0
September 1, 1989, Vol 262, No. 9 >
ARTICLE | September 1, 1989

Dipstick Urinalysis Screening of Asymptomatic Adults for Urinary Tract Disorders: Title and subTitle BreakI. Hematuria and Proteinuria FREE

Steffie Woolhandler, MD, MPH; Richard J. Pels, MD; David H. Bor, MD; David U. Himmelstein, MD; Robert S. Lawrence, MD
[+] Author Affiliations

Reprint requests to The Cambridge Hospital, 1493 Cambridge St, Cambridge, MA 02139 (Dr Woolhandler).


JAMA. 1989;262(9):1214-1219. doi:10.1001/jama.1989.03430090076037
Text Size: A A A
Published online
Article
References

We review evidence on the value of dipstick urinalysis screening for hemoglobin and protein in asymptomatic adults. In young adults, evidence from five population-based studies indicates that fewer than 2% of those with a positive heme dipstick have a serious and treatable urinary tract disease, too few to justify screening and the risks of subsequent workup. For older populations, evidence is contradictory and no recommendation can presently be made for or against hematuria screening. A population-based randomized, controlled trial of hematuria screening in the elderly is urgently needed. Proteinuria screening is not recommended in any healthy, asymptomatic adult population, since four population-based studies have found that fewer than 1.5% of those with positive dipsticks have serious and treatable urinary tract disorders.

(JAMA. 1989;262:1214-1219)

REFERENCES

1 +
Heimann GA, Frohlich J, Bernstein M.  Physicians' response to abnormal results of routine urinalysis . Can Med Assoc J . 1976;;115:1094-1095.
2 +
Sondick EJ, Young JL, Horn JW, Gloeckler-Ries LA. 1986 Annual Cancer Statistics Review . Bethesda, Md: National Cancer Institute; 1987;. National Institutes of Health publication 87-2789.
3 +
Rubin RJ.  Epidemiology of end stage renal disease and implications for public policy . Public Health . 1984;;99:492-498.
4 +
National Diabetes Data Group. Diabetes in America . Bethesda, Md: National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases; 1985;. National Institutes of Health publication 85-1468.
5 +
Loo SYT, Scottolini AG, Luangphinith S, Adam AL, Jacobs LD, Mariani AJ.  Urine screening strategy employing dipstick analysis and selective culture: an evaluation . Am J Clin Pathol . 1984;;81:634-642.
6 +
Mariani AJ, Luangphinith S, Loo S, Scottolini A, Hodges CV.  Dipstick chemical urinalysis: an accurate cost-effective screening test . J Urol . 1984;;132:64-66.
7 +
Hearne CR, Donnell MG, Fraser CG.  Assessment of new urinalysis dipstick . Clin Chem . 1980;;26:170-171.
8 +
Shaw ST, Poon SY, Wong ET.  'Routine urinalysis': is the dipstick enough? JAMA . 1985;;253:1596-1600.
9 +
Sewell DL, Burt SP, Gabbert NJ, Bumgardner RV.  Evaluation of the chemstrip 9TM as a screening test for urinalysis and urine culture in men . Am J Clin Pathol . 1985;;83:740-743.
10 +
Szwed JJ, Schaust C.  The importance of microscopic examination of the urinary sediment . Am J Med Technol . 1982;;48:141-143.
11 +
Messing EM, Young TB, Hunt VB, Emoto SE, Wehbie JM.  The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks . J Urol . 1987;;137:919-922.
12 +
Curry NS, Schabel SI, Betsill WL:  Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course . Radiology . 1986;;158:113-117.
13 +
Frame PS, Carlson SJ.  A critical review of periodic health screening using specific screening criteria: selected diseases of the genitourinary system . J Fam Pract . 1975;;2:189-194.
14 +
Smalley DL, Bryan JA.  Comparative evaluation of biochemical and microscopic urinalysis . Am J Med Technol . 1983;;49:237-239.
15 +
Schumann GB, Greenberg NF.  Usefulness of microscopic urinalysis as a screening procedure . Am J Clin Pathol . 1979;;71:452-456.
