The value of urinalysis in presumptive diagnosis of urinary tract infection in children
Keywords:
presumptive diagnosis, urinalysis, UTI
Abstract
Background Definite diagnosis of urinary tract infection (UTI)should only be established based on culture of urine specimen,
otherwise it would be considered presumptive. Since urinalysis
provides more rapid information than urine culture, clinicians
should consider to utilize urinalysis as a decision-making tool for
initiating treatment of UTI.
Objective To determine the sensitivity, specificity, predictive val-
ues, and accuracy of several urinalysis parameters, namely the ni-
trite, leukocyte esterase (LE), Gram staining, and methylene blue
reductase (MBR) tests, in supporting the diagnosis of UTI.
Methods This diagnostic test was done on 30 subjects with pyuria
during the period of April to June 2004. The sensitivity, specific-
ity, positive predictive value (PPV), negative predicitve value
(NPV) as well as the accuracy were calculated for each urinalysis
parameter with urine culture as the gold standard. The relation-
ship between categorical variables was analyzed by Fisher's exact
test or chi square test.
Results The sensitivity, specificity, PPV, NPV and accuracy for
nitrite test, leukocyte esterase (LE) test, Gram staining, and MBR
test were respectively as follows: nitrite test showed 90.5%, 66. 7%,
86.4%, 75%, and 83.3%; LE test yielded 95.2%, 33.3%, 76.9%,
75%, and 76.4%; Gram staininglOO%, 44.4%, 80.8%, 100%, and
83.3%; and MBR test 85.7%, 100%, 100%, 75%, and 90%.
Conclusions The MBR, among other urinalysis routine tests, has
the highest specificity and accuracy as well as high sensitivity in
establishing a presumptive diagnosis of UTI
References
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symptomatic pediatric outpatients. Pediatr Infect Dis J
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11. Tokan HB, Kari K. Clinical aspects and white blood cell
count in children with urinary tract infection. Pediatr Indones
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12. Jenkins RD, Fenn JP, Matsu JM. Review of urine microscopy
for bacteriuria. JAMA 1986;255:34 7-403.
13. Goldsmith BM, Campos JM. Comparison of urine dipstick,
microscopy, and culture for the detection of bacteriuria in
children. Clin Pediatr 1990;29:214-8.
14. Olson LM, Shanholtzer CJ, Willard KE, Peterson LR. The
slide centrifuge gram stain as an urine screening method. Am
J Clin Pathol1991;96:454-8.
15. Supardi I. Kesepadanan validitas metode mikroskopi,
kimiawi dan biakan air kemih untuk diagnostik bakte-
riuri [dissertation]. Bandung: Universitas Padjadjaran;
1984.
Makker SP, editors. Clinical pediatric nephrology. New York:
McGraw-Hill Inc; 1992. p. 277-322.
2. Hoberman A, Wald ER. Urinary tract infections in young
febrile children. Pediatrlnfect Dis J 1997; 15:11-7.
3. Lohr JA. Use of routine urinalysis in making a presumptive
diagnosis of urinary tract infection in children. Pediatr Infect
Dis J 1991;10:646-50.
4. Shaw KN, Gorelick MH. Urinary tract infection in the pediat-
ric patient. Ped Clin North Am 1999;46 Suppl6: 1111-24.
5. Winberg J, Andersen HJ, Bergstorm T, Jacobsson B, Larson
H, Lincoln K. Epidemiology of symptomatic urinary tract
infection in childhood. Acta Paediatr Scand 1974;252
Suppl: 1-21.
6. Elder JS. Urinary tract infections. In: Behrman RE, Kliegman
RM, Jenson HB, editors. Nelson textbook of pediatrics. 17th
ed. Philadelphia: WB Saunders Company; 2004. p. 1785-9
7. Hanson LA, Ahlstedt S, Jodal U. The host-parasite relation-
ship in urinary tract infections. Kidney Int 1975;8:S28.
8. Bergstorm T. Sex differences in childhood urinary tract infec-
tion. Arch Dis Child. 1972;47:227-32.
9. Hansson S, Jodal U. Urinary tract infection. In: Barratt TM,
Avner ED, Harmon WE, editors. Pediatric nephrology 4th
ed. Baltimore: Lippincott Williams and Wilkins; 1999. p.
835-50.
10. Weinberg AG, Gan VN. Urine screen for bacteriuria in
symptomatic pediatric outpatients. Pediatr Infect Dis J
1991;10:651-4.
11. Tokan HB, Kari K. Clinical aspects and white blood cell
count in children with urinary tract infection. Pediatr Indones
1999;39:38-46.
12. Jenkins RD, Fenn JP, Matsu JM. Review of urine microscopy
for bacteriuria. JAMA 1986;255:34 7-403.
13. Goldsmith BM, Campos JM. Comparison of urine dipstick,
microscopy, and culture for the detection of bacteriuria in
children. Clin Pediatr 1990;29:214-8.
14. Olson LM, Shanholtzer CJ, Willard KE, Peterson LR. The
slide centrifuge gram stain as an urine screening method. Am
J Clin Pathol1991;96:454-8.
15. Supardi I. Kesepadanan validitas metode mikroskopi,
kimiawi dan biakan air kemih untuk diagnostik bakte-
riuri [dissertation]. Bandung: Universitas Padjadjaran;
1984.
Published
2008-08-31
How to Cite
1.
Rachmadi D, Setyastuti A. The value of urinalysis in presumptive diagnosis of urinary tract infection in children. PI [Internet]. 31Aug.2008 [cited 5Nov.2024];48(4):199-03. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/557
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Received 2016-09-10
Accepted 2016-09-10
Published 2008-08-31
Accepted 2016-09-10
Published 2008-08-31
