Journal of Yeungnam Medical Science

Original article

Clinical investigation on acute pyelonephritis without pyuria: a retrospective observational study: Hyung Keun Song, Dong Hyuk Shin, Ji Ung Na, Sang Kuk Han, Pil Cho Choi, Jang Hee Lee; J Yeungnam Med Sci. 2022;39(1):39-45. Published online August 11, 2021; DOI: https://doi.org/10.12701/yujm.2021.01207

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Abstract PDF: Background
The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.
Methods
A retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0–5/high power field [HPF] vs. >5/HPF) in urine.
Results
More than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0–5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140–0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room.
Conclusion
The diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.

Original Article

Comparison of the results of multistix®-SG and comber-9-Test®RL urine dipstick assay.: Dae Chul Kim, Kyung Dong Kim, Bo Chan Jung, Chung Sook Kim, Kil Ho Cho; Yeungnam Univ J Med. 1991;8(1):42-52. Published online June 30, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.1.42

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Abstract PDF: Two types of urine dipstick assays, Multistix-SG and Comber-9-Test RL, were compared for compatibility, accuracy, specificity and predictive values of a positive and negative test in 501 patients' urine and artificially prepared specimen. We found that the results of semiquantitative tests of Multistix-SG and Comber-9-Test RL performed were statistically similar in patients' specimen. The urinary leukocyte esterase tests of Comber-9-Test RL assays compared with urine sediment microscopy in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test 83.7%, 48.1%, 90.3%, 47.4% and 90.1%, respectively. The urinary nitrite tests of Comber-9-Test RL assays compared with urine culture tests, in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test were 90.3%, 19.4%, 84.7%, 53.8% and 94.1, respectively. For the urinary protein, the sulfosalicylic acid method was the most sensitive test for any kinds of protein, and Multistix-SG appeared more sensitive than Comber-9-Test RL for the albuminuria. For the urinary bilirubin and glucose, two dipstick assays were similar in their diagnostic efficiency. Finally in the urinary occult blood tests, Comber-9-Test RL assays was more sensitive than Multistix-SG.

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