16 +
Schumann GB, Greenberg NF, Henry JB.  Microscopic look at urine often unnecessary . JAMA . 1978;;239:13-14.
17 +
Giudicelli P, Larroque P, Nedelec G, Talarmin F, Castanet F:  Étude critique des hématuries microscopiques par examens de dépistage . Ann Med Intern . 1984;;135:557-560.
18 +
Froom P, Ribak J, Renbassat J.  Significance of microhaematuria in young adults . Br Med J . 1984;;288:20-22.
19 +
Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N.  Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation . J Pediatr . 1979;;95:676-684.
20 +
Chen BTM, Ooi BS, Tan KK, Lim CH.  Comparative studies of asymptomatic proteinuria and hematuria . Arch Intern Med . 1974;;134:901-905.
21 +
Dodge WF, West EF, Smith EH, Bunce H.  Proteinuria and hematuria in school children: epidemiology and early natural history . J Pediatr . 1976;;88:327-347.
22 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases, II . Acta Med Scand . 1973;;194:529-535.
23 +
Johnson A, Heap GJ, Hurley BP.  A survey of bacteriuria, proteinuria and glycosuria in five-year-old school children in Canberra . Med J Aust . 1974;;2:122-124.
24 +
Silverberg DS, Allard MJ, Ulan RA, et al.  City-wide screening for urinary abnormalities in school girls . Can Med Assoc J . 1973;;109:981-985.
25 +
Mohr DN, Offord KP, Owen RA, Melton LJ.  Asymptomatic microhematuria and urologic disease: a population-based study . JAMA . 1986;; 256:224-229.
26 +
Mohr DN, Offord KP, Melton LJ.  Isolated asymptomatic microhematuria: a cross-sectional analysis of test-positive and test-negative patients . J Gen Intern Med . 1987;;2:318-324.
27 +
Golin AL, Howard RS.  Asymptomatic microscopic hematuria . J Urol . 1979;;124:389-391.
28 +
Ritchie CD, Bevan EA, Collier SJ.  Importance of occult haematuria found at screening . Br Med J . 1986;;292:681-683.
29 +
Carson CC III, Segura JW, Greene LF.  Clinical importance of microhematuria . JAMA . 1979;; 241:149-150.
30 +
Davides KC, King LM, Jacobs D.  Management of microscopic hematuria: twenty-year experience with 150 cases in a community hospital . Urology . 1986;;28:453-455.
31 +
Greene LF, O'Shaughnessy EJ, Hendricks ED.  Study of five hundred patients with asymptomatic microhematuria . JAMA . 1956;;161:610-613.
32 +
 Undiagnosed haematuria . Br Med J . 1975;; 1:647. Editorial.
33 +
Clark TW, Schor SS, Elsom KO, Hubbard JP, Elsom KA.  The periodic health examination: evaluation of routine tests and procedures . Ann Intern Med . 1961;;54:1209-1222.
34 +
Pardo V, Berian MG, Levi DF, Strauss J.  Benign primary hematuria . Am J Med . 1979;; 67( (suppl) ):s817-s822.
35 +
Copley JB, Hasbargen JA.  Idiopathic hematuria: a prospective evaluation . Arch Intern Med . 1987;;147:434-437.
36 +
Dana A, Michel JR, Jungers P, Sibert-Zbili A, Droz D, Moreau JF.  Diagnostic étiologique des hématuries microscopiques . Nouv Presse Med . 1981;;10:963-966.
37 +
Thompson IM.  The evaluation of microscopic hematuria: a population-based study . J Urol . 1987;;138:1189-1190.
38 +
Bard JRH.  The significance of asymptomatic microhematuria in women and its economic implications . Arch Intern Med . 1988;;148:2629-2632.
39 +
Gault H, Muehrcke RC.  Renal biopsy: current views and controversies . Nephron . 1983;;34:1-34.
40 +
Brill AB, Adelstein SJ, Saenger EL, Webster EW. Low-Level Radiation Effects: A Fact Book . New York, NY: Society of Nuclear Medicine Inc; 1982;.
