Urinalysis

Who Should be Tested

There is no evidence that routine urinalysis is a cost-effective screening examination. It may be considered in newly arrived refugees of all ages and ethnicities who are developmentally mature enough to provide a clean-catch urine specimen. A bag specimen may be checked for younger children, if clinically indicated, with confirmation of positive findings by catheterization.¹  This recommendation is more conservative than the current American Academy of Pediatric guidelines for children residing in the United States, because of the higher prevalences of specific conditions that may be detected in refugee children (e.g., Schistosoma haematobium).

Potential Disorders Detected

A. Schistosoma haematobium

Schistosoma haematobium is parasite present in Africa and the Middle East. In some populations (e.g., people living in endemic areas of Nigeria and Ghana), infection rates may exceed 90%.^4 5 6  Infection presents with intermittent microcytic or gross hematuria, which may be accompanied by dysuria or increased frequency. Infection is highly associated with squamous cell carcinoma of the bladder. ²   Although the infection is frequently accompanied by an AEC, confirmation is made by schistosomiasis serologic tests and/or urine ova and parasite examination. Schistosomiasis in refugees is discussed further in the intestinal parasites guidelines.

B. Renal Diseases

Although not a primary reason for a screening urinalysis, clues to the presence of many different types of systemic and renal disease may be incidentally revealed, and abnormal results should be investigated.

C. Systemic Diseases

A positive dipstick for glucose is suggestive of diabetes. Although no evidence supports formal screening of nonimmigrant adults for diabetes by fasting glucose measurements, refugee populations have never been studied. Newly arriving refugees constitute a medically vulnerable population in which realities such as lack of awareness, difficulties of navigating complicated health-care systems, and sporadic medical insurance coverage may sway the balance in favor of screening for asymptomatic diabetes. Although urinalysis is inferior to fasting blood glucose, the presence of glucosuria is suggestive of diabetes.

D. Sexually Transmitted Infections (STIs)

A urinalysis can give clues to the presence of sexually transmitted infections. A positive dipstick for leukocyte esterase or increased numbers of white blood cells in the microscopic exam is suggestive of chlamydia or gonoccocal infection. However, because of its low sensitivity this test should not be considered an effective screening method for these infections. For example, in one study, the presence of leukocyte esterase was only 61% sensitive for chlamydia infections in males.³ For a complete discussion of screening refugees for STIs, see Screening for Sexually Transmitted Infections.