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URINE Past – Present- Future

URINE Past – Present- Future. Dr. David Petts. In The Beginning. 6000 years ago Babylonians – recorded colour & clarity 500AD Brahmins – melita or ‘honey urine’ 9 th C Razes – a Persian Haematuria. Medieval. Matula 24 types of urine Colour Clarity Smell Taste. Early Urine Bench.

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URINE Past – Present- Future

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  1. URINEPast – Present- Future Dr. David Petts

  2. In The Beginning • 6000 years ago • Babylonians – recorded • colour & clarity • 500AD • Brahmins – melita or ‘honey urine’ • 9thC Razes – a Persian • Haematuria

  3. Medieval • Matula • 24 types of urine • Colour • Clarity • Smell • Taste

  4. Early Urine Bench

  5. 18th Century - Chemistry • Dobson • Urine from diabetics fermented • Residue sweet • Richard Bright • Bright’s Disease – Glomerulonephritis • Albumin • went cloudy when heated in a spoon

  6. 19th Century - Microscopy • Vigla & Rayer 1837 • Established microscopy of urine • Becquerel 1841 • Irregular Erythrocytes in Bright’s Disease • Simon • Casts in Bright’s Disease • Bird 1844 • First Book Devoted to Urine Deposits • Rieder 1898 • Comprehensive book Urine Sediments

  7. Lionel Beale

  8. Some urine deposits 1858

  9. 19th Century BacteriologyPasteur & Koch

  10. Early Bacteriology of Urine • Edgar Crookshank • Manual Of Bacteriology 1885 • Urine as a Culture Medium • Collect after cleaning with • Corrosive Sublimate!

  11. Early Bacteriology Of Urine • Dr S L Schenk • Elements of Bacteriology 1892 • Bacteriuria has been described • appears to be of a morbid nature • Thomas Bowhill - 1902 • Micrococcus urea, Micrococcus urea liquifaciens, Bacillus urea, Urobacillus pasteuri, Basillus glischogenus • Most mention Tuberculosis & Typhoid, and collection with a catheter from ladies

  12. Early Mid 20th C • Topley & Wilson 1st ed 1929 • MacKie & McCartney 3rd Ed 1931 • Cystitis - Bacterium coli • Whitby 4th ed 1944 • Bact. coli

  13. When I was Lad (1962) • Universal - • Note appearance – colour & clarity • Culture -1/6th McConkey & 1/6th Blood Agar • Centrifuge – 10 min. • Microscopy on deposit • Cells per high power field • Introduction to Medical Laboratory Technology • 1st ed 1955 • 2nd ed 1957 • Supernatant – Chemistry • Boil to detect albumin

  14. The Revolution • Quantitative culture • Quantitative microscopy • New culture media • Chemical Dip Strips • Mechanisation

  15. Quantitative Culture • Kass 1956 & 1957 Mantra • 105 = significant • 104 = borderline • <104 = not significant

  16. Quantitative Microscopy • Little 1962 showed WBC counts on deposits unreliable • Un-centrifuged urine • Counts per ml or litre • Used Haemocytometer • Costly, fragile, slow

  17. New Culture Media • MacConkey • Without salt • CLED • With Andrades • Beta-Glucoronidase Agar (BGA) • With spot indole • Chromogenic media

  18. Quantitative Culture MethodsScientific • Dilutions • Pipettes • Whole Plate • Pour Plates • Not suitable for routine use

  19. Quantitative Culture MethodsRoutine • ‘Standard loop’ • Blotting Paper Strip • Multipoint • Dip – slide • The drop • The Swab • Bit of a plate

  20. Counting Bacteria • Standard loop • 1μl, 2μl - down to 104/ml • 5μl, 10μl - down to 103/ml • Paper strip • down to 104/ml • Multipoint • down to 104/ml

  21. Modified Counting Chambers • Hilson 1964 • Petts 1972 • Kova Slide • Microtitre tray

  22. Hilson

  23. Petts 1972

  24. Inverted Microscope

  25. Lumac

  26. Orbec RAMUS 256

  27. Cellfacts Cellfacts 2

  28. Clinitek 200

  29. Sysmex UF 100

  30. UF 1000i

  31. sediMAX

  32. 939UDx™ Urine Pathology System

  33. iQ 200 Sprint

  34. Mastascan Elite

  35. ‘Standard Methods’

  36. Where are We Now?

  37. You Therefore Now Have a National StandardMethod Which Everyone Uses ?

  38. The Routine Urine A lot of unnecessary pissing about ?

  39. Size of the Problem • 400 specimens/day • 350 labs in British Isles • = 140,000 a day • About 1million litres a year • Olympic swimming pool 2.5 million litres

  40. Quality Matters • Squamous Epithelial cells • 54% of hospital samples • 64% of hospital samples from females • 44% of GP samples • 54% GP samples from females • Mixed growth • 18% • <10% of samples abnormal

  41. Use of Urine • UTI is the 2nd most common infection • Used to investigate more than UTI • Nephritis • Haematuria • Prostatitis • And other infections

  42. Why Is It Sent ? • Does the patient have UTI • MC&S • “Fishing trip” • ‘Routine’ • JIC • To check results obtained

  43. Who Does the Work? • The most junior staff • The least experienced • The least knowledgeable • The locum • Low status sample

  44. What do we look for and why? • WBCs • RBCs • Casts • Crystals • Epithelial cells • Other things

  45. Do we answer the Questions being asked ? • Sometimes • Most of the time Standard approach • One size fits all

  46. How Do We Reached Nirvana?

  47. Or Should We Reach For Nirvana?

  48. Tomorrow’s World

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