Podocitúria em gestantes hipertensas crônicas pode predizer dano renal? / Podocyturia in pregnant women with chronic hypertension may predict kidney injury?

OBJETIVO: Avaliar a presença de podocitúria em gestantes hipertensas crônicas no terceiro trimestre da gestação e a associação com doença renal. MÉTODOS: Estudo observacional descritivo em uma amostra de conveniência de 38 gestantes hipertensas crônicas. Os podócitos foram marcados com técnica de imunofluorescência indireta com antipodocina e diamidino-fenilindol (DAPI). A contagem foi feita a partir de 30 campos analisados de forma aleatória, corrigida pela creatinina urinária (podócitos/mg de creatinina). Foram assumidos dois grupos: grupo GN (função glomerular normal), com até 100 podócitos, e grupo GP (provável glomerulopatia), com mais de 100 podócitos. A dosagem de creatinina foi realizada com uso da técnica do picrato alcalino. As variáveis de análise foram o índice de massa corpórea, a idade gestacional na coleta, a pressão arterial sistólica e a pressão arterial diastólica no momento da coleta. Para a análise dos dados, foi utilizado o programa SPSS - versão 16.0. (IBM - USA). Nas análises estatísticas, foi utilizado o teste do χ2, sendo consideradas diferenças significantes valores de p<0,05. RESULTADOS: A contagem de podócitos no grupo GN teve mediana de 20,3 (0,0 a 98,1), e no grupo GP, de 176,9 (109,1 a 490,6). A média do índice de massa corpórea foi 30,2 kg/m2 (DP=5,6), a média da idade gestacional foi de 35,1 semanas (DP=2,5), a mediana da pressão arterial sistólica foi de 130,0 mmHg (100,0-160,0) e a mediana da pressão arterial diastólica de 80,0 mmHg (60,0-110,0). Não houve correlação significativa entre podocitúria e índice de massa corpórea (p=0,305), idade gestacional na coleta (p=0,392), pressão arterial sistólica (p=0,540) e pressão arterial diastólica (p=0,540). CONCLUSÕES: Não foi identificado um padrão de podocitúria compatível com a presença de glomerulopatia ativa, ainda que algumas das gestantes (15,8%) tenham exibido perda podocitária expressiva. Consideramos ser prematuro recomendar para a prática ...

PURPOSE: To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease. METHODS: This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05. RESULTS: The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540). CONCLUSIONS: In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women. .

Human Urine-derived Stem Cells Seeded Surface Modified Composite Scaffold Grafts for Bladder Reconstruction in a Rat Model

We conducted this study to investigate the synergistic effect of human urine-derived stem cells (USCs) and surface modified composite scaffold for bladder reconstruction in a rat model. The composite scaffold (Polycaprolactone/Pluronic F127/3 wt% bladder submucosa matrix) was fabricated using an immersion precipitation method, and heparin was immobilized on the surface via covalent conjugation. Basic fibroblast growth factor (bFGF) was loaded onto the heparin-immobilized scaffold by a simple dipping method. In maximal bladder capacity and compliance analysis at 8 weeks post operation, the USCs-scaffold(heparin-bFGF) group showed significant functional improvement (2.34 ± 0.25 mL and 55.09 ± 11.81 microL/cm H2O) compared to the other groups (2.60 ± 0.23 mL and 56.14 ± 9.00 microL/cm H2O for the control group, 1.46 ± 0.18 mL and 34.27 ± 4.42 microL/cm H2O for the partial cystectomy group, 1.76 ± 0.22 mL and 35.62 ± 6.69 microL/cm H2O for the scaffold group, and 1.92 ± 0.29 mL and 40.74 ± 7.88 microL/cm H2O for the scaffold(heparin-bFGF) group, respectively). In histological and immunohistochemical analysis, the USC-scaffold(heparin-bFGF) group showed pronounced, well-differentiated, and organized smooth muscle bundle formation, a multi-layered and pan-cytokeratin-positive urothelium, and high condensation of submucosal area. The USCs seeded scaffold(heparin-bFGF) exhibits significantly increased bladder capacity, compliance, regeneration of smooth muscle tissue, multi-layered urothelium, and condensed submucosa layers at the in vivo study.

