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Human schistosomiasis is one of neglected tropical diseases that remain highly prevalent in sub-Saharan Africa (SSA). Human schistosomiasis is mainly caused by two species, Schistosoma haematobium and S. mansoni, leading to urogenital and intestinal schistosomiasis, respectively. The World Health Organization (WHO) recommends mass drug administration (MDA) with praziquantel as the primary method of global intervention. Currently, MDA with praziquantel covers over half of the target population in endemic SSA countries. However, an accurate diagnosis is crucial for monitoring and evaluating the effectiveness of MDA. The standard diagnosis of both urogenital and intestinal schistosomiasis relies on the microscopic identification of eggs. However, the diagnostic sensitivity of this approach is low, especially for light or ultra-light infections. This is because Schistosoma eggs are laid inside of the venous plexus of the urinary bladder or mesenteric vein, where the adult flukes live. Approximately half of the eggs circulate in the blood vessels or are packed in neighboring tissues, while the remaining half are expelled into the lumen of the urinary bladder or intestine intermittently when the blood vessels are ruptured. In the field setting, the accuracy of any diagnostic method is critical for proper management of the intervention. The present article reviews the recent prevalence of urogenital schistosomiasis in SSA and highlights the practical limitations of diagnostic methods such as urine microscopy, urine reagent strips, molecular diagnosis, and ultrasound scanning in the field setting. Despite continuous global efforts to eliminate schistosomiasis over the past 20 years, many areas still remain endemic in SSA. No single diagnostic approach achieves acceptable sensitivity and specificity in the field setting. Therefore, any field survey should employ a combination of these methods based on the purpose of the study to accurately monitor and evaluate urogenital schistosomiasis. Based on diagnostic values and a cost–benefit analysis, a urine reagent strip test can replace urine microscopy in the field setting. The WHO criteria by ultrasound diagnosis should be updated including the echogenic snow sign and contour distortion. [ABSTRACT FROM AUTHOR]

Introduction: Urinary Tract Infection (UTI) is caused by the abnormal growth of the pathogen in the urinary tract. Urine Microscopy and culture is still the gold standard for the isolation of bacteria. However, screening tests are cost-effective and more practical in managing UTIs. Aim: To determine rapid screening tests (Gram Staining and Catalase test) compared to culture. Materials and Methods: The cross-sectional study was done in the Department of Microbiology, Jawaharlal Nehru Medical College; Acharya Vinoba Bhave Rural Hospital, Sawangi Meghe, Wardha, Maharashtra, India, for a period of one year from August 2019 to September 2020. In this study, 100 urine samples were processed by screening tests such as the Catalase test and Gram stain, followed by culture. Results: Positive predictive value of the catalase test was 55.31% and Gram’s stain was 78.26%. In contrast, the negative predictive value of catalase was 69.81%, and Gram stain was 88.88%. The sensitivity and specificity of the catalase test was 61.90% and 63.79%, respectively and the sensitivity and specificity of Gram stain was 85.71% and 82.75%, respectively. Conclusion: Gram stain had the highest sensitivity, 85.71%, and specificity of 82.75% compared to the catalase test. Candida spp. was the most frequently isolated from a urine culture, followed by Enterococcus spp. E. coli, and Klebsiella spp. were also commonly isolated from people.

Acute kidney injury is defined as an abrupt decline in kidney function, which manifests as an increase in serum creatinine level or a decrease in urine output within a short period of time. It is a commonly encountered entity in the clinical setting and necessitates a systematic diagnostic approach. Acute kidney injury etiologies are classified as either prerenal, intrinsic renal, or postrenal. This article presents the key elements of history taking, physical examination, and laboratory investigations when assessing a patient for acute kidney injury to properly classify its etiology. The use of imaging modalities is also discussed. Common etiologies of acute kidney injury in each category are highlighted. Lastly, this article provides a brief overview of management principles for acute kidney injury with a particular emphasis on indications for initiation of dialysis. [ABSTRACT FROM AUTHOR]

Abstract Background Diagnosis of schistosomiasis depends mainly on stool or urine microscopy for Schistosoma egg detection as well as immunoassays. The low sensitivity of these conventional tests makes molecular detection the diagnostic method of choice. The study aimed to detect the molecular prevalence of urine schistosomiasis and evaluate microscopic examination vs. PCR technique for detection of Schistosoma haematobium (S. haematobium) in urine of patients with suggestive symptoms or previous history of urine schistosomiasis coming from endemic regions. Results This cross-sectional study was performed on eighty patients attending the urology clinic of Sohag University Teaching Hospital from August 2016 to July 2018. Socio-demographic data and clinical data were collected. Urine samples from all study individuals were collected and examined microscopically for S. haematobium eggs as well as detection of S. haematobium DNA of using PCR assay. Microscopic examination and PCR were positive among (68.8%) and (87.5%) of cases, respectively. There was 60% agreement between microscopy and molecular assay. Microscopy was a good test to rule in cases of urine schistosomiasis, with 100% specificity and 100% PPV, but was of limited sensitivity (NPV = 40%) and missed 12.5% of positive cases. Among studied patient variables, only hematuria showed association with urine schistosomiasis with statistical significance. Conclusion Urine schistosomiasis was highly prevalent in studied population. Considering the high sensitivity and specificity of PCR, it should be implemented as the test of choice, especially in chronic urinary schistosomiasis with low infection setting. In our study population, patients presenting hematuria were likely to have S. haematobium.

Human schistosomiasis is one of neglected tropical diseases that remain highly prevalent in sub-Saharan Africa (SSA). Human schistosomiasis is mainly caused by two species, Schistosoma haematobium and S. mansoni, leading to urogenital and intestinal schistosomiasis, respectively. The World Health Organization (WHO) recommends mass drug administration (MDA) with praziquantel as the primary method of global intervention. Currently, MDA with praziquantel covers over half of the target population in endemic SSA countries. However, an accurate diagnosis is crucial for monitoring and evaluating the effectiveness of MDA. The standard diagnosis of both urogenital and intestinal schistosomiasis relies on the microscopic identification of eggs. However, the diagnostic sensitivity of this approach is low, especially for light or ultra-light infections. This is because Schistosoma eggs are laid inside of the venous plexus of the urinary bladder or mesenteric vein, where the adult flukes live. Approximately half of the eggs circulate in the blood vessels or are packed in neighboring tissues, while the remaining half are expelled into the lumen of the urinary bladder or intestine intermittently when the blood vessels are ruptured. In the field setting, the accuracy of any diagnostic method is critical for proper management of the intervention. The present article reviews the recent prevalence of urogenital schistosomiasis in SSA and highlights the practical limitations of diagnostic methods such as urine microscopy, urine reagent strips, molecular diagnosis, and ultrasound scanning in the field setting. Despite continuous global efforts to eliminate schistosomiasis over the past 20 years, many areas still remain endemic in SSA. No single diagnostic approach achieves acceptable sensitivity and specificity in the field setting. Therefore, any field survey should employ a combination of these methods based on the purpose of the study to accurately monitor and evaluate urogenital schistosomiasis. Based on diagnostic values and a cost–benefit analysis, a urine reagent strip test can replace urine microscopy in the field setting. The WHO criteria by ultrasound diagnosis should be updated including the echogenic snow sign and contour distortion.

Background: Urinary tract infection (UTI) in pregnancy is associated with significant morbidity for both the mother and the foetus. The aim of this study was to determine the prevalence of UTI, urinary bacterial susceptibility, and resistance patterns among pregnant women with a possible UTI at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. Methods: In this retrospective study, we analysed mid-stream urine culture and antibiotic susceptibility data from both inpatients and outpatients of pregnant women who attended RMMCH from January 2017 to December 2017. Data were collected from patients' files and then matched with urine microscopy, sensitivity and culture (MC&S) results from the National Health Laboratory Services (NHLS) data. Results: Urine microscopy, cultures and sensitivities were performed on 1984 specimens belonging to pregnant women who presented with symptoms and/or signs of a UTI. A total of 333 patients (16.8%) had positive bacterial cultures. Escherichia coli (E. coli) was the commonest bacterial isolate (49.9%). Other microorganisms isolated included Klebsiella species (14.4%), Enterococcus faecalis (12.9%) and coagulase-negative staphylococci (CoNS); (8.9%). Approximately 98% of organisms were sensitive to cephalexin. Cefuroxime (95.2%), ceftriaxone/cefotaxime (94.4%) and nitrofurantoin (81.9%) demonstrated antimicrobial effectiveness as indicated. Most isolates were resistant to ampicillin/amoxicillin (84.4%), Trimethoprim/Sulfamethoxazole (55.6%) and amoxicillin-clavulanic acid (50.2%). Conclusion: E. coli was the commonest pathogen causing UTIs in pregnancy with Enterococcus faecalis increasing in prevalence. The choice of antimicrobial therapy in pregnancy should be determined according to sensitivity and resistance and foeto-maternal safety. [ABSTRACT FROM AUTHOR]

