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Drugs that aim to prevent the loss of protein or albumin through urine in people with sickle cell disease

We reviewed the evidence on the effect of drugs that aim to prevent loss of protein or albumin through urine in people with sickle cell disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Tight control of mild‐to‐moderate high blood pressure for pregnant women with pre‐existing or gestational hypertension (without protein in the urine) to improve health outcomes 

High blood pressure (hypertension) is defined as a systolic blood pressure of 140 mmHg or more or a diastolic blood pressure of 90 mmHg or more. In the general population, a tight control of blood pressure reduces cardiovascular risks and is particularly important for people with diabetes or renal disease. Having high blood pressure during pregnancy is a complex clinical condition. Adverse effects include premature separation of the placenta (abruption), low birthweight, and perinatal death. Women who do not have regular antenatal care, those with severe uncontrolled hypertension and pre‐eclampsia are more likely to have poor outcomes. A woman with mild‐to‐moderate hypertension could develop severe hypertension if not managed correctly. On the other hand, lowering blood pressure dramatically may reduce placental perfusion, which could lead to fetal growth restriction, without providing extra benefit to the mother. There is no consensus regarding a clear goal of adjusting blood pressure in pregnant women with mild‐to‐moderate hypertension.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Pregnancy and birth: What are the benefits of routinely screening for bacteria in the urine of pregnant women?

It is not clear whether it would be beneficial to routinely test the urine of pregnant women for bacteria (bacteriuria screening). It is also not possible to say whether antibiotics should be used if high levels of bacteria are detected in the urine but there are no noticeable urinary tract problems.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 16, 2015

Understanding urine tests

Most people will have already given a urine sample at some point in their lives. Urine samples are needed for urine tests, which are used for things like testing for particular diseases or monitoring their progress. For instance, urine test strips can be used to indicate whether you have a urinary tract infection.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 30, 2016

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

Bladder cancer is the sixth most common cancer in the UK, affecting more than 10,000 people each year. Around 75–85% of patients are diagnosed as having non-muscle-invasive disease, which, despite treatment, has a probability of recurrence at 5 years of 31% (95% CI 24% to 37%) to 78% (95% CI 73% to 84%). Inspection of the bladder [flexible cystoscopy using white light (CSC)] facilitated with local anaesthesia and voided urine cytology (involving the examination of cells in voided urine to detect the presence of cancerous cells) are currently the routine initial investigations of the bladder in patients with haematuria or other symptoms suggestive of bladder cancer. If CSC or urine cytology are suspicious, a rigid white light cystoscopy (WLC) under general or regional anaesthesia is performed with transurethral resection of bladder tumour (TURBT) where applicable. However, WLC may fail to detect some tumours. Photodynamic diagnosis (PDD) is a technique that could potentially be used to enhance tumour detection. Also, since the mid-1990s many urine biomarker tests for detecting bladder cancer have been developed, including fluorescence in situ hybridisation (FISH), ImmunoCyt and nuclear matrix protein (NMP22).

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2010

Spot urine protein measurements in kidney transplantation: a systematic review of diagnostic accuracy

BACKGROUND: Quantification of proteinuria (albuminuria) in renal transplant recipients is important for diagnostic and prognostic purposes. Recent guidelines have recommended quantification of proteinuria by spot protein-to-creatinine ratio (PCR) or spot albumin-to-creatinine ratio (ACR). Validity of spot measurements remains unclear in renal transplant recipients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Human recombinant activated protein C for severe sepsis and septic shock in adult and paediatric patients

Sepsis and septic shock are major causes of death. Sepsis is a complex syndrome resulting from a presumed or known infection, and its pathogenesis involves interactions between inflammation and blood clotting pathways. This serious medical condition is characterized by an inflammatory response to an infection which can affect the whole body. Patients with sepsis may have developed the inflammatory response because of microbes in their blood, urine, lungs, skin, or other tissues. Severe sepsis can lead to multiple organ failure due to blood clotting in the finer blood vessels. This reduces the amount of blood reaching the organs and septic shock ensues. Protein C reduces the clotting process and a lack of protein C can lead to an exaggeration of blood clotting. Sepsis and septic shock decrease protein C levels in the body. It has been suggested that human recombinant activated protein C (APC) will increase the levels of protein C and ameliorate or prevent multiple organ failure. In this updated Cochrane review we searched the databases until June 2012. We included six randomized clinical trials which involved 6781 people (6307 adult and 474 paediatric participants) with either a high or low risk of death. All trials had high risk of bias and were sponsored by the pharmaceutical industry (Eli Lilly). We found no evidence suggesting that APC reduced the risk of death in adults or children with severe sepsis or septic shock. On the contrary, APC increased the risk of serious bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Protein Testing in Patients with Multiple Myeloma: A Review of Clinical Effectiveness and Guidelines [Internet]