Advanced Properties of Urine Derived Stem Cells Compared to Adipose Tissue Derived Stem Cells in Terms of Cell Proliferation, Immune Modulation and Multi Differentiation

Adipose tissue stem cells (ADSCs) would be an attractive autologous cell source. However, ADSCs require invasive procedures, and has potential complications. Recently, urine stem cells (USCs) have been proposed as an alternative stem cell source. In this study, we compared USCs and ADSCs collected from the same patients on stem cell characteristics and capacity to differentiate into various cell lineages to provide a useful guideline for selecting the appropriate type of cell source for use in clinical application. The urine samples were collected via urethral catheterization, and adipose tissue was obtained from subcutaneous fat tissue during elective laparoscopic kidney surgery from the same patient (n = 10). Both cells were plated for primary culture. Cell proliferation, colony formation, cell surface markers, immune modulation, chromosome stability and multi-lineage differentiation were analyzed for each USCs and ADSCs at cell passage 3, 5, and 7. USCs showed high cell proliferation rate, enhanced colony forming ability, strong positive for stem cell markers expression, high efficiency for inhibition of immune cell activation compared to ADSCs at cell passage 3, 5, and 7. In chromosome stability analysis, both cells showed normal karyotype through all passages. In analysis of multi-lineage capability, USCs showed higher myogenic, neurogenic, and endogenic differentiation rate, and lower osteogenic, adipogenic, and chondrogenic differentiation rate compared to ADSCs. Therefore, we expect that USC can be an alternative autologous stem cell source for muscle, neuron and endothelial tissue reconstruction instead of ADSCs.

Usefulness of Urine Cytology as a Routine Work-up in the Detection of Recurrence in Patients With Prior Non-Muscle-Invasive Bladder Cancer: Practicality and Cost-Effectiveness

PURPOSE: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. MATERIALS AND METHODS: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. RESULTS: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). CONCLUSIONS: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.

Detecção de podocitúria em pacientes com nefrite lúpica / Detection of podocyturia in patients with lupus nephritis

INTRODUÇÃO: A podocitúria tem sido detectada em doenças glomerulares, tais como em nefrite lúpica (NL), em que a proteinúria é uma manifestação importante, e sua ocorrência parece limitar-se à fase ativa da doença. OBJETIVO: Avaliar a podocitúria por imunofluorescência em pacientes portadores de NL e verificar possível associação com atividade clínica da doença. MÉTODOS: Foram avaliados 56 pacientes com NL. Os pacientes foram divididos em três grupos de acordo com o grau de atividade clínica: Grupo B, sem atividade (n = 17); Grupo C, com atividade discreta (n = 29) e Grupo D, moderada a grave (n = 10). Como grupo controle, foram incluídos 29 indivíduos saudáveis (Grupo A). A podocitúria foi estudada por meio de imunofluorescência indireta, usando-se anticorpos primários antipodocina, nefrina e sinaptopodina, e anticorpo secundário conjugado à FITC. Também foram avaliados os níveis de creatinina sérica e da relação proteína/creatinina (P/C) urinária, assim como a presença de hematúria e leucocitúria. RESULTADOS: A podocitúria com antipodocina e com antissinaptopodina correlacionou-se estatisticamente com a relação P/C (p = 0,001 e p = 0,013, respectivamente). Tanto a podocitúria com antipodocina, quanto a relação P/C, apresentaram correlação significante (p < 0,001) com a graduação de atividade da doença na NL, diferentemente do que se observou com os outros dois anticorpos, antinefrina e antissinaptopodina. CONCLUSÃO: Nossos achados sugerem que a pesquisa de podocitúria com anticorpos antipodocina poderia ser útil no acompanhamento de pacientes com NL, fornecendo dados relevantes quanto à atividade da doença.

INTRODUCTION: The podocyturia has been detected in glomerular diseases, such as lupus nephritis (LN), in which proteinuria is an important manifestation, and its occurrence seems to be limited to the active phase of the disease. OBJECTIVE: To evaluate podocyturia in LN patients, and the possible association with clinical disease activity. METHODS: We evaluated 56 patients with LN, that were classified in three groups according to the degree of clinical activity: Group B, no activity (n = 17), Group C with mild (n = 29) and Group D, moderate to severe activity (n = 10). The control group was composed by 29 healthy subjects (Group A). The podocyturia was studied by indirect immunofluorescence using primary antibodies to podocyte: anti-podocin, nephrin and synaptopodin, and a secondary antibody conjugated with FITC. We also evaluated serum creatinine levels, urinary protein/creatinine (P/C) ratio, hematuria and leucocituria. RESULTS: The podocyturia with anti-podocin and anti-sinaptopodin correlated statistically with the P/C ratio (p = 0.001 and p = 0.013, respectively). The podocyturia with anti-podocin, as well as the P/C ratio showed significant correlation (p < 0.001) with the degree of lupus disease activity, unlike the other two antibodies, anti-nephrin and anti-synaptopodin. CONCLUSION: Our findings show that podocyturia with anti-podocin could be useful in monitoring disease activity in LN patients.

