Laboratory Investigations

  • P. J. Martin
  • T. D. Brogan


Biochemical tests are mainly required by the urologist to assess degrees of renal impairment. This section discusses the uses and limitations of some of the tests in common use. A few notes on methodology are added to give some idea of the reproducibility of values. In the UK a scheme of quality control called the UK External Quality Assessment Scheme for General Clinical Chemistry (NEQAS) is available to all British laboratories. All laboratories are invited to participate every fortnight. Figures taken from this scheme not only allow comparison between methods but also give an idea of reproducibility between different laboratories.


Urinary Tract Infection Plasma Creatinine Recurrent Urinary Tract Infection Plasma Urea Lower Urinary Tract Infection 
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  1. Addis T (1925) A clinical classification of Bright’s diseases. JAMA 85: 163–167CrossRefGoogle Scholar
  2. Addis T, Barrett E, Poo LJ, Yuen DW (1947) The relation between the serum urea concentration and the protein consumption of normal individuals. J Clin Invest 26: 869–874CrossRefGoogle Scholar
  3. Advisory Committee on Dangerous Pathogens (1983) Report No. 1, DHSS DA(83)20. London, HMSOGoogle Scholar
  4. Arneil GC, McAllister TA, Kay P (1970) Detection of bacteriuria at room temperature. Lancet I: 119–121CrossRefGoogle Scholar
  5. Asscher AW, Sussman M, Water WE, Harvard Davis R, Chick S (1966) Urine as a medium for bacterial growth. Lancet II: 1037–1041CrossRefGoogle Scholar
  6. Bailey RR, Little PJ (1969) Suprapubic aspiration in diagnosis of urinary tract infection. Br Med J I: 293–294CrossRefGoogle Scholar
  7. Bateman JC, Barberis JR, Grice P, Klapp CT (1952) Fatal complications of intensive antibiotic therapy in patients with neoplastic disease. Arch Int Med 90: 763–773CrossRefGoogle Scholar
  8. Baum N, Dichoso CC, Carlton CE (1975). Blood urea nitrogen and serum creatinine. Urology 5: 583–588PubMedCrossRefGoogle Scholar
  9. Bhalla RB, Safai B, Metelsmann R, Schwartz MK (1983) Abnormally high concentrations of β2 microglobulin in acquired immuno-deficiency syndrome (AIDS) patients. Clin Chem 29(6): 1560PubMedGoogle Scholar
  10. Birch DF, Fairley KF, (1979) Haematuria: glomerular or non-glomerular? Lancet II: 845–846CrossRefGoogle Scholar
  11. Björnesjö KH (1956) Tuberculostatic factor in human urine. Am Rev Tuberculosis 73: 967Google Scholar
  12. Björnesjö KH (1963) The distribution of alpha amino nitrogen, urea nitrogen and non-protein nitrogen between erythrocytes and plasma in healthy males and females. Scand J Clin Lab Invest 15(Suppl 69): 25–37PubMedGoogle Scholar
  13. Bremner DA, Fairley KF, O’Keefe C, Kincaid-Smith P (1969) The serum antibody response in renal and bladder infections. Med J Aust 1: 1069–1071PubMedGoogle Scholar
  14. Briggs JD, Kennedy AC, Goldberg A (1963) Urinary white cell excretion after iron-sorbitol-citric-acid. Br Med J II: 352–354CrossRefGoogle Scholar
  15. Brogan TD, Nettleton J, Reid C (1971) The swarming of proteus on semisynthetic media. J Med Microbiol 4: 1–11PubMedCrossRefGoogle Scholar
  16. Brumfitt W, Percival A (1965) Serum antibody response as an indication of renal involvement in patients with significant bacteriuria. In: Kass EH (ed) Progress in pyelonephritis. Philadelphia, FA Davis Co. pp 118–128Google Scholar
  17. Brumfitt W, Davis BI, Rosser E (1961) Urethral catheter as a source of urinary tract infection in pregnancy and Puerperium. Lancet II: 1059–1062CrossRefGoogle Scholar
  18. Brumfitt W, Gargan RA, Hamilton-Miller JMT (1980) Diagnosis and cure of recurrent urinary infection with microaerophilic and anaerobic bacteria. Br Med J 281: 909–910PubMedCrossRefGoogle Scholar
  19. Cardiff/Oxford Bacteriuria Study Group (1978) The sequelae of covert bacteriuria in schoolgirls. A four year follow-up study. Lancet I: 889–893Google Scholar
