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Fadel R, Taliercio JJ, Daou R, Layoun H, Bassil E, Fawaz A, Arrigain S, Schold JD, Herlitz L, Simon JF, Mehdi A, Nakhoul G. Urine Sediment Examination: Comparison Between Laboratory-Performed Versus Nephrologist-Performed Microscopy and Accuracy in Predicting Pathologic Diagnosis in Patients with Acute Kidney Injury. KIDNEY360 2023; 4:918-923. [PMID: 36810426 PMCID: PMC10371296 DOI: 10.34067/kid.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
Key Points A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic red blood cells. Nephrologist-performed urine sediment analysis is also highly accurate in diagnosing acute tubular injury or glomerulonephritis when compared with kidney biopsy. Introduction Automated urine technology is becoming the standard for urinalysis microscopy. We sought to compare urine sediment analysis performed by a nephrologist with the analysis performed by the laboratory. When available, we also compared the suggested diagnosis per nephrologists' sediment analysis with the biopsy diagnosis. Methods We identified patients with AKI who had urine microscopy with sediment analysis performed by the laboratory (Laboratory-UrSA) and by a nephrologist (Nephrologist-UrSA) within 72 hours of each other. We collected data to determine the following: number of red blood cells (RBCs) and white blood cells (WBCs) per high-power field, presence and types of casts per low-power field, and presence of dysmorphic RBCs. We evaluated agreement between the Laboratory-UrSA and the Nephrologist-UrSA using cross-tabulation and the Kappa statistic. When available, we categorized the nephrologist sediment findings into four categories: (1) bland, (2) suggestive of acute tubular injury (ATI), (3) suggestive of glomerulonephritis (GN), and (4) suggestive of acute interstitial nephritis (AIN). In a group of patients with kidney biopsy within 30 days of the Nephrologist-UrSA, we assessed agreement between the nephrologist diagnosis and the biopsy diagnosis. Results We included 387 patients with both Laboratory-UrSA and Nephrologist-UrSA. The agreement was moderate for the presence of RBCs (Kappa, 0.46; 95% CI, 0.37 to 0.55) and fair for WBCs (Kappa, 0.36; 95% CI, 0.27 to 0.45). There was no agreement for casts (Kappa, 0.026; 95% CI, −0.04 to 0.07). Eighteen dysmorphic RBCs were detected on Nephrologist-UrSA compared with zero on Laboratory-UrSA. Among the 33 patients with kidney biopsy, 100% ATI and 100% GN suggested per Nephrologist-UrSA were confirmed on the biopsy. Of the five patients with bland sediment on the Nephrologist-UrSA, 40% showed ATI pathologically while the other 60% demonstrated GN. Conclusion A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic RBCs. Correct identification of these casts carries important diagnostic and prognostic value when evaluating kidney disease.
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Affiliation(s)
- Remy Fadel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan J. Taliercio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Remy Daou
- Department of Family Medicine, Saint Joseph University, Beirut, Lebanon
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Elias Bassil
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Adam Fawaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Leal Herlitz
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - James F. Simon
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Ali Mehdi
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Georges Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
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Kraus D, Köhler H, Weinmann-Menke J. Urine, doctors, and the acanthocyte’s 30th birthday. Kidney Int 2022; 101:196-200. [DOI: 10.1016/j.kint.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
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Luimstra JJ, Koçer RG, Demir AY. As time goes by, on that you can rely … preservation of urine samples for morphological analysis of erythrocytes and casts. Clin Chem Lab Med 2020; 59:e201-e204. [PMID: 33554553 DOI: 10.1515/cclm-2020-1202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Jolien J Luimstra
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Rüya G Koçer
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Ayşe Y Demir
- Laboratory for Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
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Luimstra JJ, Koçer RG, Jerman A, Klein Gunnewiek J, Gijzen K, Jacobs LHJ, Demir AY. Current state of the morphological assessment of urinary erythrocytes in The Netherlands: a nation-wide questionnaire. Clin Chem Lab Med 2020; 58:1891-1900. [PMID: 32335538 DOI: 10.1515/cclm-2020-0236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 01/03/2023]
Abstract
Background The morphological assessment of urinary erythrocytes (uRBC) is a convenient screening tool for the differentiation of nephrological (dysmorphic) and urological (isomorphic) causes of hematuria. Considering the morphological heterogeneity, this analysis is often perceived as difficult. There is no clear (inter)national consensus and there is a lack of external quality assessment programs. To gain insight into the heterogeneity within and between laboratories, we scrutinized the current state of this analysis in Dutch medical laboratories. Methods The laboratories, affiliated with the Dutch Foundation for Quality Assessment in Medical Laboratories, were invited to participate in a web-based survey, consisting of two questionnaires. The first one provided information about the institution and laboratory organization, and the second explored the variability in the morphological analysis of uRBC on the basis of categorization of 160 uRBC images. Statistical analysis was premised on binomial significance testing and principal component analysis. Results Nearly one third of the Dutch medical laboratories (65/191) with 167 staff members participated in the survey. Most of these laboratories (83%) were an integral part of secondary care. The statistical analysis of the evaluations of the participants in comparison to the consensus (three experts from two different medical laboratories) suggested a great degree of heterogeneity in the agreement. Nearly half of the participants consciously disagreed with the consensus, whereas one fifth demonstrated a random relationship with it. Conclusions In Dutch medical laboratories, results from morphological analysis of uRBC are heterogeneous, which point out the necessity for standardization and harmonization.
