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Quality Improvement of Urinalysis Results Based on Automatic Sediment Urinalysis and Urine Strip Results
J Lab Med Qual Assur 2017;39:154-161
Published online December 31, 2017
© 2017 Korean Association of External Quality Assessment Service.

A-Jin Lee1, Cheon Gang Park1, Young-Chul Bae2, and Chang-Ho Jeon1

1Department of Laboratory Medicine, Daegu Catholic University School of Medicine; 2Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu, Korea
Correspondence to: Chang-Ho Jeon
Department of Laboratory Medicine, Daegu Catholic University School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea
Tel: +82-53-650-4144
Fax: +82-53-653-8672
Received October 10, 2017; Revised December 7, 2017; Accepted December 7, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Microscopic examinations are usually performed to confirm urine sediments in samples flagged in automated urinalysis. The aim of this study was to analyze the review rates and the difference in urinalysis results according to review rules.
Methods: A total of 1,408 urine samples submitted for health screening were collected. The urine chemistry test and urine sediment test were performed using EikenUS 3100 (Eiken Chemical Co. Ltd., Japan) and Sysmex UF-1000i (Sysmex Co., Japan), respectively. We assessed the rate of agreement between the 2 analyses and the kappa values for white blood cells (WBCs) and red blood cells (RBCs). Microscopic examinations were performed for all cases of discordant results between the urine strip and automated sediment analysis, some cases of concordant results, and cases of albuminuria.
Results: The review rate was 14.3%. Microscopic examinations were additionally performed on 77 samples (77/1,207, 6.4%) including 29 and 56 samples flagged for WBCs and RBCs, respectively. Based on the results of microscopic examination, the false-positive and the false-negative results of the urine chemistry test and automatic sediment analysis were corrected. Among concordant results between two methods, a clinically significant number of false-negatives were identified (6 results of WBC detection [6/125, 4.8%] and 4 of RBC detection [4/145, 2.8%]). Among the 22 unflagged cases of albuminuria, pathologic casts were detected in 21 cases (21/22, 95.5%).
Conclusions: Microscopic examination based on the combined results of the two analyses improved the quality of the test.
Keywords : Urinalysis, Flow cytometry, Reagent strips, Microscopy, Quality improvement
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