Question about uninalysis and cultures???

[jen74]

Hi ladies.
I went to see a new urogyne last week. He is very nice and seems very knowledgable about IC. I did have a discussion though about UTI's with him. He took a urine sample that day and said it was completely normal, and said that if there is an actual infection going on, there is always usually white blood cells in the urine.
Now, when they do a urinalysis, am I correct that this does not pick up an infection? I always thought that an in office urinalysis only can pick up sugar, protein and white blood cells, but not bacteria. Is that correct?
I told the new doctor that those tests are no good and that they never pick up infections for me. I told him about the time I had a huge infectin and the dipstick test did not pick it up at all, yet my culture did. He said he usually will not send out a culture unless he has an abnormal urinalysis/dipstick test. I very much disagreed with that. He said that we carry bacteria in our urethra's all the time and that alone can cause a culture to be positive.
Dont get me wrong, he is a very good doctor it seems, and he is very caring. I mean I took the pain med he gave me and got very sick from it and had to call him in the middle of the night and he called me right back and even called the next morning to see how I was feeling. Not many doctors do that these days.
I just am not sure about the whole infection thing. I mean I sure dont want him to withhold antibitoics from me when I indeed have a infection. I am not sure where his line of thinking is in terms of infections and how to go about diagnosing them. I thought that any bacteria found in urine is considered an infection. But when he took my urine sample, he did it before he gave the instillaiton and said that since it was a catheterized specimin, and the urinalysis he did in the office was clear, there could be no infection, otherwise there would be white blood cells picked up.
Can someone explain to me the dofferencebetween the urinalysis verses the dipstick test, or are they the same thing?
Jen

[vm]

Urine Protein/dipstick:

How is it used?
Urine protein testing is used to detect protein in the urine, to help evaluate
and monitor kidney function, and to help detect and diagnose early kidney damage and disease. A dipstick urine protein is performed routinely as part of a urinalysis. It is used to screen the general population for the presence of protein in the urine. If slight to moderate amounts of protein are detected, then another urinalysis and dipstick protein may be performed at a later time to see if there is still protein in the urine or if it has dropped back to undetectable levels. If there is a large amount of protein in the first sample and/or the urine persists in the second sample, then the doctor may order a 24-hour urine protein as a follow-up test. Since the dipstick primarily measures albumin, the 24-hour urine protein test also may be ordered if a doctor suspects that proteins other than albumins are being released.

The urine protein test tells the doctor that protein is present in the urine, but it does not indicate which types are present or the cause of the proteinuria. When a doctor is investigating the reason, he also may order a serum and urine electrophoresis test to determine which proteins are being excreted and in what quantities. This is especially true if he suspects abnormal protein production, such as with multiple myeloma. He may order a Comprehensive Metabolic Panel (CMP) to look at albumin and total protein levels in the blood and to help evaluate kidney and liver function. If kidney disease or damage is suspected, he also may order imaging scans to evaluate the appearance of the organ.

When is it ordered?
A dipstick urine protein is measured frequently as a screening test whenever a urinalysis is performed. This may be done as part of a routine physical, a pregnancy workup, when a urinary tract infection is suspected, as part of a hospital admission, or whenever the doctor wants to evaluate kidney function. It may also be done when a previous dipstick has been positive for protein to see if the protein excretion persists.

What does the test result mean?

Protein in the urine is a warning sign. It may indicate kidney damage or disease or be a transient elevation due to an infection, medication, vigorous exercise, or emotional or physical stress. In some people, it may be present during the day and absent at night when the patient is lying down (orthostatic proteinuria). In pregnant women, elevated urine protein levels can be associated with pre-eclampsia.
When kidney damage is present, the amount of protein present is generally associated with the severity of damage, and increasing amounts of protein over time indicate increasing damage and decreasing kidney function.

Is there anything else I should know?
The different methods of detecting protein in the urine vary in performance. For example, a positive dipstick protein may be elevated due to other sources of protein, such as blood, semen, or vaginal secretions in the urine. Since it measures primarily albumin, the dipstick occasionally may be normal when significant quantities of other proteins are present in the urine. A 24-hour urine sample gives the protein excretion rate over 24 hours. It will be accurate only if all of the urine is collected. The protein to creatinine ratio is more of a snapshot of how much protein is in the urine at the time the sample is collected. If it is elevated, then protein is present; if it is negative, it is possible that the patient was just not excreting measurable amounts of protein at that time.

Urinalysis:

How is it used?
The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that should be followed up on. Often, substances such as protein or glucose will begin to appear in the urine before patients are aware that they may have a problem. It is used to detect urinary tract infections (UTI) and other disorders of the urinary tract. In patients with acute or chronic conditions, such as kidney disease, the urinalysis may be ordered at intervals as a rapid method to help monitor organ function, status, and response to treatment.


What does the test result mean?
Urinalysis results can have many interpretations. They are a red flag, a warning that something may be wrong and should be evaluated further. Generally, the greater the concentration of the abnormal substance (such as greatly increased amounts of glucose, protein, or red blood cells), the more likely it will be that there is a problem that needs to be addressed. But the results do not tell the doctor exactly what the cause of the finding is or whether it is a temporary or chronic condition. A normal urinalysis also does not guarantee that there is no illness. Some people will not release elevated amounts of a substance early in a disease process and some will release them sporadically during the day (which means they may be missed by a single urine sample). In very dilute urine, small quantities of chemicals may be undetectable.
[Back to top]

Both taken from:

http://www.labtestsonline.org/index.html

[jen74]

Thanks Kim.
That is kind of what I thought. Also, I know since I have gotten IC, I tend to drink alot more water as to dilute my urine so it wont be as acidic. When we drop off a urine sample at any given time of day, and if you have been drinking alot of water,then a simple urinalysis would likely miss an infection or not pick it up. That is what I was wondering.
That is why I sort of disagreed with the doctor about the UTI thing. I think a culture is always mandatory. Those dipstick tests are useless in my opinion. Also, I believe a person with IC should not have to wait the three days to be treated as that could be devastating for us opposed to a person who is healthy without IC.
Thanks for the info.
Jen