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ESREmail this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version ESR stands for erythrocyte sedimentation rate.

It is commonly called a "sed rate."

It is a test that indirectly measures how much inflammation is in the body.

How the Test is Performed A blood sample is needed. For information on how this is done, see: Venipuncture

The blood sample is sent to a lab. The test measures how fast red blood cells called erythrocytes fall to the bottom of a tall, thin tube.

How to Prepare for the Test There are no special preparations needed.

How the Test Will Feel When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed A "sed rate" is often ordered for someone who is having unexplained fevers, certain types of arthritis, muscle symptoms, or other vague symptoms that cannot be explained.

Once a diagnosis has been made, this test may be used to monitor whether the illness is becoming more active or flaring up.

This test can be used to monitor inflammatory diseases or cancer. It is a screening test, which means it cannot be used to diagnose a specific disorder.

However, it is useful for detecting and monitoring:

Autoimmune disorders Certain forms of arthritis Inflammatory diseases that cause vague symptoms Tissue death Tuberculosis Normal Results Adults (Westergren method):

Men under 50 years old: less than 15 mm/hr Men over 50 years old: less than 20 mm/hr Women under 50 years old: less than 20 mm/hr Women over 50 years old: less than 30 mm/hr Children (Westergren method):

Newborn: 0 to 2 mm/hr Newborn to puberty: 3 to 13 mm/hr Note: mm/hr. = millimeters per hour

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Although it can help diagnose some illnesses, an abnormal ESR does not prove that you have a certain condition. Other tests are almost always needed.

An increased ESR rate may be due to:

Anemia Cancers such as lymphoma or multiple myeloma Kidney disease Pregnancy Thyroid disease The immune system helps protect the body against harmful substances. In autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. ESR is often higher than normal in people with an autoimmune disorder.

Common autoimmune disorders include:

Lupus Rheumatoid arthritis in adults or children Very high ESR levels occur with less common autoimmune disorders, including:

Allergic vasculitis Giant cell arteritis Hyperfibrinogenemia (increased fibrinogen levels in the blood) Macroglobulinemia - primary Necrotizing vasculitis Polymyalgia rheumatica An increased ESR rate may be due to some infections, including:

Body-wide (systemic) infection Bone infections Infection of the heart or heart valves Rheumatic fever Severe skin infections, such as erysipelas Tuberculosis Lower-than-normal levels occur with:

Congestive heart failure Hyperviscosity Hypofibrinogenemia (decreased fibrinogen levels) Low plasma protein (due to liver or kidney disease) Polycythemia Sickle cell anemia Risks Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

Excessive bleeding Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken) Alternative Names

Erythrocyte sedimentation rate; Sed rate; Sedimentation rate

References Kushner I, Ballou SP. Acute-phase reactants and the concept of inflammation. In: Firestein GS, Budd RC, Harris ED, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 52.

Pisetsky DS. Laboratory testing in the rheumatic diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 278.

Update Date: 6/1/2011 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Browse the Encyclopedia MedlinePlus Topics Arthritis Autoimmune Diseases Crohn's Disease Giant Cell Arteritis Lupus Polymyalgia Rheumatica Ulcerative Colitis Read More Allergic vasculitis Anemia

Autoimmune hepatitis Congenital afibrinogenemia Endometritis Fibrinogen Heart failure - overview Hyperviscosity - newborn Macroglobulinemia of Waldenstrom Multiple myeloma Necrosis Necrotizing vasculitis Polycythemia vera Polymyalgia rheumatica Pulmonary tuberculosis Rheumatoid arthritis Sickle cell anemia Systemic lupus erythematosus

INR Test

The INR is a test of blood clotting, which is primarily used to monitor warfarin therapy, where the aim is to maintain an elevated INR in a certain range eg, 2.0 to 3.0. It is initially checked frequently, but as treatment is stabilised it may be done less often, eg fortnightly. Changes in the warfarin dose take several days to affect the INR result.

How the Test is Performed

The INR Test is a blood test and requires a small tube of blood from a vein approximately 4 millilitres. It is important that the tube is filled to the correct level, otherwise false results may occur.

Medical Conditions and Symptoms

The INR is usually monitored as part of warfarin therapy, but it may also be checked by your doctor in relation to Liver Function Tests, because liver dysfunction can lead to decreased production of certain clotting factors. The commoner reasons for warfarin therapy are:

Deep Venous Thrombosis (DVT) a clot in a deep vein, commonly of the leg Pulmonary Embolism (PE) a clot in the lung, that has travelled through the veins (embolised) from a DVT formed elsewhere, such as the deep veins of the leg or pelvis Atrial Fibrillation (AF) an irregular heartbeat, sometimes accompanied by an enlarged left atrium both of which predispose to the formation of blood clots in the heart, which may embolise to the blood vessels of the brain causing a cerebral infarction, a stroke also known as a CerebroVascular Accident (CVA) Some cases of Heart failure (LVF =Left Ventricular Failure or CCF =Congestive Cardiac Failure), especially when the heart is enlarged as in some forms of cardiomyopathy. Artificial heart valves of the mechanical type because of the risk of a clot forming on the valve and causing a blockage in the heart. Test Results Explained

The INR test result is given as a number. There are no units of measurement because the number is a ratio: the ratio of the samples Prothrombin Time (PT a measure of clotting), to the Prothrombin Time of a normal sample of blood. A result of 1.0, up to 1.5, is therefore normal. People on warfarin treatment will have different target INR ranges to aim for with warfarin treatment, depending on the reason for anticoagulation (blood-thinning treatment). One example is a range of 2.0 to 3.0 for DVT. An INR lower than the desired range means the blood is not thin enough or clots too easily. An INR result higher than the desired range means the blood is too thin.

Warfarin doses are adjusted, initially every few days, aiming for the desired target range of INR. As treatment is stabilised it may be done less often, eg fortnightly. Changes in the warfarin dose take several days to affect the INR result. Patients on warfarin treatment will usually be advised by telephone by their doctor, or by the laboratory doing the INR test, on whether to change their warfarin dose, or exactly what dose to take, based on the INR result. The result needs to be taken in context of recent INR measurements and dose changes. There are many medications that can affect the INR, and even a change in diet can result in changes to the INR either raising or lowering it.

A urinalysis is one of the least expensive, yet very useful diagnostic tests. This analysis is used to detected the presence of any harmful chemical of other unexpected substances in the urine. For example, the urine test can detect substances such as glucose (diabetics), blood (kidney problems), crystals (kidney stones) and also pus cells that indicate some kind of infection in your body. Pus Cells in Urine The presence of pus cells in the urine indicates an ailment in the body. In medical parlance, passage of pus cells in urine is called Pyuria.

Pyuria can be microscopic or gross. With large number of pus cells, the urine may appear turbid or it may be purulent. Pus cells are white blood cells that signify infection in the body, especially if the urine also contains bacteria. Presence of pus cells in the urine may also be a sign of infection or inflammation in the kidneys and bladder. Since the urine has to pass through the kidneys and the bladder, it may pick up some pus cells from there before voiding. The mere presence of pus cells in the urine may not clearly indicate what type of infection or ailment the patient is suffering from.

In such cases, urine test for culture and sensitivity is of great help. Further blood tests may be requested to check for certain levels of components and compounds in the blood. Symptoms of Pus Cells in Urine

There may no be any visible and obvious outward symptom of pus cells in urine. However, some of the common symptoms are: Painful, burning sensation when urinating Abdominal cramps Fever Vomiting It is critical to identify these symptoms at an early stage so appropriate diagnosis and treatment can be administered. Causes of Pus Cell in Urine Possible causes of the presence of pus cells in urine include: Kidney infection Bladder infection Infection in urethra Inflammation due to presence of bladder stones or kidney stones Immune disorders Allergies or growths anywhere along the genitourinary system Predisposing factors contributing pus cell in urine: Unhygienic habits Sexual intercourse with an infected person suffering from sexually transmitted disease (STD) Diabetes Pregnancy Sexual perversions Use of catheter Cancer of either urinary organs or the genital organs Use of steroids and immune-suppressant drugs for a long time. This lowers the immunity which may result in recurrent urinary tract infection and pus cells in urine Enlarged prostate in men

Treatment of Pus Cells in Urine Treatment for this condition will depend upon what underlying cause the diagnostic tests reveal. There would be different treatment plans for the varying underlying causes listed above. Most of the time, the doctor will prescribe antibiotics to help control infections, if these are the cause of the pus cells. If the pus cells are due to inflammation because of kidney or bladder stones, then these stones must first be dissolved or removed from the body, before other treatment is provided. Drinking enough water and fluids helps in expelling the pus cells out of the urinary system. Drinking alkaline mixture can give symptomatic relief from burning sensation while urinating. However, fluids by themselves will not eradicate the infection. For treating pus cells in urine, specific antibiotics are needed.

Epithelial cells in urine Different types of epithelial cells can be observed in urine. Some of these are readily identifiable, however it is difficult to distinguish small transitional epithelial cells from WBC and renal tubular epithelial cells from transitional epithelial cells. Thus, all nonsquamous cells in urine are considered to be of transitional origin. When we are unsure about the origin of the cells in urine, we can stain a urine sediment with Wright's stain (or Diff-quik) and perform a cytologic examination on the urine sediment. Epithelial cells are subjectively semi-quantified in urine (usually under low power using the 10x objective) as: none seen, few, moderate, many Neoplastic cells of renal, urinary or reproductive origin can exfoliate in the urine and a urinalysis is definitely indicated if a tumor in one of these sites is suspected in the animal. Examination of a regular urine sediment preparation can be the first clue to identification of neoplastic cells, however the diagnosis of neoplasia is based on cytologic criteria of malignancy in the cells, which are not easy to discern in these wet preparations. Thus, we recommend that a cytologic analysis of the urine (using a standard hematologic stain, such as Wright's stain) is performed if neoplasia is suspected. For more information on the types of epithelial cells seen in urine, click on the links in the table below or scroll down. Transitional Renal tubular Squamous Neoplasia

For a compilation of images, please refer to the urine sediment atlas.

Transitional epithelial cells The urinary tract from the pelvis down the ureters to the bladder and the proximal urethra is lined by transitional epithelial cells. These cells vary in size and shape depending on the location from which they originate, e.g. those from the renal pelvis are more caudate whereas those from the bladder are more round to polygonal and vary in size. These cells naturally slough into the urine in quite low numbers, so none to a few transitional epithelial cells are seen in the urine from healthy animals. Note that this depends on the method of urine collection, since these cells will be sloughed (traumatically) when the bladder is catheterized. Transitional epithelial cells must be distinguished from WBC, because they both have the same granular appearance. In general, transitional epithelial cells (arrow in above image) are larger and have more irregular borders than WBC (which are uniformly more round, arrowhead in above image). up

Squamous epithelial cells

These can be keratinized or non-keratinized. Non-keratinized squamous epithelial cells originate from the distal urethra, prepuce and/or vagina. They are larger than transitional cells and have small central nuclei. They can be round or have one or more flat border. Keratinized squamous epithelial cells are from the skin or vulva and are large cells with angular borders. They may or may not have nuclei (see upper image to the right). Nuclei are more visible in cells when the urine is stained with Sedi-stain (see central panel on right). If in doubt about the origin of the cells, a Wright's stain (routine hematologic stain) can be performed on a urine sediment and demonstrates the central nuclei and angular borders of squamous epithelial cells (lower panel on right). Squamous cells are frequently seen as contaminants in voided urine samples and can also contaminate samples collected by catheterization. Urine collected by cystocentesis should not contain any squamous epithelial cells. Note that although these cells are considered contaminants, large numbers may represent abnormal genitourinary conditions, specifically squamous metaplasia of the prostate in the dog. This occurs secondary to excess estrogen, usually secreted by testicular tumors (particularly Sertoli cell tumors, but this has also been reported with interstitial cell tumors). up

Renal tubular epithelial cells These are rarely seen in the urine and, as mentioned above, are very difficult to distinguish from transitional epithelial cells. If large numbers of smaller epithelial cells of uniform appearance (size and shape) are observed in the urine, a renal origin for these cells is suspected. Transitional epithelial cells tend to be more variable in size and shape (to some extent). Sloughing of large numbers of renal tubular epithelial cells would indicate renal tubular injury. up

Neoplasia Neoplastic cells, typically those of transitional epithelial origin (transitional cell carcinoma or TCC) may slough into the urine. The presence of these cells can be diagnostic of urinary neoplasia, however they are not always seen in the urine in affected animals (i..e. the lack of these cells in a urinalysis does not rule out neoplasia). TCC are more common in dogs and frequently originate in the trigone of the urinary bladder, although the prostatic urethra and urethra per se is a common site in male and female dogs, respectively (prostatic urethra TCC often invade the prostate and mimic primary prostatic carcinomas in male dogs). Diagnosis of neoplasia depends upon the identification of cytologic criteria of malignancy in the epithelial cells, e.g. marked variation in nuclear and cell size (called anisokaryosis and anisocytosis, respectively), multiple nucleoli of variable size within one The upper panel demonstrates large neoplastic epithelial cells in an unstained urine sediment nucleus, multinucleation with intracellular from a dog with a bladder mass. The lower anisokaryosis, macronucleoli. These features demonstrates that these cells display are only reliably discernable in cytologic smears panel clear cytologic criteria of malignancy in a (stained with a hematologic stain such as DiffWright's stained cytology smear of the urine. quik or Wright's stain) and are difficult to impossible to identify with confidence in an unstained preparation of urine (see image on right). Thus, a urine cytology should be performed on animals with suspected tumors. TCC usually invade the bladder wall and cause hemorrhage. They may also become secondarily inflamed from necrosis or a superimposed bacterial infection. Thus, hematuria and, to a lesser extent, pyuria, can be features of a urinalysis in animals with TCC. Rarely, other tumors originating in the bladder or kidney (e.g. lymphoma, renal carcinoma) can exfoliate into the urine. Pictured below are images from an unstained and Wright's stained urine sediment from a cat with renal lymphoma. The neoplastic lymphoblasts had exfoliated into the urine and provided the diagnosis in this case.

