A comparison of urinary albumin-total protein ratio to phase-contrast microscopic examination of urine sediment for differentiating glomerular and nonglomerular bleeding.

BACKGROUND: Hematuria can be classified as either glomerular or nonglomerular, depending on the bleeding source. We recently reported that urinary albumin-total protein ratio is potentially useful for identifying the source of hematuria. STUDY DESIGN: Diagnostic test study. SETTING & PARTICIPANTS: 579 fresh urine specimens with microhematuria (> or =5 red blood cells/high-power field) collected from patients with the source of the hematuria confirmed on histopathologic and/or imaging studies and clinical criteria assessed. INDEX TEST: Each urine specimen was evaluated morphologically by using phase-contrast microscopy and biochemically by using urinary albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio. REFERENCE TEST: Each patient had a definitive clinical diagnosis established by means of biopsy (64.4%), imaging studies (21.2%), and routine optimal microscopic examination of urine sediment (14.3%). RESULTS: Of 579 specimens, 329 were obtained from patients with glomerular disease and 250 were obtained from patients with nonglomerular disease. Mean urinary albumin-total protein, albumin-creatinine, and total protein-creatinine ratios for those with glomerular versus nonglomerular diseases were 0.73 +/- 0.11 versus 0.41 +/- 0.14 mg/mg (P < 0.001), 1,110 +/- 1,850 versus 220 +/- 560 mg/g (P < 0.001), and 1,600 +/- 3,010 versus 480 +/- 1,160 mg/g (P < 0.001), respectively. The percentage of patients with greater than 3% glomerular red cells was 83.3% versus 24.8% (P < 0.001). Receiver operating characteristic curve analysis showed that areas under the curve for albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio were 0.992, 0.781, and 0.688, respectively (P < 0.001, albumin-total protein versus albumin-creatinine; P < 0.001, albumin-total protein versus total protein-creatinine). At cutoff values of 0.59 mg/mg, 71 mg/g, and 265 mg/g, albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio had sensitivities and specificities of 97.3% and 100%, 78.9% and 61.1%, and 68.8% and 62.0% for detecting glomerular disease, respectively. Phase-contrast microscopy had sensitivity of 83.3% and specificity of 75.2% for detecting glomerular disease. LIMITATIONS: Albumin-total protein ratio cannot be used in patients with urinary total protein less than 5 mg/dL (<0.05 g/L). Use of only 1 sample from 1 patient may not be sufficient to obtain definitive results. CONCLUSIONS: Urinary albumin-total protein ratio is much more useful than phase-contrast microscopy for differentiating between glomerular and nonglomerular disease in patients with microscopic hematuria.

In vitro efficacy of imipenem in combination with six antimicrobial agents against Mycobacterium abscessus.

Antimicrobial therapy of Mycobacterium abscessus infection is difficult because there are relatively few effective treatment regimens and single-agent therapy frequently fails clinically. In light of the lack of data on the susceptibility profile of M. abscessus strains recovered from infections in Japan, the in vitro activity of imipenem in combination with clarithromycin, levofloxacin, moxifloxacin, minocycline, amikacin or tobramycin was investigated by the checkerboard method and compared with the combination amikacin and cefoxitin. The combination of imipenem with moxifloxacin, levofloxacin or clarithromycin had a higher synergistic and/or additive effect than amikacin and cefoxitin. A decrease in the MIC(90) value (minimum inhibitory concentration for 90% of the organisms) was observed in the presence of imipenem for clarithromycin, minocycline, levofloxacin and moxifloxacin. The data suggest that a combination regimen including imipenem may be a good choice in empirical treatment of M. abscessus infection.

Evaluation of hematuria using the urinary albumin-to-total-protein ratio to differentiate glomerular and nonglomerular bleeding.

BACKGROUND: Depending on the etiology and pathophysiology of hematuria, urinary bleeding is classified as glomerular hematuria or nonglomerular hematuria. Nephritis is usually detected by the presence of proteinuria, especially elevated albumin excretion. In this study, we report on the use of the urinary albumin-to-total-protein ratio to accurately differentiate glomerular and nonglomerular bleeding. METHODS: A total of 143 fresh, random urine specimens demonstrating microscopic hematuria (5 or more red blood cells per high-power field) from patients with the source of the hematuria confirmed by histopathology and/or clinical criteria were included in the study. RESULTS: Of the 143 specimens, 104 were from patients diagnosed with glomerular disease and 39 were from patients with nonglomerular disease. Corrected for urine concentration, the mean total-protein-to-creatinine (Cr) and albumin-to-Cr ratios in the glomerular disease group were 1.67 +/- 2.71 g/g Cr and 1.15 +/- 1.77 g/g Cr, respectively (P < 0.001). In the nonglomerular group, the mean total protein-to-Cr and albumin-to-Cr ratios were 0.19 +/- 0.23 g/g Cr and 0.05 +/- 0.06 g/g Cr, respectively (P < 0.001). However, considerable overlap in the ratios among glomerular and nonglomerular disease groups was observed. In contrast, the mean albumin-to-total protein ratios for glomerular and nonglomerular diseases were 0.72 +/- 0.10 and 0.35 +/- 0.17, respectively (P < 0.001). At a cutoff of 0.59, the albumin-to-total-protein ratio demonstrated a sensitivity of 97.1% (101 of 104 cases) in detecting glomerular disease. CONCLUSIONS: The urinary albumin-to-total-protein ratio is potentially a useful index for the differentiation of glomerular and nonglomerular disease in the presence of microscopic hematuria.

[Role of medical technologists in the infection control team].

The infection control team (ICT) plays important roles in many different aspects of infection control. They include (1) surveillance for hospital-acquired infection, (2) developing the infection control manual, (3) checking that the manual is followed correctly, (4) giving information about the isolation of microorganisms in the hospital, (5) educating and instructing medical staff, etc. Many data have been accumulated on a database in the microbiology laboratory. Bacterial samples are also examined in the microbiological laboratory therefore medical technologists will be the first to notice hospital-acquired infection. Offering prompt information, obtained by surveillance or routine work, greatly contributes to infection control. Furthermore, a 24hr system for the microbiological laboratory may prevent occupational infection of health care workers. The role of the medical technologist in ICT is thus important. To prevent outbreaks of infection, the regional network is also important for the collection of information about the pathogen and the susceptibility of antimicrobial agents in the region. The medical technologist should participate in and communicate with this network. As mentioned above, the inclusion of medical technologists in infection control practice is essential. To participate in the ICT, medical technologists need to have communication skills, and be recognized by other team members as an essential member.