As a student nurse, 'weighs and wees' were an important weekly, or in some cases daily, part of patient care. Urinalysis is one of the most common investigations that can lead to a formal diagnosis. It remains inexpensive and convenient when completed correctly, and can uncover significant renal or urological disease. However, there are both false positives and negatives associated with interpretation, which can lead to inappropriate investigations, diagnosis and treatment.
The role of urinalysis in primary care is being examined. Annual urinalysis as a screening tool in certain groups of patients, for example chronic kidney disease (CKD), might be abandoned. It is fair to say that urine testing may be obsolete as far as proteinuria is concerned with tests such as albumin creatinine ratio recommended in NICE guidelines (2008) and consequently adopted by the Quality Outcomes Framework (QOF). There is no reliable evidence to suggest that population screening reduces mortality rates in urological cancers (see Improving Outcomes in Urological Cancers, NICE, 2002). However, clinical situations change and concerns have been raised about missing other disease processes that may not have been apparent on initial presentation and which would be missed if annual testing is withdrawn.
The average multistick costs around £0.20 or less; this is surely a relatively small cost in comparison to the impact on survival if a potentially treatable disease is missed. My clinical experience certainly reflects this and I support the use of annual urinalysis in CKD patients and at-risk populations. However, there needs to be a robust educational programme to support those using this screening tool to avoid over-investigation: eg, avoiding routine microbiology on any urine with a positive dipstick. This has been a costly and inappropriate use of primary care resources and is where the challenge lies to get the balance right in urine dipstick testing.