Cleaning the genitalia with plain water improves accuracy of urine dipstick in childhood

Marzuillo, Pierluigi; Guarino, Stefano; Furlan, Daniela; Pecoraro, Anna; Pedullà, Marcella; Giudice, Emanuele Miraglia del; Manna, Angela La

doi:10.1007/s00431-018-3215-x

Cited by 12 publications

(5 citation statements)

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“…One limitation of our study was its retrospective design. In particular, relying on home‐based urine collections from sterile bags may have overestimated the false‐positive urine cultures due to the possibility of inadequate procedures . However, this gives an idea of what happens when exams requiring domestic procedures, such as the use of a sterile bag to collect urine, are prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…We think that it is unlikely that a non-febrile UTI with symptoms and acute onset could sustain growth retardation over the time, in the absence of systemic infective signs and, or, nephro-urological abnormalities.One limitation of our study was its retrospective design. In particular, relying on home-based urine collections from sterile bags may have overestimated the false-positive urine cultures due to the possibility of inadequate procedures 15. However, this gives an idea of what happens when exams requiring domestic procedures, such as the use of a sterile bag to collect urine, are prescribed.…”

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confidence: 99%

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Pilot study showed that poor feeding, especially with leucocyturia, increased the odds of non‐febrile urinary tract infections in children who were not toilet trained

et al. 2019

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Aim This study assessed the prevalence of wrongly diagnosed non‐febrile urinary tract infections in patients who had not been toilet trained and presented with poor feeding and, or, failure to thrive. The diagnostic value of these signs in predicting non‐febrile UTIs was also explored. Methods We focused on 59 outpatients (56.7% male) with these criteria, who had positive urine cultures and were referred to our Italian University hospital from January 2017 to January 2019. None were on antibiotics and all underwent urine cultures by bladder catheterisation. Wrongly diagnosed non‐febrile UTIs were defined by sterile urine cultures. The predictive value was evaluated using logistic regression. Results The mean age was 8.5 ± 5.7 months and 72.9% had wrongly diagnosed non‐febrile UTIs. Poor feeding was significantly higher among the 16 patients with true non‐febrile UTIs (P = .04). It was significantly predictive of non‐febrile UTIs (odds ratio 4.1, 95% confidence interval 1.1‐16.6), especially when leucocyturia was present (odds ratio 9.7, 95% confidence interval 2.3‐40.7). Conclusion Wrongly diagnosed non‐febrile UTIs were high in children with poor feeding and, or, failure to thrive. Only poor feeding and, in particular, the combination of poor feeding and leucocyturia, significantly increased the odds of non‐febrile UTI.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pilot study showed that poor feeding, especially with leucocyturia, increased the odds of non‐febrile urinary tract infections in children who were not toilet trained

et al. 2019

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“…Both Body Mass Index (BMI) > 95 th percentile according to reference values and normal renal function (eGFR > 90 mL/min/1.73 m 2 )[ 6 , 16 ] were considered as inclusion criteria. Secondary forms of NAFLD or obesity, consumption of medications, eGFR < 90 mL/min/1.73 m 2 , presence of proteinuria or hematuria at urine dipstick on urine samples[ 17 ], missing eGFR levels, or denied consent for diagnostic procedures represented exclusion criteria. Patients presenting possible signs of underlining primary kidney disease (decreased eGFR and proteinuria/hematuria) were also excluded to avoid potential affection of our analysis.…”

Section: Methodsmentioning

confidence: 99%

Pediatric non-alcoholic fatty liver disease and kidney function: Effect of HSD17B13 variant