  20. Clarke SHC (1960) Investigation into methods of collection of urine for culture from men and women. Br Med J II: 1491–1493CrossRefGoogle Scholar
  21. Darm JR, Bhagavan NV, Scottdini AG (1979) Prerenal azotemia mimicing chronic renal failure in a hypotensive patient. Clin Chem 25: 1978–1980PubMedGoogle Scholar
  22. Domenet JG, Evans DW (1969) Uraemia in congestive heart failure. Q J Med 38: 117–133PubMedGoogle Scholar
  23. Dontas AS, Kasviki-Charvati P, Papanayiotou PC, Marketos SG (1981) Bacteriuria and survival in old age. N Engl J Med 304: 939–943PubMedCrossRefGoogle Scholar
  24. Dossetor JB (1966) Creatininaemia versus uraemia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotaemia. Ann Int Med 65: 1287–1299PubMedGoogle Scholar
  25. Editorial (1972) Tetracycline and blood urea. Br Med J II: 370Google Scholar
  26. Edwards B, White RHR, Maxted H, Deverill I, White PA (1975) Screening methods for covert bacteriuria in schoolgirls. Br Med J II: 463–467CrossRefGoogle Scholar
  27. Eiden CA, Cooney JW (1935) The Addis sediment count and blood urea clearance test in normal pregnant women. J Clin Invest 14: 889–891CrossRefGoogle Scholar
  28. Espinel CH, Gregory AW (1980) Differential diagnosis of acute renal failure. Clin Nephrol 13(2): 73–77PubMedGoogle Scholar
  29. Evans DA, Kass EH, Hennekens CH, Rosner B, Miao L, Kendrick KI, Miall WE, Stuart KL (1982) Bacteriuria and subsequent mortality in women. Lancet I: 156–158CrossRefGoogle Scholar
  30. Evrin PE, Wibell L (1972) Serum β2 microglobulin in various disorders. Clin Chim Acta 43: 183–187CrossRefGoogle Scholar
  31. Eykyn S, Newman CGH (1969) Suprapubic puncture. Br J Hosp Med 1: 863–865Google Scholar
  32. Forsum U, Fritjofsson A, Frodin L, Hjelm E, Jonseil G (1978) A clinical evaluation of a test for antibody coated bacteria in the urine. Scand J Urol Nephrol 12: 45–48PubMedGoogle Scholar
  33. Fries D, Krembel CH, Delfraisy JF, Jacques L, Delavelle F, Arvis G (1975) L’étude en immunofluorescence de la bacteriurie. Nouv Presse Med 4: 2179–2182PubMedGoogle Scholar
  34. Gabriel R (1975) Variations in plasma urea and creatinine. Br Med J I: 272CrossRefGoogle Scholar
  35. Gadeholt H (1964) Quantitative estimation of urinary sediment, with special regard to sources of error. Br Med J I: 1547–1549CrossRefGoogle Scholar
  36. Garrod LP, Lambert HP, O’Grady FW (1981) In: Antibiotics and chemotherapy, 5th edn. Churchill Livingstone, Edinburgh, pp. 467–474Google Scholar
  37. George CR, Evans RA (1971) Tetracycline toxicity in renal failure. Med J Aust 1: 1271–1273PubMedGoogle Scholar
  38. George RC, Shafi MS (1982) Fastidious bacteriuria and pyuria. Lancet II: 218CrossRefGoogle Scholar
  39. Gillatt DA, O’Reilly PH (1984) Haematuria. Diagnosis, aetiology and management. Prospective analysis of 100 consecutive cases. (in preparation)Google Scholar
  40. Glynn AA, Brumfitt W, Howard CJ (1971) K antigens of Escherichia coli and renal involvement in urinary tract infection. Lancet I: 514–516CrossRefGoogle Scholar
  41. Gordon DL, McDonald PJ, Bune A, Marshall VR, Grime B, Marsh J, Sinclair G (1983) Diagnostic criteria and natural history of catheter-associated urinary tract infections after prostatectomy. Lancet II: 1269–1271CrossRefGoogle Scholar
  42. Gow JG (1981) The management of genito urinary tuberculosis. In: Hendry WF (ed) Recent advances in urology/andrology. Churchill Livingstone, Edinburgh, pp 91–106Google Scholar
  43. Gruneberg RN, Leigh DA, Brumfitt W (1969) Relationship of bacteriuria in pregnancy to acute pyelonephritis, prematurity and foetal mortality. Lancet II: 1–3CrossRefGoogle Scholar
  44. Guido OP, Oster JR, Vaamonde CA (1975) Incomplete syndrome of renal tubular acidosis induced by lithium carbonate. J Lab Clin Med 86: 386–394Google Scholar
  45. Guttmann D, Naylor GRE (1967) Dip-slide: an aid to quantitative urine culture in general practice. Br Med J II: 343–345CrossRefGoogle Scholar
  46. Hansen LP, Andersen HJ, Jørgensen PJ, Klitgaard NA (1982) Detection of leukocyturia by Cyturtest in paediatric outpatients. Dan Med Bull 29: 255–256PubMedGoogle Scholar
  47. Hawthorne NJ, Kurtz SB, Anhalt JP, Segura JW (1978) Accuracy of the antibody coated bacteria test in recurrent urinary tract infections. Mayo Clin Proc 53: 651–654PubMedGoogle Scholar
  48. Heick HM, Mohammed A, Begin-Heick N (1981) The use of the Beckman BUN analyser to determine the urea concentration in whole blood. Clin Biochem 14: 102–103PubMedCrossRefGoogle Scholar
  49. Hilson GRF (1964) A disposable counting chamber for urinary cytology. J Clin Pathol 17: 571–572PubMedCrossRefGoogle Scholar
  50. Hoeprich PD (1960) Culture of urine. J Lab Clin Med 56: 899–907PubMedGoogle Scholar
  51. Houghton BJ, Pears MA (1957) Cell excretion in normal urine. Br Med J I: 622–625CrossRefGoogle Scholar
  52. Hutchison R, Rainy H (1897) In: Clinical methods, a guide to the practical study of medicine. Cassell, London, pp 329–346Google Scholar
  53. Huttunen NP, Mella E, Mäkelä P (1970) Simple method for increasing reliability in diagnosis of urinary infection. Lancet I: 22CrossRefGoogle Scholar
  54. Isaacson LC (1960) Urine osmolarity in thirsting normal subjects. Lancet I 467–468CrossRefGoogle Scholar
  55. Jackaman FR, Darrell JH, Shackman R (1973) The dip-slide in urology. Br Med J I: 207–208CrossRefGoogle Scholar
  56. Johansson G, Backman BG, Danielson B, Fellstrom S (1980) Biochemical and clinical effects of the prophylactic treatment of renal calcium stones with magnesium hydroxide. J Urol 124: 770–774PubMedGoogle Scholar
  57. Jordan PA, Iravani A, Richard GA, Baer H (1980) Urinary tract infection caused by Staphylococcus saprophyticus. J Infect Dis 142: 510–515PubMedCrossRefGoogle Scholar
  58. Josephson B, Furst P, Javnmark O (1962) Age variations in the concentration of non-protein nitrogen, creatinine and urea in blood of infants and children. Acta Paediatr 51(Suppl 135): 111–120CrossRefGoogle Scholar
  59. Kahn S, Sagel J, Eagles L et al. (1972) The significance of serum creatinine and the blood urea-serum creatinine rated in azotaemia. S Afr Med J 46: 1828–1832PubMedGoogle Scholar
  60. Kaijser B, Hanson LA, Jodal U, Lidin-Janson G, Robbins JB (1977) Frequency of E. coli K antigens in urinary tract infections in children. Lancet I: 663–664CrossRefGoogle Scholar
  61. Kallenius G, Mollby R, Svenson SB, Winberg J, Lundblad A, Svenson S, Cedergren B (1980) The Pk antigen as receptor for the haemagglutin of pyelonephritic Escherichia coli. FEMS Microbiol Lett 7: 297–302CrossRefGoogle Scholar
  62. Kallenius G, Mollby R, Svenson SB, Helin I, Hultberg H, Cedergren B, Winberg J (1981) Occurrence of P-fimbrianated Escherichia coli in urinary tract infections. Lancet II: 1369–1372CrossRefGoogle Scholar
  63. Kalmanson GM, Hardwick HJ, Turck M, Guze LB (1975) Urinary tract infection: localisation and virulence of Escherichia coli. Lancet I: 134–136CrossRefGoogle Scholar
  64. Kampman J, Siersbaek-Nielsen K, Kristensen M, Møholm Hansen J (1974) Rapid evaluation of creatinine clearance. Acta Med Scand 196: 517–520CrossRefGoogle Scholar
  65. Kass EH (1956) Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians 69: 56–64PubMedGoogle Scholar
  66. Kass EH (1983) Should bacteriuria be treated. In: Brumfitt W, Hamilton-Miller JMT (eds) A clinical approach to progress in infectious diseases. Oxford, Oxford University Press, p. 90Google Scholar
  67. Katz YJ, Velasquez A, Bourdo SR (1962) The prednisolone provocation test for pyelonephritis. Lancet I: 1144–1145CrossRefGoogle Scholar
  68. Kerr ONS, Darison JM (1975) The assessment of renal function. Br J Hosp Med 14: 360–372Google Scholar
  69. Kierkegaard H., Feldt-Rasmussen U, Hørder M, Andersen HJ, Jørgensen PJ (1980) Falsely negative urinary leucocyte counts due to delayed examination. Scand J Clin Lab Invest 40: 259–261PubMedCrossRefGoogle Scholar
  70. Kinane DF, Blackwell CC, Brettle RP, Weir DM, Winstanley FP, Elton RA (1982) ABO blood group, secretor state, and susceptibility to recurrent urinary tract infection in women. Br Med J 285: 7–10CrossRefGoogle Scholar
  71. Little PJ (1964) A comparison of the urinary white cell concentration with the white cell excretion rate. Br J Urol 36: 360–363PubMedCrossRefGoogle Scholar
  72. Mackey JP, Sandys GH (1965) Laboratory diagnosis of infections of the urinary tract in general practice by means of dip-inoculum transport medium. Br Med J II: 1286–1288CrossRefGoogle Scholar
  73. Mansell PE, Peacock AM (1973) Direct microscopy of uncentrifuged urine. J Clin Pathol 26: 724–725PubMedCrossRefGoogle Scholar
  74. Maskell R (1974) Importance of coagulase-negative staphylococci as pathogens in the urinary tract. Lancet I: 1155–1158CrossRefGoogle Scholar
  75. Maskell R, Pead L, Allen J (1979) The puzzle of ‘urethral syndrome’: a possible answer? Lancet I: 1058–1059CrossRefGoogle Scholar
  76. Mason AMS, Golding PL (1970) Hyperglobulinaemic renal tubular acidosis: a report of nine cases. Br Med J II: 143–146CrossRefGoogle Scholar
  77. Maxwell MH, Kleeman CR (1980) Clinical disorders of fluid and electrolyte metabolism. McGraw-Hill, New YorkGoogle Scholar
  78. Meadow SR, White RHR, Johnston NM (1969) Prevalence of symptomless urinary tract disease in Birmingham schoolchildren. I—Pyuria and bacteriuria. Br Med J II: 81–84CrossRefGoogle Scholar
  79. Michie AJ (1959) Pediatric urology—summary of a round table. Pediatrics 24: 1118–1122Google Scholar
  80. Miles BE, Paton A, de Warde HE (1954) Maximum urine concentration. Br Med J II: 901–905CrossRefGoogle Scholar
  81. Moore T, Hira NR, Stirland RM (1965) Differential urethrovesical urinary cell-count. Lancet I: 626–627CrossRefGoogle Scholar
  82. Morgan DB, Carver EC, Payne RB (1977) Plasma creatinine and urea: creatinine ratio in patients with raised plasma urea. Br Med J II: 929–932CrossRefGoogle Scholar
  83. Muschel L, Osawa E (1959) Human blood group substance B and Escherichia coli 086. Proc Soc Exp Biol Med 101: 614–617PubMedGoogle Scholar
  84. Naylor PGD (1960) A simple medium which controls the swarming of proteus. J Med Lab Technol 17: 182–184PubMedGoogle Scholar
  85. Nilsson K, Evrin PE, Berggärd I (1973) Involvement of lymphoid and non-lymphoid cells in the production of β2 microglobulins—a homologue of the constant domain of lgG. Nature [New Biol] 244: 44–45Google Scholar
  86. Nilsson K, Aureli M, Bratt CG (1979) Maximum urinary concentration ability in patients with idiopathic hydronephrosis. Br J Urol 51: 432–436PubMedCrossRefGoogle Scholar
  87. Oster JR, Hotchkiss JL, Carbon M (1975) Abnormal acidification in alcoholic liver disease. J Lab Clin Med 85: 987–1000PubMedGoogle Scholar
  88. Pashe AM, Cramm RE, Crist CA, Habener JF et al. (1963) A water deprivation test of the differential diagnosis of polyuria. JAMA 185: 699–703CrossRefGoogle Scholar
  89. Pears MA, Houghton BJ (1959) Response of infected urinary tract to bacterial pyrogen. Lancet II: 1167–1172CrossRefGoogle Scholar
  90. Percival A, Brumfitt W, deLouvois J (1964) Serum-antibody levels as an indication of clinically inapparent pyelonephritis. Lancet II: 1027–1033CrossRefGoogle Scholar
  91. Pereira AT (1962) Coagulase-negative strains of Staphylococcus possessing antigen 51 as agents of urinary infection. J Clin Pathol 15: 252–253CrossRefGoogle Scholar
  92. Peters PA, Warren KS, Mahmoud AAF (1976) Rapid, accurate quantification of schistosome eggs in nuclepore filters. J Parasitol 62: 154–155PubMedCrossRefGoogle Scholar
  93. Petts DN (1972) An inexpensive multiple counting chamber for urine cell counting. Gaz Inst Med Lab Technol p. 44Google Scholar
