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Ailments and Diseases
Published in James Sherifi, General Practice Under the NHS, 2023
Uncomplicated type 2 diabetes (T2DM) became a routine part of a GP’s workload. Type 1 DM continued to be exclusively managed in secondary care. Monitoring no longer relied on blood glucose levels, a snapshot, following the introduction of glycated haemoglobin (HbA1c), which provided a video of glycaemic control over three months. Cheap finger-prick blood glucose machines replaced routine urine dipsticks as the method of choice for patients monitoring their glucose levels.
Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Newly diagnosed nephrotic syndrome in early pregnancy has been associated with hydatidiform molar pregnancies; therefore, this should be evaluated [34, 38, 39]. If the diagnosis is made prior to pregnancy, histologic diagnosis can help direct treatment. In most cases of stable disease, renal biopsy can be deferred until postpartum if histologic diagnosis is not already made. Renal biopsy in pregnancy is considered a safe option, especially if the results are expected to potentially change management [40, 41]. The presence of proteinuria >1 g in combination with GFR <40 mL/min is predictive of worse prognosis in pregnancy [29]. For this reason, patients with newly diagnosed proteinuria prior to 20 weeks gestation (1+ or greater on urine dipstick on two samples at least 6 hours but no more than 7 days apart) [8] should have a 24-hour urine collection for both protein and creatinine clearance, in order to estimate GFR [42]. Testing for proteinuria on urine dipstick is associated with a high false positive rate and contamination (blood, semen, detergents, etc.).
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 50-year-old woman presents with symptoms of voiding difficulties. A urine dipstick test is negative. What will be the first investigation to perform on this woman?Assessment of residual urine by ultrasound scan of the bladderUrinalysisUrine for microscopy culture and sensitivityUrodynamicsVoiding diary – 3 days
Prevalence of kidney injury in patients taking tenofovir based antiretroviral therapy at a primary health care clinic, in East Rand,Gauteng Province
Published in Hospital Practice, 2021
P Makamu, S Bezuidenhout, M Matlala
The final sample size/cohort of the study was lower than the calculated sample due to limited monitoring of patients’ kidney function at the facility; this could have therefore compromised the conclusions drawn from this study. The use of a manual filing system to keep patient medical information in government institutions inherits shortcomings such as lack of comprehensive patient medical history, difficulty in accessing information from a different point of services, and waste of health-care resources. The detection of proteinuria using urine dipstick was not performed at the clinic. This has therefore resulted in a lack of documented proteinuria results in the patients’ medical records. The use of urine dipstick testing is the convenient and quickest way to detect any renal involvement, especially in resource-limited rural settings. A conclusion could therefore not be drawn about proteinuria and the patient’s kidney function in this setting.
Current practice on the management of pre-operative urine dipstick results in women undergoing gynaecological surgery in Wales
Published in Journal of Obstetrics and Gynaecology, 2019
Sarah Walker, Catharina Bisseling, Sanjay Curpad, Gareth Edwards
The debate regarding the most appropriate diagnostic test for UTI and how to manage a positive result is ongoing. The urine dipstick is a screening test for UTI and its sensitivity and specificity varies (Deville et al. 2004). Mambatta et al. (2015) conclude that the sensitivity of the urine dipstick nitrite test and leukocyte-esterase (LE) test, when used in isolation, was low and cannot rule out UTI in most patients. Urine culture is therefore suggested for all patients with a suspected UTI (John et al. 2006). Furthermore, the Scottish intercollegiate guideline network (SIGN) number 88 on management of suspected bacterial UTI in adults, suggests the gold standard for the diagnosis of UTI is culture of bladder urine obtained by needle aspiration as it minimises the risk of contamination of urine specimen. All other techniques (urethral catheter and midstream specimens of urine) carry a higher risk of contamination with high false positive rates (SIGN 88 2012). Likewise, clinical guidance from the National Institute for health and Care Excellence (NICE) does not recommend the use of urine dipsticks pre-operatively in routine surgery. Instead, NICE recommends considering microscopy and culture of midstream urine sample if the presence of a UTI would influence the decision whether or not to operate (NICE CG 171 2015). This further demonstrates the lack of evidence for routine urine dipstick testing on the day of gynaecological surgery.
A case of ocular cystinosis associated with two potentially severe CTNS mutations
Published in Ophthalmic Genetics, 2019
Andrew C. Browning, Gustavo S Figueiredo, Oliver Baylis, Emma Montgomery, Clare Beesley, Elisa Molinari, Francisco C. Figueiredo, John A. Sayer
Systemic physical examination was unremarkable and tests of renal function including serum electrolytes, urea, creatinine and urinary protein/creatinine ratio were all normal. Serum immunoglobulin levels were within normal limits and no paraprotein band was found on serum electrophoresis. Her serum uric acid level was 0.25 µmol/l (normal range 0.14–0.36). Random mid-stream urine dipstick testing was negative for protein, blood and glucose and a renal ultrasound scan was also normal. The patient’s blood leucocyte cystine level was 1.3 nmol/cystine/mg protein (normal range less than 0.2). In vivo confocal microscopy of the cornea and bulbar conjunctiva using Heidelberg HRT3 laser scanning technology with the Rostock Corneal Module (Heidelberg Engineering Inc., Massachusetts, USA) demonstrated rod shaped crystals within the anterior corneal and conjunctival stroma (Figure 1b-f).