41 +
Witten DM.  Reactions to urographic contrast media . JAMA . 1975;;231:974-977.
42 +
Byrd L, Sherman RL.  Radiocontrast-induced acute renal failure: a clinical and pathophysiologic review . Medicine (Baltimore). 1979;;58:270-279.
43 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind controlled trial of phase-contrast microscopy by two observers for evaluating the source of hematuria . Nephron . 1986;;44:304-308.
44 +
Fassett RG, Horgan B, Gove D, Mathew TH.  Scanning electron microscopy of glomerular and non-glomerular red blood cells . Clin Nephrol . 1983;;20:11-16.
45 +
Fairley KF, Birch DF.  Hematuria: a simple method for identifying glomerular bleeding . Kidney Int . 1982;;21:105-108.
46 +
Schichiri M, Hosoda K, Nishio Y, et al.  Red-cell volume distribution curves in diagnosis of glomerular and non-glomerular haematuria . Lancet . 1988;;1:908-911.
47 +
Smith BC, Peake MJ, Fraser CG.  Urinalysis by use of multi-test reagent strips: two dipsticks compared . Clin Chem . 1977;;23:2337-2340.
48 +
Simpson E, Thompson D.  Routine urinalysis . Lancet . 1977;;2:361-362.
49 +
Von Bonsdorff M, Koskenvuo K, Salmi HA, Pasternack A.  Prevalence and causes of proteinuria in 20-year-old Finnish men . Scand J Urol Nephrol . 1981;;15:285-290.
50 +
Levitt JI.  The prognostic significance of proteinuria in young college students . Ann Intern Med . 1967;;66:685-696.
51 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases, I . Acta Med Scand . 1973;;194:525-528.
52 +
Muth RG.  Asymptomatic mild intermittent proteinuria . Arch Intern Med . 1965;;15:569-574.
53 +
King SE.  Diastolic hypertension and chronic proteinuria . Am J Cardiol . 1962;;9:669-674.
54 +
Vehaskari VM, Rapola J.  Isolated proteinuria: analysis of a school-age population . J Pediatr . 1982;;101:661-668.
55 +
Kunin CM.  Emergence of bacteriuria, proteinuria, and symptomatic urinary tract infections among a population of school girls followed for 7 years . Pediatrics . 1968;;41:968-976.
56 +
Gutgesell M.  Practicality of screening urinalyses in asymptomatic children in a primary care setting . Pediatrics . 1978;;62:103-105.
57 +
Canadian Task Force on the Periodic Health Examination.  The periodic health examination: 1984 update . Can Med Assoc J . 1984;;130:1278-1285.
58 +
Guidelines for the Cancer Related Checkup: Recommendations and Rationale . New York, NY: American Cancer Society; 1981;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Heimann GA, Frohlich J, Bernstein M.  Physicians' response to abnormal results of routine urinalysis . Can Med Assoc J . 1976;;115:1094-1095.
2 +
Sondick EJ, Young JL, Horn JW, Gloeckler-Ries LA. 1986 Annual Cancer Statistics Review . Bethesda, Md: National Cancer Institute; 1987;. National Institutes of Health publication 87-2789.
3 +
Rubin RJ.  Epidemiology of end stage renal disease and implications for public policy . Public Health . 1984;;99:492-498.
4 +
National Diabetes Data Group. Diabetes in America . Bethesda, Md: National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases; 1985;. National Institutes of Health publication 85-1468.
5 +
Loo SYT, Scottolini AG, Luangphinith S, Adam AL, Jacobs LD, Mariani AJ.  Urine screening strategy employing dipstick analysis and selective culture: an evaluation . Am J Clin Pathol . 1984;;81:634-642.
6 +
Mariani AJ, Luangphinith S, Loo S, Scottolini A, Hodges CV.  Dipstick chemical urinalysis: an accurate cost-effective screening test . J Urol . 1984;;132:64-66.
7 +
Hearne CR, Donnell MG, Fraser CG.  Assessment of new urinalysis dipstick . Clin Chem . 1980;;26:170-171.