  94. Pryce JD, Durnford J (1979) Laboratory test for kidney function—urea or creatinine? Lancet II: 481–482CrossRefGoogle Scholar
  95. Rahman ASMM (1979) Presence of immunoglobulin on the surface of bacteria in human urinary tract infections. MSc Thesis, Faculty of Medicine, Victoria University of ManchesterGoogle Scholar
  96. Schainuck II, Striker GE, Cutler RE et al. (1970) Structural-functional correlations in renal disease. II The correlations. Human Pathol 1: 631–641CrossRefGoogle Scholar
  97. Schoen EJ (1959) Minimum urine total solute concentration in response to water loading in normal men. J Appl Physiol 10: 267–270Google Scholar
  98. Schumann GB, Harris H, Henry JB (1978) An improved technic for examining urinary casts and a review of their significance. Am J Clin Pathol 69: 18–23PubMedGoogle Scholar
  99. Shils ME (1963) Renal disease and the metabolic effects of tetracycline. Ann Int Med 58: 389–408PubMedGoogle Scholar
  100. Stamey TA, Govan DE, Palmer JM (1965) The localization and treatment of urinary tract infections: the role of bactericidal urine levels as opposed to serum levels. Medicine (Baltimore) 44: 1–36CrossRefGoogle Scholar
  101. Stanbury JB, Wyngaarden JB, Frederickson DS (1978) Metabolic basis of inherited disease, 4th edn. McGraw-Hill, New YorkGoogle Scholar
  102. Stansfield JM (1962) The measurement and meaning of pyuria. Arch Dis Child 37: 257–262CrossRefGoogle Scholar
  103. Stokes EI, Ridgeway GL (1980) In: Clinical bacteriology, 5th edn. Edward Arnold, London, p 217Google Scholar
  104. Svanborg Eden C, Hanson LA, Jodal U, Lindberg U, Sohl Akerlund A (1976) Variable adherence to normal human urinary tract epithelial cells of Escherichia coli strains associated with various forms of urinary tract infection. Lancet II: 490–492CrossRefGoogle Scholar
  105. Thayer JM (1960) Renal abnormalities in congestive heart failure. Stanford Med Bull 18: 129–137PubMedGoogle Scholar
  106. Thomas M (1971) A rapid slide method for urine cell counts. J Med Lab Technol 28: 38–39Google Scholar
  107. Thomas VL, Shelokov A, Forland M (1974) Antibody coated bacteria in the urine and the site of urinary tract infection. N Engl J Med 290: 588–590PubMedCrossRefGoogle Scholar
  108. Thompson FD (1976) In: Williams DI, Chisholm GD (eds) Scientific foundations of urology, vol 1. Heinemann, London, pp 28–38Google Scholar
  109. Turck M, Petersdorf RG (1962) The epidemiology of non-enteric Escherichia coli infections: prevalence of serological groups. J Clin Invest 41: 1760–1765PubMedCrossRefGoogle Scholar
  110. Vaisänen V, Korhonen TK, Jokinen M, Gahmberg CG, Ehnholm C (1982) Blood group M specific haemagglutinin in pyelonephritogenic Escherichia coli. Lancet I: 1192CrossRefGoogle Scholar
  111. Valman HB (1981) Urinary tract infection. Br Med J 283:363–365CrossRefGoogle Scholar
  112. Warren JW, Tenney JH, Hoopes JM, Muncie HL, Anthony WC (1982) A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 146: 719–723PubMedCrossRefGoogle Scholar
  113. Waterworth P (1981) Sensitivity testing by the break-point method. J Antimicrob Chemother 7: 117–126PubMedCrossRefGoogle Scholar
  114. Wibell L, Bjorsell-Ostling E (1973) Endogenous creatinine clearance in apparently healthy individuals as determined by 24 hour ambulatory urine collection. Ups J Med Sci 78: 43–47PubMedGoogle Scholar
  115. Woodhouse CRJ (1982) Symptomless abnormalities. Microscopic haematuria. Br J Hosp Med 27: 163–168PubMedGoogle Scholar
  116. Zender R, Falbriard A (1965) Analyse automatique de la creatinine dans le serum et dans l’urine. Valeurs ‘normales’ chez l’honne de la creatinine ernie et de la clearance. Clin Chim Acta 12: 183–190PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1986

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  • P. J. Martin
  • T. D. Brogan

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