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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1997  |  Volume : 8  |  Issue : 4  |  Page : 419-422
Utility of Urinalysis in Patients Attending Primary Health Care Centers


1 Department of Medicine, King Saud University, Abha, Saudi Arabia
2 Epidemiology Unit, Alexandria University, Egypt

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   Abstract 

Renal diseases are often discovered accidently during routine urinalysis. To test the diagnostic value of screening for renal disease by urinalysis, a cross-sectional study was conducted in two major Primary Health Care Centers (PHCCs) in Abha, Saudi Arabia, on patients attending these PHCCs with different medical problems. A total of 10,500 patients visited the two PHCCs during the study period between January 1994 and September 1994, and 1,006 urine samples were examined. Patients known to have renal diseases, pregnant women and menstruating women were excluded from the study. There were 390 males (38.8%) with a mean age of 30.9 + 18.3 years (range 1 - 78 years) and 616 females (61.2%) with a mean age of 28.7 ± 13.9 years (range 2 - 87 years). Proteinuria was present in 12.8% of the males and 11.0% of the females. Pyuria was present more significantly in females (25%) than in males (9.5%) with a p value of 0.0001. This study shows a high prevalence of abnormal urinalysis in a country where most patients present late with advanced renal disease of unknown cause. Also, such a screening test at the PHCC level is cost-effective.

Keywords: Primary Health Care Centers, Urinalysis, Hematuria, Proteinuria.

How to cite this article:
Al-Homrany M, Mirdad S, Al-Harbi N, Mahfouz A, Al-Amari O, Abdalla S. Utility of Urinalysis in Patients Attending Primary Health Care Centers. Saudi J Kidney Dis Transpl 1997;8:419-22

How to cite this URL:
Al-Homrany M, Mirdad S, Al-Harbi N, Mahfouz A, Al-Amari O, Abdalla S. Utility of Urinalysis in Patients Attending Primary Health Care Centers. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2020 Jun 7];8:419-22. Available from: http://www.sjkdt.org/text.asp?1997/8/4/419/39341

   Introduction Top


Renal diseases are sometimes diagnosed in asymptomatic individuals but generally physicians are confronted with patients who present with advanced features of end-stage renal disease (ESRD) for which the only treatment that can be offered is dialysis or renal transplantation. An abnormal urine test may be the earliest warning of a significant renal pathology. Early detection of proteinuria and/or hematuria is useful in selecting patients who require long-term surveillance even if the severity of the hematuria or proteinuria does not warrant renal biopsy, Because of the simplicity of urinalysis, physicians often have the tendency to ignore abnormalities found by this test [1] . This attitude is deplorable because of the possible consequences of missing serious, but potentially curable conditions. Saudi Arabia has adopted the Primary Health Care Systems, and 1,737 Primary Health Care Centers (PHCCs) are already established throughout the country. The current number of PHCCs is 1,737 throughout the country. However, urinalysis is not performed routinely. We, conducted this study in two major PHCCs to explore the value of performing such a test in these centers and to study the magnitude of abnormal urinalysis in patients who have no symptoms suggestive of renal disease.


   Method Top


This is a cross-sectional study conducted in two major PHCCs, at Al-Manhal and Zera, in the city of Abha in the southern region of Saudi Arabia with a catchment population of about 18000 people. The study period was between January 1994 and September 1994. All patients attending the PHCCs were included regardless of the reason that brought them to the center. A total of 1006 urine samples were collected in the two major centers during the study period. Female patients who were menstruating or known to be pregnant at the time of urine collection were excluded. Also, patients who were known to have renal disease were not included.

Urine Collection:

Patients were instructed to obtain clean catch mid-stream urine specimens in sterile containers. Samples were examined within 1 to 2 hours Multistix, Amex Co., Bayer diagnostic was used for chemical testing (glucose, protein, leukocyte esterase, hemoglobin, pH and specific gravity).