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Affiliation(s)
- Jolien J Luimstra
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Rüya G Koçer
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Alexander Jerman
- Department of Nephrology, University of Ljubljana, Ljubljana, Slovenia
| | - Jacqueline Klein Gunnewiek
- Section General Chemistry, Dutch Foundation for External Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands
| | - Karlijn Gijzen
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Leo H J Jacobs
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Ayşe Y Demir
- Department of Clinical Chemistry and Hematology, Meander Medical Centre, Amersfoort, The Netherlands
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Hamadah AM, Gharaibeh K, Mara KC, Thompson KA, Lieske JC, Said S, Nasr SH, Leung N. Urinalysis for the diagnosis of glomerulonephritis: role of dysmorphic red blood cells. Nephrol Dial Transplant 2017; 33:1397-1403. [DOI: 10.1093/ndt/gfx274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Kamel Gharaibeh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Katherine A Thompson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Samar Said
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Chu-Su Y, Shukuya K, Yokoyama T, Lin WC, Chiang CK, Lin CW. Enhancing the Detection of Dysmorphic Red Blood Cells and Renal Tubular Epithelial Cells with a Modified Urinalysis Protocol. Sci Rep 2017; 7:40521. [PMID: 28074941 PMCID: PMC5225455 DOI: 10.1038/srep40521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/07/2016] [Indexed: 11/19/2022] Open
Abstract
Urinary sediment is used to evaluate patients with possible urinary tract diseases. Currently, numerous protocols are applied to detect dysmorphic red blood cells (RBCs) and renal tubular epithelial cells (RTECs) in urinary sediment. However, distinct protocols are used by nephrologists and medical technologists for specimen concentration and observation, which leads to major discrepancies in the differential counts of formed elements such as dysmorphic RBCs and RTECs and might interfere with an accurate clinical diagnosis. To resolve these problems, we first tested a modified urinalysis protocol with an increased relative centrifuge force and concentration factor in 20 biopsy-confirmed glomerulonephritis patients with haematuria. We successfully improved the recovery ratio of dysmorphic RBCs in clinical specimens from 34.7% to 42.0% (P < 0.001). Furthermore, we confirmed the correlation between counts by the modified urinary protocol and Sysmex UF-1000i urinary flow cytometer (r ≥ 0.898, P < 0.001). A total of 28 types of isomorphic and dysmorphic RBCs were detected using a bright field microscope, with results comparable to those using a standard phase contrast microscope. Finally, we applied Sternheimer stain to enhance the contrast of RTECs in the urinary sediments. We concluded that this modified urinalysis protocol significantly enhanced the quality of urinalysis.
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Affiliation(s)
- Yu Chu-Su
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei City 10617, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
| | - Kenichi Shukuya
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takashi Yokoyama
- Department of Central Clinical Laboratory, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Wei-Chou Lin
- Department of Pathology and Graduate Institute of Pathology, College of Medicine, National Taiwan University, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
| | - Chih-Kang Chiang
- Graduate Institute of Toxicology, College of Medicine, No. 1, Jen-Ai Rd., Taipei City 10002, Taiwan.,Department of Integrated Diagnostics &Therapeutics, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City 10002, Taiwan
| | - Chii-Wann Lin
- Institute of Biomedical Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei City 10617, Taiwan
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Martinez MG, dos S. Silva V, do Valle AP, Amaro CR, Corrente JE, Martin LC. Comparison of Different Methods of Erythrocyte Dysmorphism Analysis to Determine the Origin of Hematuria. ACTA ACUST UNITED AC 2014; 128:88-94. [DOI: 10.1159/000367848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/15/2014] [Indexed: 11/19/2022]
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Boven LA, Kemperman H, Demir AY. A comparative analysis of the Iris iQ200 with manual microscopy as a diagnostic tool for dysmorphic erythrocytes in urine. Clin Chem Lab Med 2012; 50:751-3. [PMID: 22149749 DOI: 10.1515/cclm.2011.813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ohsaki H, Hirouchi T, Hayashi N, Okanoue E, Ohara M, Kuroda N, Hirakawa E, Norimatsu Y. Diagnostic value of urine erythrocyte morphology in the detection of glomerular disease in SurePath™ liquid-based cytology compared with fresh urine sediment examination. Cytopathology 2012; 24:52-7. [DOI: 10.1111/j.1365-2303.2012.00958.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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