iaskdumbquestions

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Urinalysis are not so straightforward when you're looking at a result and are the one responsible for choosing what to do with it. The more I see, the more I realize that unless it's a rip-roaring infection, and the clinical picture is hazy (or downright counterintuitive), I am not 100% confident what to do with UA results a good proportion of the time.

I've been reading about UA, but often it's the same explanation of what each component measures, but very little on putting it all together in a patient. So here I am, humbly asking for your help. Where can I learn more about UA interpretation?

What do I do with UA results that give me information I was not suspecting based on the clinical picture?

LE but no nitrites / LE and X number of WBC but no nitrites / blood in otherwise healthy adult / is there a cutoff for how many WBC are important with LE / etc etc etc

Obviously there are too many individual scenarios to game them all, but either way it's clear... I am not an expert on UA interpretation; but I need to be.

Thank you
 
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Anri of Astora

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For urinary tract infections, your clinical context (the presence of symptoms) will be the biggest factor in determining whether you send for a urine culture or treat. Remember we do not treat asymptomatic bacteriuria (unless in a pregnant woman).

For just the UA interpretation, some UTIs will present with LE but no nitrites so you don't need both present. Pyuria is also a high sensitivity test for infection.

For blood or protein, you will need to repeat the UA a few times. If still present with no underlying infection/Foley catheter/exercise, this will need an outpatient workup.
 

PlutoBoy

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Urinalysis are not so straightforward when you're looking at a result and are the one responsible for choosing what to do with it. The more I see, the more I realize that unless it's a rip-roaring infection, and the clinical picture is hazy (or downright counterintuitive), I am not 100% confident what to do with UA results a good proportion of the time.

I've been reading about UA, but often it's the same explanation of what each component measures, but very little on putting it all together in a patient. So here I am, humbly asking for your help. Where can I learn more about UA interpretation?

What do I do with UA results that give me information I was not suspecting based on the clinical picture?

LE but no nitrites / LE and X number of WBC but no nitrites / blood in otherwise healthy adult / is there a cutoff for how many WBC are important with LE / etc etc etc

Obviously there are too many individual scenarios to game them all, but either way it's clear... I am not an expert on UA interpretation; but I need to be.

Thank you
This is a big topic but remember that persistent microscopic hematuria needs work up.

Pyuria with symptoms - treat.
 
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Moko

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The first thing I've been taught to look at is the presence of epithelial cells. If there's more than a few present, the UA could contain contaminants and I would be hesitant to interpret the result of any present bacteria, LE or nitrites. As others have mentioned, not all bacteria convert nitrates to nitrite, and nitrites may be falsely negative in polyuria. UTIs ultimately require the presence of symptoms to diagnose.

I also find urine specific gravity to be quite helpful, if the patient isn't on diuretics, and the sample is collected before significant fluid resuscitation in the ED. Hope this helps.
 

Raryn

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Raryn

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PlutoBoy

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http://www.medscape.com/viewarticle/865175 just popped up in my email today. It has some discussion of common pitfalls of (mis)interpretation of UAs.
I assumed this was common knowledge?

I used to lose it when I inherited patients with chronic indwelling Foley catheters that were started on IV Fluconazole for "candida UTI".

I also agree that the diagnosis of AMS 2/2 UTI is one of the biggest myths if not outright lies perpetuated by the medical establishment but I guess people need a reason to get the patient admitted.
 

Raryn

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I assumed this was common knowledge?

I used to lose it when I inherited patients with chronic indwelling Foley catheters that were started on IV Fluconazole for "candida UTI".

I also agree that the diagnosis of AMS 2/2 UTI is one of the biggest myths if not outright lies perpetuated by the medical establishment but I guess people need a reason to get the patient admitted.
A lot of things are "common knowledge" when you're done with training. I have no idea what stage the OP is at, but the medscape article seemed like a decent enough starting point.

And yes, misdiagnosis is a problem. So maybe common knowledge isn't so common?