1. Proteinuria Hub A brief introduction of proteinuria, followed by links to overviews, research articles, case reports and clinical trials. proteinuria by Gerri Schulman, MD. http://www.projectlinks.org/proteinuria/

Proteinuria is a condition in which urine contains an abnormal amount of protein. People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. Proteinuria may be a sign that your kidneys are damaged and that you are at risk for end-stage renal disease. You may have proteinuria without noticing any signs or symptoms. Testing is the only way to find out how much protein you have in your urine. Groups at risk for proteinuria and kidney failure include African Americans, American Indians, Hispanic Americans, Pacific Islander Americans, people who are older or overweight, and people who have a family history of kidney disease. Acne Allergy Antibiotics Antioxidants ... Evaluating Proteinuria in Children - by Mahmoud Loghman-Adham, M.D., University of Utah School of Medicine, Salt Lake City, Utah. Evaluation of Asymptomatic Proteinuria - by Vanderbilt University Medical Center. Genitourinary and Renal Disease: Proteinuria, Nephrotic Syndrome, and Nephritic Urine Proteinuria from the Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University Proteinuria: Causes - by the College of Veterinary Medicine at Cornell University. Proteinuria and renal disease progression - by Giuseppe Remuzzi, MD., Mario Negri Institute for Pharmacological Research.

2. Proteinuria Back to table of contents. proteinuria. The child with protein in their urine is a common finding in pediatric practice. Protein may be found in the urine of healthy children. The incidence increases http://pedclerk.bsd.uchicago.edu/proteinuria.html

Back to table of contents Proteinuria The child with protein in their urine is a common finding in pediatric practice. Protein may be found in the urine of healthy children. The incidence increases with age and the majority of protein is albumin. Mechanism of Proteinuria Increased glomerular filtration. The protein must pass through the glomerular capillary wall. Nephrotic Syndrome- minimal change disease and focal glomerulosclerosis Glomerulonephritis Drugs Decreased tubular reabsorption. Most filtered protein is reabsorbed proximally. With tubular damage, there will be increased protein in the urine Transport defects- Fanconi's Syndrome, Cystinosis Toxins- Penicillins, Heavy metals, Aminoglycosides, old tetracycline Ischemic injury- shock, ATN, Endotoxemia Obstructive uropathy, Polycystic disease Increased secretion - normally some protein is secreted but may increase with exercise, acute renal failure, transplant rejection, and stones. Detection of Protein in the Urine Dipsticks - Very sensitive and changes color secondary to reaction of tetrabromophenol with amino acids. Have false positives with ph >8, concentrated urine, long immersion time, or presence of wbcs or bacteria. Reading of 1+ needs to rechecked and if continues positive, timed collections should be done. Timed Collection - technically may be difficult. Doesn't allow for diurnal variations and effect of activity on proteinuria. In adults, >150 mg. 24 hours is positive. In children, > 4 mg./metered squared/hour is positive.

3. Proteinuria In Adults: A Diagnostic Approach - September 15, 2000 - American Fam proteinuria is a common finding in adults in primary care practice algorithmic approach can be used to differentiate benign causes of proteinuria from rarer, more serious disorders http://www.aafp.org/afp/20000915/1333.html

Advanced Search Proteinuria in Adults: A Diagnostic Approach MICHAEL F. CARROLL, M.D., and JONATHAN L. TEMTE, M.D., PH.D. University of Wisconsin-Madison Medical School, Madison, Wisconsin PROBLEM-ORIENTED DIAGNOSIS P roteinuria on initial dipstick urinalysis testing is found in as much as 17 percent of selected populations. Although a wide variety of conditions, ranging from benign to lethal, can cause proteinuria, fewer than 2 percent of patients whose urine dipstick test is positive for protein have serious and treatable urinary tract disorders. A knowledgeable approach to this common condition is required because the diagnosis has important ramifications for health, insurance eligibility and job qualifications. TABLE 1 Common Causes of Benign Proteinuria Dehydration Emotional stress Fever Heat injury Inflammatory process Intense activity Most acute illnesses Orthostatic (postural) disorder Definition of Proteinuria Twenty-four hundred years ago, Hippocrates noted the association between "bubbles on the surface of the urine" and kidney disease. Today, proteinuria is defined as urinary protein excretion of greater than 150 mg per day. Urinary protein excretion in healthy persons varies considerably and may reach proteinuric levels under several circumstances. Most dipstick tests (e.g., Albustin, Multistix) that are positive for protein are a result of benign proteinuria, which has no associated morbidity or mortality (

