Patients with ureteral stents may experience urinary frequency, urgency, dysuria, flank pain, and hematuria.10 They may have dull flank pain that becomes sharp with voiding. At least 10 million Americans suffer from incontinence, which means that they are not able to control the times when they urinate. ", Urology Care Foundation: "What is a Urinalysis? This content is owned by the AAFP. Oral Glucose Tolerance Test: Uses and Results. A microscopic exam checks for things too small to be seen otherwise. C. The patient may have diabetes mellitus. Coverage of diabetic supplies varies by insurance plan, but most private and public insurance plans (like Medicaid and Medicare) cover urine glucose tests. People with diabetes can do a urine test at home if they start to experience the signs and symptoms of DKA. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Getting a diagnosis of diabetes can be shocking and life-altering, but the good news is that there are steps that you can help you take to maintain adequate control of your blood sugar levels. Dysmorphic erythrocytes, which have odd shapes because of their passage through an abnormal glomerulus, suggest glomerular disease. In glomerular proteinuria, the most common type, albumin is the primary urinary protein. Yes, you can test for several things, including glucose, ketones, bilirubin, and more at home. Depending on the results, they will advise on the next steps. We avoid using tertiary references. Diabetes and your eyes, heart, nerves, feet, and kidneys. A urinalysis is a simple test that looks at a small sample of your urine. Urinary tract infection. However, healthcare professionals may use a urine test if they cannot access a vein for a blood test, or if a person has anxiety or a fear of needles. For example, if your results are only slightly abnormal and you dont have any other symptoms of an illness, your doctor may not do other tests. When glucose levels are too high, the kidneys excrete the excess amount in the urine. Results of a 24-hour urine analysis are as follows: Total volume = 5L Total glucose = 375 g Total creatinine = 2.4 g A doctor may test for protein in the urine to monitor for kidney problems. Specific gravity provides a reliable assessment of the patients hydration status. A small amount of glucose in your urine is normal. Liman, M., Jialal, I., Physiology, Glycosuria, StatPearls Publishing, 2021. Glucose is not usually found in urine, so any glucose that is found merits further testing. In healthy persons, the glomerular capillary wall is permeable only to substances with a molecular weight of less than 20,000 Daltons. D. Inform him that no treatment is needed. The presence of a ureteral stent causes mucosal irritation and inflammation; thus, findings of leukocyte esterase with white and red blood cells are not diagnostic for urinary tract infection, and a urine culture is required. It can affect people with both type 1 and type 2 diabetes. Knowing as soon as possible whether their blood sugar levels are high means a person can take measures to prevent the condition from worsening. SHARP, MD, DANIEL K. LEE, MD, AND ERIC J. ASKELAND, MD. Some of the topics you'll be assessed on include renal glucosuria as well as the effects of Cushing's disease. Glomerular hematuria typically is associated with significant proteinuria, erythrocyte casts, and dysmorphic RBCs. Diabetes is best managed with lifestyle changes and medications., Not everyone with glycosuria is unwell or needs treatment. Too much glucose can damage your organs and nerves, but your body does need enough sugar for energy.. Dipstick urinalysis is convenient, but false-positive and false-negative results can occur. Urine dipstick testing and microscopy are useful for the diagnosis of several genitourinary and systemic conditions.1,2 In 2005, a comprehensive review of urinalysis was published in this journal.3 This article presents a series of case scenarios that illustrate how primary care physicians can utilize the urinalysis in common clinical situations. The ADA recommend screening for type 2 diabetes from the age of 45 years or earlier if a person has risk factors, such as obesity. See permissionsforcopyrightquestions and/or permission requests. A patient's urinalysis reveals the presence of glucose. English, science, history, and more. If a person finds ketones in their urine, they should ask their doctor for advice. MedlinePlus: Glucose in Urine Test., Merck Manuals Consumer Version: Renal Glucosuria., Merck Manuals Professional Edition: Diabetes Mellitus (DM)., National Organization for Rare Disorders: Renal Glycosuria., NHS: Hyperglycemia (high blood sugar).. Acidity, or pH. Copyright 2005 by the American Academy of Family Physicians. It is important to note that urine tests will not