Sessa¹,

Umano²,

Cirillo³

et al. 2020

WJG

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BACKGROUND Growing evidence supports a genetic link between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD). Interesting data demonstrated that both the major NAFLD risk polymorphisms such as the I148M polymorphism in the patatin like phospholipase containing domain 3 ( PNPLA3 ) and the E167K allele in the transmembrane 6 superfamily member 2 gene ( TM6SF2 ) affect renal function. Recently the hydroxysteroid 17-beta dehydrogenase 13 ( HSD17B13 ) gene has been recognized as a novel genetic variant involved in NAFLD pathophysiology. In particular, it has been showed the protective effect of the rs72613567:TA variant of this gene against liver damage both in adults and children. AIM To investigate the impact of the rs72613567:TA variant of the HSD17B13 gene on estimated glomerular filtration rate (eGFR) in obese children. METHODS We enrolled 684 obese children (mean age 10.56 ± 2.94 years; mean BMI-SDS 2.98 ± 0.78) consecutively attending our Obesity Clinic. All the patients underwent a careful clinical assessment and a comprehensive biochemical evaluation. To detect hepatic steatosis, a liver ultrasound was performed. NAFLD was defined by ultrasound detected liver steatosis and/or alanine aminotransferase (ALT) levels > 40 IU/L. The study population was divided on the basis of the NAFLD presence. Genotyping for the rs72613567:TA variant of the HSD17B13 gene in all the enrolled subjects was also made. RESULTS Patients carrying the HSD17B13 rare A allele showed higher eGFR levels compared with homozygous patients both among subjects with and without NAFLD. A general linear model confirmed a direct and significant association of eGFR values with HSD17B13 genotype independently of PNPLA3 and TM6SF2 polymorphisms both in patients with and without NAFLD. A comparison of regression line confirmed the influence of HSD17B13 genotype on the relationship between eGFR and age both among patients with and without NAFLD. H omozygous patients for HSD17B13 genotype with NAFLD showed a significantly higher decline of eGFR with the increase of the age compared with the patients with NAFLD carrying the HSD17B13 rare A allele ( P value for intercepts = 0.005; P value for slopes = 0.94). The same effect was observed among patients without NAFLD ( P value for intercepts = 0.0012; P value for slopes...

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“…In toilet-trained children, the collection method of choice is a mid-stream, clean-catch urine specimen after appropriate genital cleansing. Recent studies have shown a significant rate of urine culture contamination in children who did not perform perineal washings (23.9%) compared to those that did (7.8%) prior to mid-stream urine collection [ 11 , 12 ].…”

Section: Diagnosismentioning

confidence: 99%

Contemporary Management of Urinary Tract Infections in Children

Olson

Dudley

Rowe

2022

Curr Treat Options Peds

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Purpose of Review Urinary tract infection (UTI) in children is a major source of office visits and healthcare expenditure. Research into the diagnosis, treatment, and prophylaxis of UTI has evolved over the past 10 years. The development of new imaging techniques and UTI screening tools has improved our diagnostic accuracy tremendously. Identifying who to treat is imperative as the increase in multi-drug-resistant organisms has emphasized the need for antibiotic stewardship. This review covers the contemporary management of children with UTI and the data-driven paradigm shifts that have been implemented into clinical practice. Recent Findings With recent data illustrating the self-limiting nature and low prevalence of clinically significant vesicoureteral reflux (VUR), investigational imaging in children has become increasingly less frequent. Contrast-enhanced voiding urosonogram (CEVUS) has emerged as a useful diagnostic tool, as it can provide accurate detection of VUR without the need of radiation. The urinary and intestinal microbiomes are being investigated as potential therapeutic drug targets, as children with recurrent UTIs have significant alterations in bacterial proliferation. Use of adjunctive corticosteroids in children with pyelonephritis may decrease the risk of renal scarring and progressive renal insufficiency. The development of a vaccine against an antigen present on Escherichia coli may change the way we treat children with recurrent UTIs. Summary The American Academy of Pediatrics defines a UTI as the presence of at least 50,000 CFU/mL of a single uropathogen obtained by bladder catheterization with a dipstick urinalysis positive for leukocyte esterase (LE) or WBC present on urine microscopy. UTIs are more common in females, with uncircumcised males having the highest risk in the first year of life. E. coli is the most frequently cultured organism in UTI diagnoses and multi-drug-resistant strains are becoming more common. Diagnosis should be confirmed with an uncontaminated urine specimen, obtained from mid-stream collection, bladder catheterization, or suprapubic aspiration. Patients meeting criteria for imaging should undergo a renal and bladder ultrasound, with further investigational imaging based on results of ultrasound or clinical history. Continuous antibiotic prophylaxis is controversial; however, evidence shows patients with high-grade VUR and bladder and bowel dysfunction retain the most benefit. Open surgical repair of reflux is the gold standard for patients who fail medical management with endoscopic approaches available for select populations.

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Cleaning the genitalia with plain water improves accuracy of urine dipstick in childhood

Cited by 12 publications

References 13 publications

Pilot study showed that poor feeding, especially with leucocyturia, increased the odds of non‐febrile urinary tract infections in children who were not toilet trained

Pilot study showed that poor feeding, especially with leucocyturia, increased the odds of non‐febrile urinary tract infections in children who were not toilet trained

Pediatric non-alcoholic fatty liver disease and kidney function: Effect of HSD17B13 variant

Contemporary Management of Urinary Tract Infections in Children

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