4. Proteinuria An introduction, a look at who is at risk, signs if this disease and kidney failure, testing, treatment, research, points to remember and resources. From The National Kidney and Urologic Diseases Information Clearinghouse. http://www.niddk.nih.gov/health/kidney/pubs/proteinuria/proteinuria.htm

Email To A Friend Home : Proteinuria Proteinuria On this page: Who is at risk? What are the signs of proteinuria and kidney failure? What are the tests for proteinuria? How is proteinuria treated? ... For More Information Proteinuria describes a condition in which urine contains an abnormal amount of protein. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in your blood also perform a number of important functions. They protect you from infection, help your blood coagulate, and keep the right amount of fluid circulating through your body. As blood passes through healthy kidneys, they filter the waste products out and leave in the things the body needs, like proteins. Most proteins are too big to pass through the kidneys' filters into the urine unless the kidneys are damaged. The main protein that is most likely to appear in urine is albumin. Albumin is smaller and therefore more likely to escape through the filters of the kidney, called glomeruli. Sometimes the term albuminuria is used when the test detects albumin specifically. Albumin's function in the body includes retention of fluid in the blood. It acts like a sponge, soaking up fluid from body tissues. Inflammation in the glomeruli is called glomerulonephritis

5. Asymptomatic Proteinuria Looks at what this disorder is, the causes, the protein, further investigation, treatment and where to get more information. http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/ProteinuriaLong.html

Asymptomatic Proteinuria from EdREN , the website of the Renal Unit of the Royal Infirmary of Edinburgh What is proteinuria? What causes proteinuria What is the protein? Is the proteinuria always a bad thing? ... Where can I find further information? What is proteinuria? Proteinuria means the appearance of protein in the urine. It is usually detected by a simple dipstick test of the urine. In some circumstances it is detected on a routine check. Usually there are no symptoms from it. What causes proteinuria? Protein should not normally appear in the urine in detectable quantities. It is usually kept in the blood by the filtering units (glomeruli) within the kidney. Proteinuria is an indicator that the kidneys are damaged in some way. Diseases that affect the filtering units themselves are the most common cause of heavy proteinuria. Sometimes this is called glomerulonephritis, meaning inflammation of the glomeruli. Just as some examples, any of the causes of nephrotic syndrome could be causes of proteinuria. What is the protein?

6. Proteinuria Continuing education for nurses online. will be able to Define proteinuria. Explain protein handling mechanisms of normal kidneys. Describe the measurement of proteinuria. Identify four classifications of proteinuria http://www.nursingceu.com/NCEU/courses/proteincc

Proteinuria Author: Cheryl Curtis, MSN, RN, CNN 1 contact hour Course posted February 28, 2003 Course expires February 28, 2005 Course Objectives Upon completion of this course the learner will be able to: Define proteinuria. Explain protein handling mechanisms of normal kidneys. Describe the measurement of proteinuria. Identify four classifications of proteinuria. List the complications of proteinuria. Introduction Proteinuria is a condition in which urine contains an excess amount of protein. Proteinuria is often one of the first signs of renal disease and is often asymptomatic. Proteinuria is a finding in almost every form of glomerular disease. Protein Handling in Normal Kidneys In a healthy kidney, the glomerular capillary wall acts as a barrier to prevent proteins from entering the urine based on size and electrical charge of the proteins. This is dependent on the integrity of the capillary wall. The glomerular capillary wall consists of three layers: the fenestrated endothelium, the glomerular basement membrane, and the epithelial cells attached to the glomerular basement membrane. The primary barrier to the filtration of protein is the glomerular basement membrane. If the glomerulus is intact, only trace amounts of albumin escape in the glomerular filtrate. Proteins that are smaller than albumin (

7. Proteinuria And Microalbuminuria - Nephrologychannel proteinuria is a kidney disorder resulting in an abnormally high amount of protein in the urine. Microalbuminuria is a type of proteinuria. http://www.nephrologychannel.com/proteinuria/