Microscopic Examination:

Samples of 10 ml urine were centrifuged at 2,000 revolutions per minute for five minutes. The supernatant was decanted and 0.1 ml of the sediment was examined first under low power (lOOx) and then under high power (400x).

Presence of 1 - protein, blood and leukocyte by dipstick was considered abnormal. White blood cells (WBCs) more than four in males or more than five in females per high power field (PHPF), and presence of more than five red blood cells (RBCs) PHPF in both sexes were considered abnormal findings.

The data were entered into a computer and SPSS PC software package was used for analysis. Chi-squared test was used when appropriate.


   Results Top


A total of 1,006 samples were screened during the study period; there were 390 males (38.8%) with a mean age of 30.9 ± 18.3 years (range=1 to 78 years) and 616 females (61.2%) with a mean age of 28.7 ± 13.9 years (range = 2 to 87 years). Reasons for visiting the two centers were identified in 901 of the screened samples while this information was not available on 105 patients [Table - 1].

[Table - 2] shows the abnormal urinary findings by dipstick. There were 50 males (12.8% of the males) and 68 females (11.0% of the females) with proteinuria. Hematuria was observed in 39 males (10.0% of the males) and 68 females (11.0% of the females). There was a higher prevalence of hematuria among male patients in the age-group of 31-50 years (p< 0.029). Pyuria was observed much more commonly in females than males (13.3% and 4.9% respectively) (p= < 0.0001). Glucosuria was detected in 12.4% of the males and 15.8% of the females with higher prevalence rate above the age of 51 years (p = < 0.0001).

Findings related to microscopic examination are summarized in [Table - 3]. Microscopic hematuria was detected in 72 (18.5%) males and 126 (20.5%) of the females. Leukocyturia is significantly more common in females than males (p = < 0.000. Other abnormalities which were detected by microscopic examination included: abnormal casts (1.4%); uric acid crystals (0.3%); calcium oxalate crystals which were seen in 11 % of the males and in only 3% of the females; amorphous urate was found in 8.9% of the males and 3% of the females; tyrosine and cystine crystals were detected in 0.3% and 0.4% of the total sample respectively.

Significant bacteriuria (> 2 + ) was seen in 4.5% of the females and 0.5% of the males. Alkaline urine (pH > 6.0) was detected in 60% of the male and 70% of the female patients. 77% of the males and 72% of the females were found to have high specific gravity (> 1.020). No ova or parasites were seen in the screened samples.


   Discussion Top


Routine urinalysis has been shown to detect a variety of abnormalities. In patients admitted to a general medical ward, the prevalence of abnormalities is likely to be high. Akin, et al found abnormalities in 57% of such patients [2] . In the general population, it is much lower with 2.5% of men undergoing routine health screening found to have hematuria [3] ; 5% of women child-bearing age have significant bacteriuria [4] . proteinuria was present in 5.8% of adults [5] and glucosuria in 1.3% [6] . Carl, et al screened 21,000 presumably healthy adults and found that 10% had atleast one urinary abnormality detected [7] . Overall, in a survey of patients in general practice, 11% of males and 18% of the females had urinary abnormalities [8] . Thus, the prevalence of urinary abnormalities is sufficiently high to justify routine urinalysis both in the hospital and in general practice, although it must be remembered that abnormal findings should be reconfirmed before further tests are undertaken.

In Saudi Arabia, the total number of patients diagnosed to have ESRD by 1993 was about 4,000 [9] . This number is increasing every year with the expected incidence being between 65.2 - 190 per million population (PMP) [10],[11] . The majority of these patients present late with uremic symptoms of unknown cause. This study, which was conducted in two major PHCCs, shows a high prevalence of proteinuria (11.7%) and hematuria (19.6%) in a country where the incidence of ESRD is expected to be high. Dialysis and/or transplantation are very expensive modes of treatment and cause tremendous economic burden on the health care system [11],[12] . The cost of hemodialysis treatment in Saudi Arabia is about US $ 19,776 per patient per year [13] and in the United States, between $ 21,060 and 26,832 per patient per year [14] Thus, there is a need to put in more effort in order to decrease the number of patients going into ESRD. This will not be achieved unless the health care system adopts a policy by which patients harboring the renal disease are identified early and offered proper treatment. We believe that PHCCs should participate effectively by performing routine urinalysis for all patients at least once a year as part of their check-up and refer patients with abnormal tests to the nephrologist. This will go a long way in reducing the incidence of ESRD thereby helping the patient as well as the health-care providers.


   Acknowledgement Top


We would like to thank Prof. B. Teklu and Prof. A. Ibrahim for reviewing the manuscript, and to thank Mr. Rollie Go and Mr. Allan Agaton for their secretarial assistance. Appreciation to all members of Al­ Manhal and Zera PHCCs for their cooperation.

 
   References Top

1.Frascr CG, Smith BC, Peake MJ. Effectiveness of an outpatient urine screening program. Clin Chem 1977;23:2216-8.  Back to cited text no. 1    
2.Akin BV, Hubbell FA, Frye EB, Rucker L, Friis R. Efficacy of the routine admission urinalysis. Am J Med 1987;82:719-22.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Ritchie CD, Bevan EA, Collier SJ. Importance of occult hematuria found at screening. Br Med J Clin Res Ed 1986;292:681-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kass EH, Savage W, Santamarina BA. The significance of bacteruria in preventive medicine. In: Kass EH, ed. Progress in Pyelonephritis. Philadelphia: FA Davis, 1965.  Back to cited text no. 4    
5.Evans DA, Williams DN, Laughlin LW, et al. Bacteriuria in a population­based cohort of women. J Infect Dis 1978;768-73.  Back to cited text no. 5    
6.Chavers BM, Vernier RL. Proteinuria and enzymuria. Semin Nephrol 1986;6:371-88.  Back to cited text no. 6  [PUBMED]  
7.Carel RS, Silverberg DS, Kaminsky R, Aviram A Routine urinalyis (dipstick) findings in mass screening of healthy adults. Clin Chem 1987;33:2106-8.  Back to cited text no. 7    
8.Elliott P. Experience of urine screening in general practice. Focus on urine analysis. Oxford: Medicine Publishing Foundation, 1983;33-35.  Back to cited text no. 8    
9.Shaheen FAM. Organ transplantation in the Kingdom of Saudi Arabia: new strategics. Saudi J Kidney Dis Transplant 1995;5(l):3-5.  Back to cited text no. 9    
10.Ibrahim MA, Kordy MN. End-stage renal disease (ESRD) in Saudi Arabia. Asia Pac J" Public Health 1992­93;6(3):140-5.  Back to cited text no. 10    
11.Mitwalli AH, Al Swailem AR, Aziz KMS, et al. The incidence of end-stage renal disease in two regions of Kingdom of Saudi Arabia. Saudi J Kidney Dis Transplant 1995;6(3):280-5.  Back to cited text no. 11    
12.Aziz KMS. Incidence of end-stage renal disease: magnitude of the problem and its implications. Saudi J Kidney Dis Transplant 1995;6(3):271-4.  Back to cited text no. 12    
13.Aldrees A, Paul TT, Abu-Aisha H, Babiker MA, Kurpad R, As wad S. A cost evaluation of hemodialysis in Ministry of Health Hospitals, Saudi Arabia: an NKF study. Saudi Kidney Dis Transplant Bull 1991;2(3): 125-33.  Back to cited text no. 13    
14.Nolph KD. Comparison of continuous ambulatory peritoneal dialysis and hemodialysis. Kidney Int Suppl 1988;24:S123-31.  Back to cited text no. 14  [PUBMED]  

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Correspondence Address:
Mohammed Al-Homrany
Consultant Nephrologist, College of Medicine, King Saud University, P.O. Box 641, Abha
Saudi Arabia
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    Abstract
    Introduction
    Method
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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