Quality statement 4: Identifying the cause – urine dipstick test

Quality statement

People have a urine dipstick test performed as soon as acute kidney injury is suspected or detected.

Rationale

Understanding the cause of acute kidney injury by testing the urine for blood and protein is important for guiding further specialised investigations and appropriate treatments. Urine dipstick testing is a simple, effective and inexpensive diagnostic test to identify underlying conditions that can be treated to either prevent acute kidney injury or reduce its severity, thus avoiding more serious consequences.

Quality measures

Structure

Evidence of local arrangements to ensure that people have a urine dipstick test performed as soon as acute kidney injury is suspected or detected.

Data source: Local data collection.

Process

Proportion of presentations where a urine dipstick test is performed within 6 hours of acute kidney injury being suspected or detected.

Numerator – the number in the denominator where a urine dipstick test is performed within 6 hours of acute kidney injury being suspected or detected.

Denominator – the number of presentations in which acute kidney injury is suspected or detected.

Data source: Local data collection.

Outcome

Preventing serious consequences resulting from not treating the causes of acute kidney injury.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (primary and secondary care providers) ensure that protocols and clear referral pathways are in place for urine dipstick testing to be carried out as soon as acute kidney injury is suspected or detected, and for appropriate responses to abnormal results.

Healthcare professionals perform urine dipstick testing as soon as acute kidney injury is suspected or detected, and know when and how to respond to abnormal results.

Commissioners (clinical commissioning groups) ensure that primary and secondary care providers have protocols in place for urine dipstick testing to be carried out as soon as acute kidney injury is suspected or detected, and for appropriate responses to abnormal results.

What the quality statement means for patients, service users and carers

People with suspected or detected acute kidney injury have their urine tested with a 'dipstick' as soon as possible to check for causes of acute kidney injury.

Source guidance

Definitions of terms used in this quality statement

Suspected or detected acute kidney injury

Symptoms or signs of acute kidney injury can vary and include passing less urine than normal, nausea and sickness, poor appetite, swelling of the legs or other parts of the body and breathlessness [NICE guideline CG169, information for the public].

Acute kidney injury is detected in line with the (p)RIFLE[1], AKIN[2] or KDIGO[3] definitions, by using any of the following criteria:

  • a rise in serum creatinine of 26 micromol/litre or greater within 48 hours

  • a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days

  • a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than 8 hours in children and young people

  • a 25% or greater fall in estimated glomerular filtration rate (eGFR) in children and young people within the past 7 days.

[NICE guideline CG169, recommendation 1.3.1]

A national algorithm that standardises the definition of acute kidney injury has been agreed and endorsed by NHS England.

Urine dipstick test

A urine dipstick tests the urine sample for blood, protein, leukocytes, nitrites and glucose, and can help to determine an underlying cause of acute kidney injury. The test should be done as soon as possible after acute kidney injury is suspected or detected, and within 6 hours at most. Catheterisation for the sake of performing the test should be avoided. The results of the test should be documented and appropriate action taken when results are abnormal. The interpretation of urine dipstick findings in a child with acute kidney injury should always be undertaken by a paediatrician or a paediatric nephrologist. [Adapted from NICE guideline CG169, full guideline with expert opinion]



[1] Risk, injury, failure, loss, end stage renal disease, (p) refers to the paediatric classification.

[2] Acute Kidney Injury Network.

[3] Kidney disease: improving global outcomes.