Diagnostic test of urine clarity in urinary tract infection
Keywords:
diagnostic test, urine clarity, urinary tract infection
Abstract
Background Early detection and prompt treatment are manda-tory in managing urinary tract infection (UTI). Failure to early de-
tect ion of UTI may result in declining of kidney function. Urine
culture is the gold standard to diagnose UTI, but it takes 3-5 days
to obtain the results. The turbidity of urine describes the presence
of bacteria or leukocytes in urine. It is important to determine the
relationship between the urine clarity by visual examination and
the absence of bacteriuria.
Objective To evaluate the diagnostic value of urine clarity by vi-
sual examination in diagnosing UTI.
Methods We conducted a prospective study in emergency care
unit, outpatient department, and children wards of Sardjito Hos-
pital, Yogyakarta. The urine specimen was collected from chil-
dren under 15 years old by catheterization or midstream urine
collections. Two independent observers evaluated the urine clar-
ity by the standard technique. Statistical analysis was assigned
to calculate the sensitivity, specificity, positive and negative pre-
dictive values, and likelihood ratio. Kappa index was used to evalu-
ate the agreement between two observers in determining the urine
clarity.
Results Two-hundred and five children were enrolled in this study.
Urine clarity in diagnosing UTI produced sensitivity of 78% (95%
CI 69;87), specificity of 84.5% (95% CI 78;91), positive predictive
value (PPV) of 77.1% (95% CI 68;86), negative predictive value
(NPV) of 85.2% (95% CI 79;92), positive likelihood ratio of 5.03
(95% CI 3.29;7.76), and negative likelihood ratio of 0.26 (95% CI
0.17;0.39).
Conclusion Urine clarity is sufficiently accurate as a diagnostic
test for UTI. The diagnostic value of urine clarity is expected to be
useful for clinicians to detect UTI earlier and to guide them in mak-
ing decision for clinical management.
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In: Buku ajar nefrologi anak. 1st ed. Jakarta: Univer-
sity of Indonesia, 1993.
2. Verrier Jones K, Hockley B, Scrivener R, Pollock JI. Di-
agnosis and management of urinary tract infection in
children under two years, assessment of practice against
published guidelines. Available from: URL: http://
www.rcpch.ac.uk/publications/clinical_docs/UTI_in_
children.pdf
3. Shaw KN, Gorelick M, McGowan KL, Yakscoe NM,
Schwartz JS. Prevalence of urinary tract infection in
febrile young children in the emergency department.
Pediatrics 1998;102:16.
4. Hoberman A, Chao HP, Keller DM, Hickey R, Davis
HW, Ellis D. Prevalence of urinary tract infection in
febrile infants. J Pediatr 1993;123:17-23.
5. Buys H, Pead L, Hallett R, Maskell R. Suprapubic as-
piration under ultrasound guidance in children with
fever of undiagnosed cause. Br Med J 1994;308:690-2.
6. Damanik MP. Tinjauan kasus-kasus infeksi saluran
kemih pada anak di bagian ilmu kesehatan anak RS
dr. Sardjito. Yogyakarta: FK UGM, 1990.
7. Anonym. Practice parameter: The diagnosis, treat-
ment, and evaluation of the initial urinary tract infec-
tion in febrile infants and young children. American
Academy of Pediatrics. Commitee on quality improve-
ment, subcommittee on urinary tract infection. Pedi-
atrics 1999;103:843-52.
8. Anonym. Modern Urine Chemistry. 7th ed. Indiana:
Miles Inc., 1990.
9. Rawal K, Senguttuvan P, Morris M, Chantler C,
Simmons NA. Significance of crystal clear urine. Lan-
cet 1990;335:1228.
10. Tremblay S, Labbe J. Crystal-clear urine and infection.
Lancet 1994;343:479-80.
11. Bulloch B, Bausher JC, Pomerantz WJ, Connors JM,
Mahabee-Gittens M, Dowd MD. Can urine clarity
exclude the diagnosis of urinary tract infection? Pedi-
atrics 2000;106:60.
12. Bulloch B, Bausher J, Connors JM, Froelke B, Mahabee-
Gittens M, Pomerantz W, et al. Does crystal clear urine
exclude a urinary tract infection(UTI)? Presented at
Pediatric Academic Societies’ Annual Meeting, New
Orleans; 1998 May 1-5.
13. Wiswell TE, Geschke DW. Risk from circumcision
during the first month of life compared with those for
uncircumcised boys. Pediatrics 1989;83:1011-4.
14. Crain EF, Gershel JC. Urinary tract infections in fe-
brile infants younger than 8 weeks of age. Pediatrics
1990;86:363-7.
15. Downs SM. Technical report: Urinary tract infection
in febrile infants and young children. The urinary tract
subcommittee of the American Academy of Pediatrics.
Committee on quality improvement. Pediatrics
1999;103:54.
Published
2016-10-18
How to Cite
1.
Kartika I, Damanik M, Soenarto S. Diagnostic test of urine clarity in urinary tract infection. PI [Internet]. 18Oct.2016 [cited 25Nov.2024];46(4):170-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/923
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Received 2016-10-15
Accepted 2016-10-15
Published 2016-10-18
Accepted 2016-10-15
Published 2016-10-18
