Is a urinalysis (urine analysis) done in patients with Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)?

Urinalysis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)

Yes, urinalysis is routinely performed as part of the initial laboratory workup in patients with SJS/TEN to monitor renal function and detect urogenital involvement. 1

Rationale for Urinalysis in SJS/TEN

Urinalysis serves several important purposes in SJS/TEN management:

1. Assessment of urogenital involvement

   • Urogenital tract involvement occurs frequently in SJS/TEN with mucosal erythema, blistering, and erosions
   • Urinary dysfunction (dysuria or retention) is common during the acute phase 1
   • Secondary infections (bacterial or candida) frequently complicate urogenital involvement

2. Monitoring renal function

   • Part of the standard laboratory workup alongside blood tests
   • Helps assess overall organ function and detect complications

3. Prevention of long-term complications

   • Serious morbidity can develop including strictures and stenosis of the urethra
   • Early detection of urogenital involvement allows for preventive measures

Initial Assessment Protocol

According to the British Journal of Dermatology guidelines, the following investigations should be performed in all SJS/TEN patients:

• Full blood count, ESR, CRP, urea and electrolytes, magnesium, phosphate, bicarbonate, glucose, liver function tests, coagulation studies, and mycoplasma serology
• Chest X-ray
• Skin biopsy
• Swabs from lesional skin for bacteriology
• Documentation of skin lesions 1

Management of Urogenital Involvement

When urogenital involvement is detected:

1. Urinary catheterization

   • Insert a urinary catheter when urogenital involvement is indicated
   • Catheterization prevents strictures forming in the urethra
   • Catheterization allows accurate output monitoring to assist fluid replacement 1

2. Regular examination

   • Examine the urogenital tract as part of the initial assessment
   • Daily documented urogenital review during the acute illness
   • For women: early assessment by a vulval specialist for consideration of dilators to prevent vaginal synechiae 1

3. Topical treatments

   • Apply white soft paraffin ointment to urogenital skin and mucosae every 4 hours
   • Use Mepitel dressings on eroded areas to reduce pain and prevent adhesions
   • Consider potent topical corticosteroid ointment once daily on involved, non-eroded surfaces 1

Monitoring and Prevention of Complications

• Maintain accurate fluid balance charts to monitor input and output
• Watch for signs of secondary infection
• Monitor for development of strictures or synechiae
• Early intervention can prevent long-term urogenital complications

Common Pitfalls to Avoid

1. Failure to catheterize: Not inserting a urinary catheter when urogenital involvement is present can lead to stricture formation and long-term urinary dysfunction

2. Inadequate monitoring: Neglecting daily urogenital examination can miss progressive involvement or complications

3. Overlooking female-specific care: Not providing early vulval specialist assessment in women can result in vaginal synechiae

4. Inadequate lubrication: Insufficient application of emollients can worsen pain and healing

The management of SJS/TEN requires a comprehensive approach with attention to all affected organ systems, including the urogenital tract. Proper urinalysis and urogenital care are essential components of the overall management strategy to reduce morbidity and improve outcomes.