Role of urinalysis in the basic diagnostic panel
All patients (including those with NETs) are strongly advised to undergo a basic laboratory testing panel to objectively assess their general condition and properly select treatment tactics. This fundamental list strictly includes a routine urinalysis (clinical urine test). Expert working groups emphasize that this diagnostic approach has a recommendation grade (Level of Conviction) of C and an evidence level (Level of Evidence Reliability) of 5.
In addition to urinalysis, the basic panel includes a comprehensive complete blood count (CBC), general clinical blood biochemistry, and a screening assessment of the hemostasis system — the coagulogram. Experts consider this set sufficient for initial evaluation, though not exhaustive. The final examination plan should always be tailored individually, based strictly on the current clinical picture and the results of other objective and instrumental diagnostic methods.
Concomitant biochemical and hematological parameters
The interpretation of urinalysis results is frequently performed in close conjunction with blood biochemistry data. Within the scope of general clinical biochemistry, the determination of the following key parameters is mandatory:
- Total protein and albumin;
- Creatinine and uric acid;
- Electrolytes: potassium and calcium (including total serum calcium);
- Enzymes: lactate dehydrogenase.
Additionally, blood glucose levels and inflammatory markers, such as serum C-reactive protein (CRP) and fibrinogen, are evaluated. In advanced diagnostic scenarios, specific procedures may be added to urine and blood tests. These include a bone marrow cytological examination (obtaining a sample via puncture and examining the smear — myelogram) and bone marrow histological examination (pathological and anatomical study of biopsy or surgical material, including the use of advanced immunohistochemical methods).
Diagnostic role across various disease periods
Diagnostic tactics and further medical management directly depend on the specific period of the disease the patient is in. For instance, when determining the period of HFRS, a patient may be in the febrile phase, shock stage, or convalescence period.
Despite the change in stages, baseline laboratory and instrumental diagnostics remain identical for all periods. This invariable basic set includes:
- Urinalysis (UA);
- Complete blood count (CBC);
- Blood chemistry panel;
- Coagulogram;
- Ultrasound examination (US) of the kidneys.
Differences in patient management across various stages lie exclusively in the application of specific diagnostic methods, whereas urinalysis remains a stable monitoring tool.
Extended screening and sediment microscopy
Within the recommended list of tests, routine urinalysis (clinical urine test) is inextricably linked with urine sediment microscopy. These two tests form the foundation of the specialized block. To obtain the most comprehensive picture of the patient's health, this block is supplemented with other panels:
- Thyroid function assessment: includes the determination of thyroid-stimulating hormone (TSH), free thyroxine (fT4), anti-thyroperoxidase antibodies (anti-TPO), and thyroglobulin.
- Infectious screening (virology): involves the detection of classes M and G antibodies (IgM, IgG) to the human immunodeficiency virus (HIV-1 and HIV-2), hepatitis C virus (HCV), as well as comprehensive hepatitis B diagnostics (HBV: surface antigen HBsAg, antibodies to HBsAg and core antigen HBcAg).
- Immunological tests (autoimmune profile): aimed at detecting antinuclear antibodies (ANA) and anti-DNA antibodies.
For quick memorization of the basic test panel, you can use the four "B"s rule: Blood count (CBC), Basic urine (UA), Biochemistry (metabolism), and Blood clotting (coagulogram).
Class and exam questions
Is routine urinalysis included in the basic panel of tests?
Yes, routine urinalysis is a mandatory part of the basic laboratory testing panel, along with a complete blood count, biochemistry, and a coagulogram.
What is routine urinalysis supplemented with in the recommended list of tests?
In the specialized block of urine tests, routine urinalysis is always supplemented with urine sediment microscopy for a more detailed examination.
Does baseline diagnostics change depending on the disease period in HFRS?
No, baseline laboratory diagnostics, including urinalysis, blood tests, and renal ultrasound, are identical for all periods (shock stage, febrile phase, convalescence period).
Is the recommended list of tests containing routine urinalysis exhaustive?
No, experts consider the specified list sufficient, but not exhaustive. The final plan is formulated based on the clinical picture and instrumental data.
What else to study on this topic
- Interpretation of general clinical blood biochemistry (total protein, albumin, creatinine, uric acid, electrolytes).
- Assessment of the hemostasis system: coagulogram and fibrinogen level.
- Infectious screening: markers of viral hepatitis B (HBV) and C (HCV), as well as HIV infection (HIV).
- Laboratory evaluation of thyroid function (TSH, fT4, anti-TPO, thyroglobulin).
- Bone marrow examination methods: cytological myelogram and histological examination using immunohistochemistry.
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