Subject and Methods

Subject and Methods

Study design:

Cross sectional study, carried out in Qalubyia Governorate, from

September 2018 to February 2019.
Size of samples:

This study was comprised (1000) school children of both sexes. Ages
of the children included in the study ranged from 6 to 12 years. Informed
consent was obtained from the children's care givers and the ministry of
education.
Inclusion Criteria:
- Age from 6 to 12 years.
- Both sexes (Males and females).
- Apparently healthy children.
Exclusion Criteria:
- Children suffering from any renal symptoms, renal diseases or having
any bleeding disorders.
- Age below 6 years or above 12 years.
Methods:
All children enrolled in this study were subjected to:
 Full History Taking:
- Personal history: Age, sex, residence and socio-economic
Status.
- Present history: Dark urine, dysuria, frequency, renal pain, change
of urine volume (Oliguria or polyuria), puffiness of eye lids,

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 Subject and Methods

generalized swelling, history suggestive acute hemolysis (Pallor or

jaundice) and history suggestive bleeding disorder (Bleeding
orifices and purpuric eruptions).
- Past history: History of pharyngitis 2 weeks ago, other diseases
and operations.
 Clinical Examination:
- General examination:
o Face (Puffiness of eye lids).
o Colour (Pallor, jaundice and cyanosis).
o Blood pressure and children were arranged according to
centile.
o Anthropometric measurements (Weight and height) and
children were also arranged according to centile.
o Limbs edema,
o Skin rash.
-Local examination:
o Neurological examination.
o Chest and heart examination.
o Abdominal examination (Renal mass, organomegaly and
ascites).
 Collection of Urine:
The first Midstream urine sample (10–20 ml) passed by the
patient at the beginning of the day collected from children in a
sterile, dry, wide-necked, leakproof container for examination.
This specimen is the most concentrated and therefore the most
suitable for culture, microscopy, and biochemical analysis.

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 Subject and Methods

Female children informed to: Wash the hands. Clean the area
around the urethral opening with clean water, dry the area with a
sterile gauze pad, and collect the urine with the labia held apart.
Male children informed to: Wash the hands before collecting a
specimen (middle of the urine flow).
 Dipstick Test Urine Analysis :
Morning urine specimen obtained from each child was tested
with urine dipstick for protein, blood, glucose, nitrite, leukocyte,
bilirubin, urobilinogen, ketones, pH and specific gravity (urine
quick test; Combur-10-Test™, Roche, Mannheim, Germany). A
dipstick test was performed on the urine specimen with reagent
strip designed to react and progressively produce color changes in
30 seconds. The results were obtained by visual comparison of
the test strip with a color chart provided on the bottle label.
Students with an initial reading of ≥ 1+ for any abnormalities
were subjected to complete urine examination.
 Laboratory Examination of Urine:
o Collection and Transport of Urine
Collection of urine as before.
The container labeled with the date, the name and number
of the patient, and the time of collection.
As soon as possible, the specimen delivered with a request
form to the laboratory. When immediate delivery to the
laboratory is not possible, the urine refrigerated at 4–6 °C.
1- We described the appearance of the specimen
Report:
– Colour of specimen

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 Subject and Methods

– Whether it is clear or cloudy (turbid)

Normal freshly passed urine is clear and pale yellow to
yellow depending on concentration.
2- Biochemical Examination including:
Reaction, Albumin, Bilirubin, Urobilinogen, Glucose,
Ketone bodies, Nitrite, Blood/Hemoglobin.
3- Examine the specimens microscopically
Preparation and examination of a wet
1) Aseptically transfer about 10 ml of well mixed urine
transferd to a labelled conical tube.
2) Centrifuged at 500–1000 g for 5 minutes. the
supernatant fluid Poured (by completely inverting the
tube) into a second container not the original one.
3) The sediment remixed by tapping the bottom of the
tube. One drop of the well-mixed sediment
transferred to a slide and covered with cover glass.
4) The preparation examined microscopically using the
10 and 40 objective with the condenser iris closed
sufficiently to give good contrast .
Urine is examined microscopically as a wet preparation to
detect: (Fatima et al., 2017)
 Significant pyuria, i.e. WBCs in excess of 5/Hpf.
 Red cells in excess of 5/Hpf.
 Casts.
 Yeast cells.
 Crystals.
 T. vaginalis motile trophozoites.

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 Subject and Methods

 S. haematobium eggs.
 Bacteria (providing the urine is freshly collected).

Those with positive results in microscopic urine analysis were subjected

to further investigations according to abnormal finding:
1- Urine Culture:
Urine culture was done for children with pus cells count of 10 or
more per high power field.
The urine was collected by midstream clean catch technique.
The children's parents were instructed to:
a) Wash hands before collection of samples.
b) Wash external genitalia and urethral opening with cleaning agent
and use water after that to remove any traces of cleaning agent used.
c) Void first drops of urine in the toilet and the rest in the sterilized cup
given to them.
The samples after that were sent to the laboratory within two hours.
2- Abdominal Ultrasound:

Those with hematuria have undergone abdominal ultrasound to

exclude renal stones or gravels and exclude the presence of any
hydronephrotic or back pressure changes (Stamatiou et al., 2009)

3- 24 hrs Urine Protein:

 Those with proteinuria were subjected to 24 hrs urine protein.

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 Subject and Methods

Statistical analysis:
The data were recorded on an “Investigation report form”. These data
were tabulated, coded then analyzed using the computer program SPSS
(Statistical package for social science) version 16 to obtain.

1. Descriptive data:

Descriptive statistics were calculated for the data in the form of:

1. Mean.

2. Standard deviation (±SD).

3. Number and percent.

2. Analytical statistics:

In the statistical comparison between the different groups, the

significance of difference was tested using one of the following tests:-

1- Student's t-test:-Used to compare between mean of two groups of

numerical (parametric) data.

2- Inter-group comparison of categorical data was performed by using

chi square test (X2-value).

A P value <0.05 was considered statistically significant (S). And a

P value <0.0001 was considered highly significant (HS) in all analyses
(Greenberg et al., 1996).

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