The Abnormal Urinalysis

The Abnormal Urinalysis
Hiren P. Patel, MD
Department of Pediatrics, Section of Nephrology, Columbus Children’s Hospital,
The Ohio State University College of Medicine and Public Health, 700 Children’s Drive,
Columbus, OH 43205, USA
The urinalysis is one of the most commonly ordered clinical tests in pediatrics.
This frequency is partly due to the ease of urine collection and testing. Urine
testing has been a part of medicine for many centuries, with Hippocrates having
written about urine examination as early as 400 bc [1,2]. Advances in chemistry
allowed significant progress in urine testing during the nineteenth century, and
the modern era of reagent strip (dipstick) testing began in 1956 [3]. Urine testing
can be used to screen for a number of disorders. Because it is most commonly
used in the primary care office setting, the components of the urine dipstick test
are emphasized in this article. In addition to the basic urinalysis, this article
reviews urine microscopic analysis and the urine quantification tests that are more
commonly being used.
Urine screening
The merits of mass screening of asymptomatic healthy children have been
debated for some time [4–6]. The American Academy of Pediatrics previously
recommended a screening urinalysis at four time points during childhood, but the
current recommendation is to obtain a screening urinalysis only at the preschool
physical and yearly in sexually active adolescents to look for leukocyte esterase
(LE) [7]. Many pediatricians obtain screening urinalyses more frequently. It is
common to find abnormalities on urine screening tests, but in most cases, these
are transient or due to a false positive reading [8]. Screening can also identify
individuals who have subclinical chronic kidney disease who may potentially
0031-3955/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.pcl.2006.02.004 pediatric.theclinics.com
E-mail address: patelh@pediatrics.ohio-state.edu
Pediatr Clin N Am 53 (2006) 325– 337