Comparison of urine analysis using manual and sedimentation methods / Comparación del análisis de orina usando el método manual y el método de sedimentación

OBJECTIVE: Microscopic examination of urine sediment is an essential part in the evaluation of renal and urinary tract diseases. Traditionally, urine sediments are assessed by microscopic examination of centrifuged urine. However, the current method used by the Georgetown Public Hospital Corporation Medical Laboratory involves uncentrifuged urine. To encourage high level of care, the results provided to the physician must be accurate and reliable for proper diagnosis. The aim of this study is to determine whether the centrifuge method is more clinically significant than the uncentrifuged method. METHODS: In this study, a comparison between the results obtained from centrifuged and uncentrifuged methods were performed. A total of 167 urine samples were randomly collected and analysed during the period April-May 2010 at the Medical Laboratory, Georgetown Public Hospital Corporation. The urine samples were first analysed microscopically by the uncentrifuged, and then by the centrifuged method. The results obtained from both methods were recorded in a log book. These results were then entered into a database created in Microsoft Excel, and analysed for differences and similarities using this application. Analysis was further done in SPSS software to compare the results using Pearson's correlation. RESULTS: When compared using Pearson's correlation coefficient analysis, both methods showed a good correlation between urinary sediments with the exception ofwhite bloods cells. The centrifuged method had a slightly higher identification rate for all of the parameters. CONCLUSIONS: There is substantial agreement between the centrifuged and uncentrifuged methods. However, the uncentrifuged method provides for a rapid turnaround time.

OBJETIVO: El examen microscópico del sedimento de orina es una parte esencial en la evaluación de enfermedades renales y del tracto urinario. Tradicionalmente, los sedimentos de orina son evaluados mediante examen microscópico de orina centrifugada. Sin embargo, el método actual usado por el Laboratorio Médico de la Corporación del Hospital Público de Georgetown recurre a la orina no centrifugada. Con el propósito de estimular un alto nivel de cuidado, los resultados proporcionados al médico tienen que ser exactos y fiables para un diagnóstico apropiado. El objetivo de este estudio es determinar si el método de la centrifugación es clinicamente más significativo que el método sin centrifugación. MÉTODOS: En este estudio, se hace una comparación entre los resultados obtenidos a partir del método con centrifugado y sin centrifugado. Un total de 167 muestras de orina fueron recogidas aleatoriamente y analizadas durante el periodo de abril a mayo de 2010 en el Laboratorio Médico de la Corporación del Hospital Público de Georgetown. Las muestras de orina se analizaron primero microscópicamente por el método sin centrifugado, y entonces por el método con centrifugación. Los resultados obtenidos mediante ambos métodos fueron registrados en un en un diario de documentación. Estos resultados fueron entonces introducidos en un banco de datos creado en Microsoft Excel, y analizados en cuanto a sus diferencias y similitudes usando esta aplicación. El análisis se realizó también más tarde mediante el software de SPSS para comparar los resultados usando la correlación de Pearson. RESULTADOS: Al ser comparados mediante análisis basado en el coeficiente de correlación de Pearson, ambos métodos mostraron una buena correlación de los sedimentos urinarios, con excepción de los leucocitos. El método de la centrifugación tuvo una tasa de identificación ligeramente más alta para todos los parámetros. CONCLUSIONES: Existe una correspondencia sustancial entre los métodos con centrifugado y sin centrifugado. Sin embargo, el método que no emplea la centrifugación ofrece un tiempo de respuesta más rápido.