Unstained urine sediment from a cat A Wright's stained smear revealed demonstrating a large uniform round numerous leukocytes (neutrophils, cell with a high nuclear to cytoplasmic with phagocytized bacterial rods) and ratio (arrow; a similar cell is observed moderate numbers of large round cells at the top, the other cells are with round nuclei, small amounts of interpreted as transitional epithelial deep blue cytoplasm and high nuclear cells). This was not a normal finding to cytoplasmic ratios (arrow). This in urine, hence a cytospin smear of the was diagnostic for lymphoma, which urine was prepared and stained with originated from the cat's kidney. This Wright's stain for cytology. phenomenon is quite rare.

How to Get Rid of Mucus in Urine After confirming the underlying condition, treatment options will vary from use of antibiotics to changes in dietary guidelines.

The mucus is a sticky, thick fluid like substance released by the mucous membrane, a tissue that covers the interior surface of various organs such as the lungs, urinary tract and the large intestine (colon). The mucus makes the intestinal passage slippery, thereby ensuring unobstructed movement of the fecal matter. As aforementioned, the mucous membrane is also found covering the inner surface of the urinary tract, which primarily consists of organs like kidneys, urethra, bladder and the ureters. The urine is acidic in nature and so the inner wall of the urinary tract can get damaged due to high acidity of the urine. However, this does not happen as it is covered with the thick mucous membrane. So, is mucus in urine normal? Although detection of mucus threads in urine is not an issue, too much of mucus is indicating something wrong with the urinary tract and the large intestine. The following article discusses ways of getting rid of mucus.

Antibiotics Antibiotics such as amoxicillin is the first line of treatment when mucus in urine is the result of a urinary tract infection (UTI). UTI is triggered by bacterial growth and can strike any part of the urinary system (kidneys, bladder, urethra, ureters or the prostate). A UTI is typically marked by painful urination, pelvic pain and a restless desire to urinate frequently. A 7 day antibiotic course is enough to cure the infection.

A sexually transmitted infection caused by the bacteria chlamydia can also be responsible for causing mucus in urine. In this case also the patient is put on antibiotics like erythromycin, which helps to get rid of the infection within a week or two. Having a sexual intercourse with partners affected with chlamydia is the reason why more than 3 million Americans fall victims to this infection every year. Discomfort during sexual intercourse, painful urination and penile or vaginal discharge are some of the most common symptoms associated with sexually transmitted diseases.

Dietary Changes Mucus in urine can also be due to irritable bowel syndrome (IBS) and in such circumstances, eliminating certain foods that aggravate this condition is a must. A person diagnosed with IBS typically experiences bloating, abdominal pain, gas and bowel dysfunction that appears in the form of constipation and diarrhea. IBS interferes with the normal functioning of the large intestine, hence healthy bowel movement is a distant possibility in IBS patients. As the cause of this intestinal disorder is not known, treatment is given to alleviate symptoms. By simply staying away from gassy foods like broccoli, cabbage and cauliflower as well as from carbonated beverages, one might experience relief from bloating. Eating vegetables in raw form should also be avoided as it can cause build up of gas, ultimately leading to bloating and abdominal discomfort. Apart from dietary changes, anti-diarrhea medicines or fiber supplements like Metamucil may be prescribed to restore healthy bowel function.

Anti-inflammatory Medicines Mucus in urine can also occur as a consequence of ulcerative colitis, a condition in which the lining of the colon appears swollen. This is followed by ulcers in the inner wall of the colon. The development of ulcers inflicts damage upon the mucous membrane lining the colon. This leads to excess production of mucus, which may eventually mix with urine. This inflammatory condition that strikes the large intestine is usually treated with anti-inflammatory drugs like sulfasalazine, corticosteroids and mesalamine that can play a crucial in managing symptoms of ulcerative colitis.

Mucus in urine test is often referred to as urinalysis that verifies the clarity of urine. Presence of too much mucus or bacteria turns the urine cloudy. Urine not appearing clear can be easily detected in urinalysis and so if the test results reveals cloudy urine, it should not be ignored and necessary medical treatment should be given depending upon the underlying cause. Read more at Buzzle: