[A review of urinary examination--what medical practice expects now and what urinary examinations have to provide in the future].

Urinary examination can be performed frequently because of its non-invasive nature. To take advantage of this advantage, it is important to inform clinicians about the following: not only analytical results of chemical as well as morphological components but also easy-to-understand factors that are comprehensively analyzed, causing these components to emerge in urine. Here we review issues with the guidelines for hematuria diagnosis and management guidelines for chronic kidney disease. We report issues with the standard urinary erythrocyte count to define hematuria, the significance of urinary albumin test strips in the prevention of CKD or CVD development, and information on the morphologies of urinary erythrocytes.

Parvovirus B19-associated purpuric-petechial eruption.

BACKGROUND: Papular-purpuric gloves-and-socks syndrome, characterized by focal acral purpuric eruptions with a symmetrical distribution, is a rare but representative purpuric dermatosis closely associated with parvovirus B19 (PVB19) infection. However, several atypical presentations such as involvement of other sites and generalized involvement have been recently reported in PVB19 infected patients. Such multifaceted features can cause considerable confusion when making a diagnosis of purpuric eruption associated with PVB19. OBJECTIVES: Describe two febrile patients with atypical presentation of papular-purpuric eruptions due to PVB19 infection and discuss the distinctive features of purpuric-petechial eruptions associated with PVB19 infection. STUDY DESIGN: Case reports and viral diagnosis by serologic tests and real-time PCR for PVB19 DNA in the serum. RESULTS: One presented with "asymmetrical gloves without socks" distribution of papular purpuric eruptions accompanied by asymmetrical intertriginous involvement, the other with generalized distribution characterized by prominent intertriginous and truncal involvement. Both cases were followed by erythema infectiosum. Paired serum antibody analysis and real-time PCR indicated the link between the development of papular purpuric eruption and the viremic phase of primary PVB19 infection. CONCLUSIONS: PVB19 infection should be considered in any patient presenting with a petechial or purpuric eruption of unclear origin, and not solely for PPGSS type presentations. Therefore, we propose a simple name "PVB19-associated purpuric-petechial eruption" to describe polymorphous purpuric-petechial eruptions due to PVB19 infection, coinciding with the viremic phase of primary infection and infectivity, characterized by a self-limiting course with a benign prognosis and common histological findings.

Urinary heme oxygenase-1 as a sensitive indicator of tubulointerstitial inflammatory damage in various renal diseases.

BACKGROUND/AIMS: In oxidative stress, heme oxygenase-1 (HO-1) plays a pivotal role in maintaining renal function and protecting renal structure, especially in renal tubular epithelial cells. We examined urinary HO-1 (uHO-1) levels to assess whether uHO-1 acts as a sensitive biomarker for detecting tubulointerstitial inflammatory damage in renal diseases. METHODS: Immunohistochemical analyses and enzyme-linked immunosorbent assays for uHO-1 were performed using 61 urine samples (supernatants and sediment lysates) from healthy children and renal disease patients. RESULTS: Proximal and distal epithelial cells showed higher uHO-1 levels than squamous and urothelial cells. Inflammatory renal disease patients had higher uHO-1 levels than noninflammatory renal disease patients and controls. In IgA nephropathy, patients with interstitial cellular infiltration showed higher uHO-1 levels than those without it. Among patients with increased urinary ß(2)-microglobulin or N-acetyl-ß-D-glucosaminidase levels, uHO-1 levels increased only in those with renal disease and tubulointerstitial inflammatory damage. uHO-1 levels positively correlated with urinary interleukin-6 in inflammatory renal disease patients. CONCLUSIONS: These results indicate that uHO-1 is a potentially useful, novel, and noninvasive biomarker for evaluating the degree of tubulointerstitial inflammatory damage in renal disease.

[Pitfalls in measuring urinary proteins: age-related changes in urinary creatinine excretion that affect the urine protein/creatinine ratio].

Knowing the amount of protein excreted in the urine is important in determining the severity and activity of renal diseases. In general, screening tests have been carried out using the urine dipstick. However, there are limitations in determining the amount of urinary protein excretion using qualitative tests for protein in spot urine samples due to the concentration and dilution of urine. Therefore, when using spot urine samples, it is helpful to calculate the urine protein/creatinine ratio (P/C) by simultaneous measurement of urinary creatinine for determining daily protein excretion. We examined P/C measurements using the dipstick method in 22,718 subjects who visited our hospital for health examinations. The results showed positive rates for qualitative urinary protein (1 + and more) of 4.2% for males and 2.7% for females. Also positive rates for P/C (150 mg/g.cre and more) were found of 7.7% for males and 10.2% for females. The results showed a reversal of positive rates for males and females compared with the results of qualitative urinary protein. In addition, P/C showed a higher positive rate in 70 years old or older both for males and females. The distribution of urinary creatinine levels simultaneously measured by dipstick method showed that the percentage of diluted urine with urinary creatinine level less than 50 mg/dL was 6.8% for males and 18.3% for females overall. Females showed a higher rate and the percentage tended to increase with age both for males and females. From these results, it was suggested that changes in urinary creatinine excretion with age that affect the P/C ratio are large. We then measured the albumin excretion rate in the 24-hour urine as well as examined the correlation between the urinary creatinine concentration and albumin index with regard to age and sex in 1,280 diabetic patients. The results showed that daily urinary creatinine excretion overall in males, overall in females, in males over 80 years old and in females over 80 years old were 1.063 +/- 0.428 g/day (mean +/- S.D.), 0.714 +/- 0.270 g/day, 0.666 +/- 0.201 g/day, and 0.531 +/- 0.017 g/day, respectively, which showed large variations. From these results, creatinine correction, in which uniformity of daily urinary creatinine excretion is the principle, is useful for assessment of short-term fluctuations in the individuals. However, it is indicated that there is a problem when used for screening, from young people to the elderly.

[Clinical usefulness of urine-formed elements' information obtained from bacteria detection by flow cytometry method that uses nucleic acid staining].

Recently, specific detection method for Bacteria, by flow cytometry method using nucleic acid staining, was developed as a function of automated urine formed elements analyzer for routine urine testing. Here, we performed a basic study on this bacteria analysis method. In addition, we also have a comparison among urine sediment analysis, urine Gram staining and urine quantitative cultivation, the conventional methods performed up to now. As a result, the bacteria analysis with flow cytometry method that uses nucleic acid staining was excellent in reproducibility, and higher sensitivity compared with microscopic urinary sediment analysis. Based on the ROC curve analysis, which settled urine culture method as standard, cut-off level of 120/microL was defined and its sensitivity = 85.7%, specificity = 88.2%. In the analysis of scattergram, accompanied with urine culture method, among 90% of rod positive samples, 80% of dots were appeared in the area of 30 degrees from axis X. In addition, one case even indicated that analysis of bacteria by flow cytometry and scattergram of time series analysis might be helpful to trace the progress of causative bacteria therefore the information supposed to be clinically significant. Reporting bacteria information with nucleic acid staining flow cytometry method is expected to contribute to a rapid diagnostics and treatment of urinary tract infections. Besides, the contribution to screening examination of microbiology and clinical chemistry, will deliver a more efficient solution to urine analysis.