Search for


TEXT SIZE

search for



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
E-mail: chjeon@cu.ac.kr
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 (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
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
References
  1. Kim KD. Urinalysis. In: Korean Society for Laboratory Medicine, editor. Laboratory medicine. 5th ed. Seoul:Panmun Education, 2014: 497-508.
  2. Han TH. Urinalysis: the usefulness and limitations of urine dipstick testing. J Korean Soc Pediatr Nephrol 2013;17:42-8.
    CrossRef
  3. Lee SJ. The clinical use of routine urinalysis. J Korean Soc Pediatr Nephrol 2013;17:35-41.
    CrossRef
  4. Broeren MA, Bahceci S, Vader HL, Arents NL. Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer. J Clin Microbiol 2011;49:1025-9.
    Pubmed KoreaMed CrossRef
  5. Lee W, Ha JS, Ryoo NH. Comparison of the Automated Cobas u 701 Urine Microscopy and UF-1000i Flow Cytometry Systems and manual microscopy in the examination of urine sediments. J Clin Lab Anal 2016;30:663-71.
    Pubmed CrossRef
  6. Jiang T, Chen P, Ouyang J, Zhang S, Cai D. Urine particles analysis: performance evaluation of Sysmex UF-1000i and comparison among urine flow cytometer, dipstick, and visual microscopic examination. Scand J Clin Lab Invest 2011;71:30-7.
    Pubmed CrossRef
  7. Susianti H, Lie S, Yoavita. Auto-identification of discrepancies between urine test strip and sediment results using cross check function on fully automated urine analyzer. Int Clin Pathol J 2015;1:00020.
    CrossRef
  8. Miura M, Kondo T, Mizuno M, Morikawa T. The basic analytical performance of fully automated integrated urine analyzer UX-2000 CHM unit. Sysmex J Int 2013;23:1-4.
  9. Steinmetz J, Henny J, Gueguen R. Stepwise strategies in analysing haematuria and leukocyturia in screening. Clin Chem Lab Med 2006;44:464-70.
    Pubmed CrossRef
  10. Lee W, Kim Y, Chang S, Lee AJ, Jeon CH. The influence of vitamin C on the urine dipstick tests in the clinical specimens: a multicenter study. J Clin Lab Anal 2017;31:e22080.
    Pubmed CrossRef
  11. Van der Zwet WC, Hessels J, Canbolat F, Deckers MM. Evaluation of the Sysmex UF-1000i urine flow cytometer in the diagnostic work-up of suspected urinary tract infection in a Dutch general hospital. Clin Chem Lab Med 2010;48:1765-71.
    Pubmed CrossRef
  12. Budak YU, Huysal K. Comparison of three automated systems for urine chemistry and sediment analysis in routine laboratory practice. Clin Lab 2011;57:47-52.
    Pubmed