8 +
Shaw ST, Poon SY, Wong ET.  'Routine urinalysis': is the dipstick enough? JAMA . 1985;;253:1596-1600.
9 +
Sewell DL, Burt SP, Gabbert NJ, Bumgardner RV.  Evaluation of the chemstrip 9TM as a screening test for urinalysis and urine culture in men . Am J Clin Pathol . 1985;;83:740-743.
10 +
Szwed JJ, Schaust C.  The importance of microscopic examination of the urinary sediment . Am J Med Technol . 1982;;48:141-143.
11 +
Messing EM, Young TB, Hunt VB, Emoto SE, Wehbie JM.  The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks . J Urol . 1987;;137:919-922.
12 +
Curry NS, Schabel SI, Betsill WL:  Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course . Radiology . 1986;;158:113-117.
13 +
Frame PS, Carlson SJ.  A critical review of periodic health screening using specific screening criteria: selected diseases of the genitourinary system . J Fam Pract . 1975;;2:189-194.
14 +
Smalley DL, Bryan JA.  Comparative evaluation of biochemical and microscopic urinalysis . Am J Med Technol . 1983;;49:237-239.
15 +
Schumann GB, Greenberg NF.  Usefulness of microscopic urinalysis as a screening procedure . Am J Clin Pathol . 1979;;71:452-456.
16 +
Schumann GB, Greenberg NF, Henry JB.  Microscopic look at urine often unnecessary . JAMA . 1978;;239:13-14.
17 +
Giudicelli P, Larroque P, Nedelec G, Talarmin F, Castanet F:  Étude critique des hématuries microscopiques par examens de dépistage . Ann Med Intern . 1984;;135:557-560.
18 +
Froom P, Ribak J, Renbassat J.  Significance of microhaematuria in young adults . Br Med J . 1984;;288:20-22.
19 +
Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N.  Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation . J Pediatr . 1979;;95:676-684.
20 +
Chen BTM, Ooi BS, Tan KK, Lim CH.  Comparative studies of asymptomatic proteinuria and hematuria . Arch Intern Med . 1974;;134:901-905.
21 +
Dodge WF, West EF, Smith EH, Bunce H.  Proteinuria and hematuria in school children: epidemiology and early natural history . J Pediatr . 1976;;88:327-347.
22 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases, II . Acta Med Scand . 1973;;194:529-535.
23 +
Johnson A, Heap GJ, Hurley BP.  A survey of bacteriuria, proteinuria and glycosuria in five-year-old school children in Canberra . Med J Aust . 1974;;2:122-124.
24 +
Silverberg DS, Allard MJ, Ulan RA, et al.  City-wide screening for urinary abnormalities in school girls . Can Med Assoc J . 1973;;109:981-985.
25 +
Mohr DN, Offord KP, Owen RA, Melton LJ.  Asymptomatic microhematuria and urologic disease: a population-based study . JAMA . 1986;; 256:224-229.
26 +
Mohr DN, Offord KP, Melton LJ.  Isolated asymptomatic microhematuria: a cross-sectional analysis of test-positive and test-negative patients . J Gen Intern Med . 1987;;2:318-324.
27 +
Golin AL, Howard RS.  Asymptomatic microscopic hematuria . J Urol . 1979;;124:389-391.
28 +
Ritchie CD, Bevan EA, Collier SJ.  Importance of occult haematuria found at screening . Br Med J . 1986;;292:681-683.
29 +
Carson CC III, Segura JW, Greene LF.  Clinical importance of microhematuria . JAMA . 1979;; 241:149-150.
30 +
Davides KC, King LM, Jacobs D.  Management of microscopic hematuria: twenty-year experience with 150 cases in a community hospital . Urology . 1986;;28:453-455.
31 +
Greene LF, O'Shaughnessy EJ, Hendricks ED.  Study of five hundred patients with asymptomatic microhematuria . JAMA . 1956;;161:610-613.
32 +
 Undiagnosed haematuria . Br Med J . 1975;; 1:647. Editorial.