Home Search SiteMap Ask the Dr. ... Medical Store advertisement advertisement MICROALBUMINURIA Overview Types Cause Symptoms ... Treatment CONDITIONS Acute Glomerulonephritis (AGN) Acute Interstitial Nephritis (AIN) Acute Renal Failure (ARF) Acute Tubular Necrosis (ATN) Anemia Chronic Renal Failure Diabetic Nephropathy Hematuria ... Nephrotic Syndrome (NS) Polycystic Kidney Disease Microalbuminuria Renal Artery Stenosis (RAS) Renal Vascular Hypertension (RVH) TREATMENT OPTIONS Hemodialysis Peritoneal Dialysis Kidney Transplant RELATED CONDITIONS Electrolyte Imbalance Hemolytic Uremic Syndrome (HUS) Thrombotic Thrombocytopenic Purpura (TTP) RESOURCES Anatomy Links Clinical Trials Videos ... What Is a Nephrologist? ABOUT US Healthcommunities.com Pressroom Testimonial Bibliography Overview Proteinuria is an abnormally high amount of protein in the urine. Proteins in the blood, like albumin and immunoglobulin, help coagulation (clotting), balance bodily fluids, and fight infection. The kidneys remove wastes from protein-rich blood through millions of tiny filtering screens called glomeruli. Most proteins are too large to pass through the glomeruli into the urine. The glomeruli are negatively charged, so they repel the negatively charged proteins. Thus, a size and charge barrier keeps protein molecules from entering the urine. But when the glomeruli are damaged, proteins of various sizes pass through them and are excreted in the urine.

8. Information From Your Family Doctor proteinuria in children A look at the role of protein in the body, what this disorder is, treatment and how to do a 24 hour urine collection. http://familydoctor.org/handouts/329.html

Advanced Search familydoctor.org Home For Parents Proteinuria What's the role of proteins in the body? What is proteinuria? What is orthostatic proteinuria? How is proteinuria treated? ... How do I do a 24-hour urine collection? Proteinuria in Children Printer-friendly version Email this article What's the role of proteins in the body? Proteins are essential in our bodies. Normally, proteins move around in our blood, carrying food, hormones and medicine to all parts of the body. They also help keep water inside tiny blood vessels. Return to top What is proteinuria? Proteinuria is the name of a medical condition. It means protein is in the urine. As blood moves through the kidneys, the kidneys filter out waste products, excess fluid and salts. The clean blood cycles back through the body. Most proteins are too big to go through the kidneys, so usually no protein is found in urine. If your doctor finds protein in your child's urine, that means your child's kidney may not be working as they shouldpossibly because of inflammation (swelling). Sometimes infection or toxic chemicals damage the kidneys, and this makes protein show up in the urine. Dipping a special strip of paper into a sample of urine tells your doctor if protein is in it. If only a little protein is in the urine, your child probably has a benign (harmless) condition such as orthostatic proteinuria (see below). Your doctor might do a few other tests to make sure.

9. Free Online CME: Proteinuria Send this activity. to a colleague. proteinuria. Lesson Release Date 1/9/03. Lesson Expiration Date 1/9/05. Target AudienceDirected to primary care physicians including family practitioners and internists. Objectives Recite the definition of abnormal proteinuria. Describe how to evaluate proteinuria. Discuss the significance of http://www.clevelandclinicmeded.com/decisionmaking/proteinuria/intro1.asp

Send this activity to a colleague PROTEINURIA Lesson Release Date: 1/9/03 Lesson Expiration Date: 1/9/05 Target Audience: Directed to primary care physicians including family practitioners and internists. Objectives After completing this case, the participant should be able to: Recite the definition of abnormal proteinuria Describe how to evaluate proteinuria Discuss the significance of orthostatic proteinuria Explain what criteria to use to refer a patient to a kidney specialist Lesson Design Each lesson within the Clinical Decisions series includes an interactive case, supporting educational materials from leading medical journals and national practice guidelines, a CME test and an evaluation. Throughout the interactive case, you may proceed to the next question once you answer each question correctly. In addition to allowing you to proceed, the correct answer also reveals the rationale for the answer. In the CME test section, you may not proceed until you select the correct answer.