Análise comparativa de duas metodologias para a identificação de cilindros hemáticos urinários / Comparative analysis of two methodologies for the identification of urinary red blood cell casts

INTRODUÇÃO: A presença de hemácias dismórficas na urina é um forte indicativo da origem glomerular do sangramento, sendo uma ferramenta importante no diagnóstico de glomerulonefrites. Os cilindros hemáticos geralmente acompanham as hemácias dismórficas, sendo também fortes indicadores de hematúria glomerular, embora não sejam encontrados com frequência no exame parcial de urina. OBJETIVO: Comparar duas técnicas de concentração de amostras em uma série de exames de urina com hematúria dismórfica. MATERIAL E MÉTODOS: Foram selecionadas 249 amostras com hematúria dismórfica a partir de 4.277 amostras de urina de rotina. As amostras foram processadas utilizando-se duas técnicas: a convencional e a de concentração. O percentual de identificação dos cilindros hemáticos foi comparado de acordo com a metodologia utilizada. RESULTADOS: A presença de cilindros hemáticos pela técnica de concentração foi estatisticamente maior (52,6 por cento) em comparação com a positividade pela metodologia convencional (8,4 por cento) (p < 0,001). DISCUSSÃO E CONCLUSÃO: Sugere-se que a técnica convencional não concentrou suficientemente a amostra de urina e os cilindros hemáticos ficaram no sobrenadante, sendo descartados. A utilização da técnica de concentração aumentou a sensibilidade técnica para a pesquisa dos cilindros hemáticos. Portanto, a técnica de concentração, associada à presença de hemácias dismórficas, mostrou-se útil para aumentar a concordância dos dois parâmetros laboratoriais para a detecção da hematúria de origem glomerular como auxílio diagnóstico das glomerulopatias, importante causa de doença renal crônica.

INTRODUCTION: Dysmorphic red blood cells (RBCs) in the urine are a strong indicator of a glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria. OBJECTIVE: This study tested the superiority of a urine concentration technique (CT) over the standard method (SM) for RBC cast identification in a group of patients suspected of glomerular hematuria. MATERIAL AND METHODS: Of a total of 4,227 routine urinary samples, 249 with dysmorphic hematuria were selected. The samples were processed according to two techniques: standard method (SM) and concentration technique (CT). The percentages of RBC cast identification according to each method were compared. RESULTS: The CT showed a higher rate of RBC casts (52.6 percent) compared to the SM (8.4 percent) (p < 0.001). DISCUSSION AND CONCLUSION: We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded. The CT increased the sensitivity of the RBC cast yield. The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification of glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.

Diagnostic value of urinary CK-20 RNA and VEGF in bladder cancer

The present study was carried out to evaluate the diagnostic value of urinary cytokeratin 20 [CK-20] RNA and vascular endothelial growth factor [VEGF] in comparison with urine cytology in the detection of bladder cancer. This study included 80 patients with bladder cancer, 20 patients with bilharzial bladder lesions and 20 normal volunteers as control group. CK-20 RNA in urine sediment was detected by reverse transcription polymerase chain reaction [RT-PCR]. VEGF in urine supernatant was detected by ELISA and confirmed by western blotting [WB]. The median value of VEGF and positivity rates of both VEGF and CK-20 in bladder cancer group was significantly higher as compared to benign bladder lesions group and normal control group. There was no significant association between the postivity rates of CK-20 and VEGF with any of the clinicopathological factors except a significant positive association between VEGF positivity and clinical stage. The overall sensitivity, specificity, positive predictive value, negative predictive value were; 66.25%, 92.5%, 94.46%, 57.81% for VEGF, 65.2%, 70%, 80.65%. This article was taken from Ph.D thesis submitted by Ekram Fadl Al-Eryani To: Faculty of Medicine-Ain Shams University. 2005 48.28% for voided urine cytology, and 83.7%, 100%, 100%, 75.47% for CK-20 respectively. Combined sensitivity of cytology, VEGF andCK-20 RNA reached [96.25%] and was higher than the combined sensitivity of cytology and VEGF [90%], or cytology and CK-20 RNA [92.5%], or VEGF and CK-20 [91.25%]. These results indicate that VEGF can be quantitively measured in urine of bladder cancer patients, and its combined use with cytology increases its sensitivity

Leucocitúria em pacientes submetidas a quimioterapia e coleta de urina / Leucocituria in patients submitted to chemoteraphy and urine collection / Leucocitúria en pacientes sometidas a quimioterapia y recolección de orina

O objetivo do estudo foi verificar a freqüência de leucocitúria em portadoras de câncer ginecológico em quimioterapia (QT) e avaliar as práticas na coleta de urina para exame. Pesquisa descritiva, transversal realizada com mulheres portadoras de câncer ginecológico, durante seções de QT. Com entrevista semi-estruturada foi identificada técnica da coleta de urina e verificados os resultados dos exames realizados antes das seções de QT. Das 30 entrevistadas, 80 por cento relataram coletar corretamente urina, 100 por cento apresentaram pelo menos um erro durante o processo. A frequência de leucocitúria foi de 30 episódios. Os erros ocorreram principalmente na higienização genital e coleta do jato urinário. Infere-se que a forma errônea na coleta de urina somada a neutropenia sejam responsáveis pela leucocitúria.

The proposal of the study was to verify leucocituria frequency in carriers of gynecological cancer in chemotherapy (CT) and to identify practices in urine collection for exam. Descriptive transversal study carried out with ginecologyc cancer patients during chemotherapy sections. With semi-structured interview, it was identified urine collection technique and verified the results of exams accomplished before chemotherapy sections. Among 30 interviews, 80 percent related to collect urine correctly, 100 percent presented at last a mistake during the process. Leucocituria frenquency was 30 episodes. The mistakes occurred mostly in genital cleaning and collection of the urinary jet. It infers that the erroneous form in the collection in addition to the neutropenia can be responsible for the leucocituria.

El objetivo del estudio fue verificar la frecuencia de leucocitúria en portadoras de cáncer ginecológico en quimioterapia (QT) e identificar las prácticas en la colecta de orina para examen. Pesquisa descriptiva transversal realizada con portadoras de cáncer ginecológico, durante las secciones de QT. Por medio de entrevista semi-estructurada fue identificada técnica de colecta de orina y verificados los resultados de los exámenes realizados antes de las secciones de QT. De las 30 entrevistadas, 80 por ciento relataron colectar correctamente la orina, 100 por ciento presentaron por lo menos un error durante el proceso. La frecuencia de leucocitúria fue de 30 episódios. Los errores ocurrieron principalmente en la higienización genital y colecta del chorro urinario. Se infiere que la forma errada en la colecta de orina sumada a la neutropénia sean responsables por la leucocitúria.

Urovysion™ testing can lead to early identification of intravesical therapy failure in patients with high risk non-muscle invasive bladder cancer

Purpose: In this study, we investigated the ability of UroVysion™ to assess response to intravesical therapy in patients with high risk superficial bladder tumors. Materials and methods: We performed a retrospective review of patients undergoing intravesical therapy for high risk superficial bladder tumors. Urine specimens were collected for UroVysion™ analysis before and immediately after a course of intravesical therapy. Cytology and cystoscopy were performed six weeks after treatment, using either a positive cytology or visible abnormality on cystoscopy as a prompt for biopsy. The operating characteristics of the UroVysion™ test were then determined. Results: 41 patients were identified in whom 47 cycles of induction and 41 cycles of maintenance intravesical therapy were given during the study period. This yielded a total of 88 treatment and evaluation cycles. Median follow-up was 9 months per induction (range 1-21 months) and 13 months per patient (range 1-25 months). A total of 133 urine samples were collected for UroVysion™ of which 40 were positive. Based upon standard clinical evaluation, 41 biopsies were performed which detected 20 recurrences. UroVysion™ testing performed immediately upon completion of therapy for the 41 patients undergoing biopsy yielded a sensitivity, specificity, and accuracy of 85 percent, 61 percent, and 71 percent. Conclusions: The use of UroVysion™ following intravesical therapy for high-risk superficial bladder tumors helps to identify patients at high risk of refractory or recurrent disease who should undergo immediate biopsy under anesthesia.

Detection of human telomerase reverse transcriptase messenger RNA in urine of high risk patients as a non invasive molecular diagnostic tool for urinary bladder cancer in Egyptians

Bladder cancer is an important national health problem as it is the leading cancer in men in Egypt. Cystoscopy and biopsy, currently remains the gold standard procedure for diagnosis, yet, it is invasive and costly. Urinary cytopathology remains to be the only non-invasive alternative method for diagnosis. Although it is tumour specific, yet it has a poor sensitivity, especially for low grade tumours. Detection of Telomerase enzyme in exfoliated urinary cells is a potentially good molecular diagnostic marker in bladder cancer, since the catalytic subunit of this enzyme [hTERT] proved to be essential for cellular immortality and oncogenesis. The study comprised 39 patients [36 with urothelial carcinomas and 3 cases were squamous cell carcinoma] with bladder cancer and 22 non cancer control [including 14 patients with benign urological disorders and 8 healthy volunteers]. The urine sample was split into two aliquots one was used to undertake RNA extraction and hTERT/GAPDH RT-PCR semi-quantitative assay and the second for cytological examination. Cystoscopy was considered the reference standard for the identification of bladder cancer. The hTERT/GAPDH RT-PCR test showed significantly higher diagnostic sensitivity than cytology [84% Vs. 75% p<0.008] for confirmed UCC, particularly for low grade non-muscle invasive UCC [82% Vs. 64% p<0.005]. On combining the two tests a sensitivity of 95% was obtained. A positive hTERT expression was detected 4-5 months earlier than cystoscopic evidence of recurrence in 2 patients during their follow up. In this pilot study, detection of hTERT expression in urine has shown to be a more sensitive marker for diagnosis of bladder cancer than cytology. The combination of urinary hTERT mRNA with cytological testing augments the sensitivity for the non-invasive early diagnosis of bladder cancer. This finding warrants further extended study to validate the potential role of hTERT expression as a diagnostic non invasive tool for high risk patients and detection of recurrence in bladder cancer in Egypt

The Utility of Fluorescence In Situ Hybridization for Detection of Bladder Urothelial Carcinoma in Routine Clinical Practice

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.

the current management of chronic prostatitis/chronic pelvic pain syndrome effective

To re-evaluate the efficacy of the current applied manage-merit of chronic prostatitis/CPPS. From September 2000 to December 2006, 1690 patients diagnosed as chronic prostatitis/chronic pelvic pain syndrome [CP/CPPS] were managed in this series, in Urology Department, Benha Faculty of Medicine and Al Noor Specialist Hospital KS.A. We have classified the patients into 3 groups according to presence of pus cells in expressed prostatic secretion or urine sample after massage [VB3] in Stamy's method, and according to NIH/CP classification, the three groups have been subdivided to A and B subgroup. The subgroup A received antibiotics and subgroup B received placebo, anti-inflammatories, plant extract or alpha-blockers. Evaluation of the result of management was done according to NIH-CPSI score. Data from the 3 groups were analyzed and compared. The improved patients were statistically analyzed according to the decrease by more than 25% NIH/CPSI score from the base line. The results of the present study have revealed that there was in significant difference between the improved percentages of patients in subgroup A1 [44.6%] received antibiotics in comparison to patients in subgroup Bl [43.2%] received placebo or other measures in the 1[st] group P>0.05. In the 2nd group there was significant improvement in subgroup B2 63.5% than group A[3] 24.5%, in the 3[rd] group there was significant increase in the percentage of the total improved patients but there was no significant difference between the improved patients of the two subgroups A[3], B[3]. We concluded from this study that the management of chronic prostatitis/chronic pelvic pain syndrome still a challenge for urolo-gists and there was no significant difference between the percentage of improved patients treated by antibiotics and other treated by placebo or other measures and further research is needed and more studies are required to confirm efficacy of therapies and trial of another measures

Evaluation of iQ200 Automated Urine Microscopy Analyzer / 대한진단검사의학회지

BACKGROUND: Microscopic examination of urine sediment is one of the most commonly performed tests in the clinical laboratory. However, manual microscopic sediment examination is labor-intensive, time-consuming and imprecise. In this study, we evaluated the analytical performance and clinical usefulness of a recently introduced image-based automated urinalysis system, Iris iQ200 (Iris Diagnostics, USA). METHODS: We assessed the iQ200 for linearity, precision and carryover rate using patient's samples and quality control materials. On 337 urine samples, urine sediment analyses performed by the iQ200 were compared with manual microscopy results. RESULTS: The iQ200 showed a good linearity (r2>0.99) for all cellular components analyzed. Within-run and total CVs on urine specimens and quality control samples were less than 10% except for within-run CV for the samples with low concentration of the squamous epithelial cells. The carryover rates were 0.21% for RBCs and 1.92% for WBCs. The agreement rates within one grade between the iQ200 and manual microscopy for RBCs, WBCs, and squamous epithelial cells were 93.8%, 94.2% and 96.9%, respectively. CONCLUSIONS: Since the iQ200 showed a reliable analytical performance and good concordance with manual microscopy, it could be useful in the clinical practice as a screening procedure.