33 +
Clark TW, Schor SS, Elsom KO, Hubbard JP, Elsom KA.  The periodic health examination: evaluation of routine tests and procedures . Ann Intern Med . 1961;;54:1209-1222.
34 +
Pardo V, Berian MG, Levi DF, Strauss J.  Benign primary hematuria . Am J Med . 1979;; 67( (suppl) ):s817-s822.
35 +
Copley JB, Hasbargen JA.  Idiopathic hematuria: a prospective evaluation . Arch Intern Med . 1987;;147:434-437.
36 +
Dana A, Michel JR, Jungers P, Sibert-Zbili A, Droz D, Moreau JF.  Diagnostic étiologique des hématuries microscopiques . Nouv Presse Med . 1981;;10:963-966.
37 +
Thompson IM.  The evaluation of microscopic hematuria: a population-based study . J Urol . 1987;;138:1189-1190.
38 +
Bard JRH.  The significance of asymptomatic microhematuria in women and its economic implications . Arch Intern Med . 1988;;148:2629-2632.
39 +
Gault H, Muehrcke RC.  Renal biopsy: current views and controversies . Nephron . 1983;;34:1-34.
40 +
Brill AB, Adelstein SJ, Saenger EL, Webster EW. Low-Level Radiation Effects: A Fact Book . New York, NY: Society of Nuclear Medicine Inc; 1982;.
41 +
Witten DM.  Reactions to urographic contrast media . JAMA . 1975;;231:974-977.
42 +
Byrd L, Sherman RL.  Radiocontrast-induced acute renal failure: a clinical and pathophysiologic review . Medicine (Baltimore). 1979;;58:270-279.
43 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind controlled trial of phase-contrast microscopy by two observers for evaluating the source of hematuria . Nephron . 1986;;44:304-308.
44 +
Fassett RG, Horgan B, Gove D, Mathew TH.  Scanning electron microscopy of glomerular and non-glomerular red blood cells . Clin Nephrol . 1983;;20:11-16.
45 +
Fairley KF, Birch DF.  Hematuria: a simple method for identifying glomerular bleeding . Kidney Int . 1982;;21:105-108.
46 +
Schichiri M, Hosoda K, Nishio Y, et al.  Red-cell volume distribution curves in diagnosis of glomerular and non-glomerular haematuria . Lancet . 1988;;1:908-911.
47 +
Smith BC, Peake MJ, Fraser CG.  Urinalysis by use of multi-test reagent strips: two dipsticks compared . Clin Chem . 1977;;23:2337-2340.
48 +
Simpson E, Thompson D.  Routine urinalysis . Lancet . 1977;;2:361-362.
49 +
Von Bonsdorff M, Koskenvuo K, Salmi HA, Pasternack A.  Prevalence and causes of proteinuria in 20-year-old Finnish men . Scand J Urol Nephrol . 1981;;15:285-290.
50 +
Levitt JI.  The prognostic significance of proteinuria in young college students . Ann Intern Med . 1967;;66:685-696.
51 +
Alwall N, Lohi A.  A population study on renal and urinary tract diseases, I . Acta Med Scand . 1973;;194:525-528.
52 +
Muth RG.  Asymptomatic mild intermittent proteinuria . Arch Intern Med . 1965;;15:569-574.
53 +
King SE.  Diastolic hypertension and chronic proteinuria . Am J Cardiol . 1962;;9:669-674.
54 +
Vehaskari VM, Rapola J.  Isolated proteinuria: analysis of a school-age population . J Pediatr . 1982;;101:661-668.
55 +
Kunin CM.  Emergence of bacteriuria, proteinuria, and symptomatic urinary tract infections among a population of school girls followed for 7 years . Pediatrics . 1968;;41:968-976.
56 +
Gutgesell M.  Practicality of screening urinalyses in asymptomatic children in a primary care setting . Pediatrics . 1978;;62:103-105.
57 +
Canadian Task Force on the Periodic Health Examination.  The periodic health examination: 1984 update . Can Med Assoc J . 1984;;130:1278-1285.
58 +
Guidelines for the Cancer Related Checkup: Recommendations and Rationale . New York, NY: American Cancer Society; 1981;.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems