European Urinalysis Guidelines

Kouri, Timo; Fogazzi, Giovanni B.; Gant, Vanya; Hallander, Hans O.; Hofmann, Walter; Guder, W. G.

doi:10.1080/00365513.2000.12056993

Cited by 221 publications

(88 citation statements)

References 189 publications

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“…Urinary microscopy was always performed on the second urine of the morning produced over a period of 2 h. All samples were processed within 3 h from collection according to the following standardised method previously published [20]: centrifugation of a 10 ml aliquot of urine for 10 min at 400 g (which corresponds to 2,000 rpm with the centrifuge of our laboratory); removal by suction of 9.5 ml of supernatant urine; gentle but thorough resuspension of the pellet in the remaining 0.5 ml of urine; transfer by means of a precision pipette of 50 μl of resuspended sediment to a glass slide covered with a glass coverslip with a size of 24×32 mm; examination of the samples in blind conditions by either GBF or GG, who used the same criteria for the evaluation of UEM (a 100% agreement was found in the classification of haematuria as glomerular or nonglomerular by using the criteria described below for ten samples, which were examined separately by the two observers in blind conditions); the use of a Leica Dialux 20 microscope equipped with phase contrast lenses, a device which is suggested for UEM evaluation [13] as well as for routine work [24]; counting of the erythrocytes per HPF at 400x; search of erythrocytic casts over 50 microscopic fields at low-power magnification [160x lowpower field (LPF)]; expression of the erythrocytes found as lowest-highest number/HPF (e.g. 3-5/HPF) and of casts as number/50 LPF.…”

Section: Methodsmentioning

confidence: 99%

Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy

et al. 2008

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The evaluation of urinary erythrocyte morphology (UEM) has been proposed for patients with isolated microscopic haematuria (IMH) to early orientate the diagnosis towards a glomerular or a nonglomerular disease. However, to date, the role of this test in patients with IMH has very rarely been investigated. Sixteen patients (ten children, six adults) with persistent IMH classified as glomerular on the basis of repeated UEM evaluations (55 urine samples, two to eight per patient) were submitted to renal biopsy. This showed a glomerular disease in 14/16 patients (87.5%) (nine thin basement membrane disease; three Alport syndrome; two other), whereas in two patients, no abnormalities were found. Of four microscopic criteria investigated to define a IMH as glomerular, >80% dysmorphic erythrocytes were not found in any sample, >or=40% dysmorphic erythrocytes alone were seen in seven samples (12.7%), >or=5% acanthocytes alone in 15 samples (27.3%) and erythrocytic casts in six samples (10.9%). There was >or=40% dysmorphic erythrocytes associated with >or=5% acanthocytes in 25 samples (45.5%). Sensitivity and positive predictive values in diagnosing a glomerular haematuria were 59.2% and 90.6%, respectively, for >or=40% dysmorphic erythrocytes, 69.4% and 85% for >or=5% acanthocytes/G1 cells and 12.2% and 100% for erythrocytic casts. Our findings demonstrate that the evaluation of UEM is useful to identify patients with an IMH of glomerular origin.

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Section: Methodsmentioning

confidence: 99%

Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy

et al. 2008

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“…Biological ( in vivo ) factors, changing the true concentration of a measured component, cause problems in the interpretation of laboratory results, although the measurement process itself is correct. They are called influence factors and patients should be adequately explained about possible interferences ( 59 ). …”

Section: Acrmentioning

confidence: 99%

The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations

Biljak

Honović²,

Matica

et al. 2017

Biochem Med

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Chronic kidney disease (CKD) is a common clinical condition with significant adverse consequences for the patient and it is recognized as a significant public health problem. The role of laboratory medicine in diagnosis and management of CKD is of great importance: the diagnosis and staging are based on estimation of glomerular filtration rate (eGFR) and assessment of albuminuria (or proteinuria). Therefore, the joint working group of the Croatian society of medical biochemistry and laboratory medicine and Croatian chamber of medical biochemists for laboratory diagnostics in CKD issued this national recommendation regarding laboratory diagnostics of CKD. Key factors for laboratories implementing the national guidelines for the diagnosis and management of CKD are: 1. Ensure good communication between laboratory professionals and clinicians, such as nephrologists or specialists in general/family medicine, 2. Ensure all patients are provided with the same availability of laboratory diagnostics, 3. Ensure creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision, 4. Select the appropriate GFR estimating formula. Recommended equation is the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD – EPI) equation, 5. In reporting the key laboratory tests (creatinine, eGFR, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio) use the appropriate reporting units, 6. Provide adequate information on limitations of creatinine measurement. The manuscript has been organized to identify critical points in laboratory tests used in basic laboratory diagnostics of CKD and is based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.

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“…However, this cut-off limit has been debated in recent years resulting in the use of reduced diagnostic thresholds ranging from 10 2 [4-7] and 10 3 [8-11]. …”

Section: Introductionmentioning

confidence: 99%

Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs

et al. 2010

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BackgroundAcute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (102 or 103 or 105 CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making.MethodsSearches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 102 CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model.ResultsSixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 102 CFU/ml; 55.4% at ≥ 103 CFU/ml and 44.8% at ≥ 102 CFU/ml ≥ 105 CFU/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 102 CFU/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of UTI to 75.8% at ≥ 102 CFU/ml and 67.4% at ≥ 103 CFU/ml. Probability of UTI increases to 93.3% and 90.1% at ≥ 102 CFU/ml and ≥ 103 CFU/ml respectively when presence of hematuria is combined with a positive dipstick result for nitrites. Subgroup analysis shows improved diagnostic accuracy using lower reference standards ≥ 102 CFU/ml and ≥ 103 CFU/ml.ConclusionsIndividual symptoms and signs have a modest ability to raise the pretest-risk of UTI. Diagnostic accuracy improves considerably when combined with dipstick tests particularly tests for nitrites.

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European Urinalysis Guidelines

Cited by 221 publications

References 189 publications

Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy

Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy

The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations

Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs

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