Colestasis gravidica: a propósito de un caso / Cholestasis gravidarum: a purpose of a case

La Colestasis Gravídica en un síndrome que habitualmente se produce en el tercer trimestre del embarazo y se resuelve en el embarazo. Se caracteriza clínicamente por la presencia de prurito, ictericia o ambos sin otra disfunción hepática importante. En el siguiente trabajo se reporta caso de paciente femenino de 24 años III gestas II para FUR: 12/8/06 quien refiere de 6 días de evolución orinas coluricas, prurito generalizado predominio de manos y tórax, exámenes para clínicos con aumento de un transaminasas, fosfatasas alcalinas, se diagnóstica colestasis gravídica, patología de baja incidencia de 1/300 y 1/2000 embarazos, se considera importante realizar una revisión académica del mismo.

An appraisal of urine cytology in the diagnosis of transitional cell carcinoma of the urinary bladder

Urine cytology has an acceptable sensitivity, and specificity that justifies its use in the current diagnostic protocol. In Iraq transitional cell carcinoma [TCC] constitute about 62.1% of bladder cancer [which ranks the third according to the results of Iraqi Cancer Registry 1995-1997]. Urine cytology used in the primary diagnosis, follow up, and in the screening programs of asymptomatic but high-risk patients. This study was conducted on 93 patients, diagnosed or clinically suspected to have TCC of the urinary bladder attending to the Urological department in AL-Kadhimiya Teaching Hospital, AL-Yarmouk Teaching Hospital, and Baghdad Medical City. During the period from July 2004 to July 2005. 76 were males and 17 were females. Urine cytological examination was done to those patients using two types of stain hematoxylin and eosin, and papanicoloau stain] to detect malignant cells with the identification of the degree of differentiation, if possible, the cytological findings were correlated with the hisiopathological findings. And the cytological findings compared regarding each type of stain. Mean age of the patients was 59 year. Male.female ratio was 4.4:1. Main clinical presentation was hematuria [45.8%] of the total. Urine cytological examination has a sensitivity of 87.7%, specificity of 100% with an overall accuracy of 78% in the detection of TCC of urinary bladder. The main chief complaint of patients with TCC was haematuriawitch constitute 45.8% of the total. The percentage of highgrade cases in urine cytology was higher than that in histopathology.the percentage of cases of TCC diagnosed by papanicoloau stain was more than that diagnosed by II and E [73.24% by pap stain versus 70.42% by H and E]. Urine cytology has an acceptable sensitivity, specificity and an overall accuracy in the diagnosis of TCC of urinary bladder, and it offers a good chance for determination of the grade of the tumor especially in high grade tumor. Pap stain was better in the diagnosis of TCC

Evaluation of Urine NMP22 Point-of-Care Test for the Screening of Bladder Cancer / 대한진단검사의학회지

BACKGROUND: Screening of high-risk patients using bladder tumor markers can offer an advantage of early detection and saving medical costs. For these purpose many tumor markers have been developed to supplement invasive cystoscopy. Our study evaluated the NMP22 point-of-care test (NMP22 POCT), which is one of the tumor makers, comparing with the standard urine cytology for the diagnosis of bladder cancer. METHODS: From January to September 2005, 232 patients who had undergone a cystoscopy due to bladder cancer associated symptoms including hematuria and dysuria were enrolled in this study. Urine specimens were collected for NMP22 POCT and cytology. NMP22 POCT and urine cytology were compared for sensitivity and specificity. In addition, we evaluated urine stick test and microscopy to explain some false-positive results in NMP22 POCT. RESULTS: Superficial transitional cell carcinoma was diagnosed in 10 patients. The sensitivity of NMP22 test was 60% (95% confidence interval [CI], 26.2-87.8%), whereas that of cytology was 33.3% (95% CI, 7.5-70.1%); however, the difference was not significant. The specificity of NMP22 test was 69.8% (95% CI, 63.3-75.8%), compared with 99.0% (95% CI, 96.5-99.9%) for cytology (P<0.001). The presence of microscopic RBCs in urine specimen was significantly associated with the lower specificity of NMP22 POCT (P=0.02). CONCLUSIONS: NMP22 POCT was significantly less specific than urine cytology. To be useful as a bladder cancer screening test, the NMP22 test should have a higher specificity.