adulto Jovem
20.
Int J Infect Dis ; 90: 132-137, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693938

RESUMO

BACKGROUND: Indirect diagnostic tests are used to assess the disease burden and to monitor the impact of different interventions in areas endemic for urinary schistosomiasis. This study was performed to assess their accuracy in the diagnosis of urinary schistosomiasis among primary school children in low and moderate transmission areas in the districts of Mpwapwa and Chakechake, respectively. METHODS: School children were interviewed regarding their history of haematuria and participation in treatment campaigns. Urine samples were collected and inspected for macro-haematuria (visual haematuria) and tested for micro-haematuria using urine reagent strips and Schistosoma haematobium eggs by urine filtration method. RESULTS: The prevalence of S. haematobium was 6.8% in Mtera Dam area and 38.7% in Uwandani Shehia. In Mtera Dam area, a history of haematuria and visual haematuria had low sensitivity (<60%) with high specificity (>90%). The urine reagent strips had high sensitivity and specificity (≥75%). In Uwandani Shehia, a history of haematuria had high sensitivity and specificity (>60%). Visual haematuria had low sensitivity (<50%) but high specificity (>80%). The urine reagent strips maintained high performance in all parameters assessed. CONCLUSIONS: The study findings suggest that urine reagent strips will continue to serve as a very useful adjunct test for monitoring the prevalence of urinary schistosomiasis in endemic areas.


Assuntos
Esquistossomose Urinária/diagnóstico , Adolescente , Animais , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Feminino , Hematúria/diagnóstico , Humanos , Masculino , Praziquantel/uso terapêutico , Prevalência , Fitas Reagentes , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/epidemiologia , Sensibilidade e Especificidade , Tanzânia/epidemiologia
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