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Introduction: in spite of the introduction of automated systems for urine sediment analysis, microscopy examination remains the gold standard. External Quality Assessment (EQA) programs on urine sediment are rare. This paper provides an analysis of results from 2012 to date of the EQA Italian program (Centro di Ricerca Biomedica, Regione Veneto) which involves today 255 laboratories. Methods: the EQA program includes four surveys/year. Participants are asked to identify and provide the clinical association of the presence of specific particles (2 surveys) and formulate the diagnosis of clinical cases presented (2 surveys). In 11 years, 202 images were proposed: 64 cells (9 types), 10 lipids (4 types), 59 casts (16 types), 36 crystals (13 types), 14 microorganisms (5 types), 19 contaminants (8 types) and 22 clinical cases were presented. Results: the correct identification rate (median; interquartiles) was very high for micro organisms (96.4; 91.9-99.9); high for crystals (92.2; 80.2-96.3) and lipids (91.1; 90.5-93.6); followed by casts (87.7; 80.1-91.8); contaminants (87.3; 77.2-96.0) and cells (82.8; 74.4-91.3). For clinical associations, the rate of correct answers was 96.5 (range 48.7- 100%). For clinical cases, due to the overall rate of particle misidentification throughout surveys, only 58.6% (44.9- 68.8%) of participants achieved access to clinical diagnosis. Of these, 92,0% (78.1-95.5%) were able to indicate the correct diagnosis. Conclusions: the program can be used as a tool to improve the identification of urine particles and the knowledge of their clinical significance and to encourage specialists of laboratory medicine to correlate urine findings with other laboratory data and the clinical history of the patient, an aspect that improves the value of the day by day work. [ABSTRACT FROM AUTHOR]

The protein concentration in urine is a valuable parameter in assessing kidney function. Usually, blood proteins do not pass through the renal filter in healthy subjects; proteinuria, which can sometimes be detected as a simple, occasional laboratory finding, is a relatively common condition of which those affected are unaware. Epidemiologically, it is a condition that involves almost 10% of the population worldwide. The mechanisms underlying the release of proteins by the kidneys are different: a newly detected proteinuria may precede the onset of renal disease or systemic diseases, and the physician must appropriately evaluate it. This paper provides a hint of epidemiology, some notes of pathophysiology, an overview of the types of proteinuria, a rundown on laboratory techniques and a brief, certainly not exhaustive, review of some non-oncological pathologies associated with proteinuria. The aim is to show the extent to which proteinuria can play a decisive role in the patient's overall assessment. The urine protein test, a basic, non-invasive test, easy to perform by any laboratory, even the most poorly equipped, is a fundamental indicator of a subject's health status in combination with other markers. Thus, it confirms once again the crucial role of the laboratory in providing the physician with necessary diagnostic and prognostic data that is easy to perform, inexpensive and yet of great benefit for the patient management. [ABSTRACT FROM AUTHOR]

Introduction: the Coordination Regional Center for Laboratory Medicine of Lombardy Region provides the External Quality Assessment (EQA) scheme of urine particle evaluation with the aim to verify the inter-laboratory reproducibility of the morphological identification of urine particles. In 2022 we evaluated the concordance between the results obtained testing the same images proposed in two different exercises. Methods: the EQA material consisted of digitalized images of two urine sediments (Case 1 and Case 2) in phase contrast microscopy, where the recognition of the most relevant elements (maximun 4) and the correlation to a clinical condition were requested. To each correct recognition a score of 1 was assigned. Results: in the image of Case 1 leukocytes, bacteria, isomorphic red blood cells and aggregated leukocytes, the typical elements of a urinary tract infection, were recognizable. In the image of Case 2 leukocytes, dysmorphic red blood cells and acanthocytes, the typical elements in a haematuria condition in glomerulonephritis, were recognizable. The percentage of recognition incresead from the first to the second exercise in both the Cases, although few laboratories obtained a full score and many laboratories did not recognized the most common elements frequently present in a urine sediment. Discussion: this EQA scheme was very helpful to verify and strengthen basic skills for the recognition of urinary sediment particles in order to support the clinical decision-making process, although there is some work to be done in order to improve the skills of the operators and the culture of quality in this specific field of laboratory medicine. [ABSTRACT FROM AUTHOR]