Protein manifestations characteristic of multiple myeloma (MM) include increases of monoclonal (M)-protein concentrations (IgG, IgA, IgA, IgD), light chain concentrations (including kappa [κ] and lambda[λ]), abnormal β2-microglobulin, serum albumin, creatinine, and hemoglobin levels, and findings of bone marrow plasma cells (of greater than or equal to 5%). Measurement of the protein manifestations produced by patients can be achieved by numerous methods. Traditional tests that measure M-proteins are the 24-hour urine collection test, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunofixation electrophoresis (IFE). One newer test (developed in 2001) is the serum free light chain (sFLC) assay. The frequency with which to test using any of the tests along with the clinical utility of the newer tests remains in question. It is for this reason that a review of the clinical effectiveness, clinical utility, and guidelines of repeat testing for protein abnormalities in patients with MM was undertaken.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 9, 2015
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The effect of n-3 long-chain polyunsaturated fatty acid supplementation on urine protein excretion and kidney function: meta-analysis of clinical trials

The authors concluded that n-3 LPUFA supplementation lowered urinary protein excretion, but did not reduce decline in glomerular filtration rate. In view of the small sample sizes and suboptimal quality of the included studies, as well as incomplete reporting of review methods, these conclusions should be interpreted with some caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review

This review assessed the utility of the protein:creatinine ratio in a random urine sample to rule out proteinuria as defined by 24-hour urine protein measurement. The authors' conclusion that the protein:creatinine ratio can be used to rule out proteinuria was somewhat optimistic given the data presented. Limitations in the search strategy and methodology used in the review could also cast doubt upon its findings.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Urine survivin as a diagnostic biomarker for bladder cancer: a systematic review

This review concluded that the clinical utility of urine survivin as a bladder tumour marker remained uncertain. Only studies that investigated diagnostic accuracy were included in the review. Limitations of the review and the methodological limitations and paucity of available evidence mean that the estimates of diagnostic accuracy could be overestimated. The uncertainty expressed in the authors' conclusions seems appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction

This well-conducted review found that none of the foetal urine tests investigated by the included studies showed sufficient accuracy to predict poor postnatal renal function. These conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

This review concluded that photodynamic diagnosis had higher sensitivity but lower specificity than white light cystoscopy for detecting bladder cancer. Strategies that involved biomarkers and/or photodynamic diagnosis provided additional benefits at a cost that society might be willing to pay. The authors’ detailed and cautious conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

[Nuclear matrix protein 22 and urinary cytology test in the diagnosis of bladder cancer: a meta-analysis]

OBJECTIVE: Systematic reviews of diagnostic value of the nuclear matrix protein 22 (NMP22) and urine cytology for bladder cancer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The protein-to-creatinine ratio for the prediction of significant proteinuria in patients at risk for preeclampsia: a meta-analysis

OBJECTIVE: To investigate the diagnostic accuracy of the protein-to-creatinine ratio from random urine collections to confirm the presence of proteinuria in women being evaluated for preeclampsia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Combination of different types of tests for the non‐invasive diagnosis of endometriosis

Women with endometriosis have endometrial tissue (the tissue that lines the womb and is shed during menstruation) growing outside the womb within the pelvic cavity. This tissue responds to reproductive hormones, causing painful periods, chronic lower abdominal pain and difficulty conceiving. Currently, the only reliable way of diagnosing endometriosis is to perform keyhole surgery and visualise the endometrial deposits inside the abdomen. Because surgery is risky and expensive, combinations of various tests have been evaluated for their ability to detect endometriosis non‐invasively. An accurate test could lead to the diagnosis of endometriosis without the need for surgery or it could reduce the need for diagnostic surgery so only women who were most likely to have endometriosis would require it.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Protein/creatinine ratio in preeclampsia: a systematic review

OBJECTIVE: To estimate the accuracy of the protein/creatinine ratio in predicting 300 mg of protein in 24-hour urine collection in pregnant patients with suspected preeclampsia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Diagnostic accuracy of urinary spot protein: creatinine ratio for proteinuria in hypertensive pregnant women - systematic review

This review found that the spot:creatinine ratio has reasonable accuracy for ruling out proteinuria of 0.3 g/day or more, but there are insufficient data on the accuracy of the spot albumin:creatinine ratio. These conclusions are supported by the results presented and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials

This review assessed the effect of consuming a low protein diet, compared to a normal protein intake, on renal outcomes in people with diabetes. The authors concluded that no strong improvements in kidney function were demonstrated. Despite poor reporting of some aspects of the review process, this conclusion is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

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