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Medical Forum / General / Laboratory / August 2005

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routine urinalysis

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Mediresearch - 16 Aug 2005 20:29 GMT
Could someone steer me in the right direction for recent debate on the
clinical value of routine urinalysis?
Robert - 16 Aug 2005 20:52 GMT
> Could someone steer me in the right direction for recent debate on the
> clinical value of routine urinalysis?

Can you be more specific? There is no debate that a urinalysis is useful.
What context are you referring to?
Mediresearch - 16 Aug 2005 21:08 GMT
Is there a screening benefit to conducting urinalyis at every physical?
JEDilworth - 16 Aug 2005 21:26 GMT
Yes, there is a large screening benefit.

A urine dipstick can pick up glucose, protein, an increase in WBC's,
blood for starters. I assume by "urinalysis" you mean a "routine
urinalysis" and not drug screening or any other testing. If you mean the
latter, that's a whole different discussion.

A urine microscopic can pick up casts (not normal), WBC's, RBC's, yeast,
trichomonas, bacteria, and lots of urinary tract abnormalities.

Glucose in the urine can be indicative of diabetes; protein, LOTS of
things; WBC's, infection, blood, LOTS of things. It is an inexpensive
way to screen for many problems, some of which can be serious.

I take it you don't want a urinalysis done on yourself? Routine
urinalysis doesn't have anything to do with drug screening.

Judy Dilworth, M.T. (ASCP)
Microbiology

> Is there a screening benefit to conducting urinalyis at every physical?
Mediresearch - 16 Aug 2005 21:44 GMT
No not for me.  I working on a profile for basic practice protocols on
visual dipsticks vs instrument reads and needed to go back to the
basics.  Does urinalysis during routine patient physicals have the
potential to reduce health care costs by cheaply screening for and
identifying diseases not preseting.

Like in the case of bladder cancers or urinary tract infections.
Robert - 16 Aug 2005 22:04 GMT
> No not for me.  I working on a profile for basic practice protocols on
> visual dipsticks vs instrument reads and needed to go back to the
[quoted text clipped - 3 lines]
>
> Like in the case of bladder cancers or urinary tract infections.

You would have to scan for those on google but my take is that it may not
reduce cost and may actually increase costs in working up abnormal findings
that are not really significant or acted upon under other conditions.
You would have to ask your doctors about that. Do they work up everything on
an abnormal UA and if they don't then it's not needed.
Shylirin - 22 Aug 2005 08:23 GMT
> No not for me.  I working on a profile for basic practice protocols on
> visual dipsticks vs instrument reads and needed to go back to the
> basics.

Just wanted to point out that instrument reads provide more precise results
over continuous dipstick reads.  Human eyes and brains can interpret one
wavelength as two slightly different colors, and this introduces bias into
the test, thus making an instrument better with regards to consistent
results for patient care.  Also, instead of having the tech need to watch
the strips develop, you can put the strip on the instrument and walk away
for the time it takes to run.
However, having and maintaining an analyzer has its own expenses that may
become a factor depending on your budget.  I have a Clinitek 500, and after
the initial purchase, my only routine analyzer-only related expenses are
thermal paper, electricity, soap & water (to clean with).  These are very
small expenses for me, and the same size thermal paper is used by two
different analyzers and I can get a volume discount, thus further reducing
costs.

Does urinalysis during routine patient physicals have the
> potential to reduce health care costs by cheaply screening for and
> identifying diseases not preseting.
>
> Like in the case of bladder cancers or urinary tract infections.

I have to agree that this is somewhat dependent on how the physicians follow
up on abnormal results.  In other words, will they panic over anything and
order a full workup, or will they use common sense and look for a rational
explanation from the patient or the history.  Horses before zebras and all
that.  However, if the physicians use their heads while evaluating the
results, it also has the potential to provide a real cost savings with
regards to those smaller percentages of patients who have a new onset
disease that is caught before the patient is in dire straits.  My lab
routinely performs screening urinalysis for physicals, and more recently as
a state health requirement for pediatric patients on state funded
healthcare.  We've caught numerous UTI's in the early stages before symptoms
were evident, thus reducing the number of office visits and associated
expenses.  Out of 21 physicians in our facility, I've only had one that
wants to overwork an abnormal UA, and after a visit with one of our
Pathologists, he seems to have eased up quite a bit.  Seems to have been an
education issue.  :)

Shylirin
Robert - 16 Aug 2005 21:54 GMT
> Is there a screening benefit to conducting urinalyis at every physical?

There is controversy about having "annual" physicals.

http://www.npr.org/templates/story/story.php?storyId=4781138

http://www.pamf.org/preventive/healtheval.html

It reminds me of the last question I answered from somebody who asked me
what can cause protein in the urine. He was concerned about it. I told him a
lot of things but blood pressure was one. He said that his blood pressure
was 180/110 and out of control at the time and was seeing his doctor about
it. BINGO.

Most pre employment physicals always include a UA. I think most of the
impact is here. I have known denial of employment with abnormal UA findings.
Some UA's are only dipstick screens and if everything is normal then the
microscopic exam can be skipped or credited and cost less.

So my final answer is it depends on why you are doing the physical. The
physical itself may not be needed or if it's been a while then it may be
needed for certain conditions.
My doctor has never ordered one for a regular physical with me and in
general I think it yields very little in most asymptomatic cases and has
taken a hit on hospital admissions also.
 
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