Interobserver Reliability of Urine Sediment Interpretation

Wald, Ron; Bell, Chaim M.; Nisenbaum, Rosane; Perrone, Samuel; Liangos, Orfeas; Laupacis, Andreas; Jaber, Bertrand L.

doi:10.2215/cjn.05331008

Cited by 48 publications

(38 citation statements)

References 27 publications

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“…These results confirm that several urinary sediment particles are, entirely or partly, misidentified by laboratory personnel, as demonstrated in previous studies [5,6,15,18,19] and confirmed by a survey involving nephrologists [20]. This can have important clinical implications.…”

Section: Discussionsupporting

confidence: 90%

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

Fogazzi

Secchiero

Garigali

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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Section: Discussionsupporting

confidence: 90%

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

Fogazzi

Secchiero

Garigali

et al. 2014

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…In addition, urine microscopy seems to be an 'abandoned art' as Fogazzi and Grignani [6] assumed in 1998. Furthermore, a loss of experience in performing urine microscopy, indicated by a reduced inter-observer agreement [28] , suggests that few investigators still have the experience to perform a urine sediment examination properly.…”

Section: Discussionmentioning

confidence: 99%

Urinary [TIMP-2]·[IGFBP7] - Novel Biomarkers to Predict Acute Kidney Injury

et al. 2016

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Background: Urine microscopy is an established technique to assess kidney disease, and can add valuable information about the mechanism of damage. However, it requires the time and expertise of an experienced nephrologist and, therefore, is typically used for a limited number of patients in practice. A rapid biomarker test that identifies patients from the emergency department (ED) who are likely to have positive urine microscopy findings would enable more efficient use of this technique. Methods: Four hundred patients were enrolled in the ED; thereof 362 patients had available both tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2]·[IGFBP7] and urine score (U-Score) data at enrollment. U-Score was assessed through urine microscopy as described previously. Results: Fifteen (4%) of 362 patients had a U-Score >0. When patients were stratified into 3 groups using the validated [TIMP-2]·[IGFBP7] cutoffs of 0.3 and 2.0, the proportion of patients with a positive U-Score increased across the 3 strata from 1 to 6 to 24% (p < 0.001). At the 0.3 cutoff, [TIMP-2]·[IGFBP7] had a sensitivity of 87%, specificity of 62% and negative predictive value (NPV) of 99% for prediction of a positive U-Score. At the 2.0 cutoff, specificity increased to 95% and positive predictive value (PPV) increased to 24%. Conclusions: In ED patients, urinary [TIMP-2]·[IGFBP7] had a high NPV (99%) for ruling out a positive U-Score using the 0.3 cutoff and had a PPV of 24% (6-fold greater than the pre-test probability) using the 2.0 cutoff. As such, urinary [TIMP-2]·[IGFBP7] may enable more effective use of urine microscopy in these patients and thereby save time and personnel resources. Summary: Urine microscopy is an established technique to assess acute kidney injury and can add valuable information about the mechanism of damage; however it requires the time and expertise of an experienced nephrologist and, therefore, is typically used for a limited number of patients in clinical practice. We have shown in ED patients, urinary [TIMP-2]·[IGFBP7] had a high NPV (99%) for ruling out a positive U-Score using the 0.3 cutoff and had a PPV of 24% (6-fold greater than the pre-test probability) using the 2.0 cutoff. As such, urinary [TIMP-2]·[IGFBP7] may enable more effective use of urine microscopy in these patients and thereby save time and personnel resources.

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“…However, this approach can be criticized because the sediMAX in our laboratory is now fully automated on the basis of our experience, whereas for all particles except WBCs and bacteria, FUS-200 was used to recognize and count particles according to manufacturer's recommendations only. However, outcomes based on visual interpretation can be highly variable (24,25), and the agreement between analyzers is better than that between analyzers and visual interpretation of microscopic images (26). These factors suggest that to reduce variation, it may be justified to switch to automation (1).…”

Section: Comparison Of Fus-200 To Sedimaxmentioning

confidence: 99%