indicate whether blood glucose levels are too low. For the patient in case 1, because of his age, clinical history, and lack of other clear causes, the most appropriate course of action is to obtain blood urea nitrogen and creatinine levels, perform computed tomographic urography, and refer the patient for cystoscopy.5 An algorithm for diagnosis, evaluation, and follow-up of patients with asymptomatic microscopic hematuria is presented in Figure 1.5 The AUA does not recommend repeating urinalysis with microscopy before the workup, especially in patients who smoke, because tobacco use is a risk factor for urothelial cancer (Table 3).5, A previous article in American Family Physician reviewed the American College of Radiology's Appropriateness Criteria for radiologic evaluation of microscopic hematuria.8 Computed tomographic urography is the preferred imaging modality for the evaluation of patients with asymptomatic microscopic hematuria.5,8 It has three phases that can detect various causes of hematuria. Blood may make urine look red or the color of tea or cola. If you have symptoms of a kidney or urinary tract problem, you may have the tests to help find out what the problem is.. What is a urinalysis? Some types like renal glycosuria and gestational glycosuria dont cause any symptoms.. This phenomenon occurs because the ureteral stent bypasses the normal nonrefluxing uretero-vesical junction, resulting in transmission of pressure to the renal pelvis with voiding. What is the urinary tract? Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture. Diabetic ketoacidosis can cause urine to have a fruity or sweet odor, and alkaline fermentation can cause an ammoniacal odor after prolonged bladder retention. Copyright 2023 American Academy of Family Physicians. . You may have a urinalysis as part of a routine check of your overall health, like during your yearly physical. Are any of these substances abnormal in urine? They include: Your doctor may want to test your urine if youre getting ready to have surgery or are about to be admitted to the hospital. Is the ketogenic diet right for autoimmune conditions? See how one patient learned to manage her weight and diet. These cells are smaller and rounder than squamous cells, and they have larger nuclei. A midstream clean-catch technique usually is adequate in men and women. Therefore, detecting glucose in the urine may be both a sign and a reminder to regulate your blood glucose levels more tightly. Quiz, Kidney Function Test Values: BUN and Creatinine , contains very high levels of glucose, or the patient may . , Diabetes causes glycosuria because there either isnt enough insulin, or your body cant use what's available. Home tests are similar to these. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments. A dipstick is a thin, plastic stick with strips of chemicals on it. Because a urinary tract infection cannot be ruled out by the absence of an active urine sediment, a urine culture should always be performed in glucosuric animals, because infection is commonly present. Knowing about self-testing for both glucose and ketones can enable a person with diabetes to have more control over their condition. This can reveal the type of bacteria present and gives an idea of which treatment to prescribe. All Rights Reserved. Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. Quiz, Urine Test Types: pH, Ketones, Proteins, and Cells, Urine Test Types: pH, Ketones, Proteins, and Cells Youll either be asked to collect a urine sample at home and bring it with you, or youll make it at your doctors office. Which of the following substances may be needed as a supplement for a patient suffering renal osteodystrophy? Hematuria is divided into glomerular, renal (i.e., nonglomerular), and urologic etiologies (Table 4).21. Asymptomatic bacteriuria is the isolation of bacteria in an appropriately collected urine specimen obtained from a person without symptoms of a urinary tract infection. Microscopic examination is an indispensable part of urinalysis; the identification of casts, cells, crystals, and bacteria aids in the diagnosis of a variety of conditions. Based on this patient's history, symptoms, and urinalysis findings, which one of the following is the most appropriate next step? During these times, they should test their ketone levels every 46 hours, according to the ADA. Quiz, Important Liver Values: Albumin, ALT, ALP & AST A person who has high levels of glucose in the urine during pregnancy may need monitoring for gestational diabetes. In a patient with a ureteral stent, urinalysis alone cannot establish the diagnosis of urinary tract infection. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. This content is owned by the AAFP. The normal odor of urine is described as urinoid; this odor can be strong in concentrated specimens but does not imply infection. Renal glycosuria usually doesnt have any symptoms and doesnt need treatment. Clean-catch specimens from female patients frequently are contaminated by vaginal flora. Which of the following should be considered first? However, when a person has diabetes, glucose can pass from the kidneys into the urine. If the acid is . In severe cases, a person may experience: urinate a little first before filling the container, as a mid-stream specimen gives the most accurate reading, fill three-quarters of the container and secure the lid, give the sample back to the doctor or place it in a specified area. A patient's urinalysis reveals the presence of glucose. Quiz, Amylase and Pancreatic Lipase: Causes & Associated Conditions National Kidney Foundation. Exercise-induced hematuria is a relatively common, self-limited, and benign condition. The next steps depend on why you had the test in the first place. Urine must be refrigerated if it cannot be examined promptly; delays of more than two hours between collection and examination often cause unreliable results.2. A glucose in urine test measures the amount of glucose in your urine (pee). If a random urine sample shows more than 0.25mg/ml, this is considered glycosuria and can be caused by too high blood glucose levels, a problem with your kidney filters, or both. 38 Cerebral edema predominantly. Nonglomerular hematuria is secondary to tubulointerstitial, renovascular, or metabolic disorders. Some of the things a dipstick examination can check for include: A urinalysis can help to detect many diseases before you feel symptoms. This test is specific but not highly sensitive. A small amount of urine will be looked at under a microscope to check for things that do not belong in normal urine that cannot be seen with the naked eye, including red blood cells, white blood cells (or pus cells), bacteria (germs), or crystals (which are formed from chemicals in the urine and may eventually get bigger and become kidney stones). JEFF A. SIMERVILLE, M.D., WILLIAM C. MAXTED, M.D., AND JOHN J. PAHIRA, M.D. Approximately 80% of patients with a ureteral stent experience stent-related pain that affects their daily activities.11. Ketones can also enter the urine, so a doctor can use a urine test to detect DKA. The predominant cellular elements determine the type of cast: hyaline, erythrocyte, leukocyte, epithelial, granular, waxy, fatty, or broad (Figure 3). Uric acid calculi are associated with acidic urine. Quiz, Electrolytes in Urine: Normal Lab Values and Causes of Change In some cases, the loss of urine is so Urinary tract infections are responsible for nearly 10 million healthcare visits each year. Fanconi syndrome is a general term for a defect in your kidneys that causes problems absorbing glucose. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, What to expect when seeing a doctor for diabetes, Everything you need to know about urinalysis, a fruity or acetone smell on the breath. Other causes of high urine glucose levels include renal glycosuria (a rare condition in which the kidneys release glucose into urine even when blood sugar is not elevated) and gestational diabetes, which occurs during pregnancy. What are the causes of high glucose in urine besides diabetes? Macroscopic Urinalysis: Characteristic Result Color Yellow Appearance Turbid Leukocyte Esterase 3+ Nitrite Finding and treating a problem early can help keep serious diseases from getting worse. A urinalysis is just one piece of information about whats going on in your body. According to the American Diabetes Association, symptoms of DKA include: Anyone who thinks they might have DKA should first check their blood sugar levels. [ corrected] To detect significant pyuria accurately, 30 seconds to two minutes should be allowed for the dipstick reagent strip to change color, depending in the brand used. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Most people with kidney lupus (lupus nephritis) will have an abnormal urinalysis. What is the effect of this change? Inform the patient that he has a urinary tract infection, obtain a urine culture, and treat with antibiotics. Copyright 2023 American Academy of Family Physicians. These are a sign of infection or inflammation, either in the kidneys or anywhere else along your urinary tract. A patient is taking a nephrotoxic drug. Explain Ans: 2)As a person ages, nephron tubules lose some of their ability to concentrate urine. The onset of symptoms in those with type 2 diabetes is more gradual and usually occurs in adulthood. [ corrected] Under high-powered magnification, gram-negative rods, streptococci, and staphylococci can be distinguished by their characteristic appearance. Squamous epithelial cells are large and irregularly shaped, with a small nucleus and fine granular cytoplasm; their presence suggests contamination. glucosuria) is. This can be caused by: It can also be caused by some genetic conditions, including: Alimentary glycosuria can happen when you eat lots of carbohydrates at a meal. What is the correct interpretation by the nurse. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Glomerular, renal, and urologic causes of microhematuria often can be differentiated by other elements of the urinalysis. If a random urine sample shows more than .25mg/ml, this is considered glycosuria and can be caused by too high blood glucose levels, a problem . Like glomerular hematuria, it often is associated with significant proteinuria; however, there are no associated dysmorphic RBCs or erythrocyte casts. Choose an answer and hit 'next'. A urine glucose test can be part of a urinalysis, a test to evaluate the content and chemical makeup of urine. There are often no symptoms, but some people may experience thirst, urination, and other symptoms. Triple phosphate crystals may be normal but often are associated with alkaline urine and UTI (typically associated with Proteus species). Results of his urinalysis with microscopy are shown in Table 5. Things the dipstick test can check for include: If urinalysis is the only test youre having, you should be able to eat and drink normally before the procedure. A high sugar content is a marker for. Other causes of abnormal odors include gastrointestinal-bladder fistulas (associated with a fecal smell), cystine decomposition (associated with a sulfuric smell), and medications and diet (e.g., asparagus). In this article, we look at types of urine tests for diabetes and how to understand the results. Tubular proteinuria results when malfunctioning tubule cells no longer metabolize or reabsorb normally filtered protein. MNT is the registered trade mark of Healthline Media. A urinalysis is also called a "urine test." Chronically high blood sugar levels are toxic to your blood vessels, causing them to narrow and become more clogged over time. Thus, a positive result is helpful, but a negative result does not rule out UTI.6 The nitrite dipstick reagent is sensitive to air exposure, so containers should be closed immediately after removing a strip. Persons with UTIs often have urine with a pungent odor. Be prepared with good lighting and a timer to help you accurately read the results. ) A urinalysis reveals that the patient's urine contains glucose, hemoglobin, and white blood cells (pus). Can I get home tests for all of the above, or only for ketones? Ketonuria most commonly is associated with uncontrolled diabetes, but it also can occur during pregnancy, carbohydrate-free diets, and starvation. As an aside, high glucose levels can also make your urine smell fruity. Thank you, {{form.email}}, for signing up. Harvard School of Public Health. Visualization of intact erythrocytes on microscopic examination of the urinary sediment can distinguish hematuria from other conditions. Causes of hematuria can be classified as glomerular, renal, or urologic35 (Table 16 ). Treat with 14 days of ciprofloxacin, and tailor further antibiotic therapy according to culture results. All other trademarks and copyrights are the property of their respective owners. Beets and food dyes can discolor your urine, so you may want to watch what you eat beforehand. Once you have collected an ounce or two of urine, you will return the container to the healthcare provider, and it will be sent to the lab for analysis. A urinalysis can test for high levels of ketones and glucose in your child's urine, both signs of diabetes. Obtain blood urea nitrogen and creatinine levels, perform computed tomographic urography, and refer for cystoscopy. Your support helps families facing kidney, Tests to Measure Kidney Function, Damage and Detect Abnormalities. Urinalysis is invaluable in the diagnosis of urologic conditions such as calculi, urinary tract infection (UTI), and malignancy. 14 Increased USG is associated with. The test results will identify the levels of glucose, ketones, and protein in the urine. No matter the type, the following symptoms may be an early sign of diabetes: If you plan to take a urine glucose test at a healthcare providers office, you may want to bring with you a list of medications that you are taking, as some medications may affect your test results. Pregnancy and kidney disorders are the most common nondiabetic causes of high glucose levels in urine. Decreased glomerular filtration rate (GRT) is concentrating the urine too much C. The patient may have diabetes mellitus D. The patient has kidney failure C. the patient may have diabetes mellitus A critical care patient is to receive continual renal replacement therapy (CRRT). You will receive your score and answers at the end. At your appointment with your healthcare provider, you will be given a container to collect a sample of your urine and instructions on the "clean catch" method to help ensure the sample is sterile. Everything You Need to Know About Blood Sugar Tests, 6 Blood-Sugar Friendly Foods to Eat During Diabetes Awareness Month. As your kidneys get less blood, the filtration mechanism that removes waste and reabsorbs vital nutrients becomes damaged. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. She has constant dull left flank pain that becomes sharp with voiding. High ketone levels can be dangerous, and may lead to ketoacidosis. Calcium oxalate crystals have a refractile square envelope shape that can vary in size. If your levels are high, your healthcare provider will recommend a blood glucose test to confirm the diagnosis. In patients with suspected microscopic hematuria, urine dipstick testing may suggest the presence of blood, but results should be confirmed with a microscopic examination. Can diet help improve depression symptoms? copyright 2003-2023 Study.com. The presence of bacteria in a properly collected male urine specimen is suggestive of infection, and a culture should be obtained. There are three main causes of glycosuria:, Diabetes, called diabetes mellitus, is a condition where your body cant make enough insulin or use insulin properly. Those who use insulin or other medications may need to monitor for low blood sugar. A urine glucose test is an indirect way of determining if blood glucose levels are too high, which may be a sign of diabetes. Although urine cytology is typically part of the urologic workup, it should be performed at the time of cystoscopy; the AUA does not recommend urine cytology as the initial test.5, After ureteroscopy with lithotripsy, a ureteral stent is often placed to maintain adequate urinary drainage.10 The stent has one coil that lies in the bladder and another that lies in the renal pelvis. Cystine crystals are colorless, have a hexagonal shape, and are present in acidic urine, which is diagnostic of cystinuria. Further evaluation of patients with glomerular and nonglomerular hematuria should include determination of renal function and 24-hour urinary protein or spot urinary protein-creatinine ratio. Photo by Peter Dazeley/Getty Images What a Urine Glucose Test Measures Diabetes is a group of conditions that affect the body's ability to regulate blood sugar levels. The excess of glucose produced by the insulinoma impairs the exit of glucose out of the cell leading to decreased levels of glucose in the blood. If urine or other tests reveal high levels of protein, glucose, or ketones, the person should take measures to prevent any problems from getting worse. Although urinalysis is not recommended as a routine screening tool except in women who may be pregnant, physicians should know how to interpret urinalysis results correctly. Are any of these substances abnormal in urine? While this test is less accurate than a blood glucose test, a urine glucose test is a quick and easy way to monitor your glucose if you have type 1 or type 2 diabetes. Obesity and weight gain are major factors in getting type 2 diabetes. When this happens, the cells do not have enough glucose for energy. All rights reserved. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html, https://www.ncbi.nlm.nih.gov/books/NBK470195/, https://medlineplus.gov/lab-tests/glucose-in-urine-test/, http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944103/, https://rarediseases.org/rare-diseases/renal-glycosuria/, http://clinical.diabetesjournals.org/content/37/1/11, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278382/, Gut microbiome appears to fluctuate throughout the day and across seasons, One-hour endoscopic procedure could eliminate the need for insulin for type 2 diabetes, New clues to slow aging? This is sometimes also called glucosuria., Normally, your body eliminates glucose in your urine when your blood sugar levels are too high. At the doctors office, a health professional will give the individual a clean, clear container and ask them to do the following: A doctor will dip a strip into the urine, which will change color according to the levels of various substances in the urine. In overflow proteinuria, lowmolecular-weight proteins overwhelm the ability of the tubules to reabsorb filtered proteins. The urinary system ( Help families facing kidney High glucose levels can make your urine cloudy. This lesson covers the following objectives: 20 chapters | The onset of symptoms in those with type 1 diabetes is usually more sudden and occurs in childhood. Your doctor may also order a urinalysis if you experience symptoms such as: ( 1) Blood in. Ans: 3) Fatty tissue holds the kidneys in place. If a primary care physician identifies a neglected ureteral stent, prompt urologic referral is indicated for removal. I would like to to do my testing at home before going to the doctor for confirmation. Your body gets rid of the excess through your urine., Gestational diabetes is a type of diabetes that happens during pregnancy. 2005 - 2023 WebMD LLC, an Internet Brands company. Renal glycosuria occurs when a person's kidneys are damaged. Which of the following should be considered first? decreases in epinephrine and increases in cortisol, decreases in cortisol and increases in epinephrine, cortisol and epinephrine release that promote increases in glucose formation. WebMD does not provide medical advice, diagnosis or treatment. They may also do a glucose tolerance test (GTT) to find out if the body is having problems processing glucose. Simple steps to prevent diabetes. American Association for Clinical Chemistry: "Urinalysis. The best results come from using whats known as the clean catch method. If a person receives an early diagnosis of kidney disease, they may be better able to control it through diet and possibly medications. Foamy urine can be a sign of kidney problems. 274 quizzes. Patients with microscopic hematuria (i.e., at least three red blood cells per high-power field in two of three specimens) should be evaluated to exclude renal and urinary tract disease. After some predetermined amount of time (usually indicated in the instruction manual or on the box), you'll check the color of the urine strip to determine your glucose levels. You may also want to drink fluids before you arrive at your appointment so that you can easily produce urine when asked to do so. Men normally have fewer than two white blood cells (WBCs) per HPF; women normally have fewer than five WBCs per HPF. Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage? A more recent article on office-based urinalysis is available. . Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. A urinalysis reveals that the patient's urine contains glucose, hemoglobin, and white blood cells (pus). Glycosuria occurs in some conditions like diabetes. A self-monitoring urine glucose test usually involves holding the test strip under a stream of urine or placing a test strip into a sample cup of urine that you have collected. Type II (proximal) RTA is characterized by an inability to reabsorb bicarbonate. Uric acid crystals are yellow to orange-brown and may be diamond- or barrel-shaped. Insulin is the hormone that helps move glucose from the blood into the cells, therefore, when the level of insulin increase, the level of glucose decreases. This can lead to severe complications. Some of the things that shouldnt be in your urine that a microscope can find include: The third part of urinalysis is the dipstick test, which uses a thin plastic strip treated with chemicals. It is caused by gene changes that lead to defects in your kidney tubules where glucose is absorbed. Tubular reabsorption of glucose is via active transport, thus requiring energy, and is done in response to balance the glucose in the body. Foods, medications, metabolic products, and infection can cause abnormal urine colors (Table 1).3 Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. The doctor will compare the strip with a color chart to determine the level of glucose, ketones, and protein in the urine. Urinalysis is a series of tests on your urine, or pee. Quiz, Psychological Research & Experimental Design, All Teacher Certification Test Prep Courses, The Consequences of an Aberrant Immune System, Major Disorders Involving the Nervous System, Conditions Affecting the Gastrointestinal System, Alterations of the Musculoskeletal System, Clinical Test Results: Electrolytes, Cells, and Blood Proteins, Working Scholars Bringing Tuition-Free College to the Community, Explain and define what glycosuria (a.k.a. Ketones, products of body fat metabolism, normally are not found in urine. Foam can be a sign of kidney disease, while cloudy urine may mean you have an infection. Results of her urinalysis with microscopy are shown in Table 4. It often develops later in life, but children who have obesity can also get type 2 diabetes. The test involves the examination of different aspects of the urine, including: appearance (cloudy or clear . For example, a urinary tract infection can make urine look cloudy instead of clear. The excess of glucose produced by the insulinoma destroys the glucose molecules in the blood. Because toxins and excess fluid are removed from the body in urine, analysis of urine can provide important health clues. It also reflects the concentrating ability of the kidneys.

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