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      The diagnostic performance of human urinary dipsticks to estimate urine pH, specific gravity (SpG), and protein in horses: are they reliable?

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          Abstract

          Background

          Urinalysis is a critical diagnostic test which is performed in routine veterinary medicine practice. In this diagnostic test, semiquantitative measurement of urine biochemical substances is carried out using urinary dipstick. In the current study, we evaluated the diagnostic performance of human urinary dipsticks to estimate pH, specific gravity (SpG), and protein in 80 urine specimens collected from horses. These parameters were measured using two commercial human dipsticks (KP and MN in abbreviation) and quantitative reference methods. The reference methods for pH, SpG, and protein were pH meter, handheld refractometer, and pyrogallol red method, respectively. The correlation between the semiquantitative dipstick analysis and quantitative reference methods was determined using Spearman’s rank correlation coefficient.

          Results

          In general, our results revealed that the both human urinary dipsticks are unreliable tests for urinary pH, SpG, and protein content in horses. The analysis indicated that there was a poor correlation between the urine dipsticks and reference method (KP: r S = 0.534 and MN: r s = 0.485, Ps < 0.001) for protein. Additionally, there was a weak correlation between the results of pH measured using the urine dipsticks and reference method (KP: r S = 0.445 and MN: r s = 0.370, Ps < 0.001). Similar findings were obtained for SpG (KP: r S = 0.285, MN: r s = 0.338, Ps < 0.001). The estimation of proteinuria using the human dipsticks in horses lacked specificity, as many false positive protein results were obtained.

          Conclusion

          We observed that the human commercial urinary dipsticks used in this study were not reliable to correctly estimate urine protein, SpG, and pH in horses.

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          Most cited references15

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          Dipstick measurements of urine specific gravity are unreliable.

          To evaluate the reliability of dipstick measurements of urine specific gravity (U-SG). Fresh urine specimens were tested for urine pH and osmolality (U-pH, U-Osm) by a pH meter and an osmometer, and for U-SG by three different methods (refractometry, automatic readout of a dipstick (Clinitek-50), and (visual) change of colour of the dipstick). The correlations between the visual U-SG dipstick measurements and U-SG determined by a refractometer and the comparison of Clinitek((R))-50 dipstick U-SG measurements with U-Osm were less than optimal, showing very wide scatter of values. Only the U-SG refractometer values and U-Osm had a good linear correlation. The tested dipstick was unreliable for the bedside determination of U-SG, even after correction for U-pH, as recommended by the manufacturer. Among the bedside determinations, only refractometry gives reliable U-SG results. Dipstick U-SG measurements should be abandoned.
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            Comparison of white blood cell differential percentages determined by the in-house LaserCyte hematology analyzer and a manual method.

            The LaserCyte hematology analyzer (IDEXX Laboratories, Chalfont St. Peter, Bucks, UK) is the first in-house laser-based single channel flow cytometer designed specifically for veterinary practice. The instrument provides a full hematologic analysis including a 5-part WBC differential (LC-diff%). We are unaware of published studies comparing LC-diff% results to those determined by other methods used in practice. To compare LC-diff% results to those obtained by a manual differential cell count (M-diff%). Eighty-six venous blood samples from 44 dogs and 42 cats were collected into EDTA tubes at the Forest Veterinary Centre (Epping, UK). Samples were analyzed using the LaserCyte within 1 hour of collection. Unstained blood smears were then posted to Langford Veterinary Diagnostics, University of Bristol, and stained with modified Wright's stain. One hundred-cell manual differential counts were performed by 2 technicians and the mean percentage was calculated for each cell type. Data (LC-diff% vs M-diff%) were analyzed using Wilcoxon signed rank tests, Deming regression, and Bland-Altman difference plots. Significant differences between methods were found for neutrophil and monocyte percentages in samples from dogs and cats and for eosinophil percentage in samples from cats. Correlations (r) (canine/feline) were .55/.72 for neutrophils, .76/.69 for lymphocytes, .05/.29 for monocytes and .60/.82 for eosinophils. Agreement between LC-diff% and Mdiff% results was poor in samples from both species. Bland-Altman plots revealed outliers in samples with atypical WBCs (1 cat), leukocytosis (2 dogs, 9 cats), and leukopenia (16 dogs, 11 cats). The LaserCyte generated error flags in 28 of 86 (32.6%) samples, included 7 with leukopenia, 8 with lymphopenia, 7 with leukocytosis, 1 with anemia, and 1 with erythrocytosis. When results from these 28 samples were excluded, correlations from the remaining nonflagged results (canine/feline) were .63/.65 for neutrophils, .67/.65 for lymphocytes, .11/.33 for monocytes, and .63/.82 for eosinophils. Although use of a 100-cell (vs 200-cell) M-diff% may be a limitation of our study, good correlation between WBC differentials obtained using the LaserCyte and the manual method was achieved only for feline eosinophils.
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              Urinalysis interpretation: how to squeeze out the maximum information from a small sample.

              The urinalysis is an essential part of the diagnostic evaluation for all urinary and many metabolic diseases. Its assessment includes evaluation of physical characteristics (color, clarity, and volume), biochemical parameters (urine pH, blood, glucose, ketones, bilirubin, urobilinogen, and protein) and microscopic sediment evaluation (RBC, WBC, organisms, epithelial cells, crystals, and casts). Many of these parameters are influenced by collection method and therefore, it is essential to interpret accordingly. Knowledge of factors that can interfere with the accuracy of some test results can decrease improper interpretation. When all of these parameters are evaluated in combination with clinical signs, physical examination, thorough history and other laboratory tests, a diagnosis will often be attained.
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                Author and article information

                Contributors
                zainab.shiravi@gmail.com
                nedaeskandarzade@yahoo.com
                masud.imani@yahoo.com
                mahdiehrrezaei@gmail.com
                +983413222944 , zamani_2012@ut.ac.ir
                Journal
                BMC Vet Res
                BMC Vet. Res
                BMC Veterinary Research
                BioMed Central (London )
                1746-6148
                12 July 2019
                12 July 2019
                2019
                : 15
                : 242
                Affiliations
                [1 ]ISNI 0000 0000 9826 9569, GRID grid.412503.1, Department of Clinical Science, Faculty of Veterinary Medicine, , Shahid Bahonar University of Kerman, ; P.O Box: 76169133, Kerman, Iran
                [2 ]ISNI 0000 0000 9826 9569, GRID grid.412503.1, Department of Basic Science, Faculty of Veterinary Medicine, , Shahid Bahonar University of Kerman, ; Kerman, Iran
                Author information
                http://orcid.org/0000-0002-6745-9292
                Article
                1998
                10.1186/s12917-019-1998-2
                6626356
                31300054
                390c0014-540b-49e0-937c-1a4fdb01e2cd
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 February 2019
                : 8 July 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Veterinary medicine
                horse,human urinary dipstick,ph,protein,specific gravity
                Veterinary medicine
                horse, human urinary dipstick, ph, protein, specific gravity

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