Evaluation of clinical cases in External Quality Assessment Scheme (EQAS) for the urinary sediment

Fogazzi, Giovanni B.; Secchiero, Secchiero; Garigali, Giuseppe; Plebani, Mario

doi:10.1515/cclm-2013-0785

Cited by 6 publications

(4 citation statements)

References 20 publications

(25 reference statements)

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“…The present study reports on all 27 clinical cases; the results on 10 and seven of which have been described in detail in two previous papers [11,22].…”

Section: Discussionmentioning

confidence: 88%

“…Period 2001-2011: The methods and results of the program, which in this period was under the responsibility and guidance of one of us (G.B.F. ), a nephrologist with an expertise in urinary sediment and urinalysis [18][19][20][21][22][23][24][25], has been described in details elsewhere [6,21,22]. In this period, the descriptive identification of particles were evaluated as correct, partially correct, incorrect or no answer and scored accordingly (5, 3, 0, and −2 respectively).…”

Section: Main Features Of the Programmentioning

confidence: 99%

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The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey

Secchiero

Fogazzi

Manoni³

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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ObjectivesIn spite of the introduction of automated systems for urinary sediment analysis, microscopy examination remains the gold standard, and it is more than ever important to perform it with a good and reliable quality. External Quality Assessment (EQA) programs on urinary sediment are rare. The present paper provides an analysis of results from 2001 to date of the EQA Italian program which involves today 230 laboratories.MethodsThe program includes four surveys per year. Participants are asked the identification and clinical associations of urinary sediment particles, shown as phase contrast microscopy images in the website of the Center of Biomedical Research (CRB) (2 surveys), and the diagnosis of clinical cases presented by both images and a short clinical history (2 surveys). The results of each survey are then scored and commented. In 20 years, 298 images were presented: 90 cells (9 types), 23 lipids (5 types), 87 casts (21 types), 53 crystals (14 types), 22 microorganisms (5 types), and 23 contaminants (9 types). Moreover, 27 clinical cases, covering a wide spectrum of conditions with different degrees of complexity, were presented to participants.ResultsIdentification: among urinary particle categories, the correct identification rate (obtained for each particle from the sum of correct + partially correct answers) was very high for micro-organisms (mean ± SD: 96.2 ± 3.5%), high for lipids (88.0 ± 11.8%) and crystals (87.0 ± 16.5%) followed, in decreasing order, by cells (82.1 ± 15.9%), casts (81.8 ± 14.8%), and contaminants (76.7 ± 22.1%). Clinical associations (n=67): the rate of correct answers was 93.5 ± 5.7% ranging from 75.0 to 100% for all but one clinical association (i.e., acute glomerulonephritis: 55.4%). Clinical cases: throughout surveys, due to the overall rate of particle misidentification, only 59.8 ± 17.1%, (range 32.5–88.7%) of participants achieved access to clinical diagnosis. Of these, 88.7 ± 10.6% (range 59.9–99.3%) were able to indicate the correct diagnosis.ConclusionsOur program can be used as a tool to improve the identification of urine particles and the knowledge of their clinical meaning and to encourage specialists of laboratory medicine to correlate urinary findings with other laboratory data and the clinical history, an aspect that improves the value of the day by day work.

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“…The present study reports on all 27 clinical cases; the results on 10 and seven of which have been described in detail in two previous papers [11,22].…”

Section: Discussionmentioning

confidence: 88%

Section: Main Features Of the Programmentioning

confidence: 99%

The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey

Secchiero

Fogazzi

Manoni³

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…We also recruited many expert nephrologists known for their interest in urine sediment examination and teaching. Notably, studies by Secchiero et al, 18 and Fogazzi et al 19,20 from Italy, in which images of urine sediment particles were interpreted by laboratory personnel, reported variable but often excellent percent agreement. In Secchiero et al, 18 the percentages of reviewers who correctly identified isomorphic RBCs, hyaline casts, and granular casts were 84.7%, 89.5% and 74.9%, respectively.…”

Section: Jama Network Open | Nephrologymentioning

confidence: 99%

Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment

et al. 2020

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Key Points Question What is the interobserver reliability among practicing nephrologists when interpreting urine sediment findings? Findings In this diagnostic study, 14 nephrologists provided 1064 interpretations of images of urine sediment findings. Agreement could be classified as slight, fair, moderate, substantial, or almost perfect. The interobserver reliability of urine sediment findings is mostly moderate to substantial but varies widely. Meaning Results of this study suggest that efforts to decrease variability in urine sediment interpretations may help increase the yield of this widely used test in medicine.

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“…polarised light microscopy, as well as to the use of specific cytological staining. Therefore, it is essential that clinical laboratories should be involved in reliable internal quality control (IQC) programs and external quality assessment (EQA) schemes for both the preanalytical and analytical phase of urinalysis [24][25][26]. The laboratories should be directly connected with international and national societies or working groups such as the European Federation of Laboratory Medicine (EFLM) or the Italian intersocietary SIBioC/SIMeL working group for urinalysis or Italian urinalysis working group (GIAU) [27].…”

Section: Pigmented Castsmentioning

confidence: 99%

Cylindruria

Caleffi

Lippi

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The morphological analysis of urine sediment is an essential part of urinalysis and casts are important elements of urinary sediment. Their shape is typically cylindrical, with extremities often rounded. Casts form within the renal tubules and are made of Tamm-Horsfall glycoprotein (THG). Under some physiological or pathological conditions THG fibrils aggregate giving rise to casts, whose formation is favoured by a number of factors including high urine osmolality and/or low pH. Casts can be found in normal subjects, in non-renal conditions, such as fever, dehydration, and acute heart failure as well as in virtually all renal diseases. Casts can be classified on the basis of their morphology as hyaline, granular, waxy, fatty, cellular (leukocytic, erythrocytic, epithelial), containing crystals or microorganisms, pigmented and mixed. As the correct identification of casts is crucial for an accurate and timely diagnosis of renal disorders, laboratory professionals should be trained to identify and classify casts properly.

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Evaluation of clinical cases in External Quality Assessment Scheme (EQAS) for the urinary sediment

Abstract: Our findings demonstrate that once the correct identification of urinary sediment particles is obtained, most participants are able to associate urinary findings with the respective clinical conditions, thus establishing the correct diagnosis.

Cited by 6 publications

References 20 publications

The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey

The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey

Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment

Cylindruria

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