10. KDOQI CKD Guidelines In this guideline, the term proteinuria refers to increased urinary excretion of albumin for detection and monitoring of proteinuria in adults and children differ because http://www.kidney.org/professionals/doqi/kdoqi/p5_lab_g5.htm

NKF K/DOQI GUIDELINES Executive Summaries of 2000 Updates Anemia Hemodialysis Peritoneal Dialysis ... History of DOQI K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification PART 5. EVALUATION OF LABORATORY MEASUREMENTS FOR CLINICAL ASSESSMENT OF KIDNEY DISEASE GUIDELINE 5. ASSESSMENT OF PROTEINURIA Guidelines for Adults and Children It is usually not necessary to obtain a timed urine collection (overnight or 24-hour) for these evaluations in either children or adults. First morning specimens are preferred, but random specimens are acceptable if first morning specimens are not available. In most cases, screening with urine dipsticks is acceptable for detecting proteinuria: Standard urine dipsticks are acceptable for detecting increased total urine protein. Albumin-specific dipsticks are acceptable for detecting albuminuria. Patients with a positive dipstick test (1+ or greater) should undergo confirmation of proteinuria by a quantitative measurement (protein-to-creatinine ratio or albumin-to-creatinine ratio) within 3 months. Patients with two or more positive quantitative tests temporally spaced by 1 to 2 weeks should be diagnosed as having persistent proteinuria and undergo further evaluation and management for chronic kidney disease as stated in Guideline 2 Monitoring proteinuria in patients with chronic kidney disease should be performed using quantitative measurements.

11. Proteinuria proteinuria. renal disease obstructive nephropathy orthostatic proteinuria; early morning urine normal http://www.geocities.com/davidscerri/proteinuria.htm

PROTEINURIA renal disease: glomerulonephritis [various causes; commonest is diabetes mellitus] urinary tract infection obstructive nephropathy [orthostatic proteinuria; early morning urine normal] renal vein thrombosis (+ haematuria + loin pain) chronic interstitial nephritis eg. analgesic nephropathy nephrotic syndrome tubular disease [tubular proteinuria; very rare; proteinuria is mainly globulins]: Fanconi syndrome recovery phase of acute tubular necrosis heavy metal poisoning cystinosis extra-renal causes: congestive heart failure constrictive pericarditis postural (orthostatic) proteinuria transient in febrile illnesses following heavy exercise pregnancy multiple myeloma (Bence-Jones proteins; pass through normal glomeruli) click here to return to the main contents page of Differential Diagnoses in General Medicine

12. Proteinuria Defines proteinuria and discusses who is at risk. Reviews the signs of proteinuria and provides information about testing procedures and treatment options. http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/

Email To A Friend Home : Proteinuria Proteinuria On this page: Who is at risk? What are the signs of proteinuria and kidney failure? What are the tests for proteinuria? How is proteinuria treated? ... For More Information Proteinuria describes a condition in which urine contains an abnormal amount of protein. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in your blood also perform a number of important functions. They protect you from infection, help your blood coagulate, and keep the right amount of fluid circulating through your body. As blood passes through healthy kidneys, they filter the waste products out and leave in the things the body needs, like proteins. Most proteins are too big to pass through the kidneys' filters into the urine unless the kidneys are damaged. The main protein that is most likely to appear in urine is albumin. Albumin is smaller and therefore more likely to escape through the filters of the kidney, called glomeruli. Sometimes the term albuminuria is used when the test detects albumin specifically. Albumin's function in the body includes retention of fluid in the blood. It acts like a sponge, soaking up fluid from body tissues. Inflammation in the glomeruli is called glomerulonephritis

13. Connecticut Children's Medical Center: Nephrology Provides primary and consultative services to patients with a variety of renal disorders including hematuria, proteinuria, nephrotic syndrome, acute renal failure, recurrent urinary tract infection, congenital renal anomalies including hydronephrosis and cystic diseases of the kidneys, kidney stones, chronic renal failure, end stage renal disease, hypertension, and a variety of fluid and electrolytes disorders. http://www.ccmckids.org/departments/neph.htm

Staff Office Locations The Division provides primary and consultative services to patients with a variety of renal disorders including hematuria, proteinuria, nephrotic syndrome, acute renal failure, recurrent urinary tract infection, congenital renal anomalies including hydronephrosis and cystic diseases of the kidneys, kidney stones, chronic renal failure, end stage renal disease, hypertension, and a variety of fluid and electrolytes disorders. In collaboration with Hartford Hospital's dialysis and transplant program, the Nephrology Division provides acute and chronic peritoneal and hemodialysis as well as renal transplantation. Staff Majid Rasoulpour, M.D. - Director mrasoul@ccmckids.org University of Tehran, 66 University of Tehran, 70, M.D. Internship/Residency: Lawrence General Hospital (MA), Rotating, 73-74; University of Connecticut, Pediatrics, 74-76; Fellowship: University of Connecticut, Pediatric Nephrology, 76-78 Board Certification: Pediatrics, 78; Pediatric Nephrology, 82

14. How To Manage Asymptomatic Proteinuria How to manage asymptomatic proteinuria. Nephrotic level proteinuria usually requires renal biopsy to establish the cause, unless this is immediately evident. http://renux.dmed.ed.ac.uk/EdREN/Unitbits/ProtGuide.html

How to manage asymptomatic proteinuria A guideline for medical practitioners from EdREN , the website of the Renal Unit, Royal Infirmary of Edinburgh. Jump to summary of monitoring for low-risk patients Note that this guidance excludes pregnancy , and nephrotic level proteinuria Establish that the result is a true positive: Check separate samples including early morning. Persistent proteinuria on stick testing is abnormal and implies intrinsic renal disease. Exclude the following: fever urine infection exercise-induced proteinuria 'orthostatic proteinuria' - absent in early morning sample* *Though this requires monitoring, and may require further investigation if levels of protein are high Establish also that the finding is consistent Investigations Assess history blood pressure renal function , seek evidence for diabetes mellitus (random blood glucose and glycosylated Hb). The presence of the following increase the likelihood of significant renal disease, and indicate that further nephrological investigations are appropriate: Factors increasing likelihood of renal disease haematuria also present raised serum creatinine (if renal function is deteriorating, investigation is urgent)

15. Proteinuria 05/03 160 proteinuria Normal urine contains only a tiny amount of protein, with albumin being one type The normal cutoff for proteinuria (protein in the urine) is less http://www.thebestga.com/proteinuria.pdf

16. Proteinuria For Internal Use Only. Not For Use With The Public. and is not personal medical advice for clients.proteinuria Normal urine contains only a tiny amount of protein The normal cutoff for proteinuria (protein in the urine) is less http://fm-inc.fileburst.com/pdf/Questionnaires/Proteinuria.pdf

17. Evaluating Proteinuria In Children - October 1, 1998 - American Academy Of Famil Evaluating proteinuria in Children. MAHMOUD LOGHMANADHAM, MD, University of Utah School of Medicine, Salt Lake City, Utah, Mechanisms of proteinuria. http://www.aafp.org/afp/981001ap/loghman.html

Advanced Search Articles Departments Patient Information Evaluating Proteinuria in Children MAHMOUD LOGHMAN-ADHAM, M.D., University of Utah School of Medicine, Salt Lake City, Utah A patient information handout on proteinuria, written by the author of this article , is provided on page 1158. Proteinuria is a common laboratory finding in children. It can be identified as either a transient or a persistent finding and can represent a benign condition or a serious disease. A rapid but qualitative assessment of proteinuria can be made using dipstick or sulfosalicylic acid methods. More precise quantitation is obtained by measuring protein excretion in 24-hour urine samples or by calculating the protein/creatinine ratio in random urine samples. Orthostatic proteinuria is a benign condition characterized by the presence of protein in urine samples collected in the upright position during the day and its absence in samples collected in the supine position. Persistent proteinuria and proteinuria associated with hematuria or other signs of renal disease carry a more severe prognosis. The latter conditions require referral to a pediatric nephrologist for further evaluation, which may include renal biopsy. M ost healthy children excrete small amounts of protein in their urine, representing so-called physiologic proteinuria.

18. Virtual Naval Hospital: General Medical Officer Manual: Clinical Section General Medical Officer (GMO) Manual Clinical Section Urologic/Renal Disorders. proteinuria. Department of the Navy. Bureau of Medicine and Surgery. Peer Review Status Internally Peer Reviewed( 1) http://www.vnh.org/GMO/ClinicalSection/104Proteinuria.html

General Medical Officer (GMO) Manual: Clinical Section: Urologic/Renal Disorders Proteinuria Department of the Navy Bureau of Medicine and Surgery Peer Review Status: Internally Peer Reviewed (1) Introduction Proteinuria may be the first and only evidence of renal disease. Most healthy persons excrete up to 150 mg of urinary protein daily, which may vary from negative to 2+ on urine dipstick analysis. Although the prevalence of proteinuria on routine screening of healthy individuals has been as high as 3.5 percent, the incidence of renal disease in this population is very low. It is clear that the discovery of proteinuria necessitates a thorough evaluation to separate these healthy individuals from those with significant renal disease. (2) Urinalysis (3) Evaluation Once proteinuria is detected by dipstick, the next step should be to obtain a detailed history, physical exam, and urine microscopy. This includes family history as well as prior evaluations and medications (i.e., NSAIDs). The exam should look for evidence of renal or systemic disease, focusing on blood pressure, pulse, fundi, cardiovascular, skin, abdominal (palpable kidneys or bruits), and the presence or absence of edema. (4) Functional Proteinu ria If no such evidence is found, repeat dipstick analysis should be done two or three times. If these subsequent qualitative tests, in well-concentrated specimens, are negative for protein, the initial proteinuria is transient or functional. Functional proteinuria may be seen in conditions such as high fever, emotional stress, cold exposure, strenuous exercise, infection, and other acute medical illnesses. Idiopathic transient proteinuria is a common cause of proteinuria in young adults, especially men. It is characterized by proteinuria on a routine urinalysis that disappears on repeat testing and is found in asymptomatic, healthy individuals with normal renal function.

19. Proteinuria - Wikipedia, The Free Encyclopedia proteinuria. From Wikipedia, the free encyclopedia. proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine. http://en.wikipedia.org/wiki/Proteinuria

Proteinuria From Wikipedia, the free encyclopedia. Proteinuria (from protein and urine ) means the presence of an excess of serum proteins in the urine Serum protein that get filtered into primary urine are readily absorbed. If protein is present in urine sample it usually means some damage to renal structures or excess of some pathologic protein in serum. With gross proteinuria hypoproteinemia can develop and it results in diminished oncotic pressure ( ascites edema , hydrothorax). Proteinuria is a leading symptom of: nephrotic syndromes eclampsia toxic lesions of kidneys edit Related topics albuminuria microalbuminuria Views Article Discussion Edit History Personal tools Log in Navigation Main Page Community portal Current events Recent changes ... Donations Search Toolbox What links here Related changes Special pages This page was last modified 21:50, 7 Mar 2004. All text is available under the terms of the GNU Free Documentation License (see for details). About Wikipedia

20. Proteinuria This particular chapter, authored by PM Hall, MD, deals with proteinuria. The Cleveland Clinic. Clinical proteinuria, 300. 200. 300. PREVALENCE. http://www.clevelandclinicmeded.com/diseasemanagement/nephrology/proteinuria/pro

Published May 29, 2002 Reviewed December 17, 2003 P.M. Hall, MD Department of Nephrology Print Chapter The Cleveland Clinic Foundation Definition Prevalence Pathophysiology Signs and ... References National Guidelines National Kidney Foundation: Assessment of Proteinuria DEFINITION Proteinuria usually reflects an increase in glomerular permeability for normally non-filtered plasma macromolecules such as albumin. A 24-hour urine collection containing more than 150 mg of protein is abnormal. Significant proteinuria is suspected when a dipstick test of the urine is persistently positive for protein. In such a situation the daily protein excretion will usually exceed 300-500 mg per day. Since the dipstick method can detect urine protein concentration of as little as 30 mg/dL, a very concentrated urine specimen might test positive for protein even though the quantitative amount of proteinuria is less than 150 mg/day. of proteins in the urine. The SSA test is carried out by mixing 1 part urine supernatant (eg, 2.5 mL) with 3 parts 3% sulfosalicylic acid and grading the resultant turbidity

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