Acute kidney injury is defined as an abrupt decline in kidney function, which manifests as an increase in serum creatinine level or a decrease in urine output within a short period of time. It is a commonly encountered entity in the clinical setting and necessitates a systematic diagnostic approach. Acute kidney injury etiologies are classified as either prerenal, intrinsic renal, or postrenal. This article presents the key elements of history taking, physical examination, and laboratory investigations when assessing a patient for acute kidney injury to properly classify its etiology. The use of imaging modalities is also discussed. Common etiologies of acute kidney injury in each category are highlighted. Lastly, this article provides a brief overview of management principles for acute kidney injury with a particular emphasis on indications for initiation of dialysis.

Background: Urinary tract infection (UTI) in pregnancy is associated with significant morbidity for both the mother and the foetus. The aim of this study was to determine the prevalence of UTI, urinary bacterial susceptibility, and resistance patterns among pregnant women with a possible UTI at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. Methods: In this retrospective study, we analysed mid-stream urine culture and antibiotic susceptibility data from both inpatients and outpatients of pregnant women who attended RMMCH from January 2017 to December 2017. Data were collected from patients’ files and then matched with urine microscopy, sensitivity and culture (MCS) results from the National Health Laboratory Services (NHLS) data. Results: Urine microscopy, cultures and sensitivities were performed on 1984 specimens belonging to pregnant women who presented with symptoms and/or signs of a UTI. A total of 333 patients (16.8%) had positive bacterial cultures. Escherichia coli (E. coli) was the commonest bacterial isolate (49.9%). Other microorganisms isolated included Klebsiella species (14.4%), Enterococcus faecalis (12.9%) and coagulase-negative staphylococci (CoNS); (8.9%). Approximately 98% of organisms were sensitive to cephalexin. Cefuroxime (95.2%), ceftriaxone/cefotaxime (94.4%) and nitrofurantoin (81.9%) demonstrated antimicrobial effectiveness as indicated. Most isolates were resistant to ampicillin/amoxicillin (84.4%), Trimethoprim/Sulfamethoxazole (55.6%) and amoxicillin-clavulanic acid (50.2%). Conclusion: E. coli was the commonest pathogen causing UTIs in pregnancy with Enterococcus faecalis increasing in prevalence. The choice of antimicrobial therapy in pregnancy should be determined according to sensitivity and resistance and foeto-maternal safety.

Background: Diagnosis of schistosomiasis depends mainly on stool or urine microscopy for Schistosoma egg detection as well as immunoassays. The low sensitivity of these conventional tests makes molecular detection the diagnostic method of choice. The study aimed to detect the molecular prevalence of urine schistosomiasis and evaluate microscopic examination vs. PCR technique for detection of Schistosoma haematobium (S. haematobium) in urine of patients with suggestive symptoms or previous history of urine schistosomiasis coming from endemic regions. Results: This cross-sectional study was performed on eighty patients attending the urology clinic of Sohag University Teaching Hospital from August 2016 to July 2018. Socio-demographic data and clinical data were collected. Urine samples from all study individuals were collected and examined microscopically for S. haematobium eggs as well as detection of S. haematobium DNA of using PCR assay. Microscopic examination and PCR were positive among (68.8%) and (87.5%) of cases, respectively. There was 60% agreement between microscopy and molecular assay. Microscopy was a good test to rule in cases of urine schistosomiasis, with 100% specificity and 100% PPV, but was of limited sensitivity (NPV = 40%) and missed 12.5% of positive cases. Among studied patient variables, only hematuria showed association with urine schistosomiasis with statistical significance. Conclusion: Urine schistosomiasis was highly prevalent in studied population. Considering the high sensitivity and specificity of PCR, it should be implemented as the test of choice, especially in chronic urinary schistosomiasis with low infection setting. In our study population, patients presenting hematuria were likely to have S. haematobium. [ABSTRACT FROM AUTHOR]

Objective Examination of urine sediment is crucial in acute kidney injury (AKI). In such renal injury, tubular epithelial cells, epithelial cell casts, and dysmorphic red cells may provide clues to etiology. The aim of this study was to compare automated urinalysis findings with manual microscopic analysis in AKI. Methods Samples from patients diagnosed with AKI and control patients were included in the study. Red blood cells, white blood cells, renal tubular epithelial cells/small round cells, casts, and pathologic (path) cast counts obtained microscopically and by a UF1000i cytometer were compared by Spearman test. Logistic regression analysis was used to assess the ability to predict AKI from parameters obtained from the UF1000i. Results There was poor correlation between manual and automated analysis in AKI. None of the parameters could predict AKI using logistic regression analysis. However, the increment in the automated path cast count increased the odds of AKI 93 times. Conclusion Automated urinalysis parameters are poor predictors of AKI, and there is no agreement with manual microscopy. [ABSTRACT FROM AUTHOR]

Fully automated urine analyzers are generally preferred in laboratories with high throughput. When these systems are used; especially the sediment analysis should be made by a well-skilled technician before reporting to discriminate well the interferences (like yeast or crystals) from erythrocytes and leukocytes. The purpose of the present study is to detect the correlation of erythrocyte and leukocyte numbers without any corrections in sediment field images of BT Uricell 1280 (BT products, Izmir, Turkey) fully automated urine analyzer with manual microscopy reports. A total of 528 first morning urine samples were studied by both BT Uricell 1280 and manual microscopy concurrently. The degree of concordance (Kappa coefficient) were evaluated. The sensitivity, specificity and positive and negative predictive value for the BT Uricell 1280 compared to manual microscopic examination were assessed. Precision and carry over studies were also performed. The degree of concordance of erythrocyte and leukocyte counts in microscopy of 528 urine specimens with manual microscopy was found to be 0.42 and 0.52 respectively (kappa coefficient). The sensitivity and specificity values of RBC and WBC were calculated for BT Uricell 1280 as 62.6%, 91.1%, 77.6%, 88.8%, respectively. The results of carry over analysis for both RBC and WBC were 0 %. The sediment microscopy analysis of erythrocytes and leukocytes with BT Uricell 1280 without any corrections presented moderate correlation with manual microscopy. A better correlation can be achieved by a more detailed examination of field images of the analyzer. [Med-Science 2018; 7(3.000): 503-6]

Hematuria is one of the alarming manifestations of a renal disease. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or non-glomerular disorders. Clinical presentation and urine microscopy can differentiate glomerular from non-glomerular hematuria. In the majority, a good clinical examination and basic investigations including a urine microscopic examination with sophisticated tools like phase contrast and automated microscopes can help differentiate glomerular from non-glomerular causes for hematuria. Drug induced hematuria, especially secondary to use of analgesics needs to be recognized in routine clinical practice. Rarer causes of hematuria may need more detailed evaluation with a renal biopsy, electron microscopy, urine biochemical testing and imaging. There is no specific treatment to resolve or prevent hematuria. Resolution of hematuria usually occurs with appropriate management of the underlying disorder. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation. Prompt referral to a pediatric nephrologist is indicated in situations when hematuria does not resolve within 2 weeks of onset of glomerulonephritis, there is a need for a renal biopsy, in the presence of persistent microscopic hematuria and need for specific urine biochemistry testing or imaging studies. [ABSTRACT FROM AUTHOR]

Background: The case concerns a 30-year-old woman in the 24th week of pregnancy presenting to the medical emergency room with fever and abdominal pain. Urine sediment microscopy revealed the presence of unknown needle-shaped crystals. Methods: Crystals identification was performed by Fourier-Transform Infrared Spectroscopy coupled to Attenuated Total Reflectance (FTIR-ATR). Results: Amoxicillin crystals were verified with semiquantitative results of 87.7%. Conclusions: Drug-induced crystalluria is a frequent finding in urine examination and it may be asymptomatic. FTIR spectroscopy is a rapid and specific tool in identification of crystals and could be useful supporting renal disease diagnosis and monitoring drug therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury. Materials and methods The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI. Results AKI is defined by the rate of rise of serum creatinine and a decline in urine output. The pathophysiology is diverse and requires a careful and systematic assessment of predisposing factors and localization of site of injury. The majority of AKIs are due to prerenal causes such as fluid volume deficit, sepsis, or renal as in acute tubular injury. The use of central venous and arterial blood pressure monitoring and inferior vena cava echocardiography complemented by urine analysis and microscopy allows assessment of fluid volume status and AKI etiology. Conclusions Timely intervention by avoidance of fluid volume deficit and nephrotoxic agents and blood pressure support can reduce the incidence of AKI in critically ill patients.

A survey was circulated to consultant gynaecologists across Wales, to evaluate the management of pre-operative urine dipstick results. Questions were based on NICE guideline 171, regarding the management of urinary incontinence in women. Six respondents never checked their patient's urine dipstick results. Of the remaining 37 respondents, 70% always check and 30% sometimes check. Overall, 37.1% cancelled surgery when a urine dipstick was positive for either nitrite or leukocyte-esterase (LE). A significantly larger proportion cancelled surgery when symptomatic for urinary tract infection (p< 0.001), and when nitrite and LE positive compared to only LE positive (p< 0.05). This survey provides evidence that gynaecological operations are potentially being cancelled unnecessarily based on a screening test with limited sensitivity and specificity. Further research is needed into the outcomes of gynaecological surgery in women symptomatic of urinary tract infection to provide guidance on the use of pre-operative urinalysis and the management of test results. Impact statement What is already known on this subject? The strongest risk factor for postoperative urinary tract infections (UTIs) is a pre-operative recurrent UTI (Nygaard et al. 2011 ). This is the reason behind the urine dipstick being part of the pre-operative checklist for gynaecological surgery. Traditionally, a suspected UTI would mean postphoning surgery whilst treating the UTI. It is known that the sensitivity of the nitrite test and leukocyte-esterase test when used alone is low and cannot rule out UTI in most patients (Mambatta et al. 2015 ). Urine culture is therefore suggested for all patients with a suspected UTI (John et al. 2006 ). To our knowledge, there are no data available on whether we should be postphoning gynaecological surgery based on a urine dipstick result. Whatthe results of this study add? Overall, 37.1% of respondents cancelled surgery when a pre-operative urine dipstick was positive for either nitrite or leukocyte-esterase. This provides evidence of variation in the practice of using the urine dipstick in women undergoing gynaecological surgery in Wales. These cancellations are potentially unnecessarily. Furthermore, 14% of respondents did not use a urine dipstick and the majority did not act on an abnormal results, implying clinicians have a low confidence in the test as a screening tool. Whatthe implicationsareof these findings for clinical practice and/or further research? We propose removing the urine dipstick as a pre-operative screening test. Asymptomatic bacteriuria is common in women and routine screening for UTI pre-operatively will therefore inevitably lead to unnecessary intervention (i.e. cancellation). Further research is needed into the outcomes of gynaecological surgery in women symptomatic of UTI to be able to provide guidance on the use of pre-operative urinalysis and management of the test results. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the analytical performances of Sysmex UF-5000 and Dirui FUS-200 and to compare the results with manual microscopy and between each other. Two hundred fifty urine samples were analyzed for evaluation. Mid-stream specimens were studied sequentially using Dirui FUS-200 and Sysmex UF-5000, and also with manual microscopy within one hour. The physical and chemical components of urinalysis, and sediment results were investigated. The precision results of the FUS-200 and UF-5000 for WBCs, RBCs, and ECs were acceptable. The both analyzers demonstrated good linearity (r > 0.97), with no carry-over. The comparisons of FUS-200 and UF-5000 with manual microscopy for RBCs, WBCs, and ECs on 250 samples exhibited good agreement with little bias (R > 0.780). Only, the moderate agreements were obtained for calcium oxalate for both analyzers (R = 0.512, and 0.648, respectively). The sensitivities of the FUS-200 and UF-5000 were 75.8% and 86.8%, with specificities of 92.3% and 87.8% for WBCs, for RBCs the sensitivities were 91.1%, and 84.4% with specificities of 82.2%, and 89.6% for both analyzers. Kappa values of the UF-5000 were higher than FUS-200 for WBCs, RBCs, ECs, and calcium oxalate. The FUS-200 and UF-5000 urine analyzers, are both accurate, very precise systems and can be safely used in clinical laboratories. However, due to the technological characteristics of the UF-5000 analyzer, its positive impacts on the morphologic recognition and enumeration of RBCs and WBCs should be taken into account, particularly in university hospital laboratories with high patient volumes. [ABSTRACT FROM AUTHOR]

Background: Women with urinary tract infections (UTIs) often present with urinary complaints such as frequency of micturition, dysuria, foul-smelling urine and other non-specific symptoms like fever. Physicians may order urine microscopy to guide empirical antibiotic prescription. However, the performance of this approach has not been assessed.Objectives: This study aimed to determine the accuracy of UTI symptoms and urine microscopy associated with culture-positive UTI in Asian women.Methods: A cross-sectional study of adult women who presented with UTI-related symptoms was conducted at three public primary care clinics in Singapore. Demographic data and information on their symptoms were collected, followed by urine microscopy and culture to diagnose UTI. The sensitivity, specificity, positive (PPV), negative predictive values (NPV), accuracy (ACC) and area under curve (AUC) of combinations of symptom and urine investigations were analysed in association with culture-positive UTI, which was regarded as a benchmark.Results: Data on 564 women (73.9% Chinese, 11.5% Malay, 8.2% Indian) were analysed, of which 259 (45.9%) had culture-positive UTI. Frequency and foul-smelling urine, pyuria (WBC ≥10/hpf) and semi-quantitative bacterial count (≥2+) were significantly associated with positive urine culture. The ACC and AUC for single or multiple urinary and/or general symptoms were low. Urine pyuria (minimally >10/hpf) alone or in combination with symptoms and/or semi-quantitative bacterial count achieved high sensitivity (>85%) and PPV, NPV, ACC and AUC of >70%.Conclusion: Urinary symptoms have limited accuracy in diagnosing culture-positive UTI. Concurrent urine microscopy showing presence of pyuria and/or bacterial count increased the diagnostic accuracy of culture-positive UTI. [ABSTRACT FROM AUTHOR]

Background: Currently, numerous review procedures are applied to perform the urine sediment examination. Clinical technologists and nephrologists use different procedures for the determination of specimen concentration and for particle counting. These techniques may underestimate the formed elements such as pathological casts (CASTs) and renal tubular epithelial (RTE) cells and might interfere with clinical diagnosis. The aim of this study was to evaluate a modified review procedure for urinary analysis and to narrow the gap between nephrologists and technologists by increasing the detection positivity rate for pathological formed elements. Methods: We implemented a modified urinalysis procedure between October 2016 and January 2017 based on strict manual microscopic criteria and the currently available equipment. We confirmed the agreement between methods using a review procedure and Sysmex UF-1000i urinary flow cytometer (Pairwise Agreement > 0.88 for WBCs, RBCs, CASTs, and SRCs). Then we derived the review procedure that was based on the optimal sensitivity and specificity as follows: RBC > 26.1/µL, WBC > 37.0/µL, CAST > 1.0/µL, SRC > 8.2/µL, XTAL > 1.5/µL, YLC > 10.0/µL, BACT > 287.5/µL. Results: Of the 317 specimens investigated, 17.4% (26/149) and 31.5% (39/124) of the specimens for RTEs and Path. CASTs, respectively, were correctly detected using the proposed review procedure. Sensitivity and specificity for this procedure was 96.9% and 46.2%, respectively. In addition, we verified the ability of the procedure to detect the pathological elements with technologists and nephrologists and the agreement was satisfactory. Conclusions: This modified review procedure can significantly improve the quality of urinalysis and reduce the risk of underestimating the detection of pathological particles. [ABSTRACT FROM AUTHOR]

Background: Urinalysis based on microbiological culture and manual microscopy requires expertise and is labor intensive. Automated screening could save time and improve patient management in clinical settings. Methods: We evaluated the fully automated cobas u 701 analyzer for identifying infection-negative urine samples using 2,046 anonymized samples from a routine pathology laboratory. Samples containing ≥ 40 white blood cells (WBC)/μL and/or ≥ 100 bacteria/μL were considered positive. For microbiological cultures: pure growth of ≥ 108 colony-forming units (cfu)/L was considered significant; > 107 cfu/L was considered significant for pregnant women, children < 12 years, immune-compromised/critical care patients or patients with > 100 WBC/μL. Results: The cobas u 701 analyzer identified 1,346 positive samples, giving a 65.7% culture rate. Sensitivity and negative predictive value were high (> 99%). Most replicates were within two standard deviations of the original measurement. Conclusions: The cobas u 701 analyzer is an effective screening tool for routine urinalysis and demonstrates rapid turnaround times, thus benefiting patients and clinicians. [ABSTRACT FROM AUTHOR]

Background: Automated urine sediment analyzers have proven their feasibility in medical laboratories. However, editing manual microscopic review of some specimens severely limits the usefulness of such systems. This study aims to give feedback on the practical experience on "Yeast", which is one of the parameters that compel frequent manual reviews. Methods: 5448 freshly collected urine specimens submitted from various departments of our hospital for diagnostic urinalysis were studied by the UriSed® (77 Elektronika, Hungary). A specialist medical doctor inspected every image on-board, and reviewed the ones with a "Yeast" alarm by traditional manual microscopy. Results: UriSed alarmed in 491 samples (9%) for yeast. In 59 samples (1%) the number of particles exceeded the cut-off and a "positive for yeast" was set. A false positive report of yeast +1 to 3+/H PF was found in 51 samples (0.9%). There were 8 cases with positive for yeast from both microscopic methods. Thirty-three "negative for yeast" samples were corrected as positive after the manual microscopic review. Conclusions: We report a high percentage of false positives and negatives in the yeast parameter, in line with other studies on UriSed as well as on other instruments in the market. As an important feedback, our observations showed that the major concern in false results was "the focusing problem". We believe in the necessity of a focus check and comparison of alarms between images on board.

Background Fully automated urine analyzers integrated with expert software can help to select samples that need review in routine clinical laboratory. This study aimed to define review rules to be set in the expert software Director for routine urinalysis on the AutionMAX-SediMAX platform. Methods A set of 1002 urinalysis data randomly extracted from the daily routine was used. The blind on-screen assessment was used as a reference. The data set was used to optimize the standard rules preset in the software to establish review criteria useful to intercept automated microscopy misidentification and particles suggestive of clinically significant profile. The review rate was calculated. The rules-set was also evaluated for the selection of clinically significant samples. Results The review rules established were cross-checked between AutionMAX and SediMAX parameters, element reporting by SediMAX and strip results. For the complete rules-set the review rate was 47.6% and the efficiency for clinically significant sample selection was 58%. Finally, on the basis of the review rules an algorithm for routine practice was created. Conclusions Review rules applied to the algorithm for routine practice enhance workflow efficiency and optimize sample screening. Revision is not necessary for samples not flagged by the rules. [ABSTRACT FROM AUTHOR]

Objective: Automated urine analysis is usually preferred for laboratories with intensive workload. The aim of this study was to evaluate the performance of the automated urine analyser H-800/FUS-100 and detect the error sources. Materials and methods: One thousand four hundred fifty nine fresh urine samples were analyzed with H-800/FUS-100 automated systems. The urine sediment of the samples with discrepant strip and microscopy results were confirmed by manual microscopy. Precision and carry over studies were performed. Results: The discrepancy is detected in a ratio of 5.89% between chemical analysis (H-800) and microscopic analysis (FUS-100) of the device. A total of 86 discrepant samples were detected. Fifty six of 86 were erythrocyte discrepancies (65.1%) and 30 of 86 were leukocyte discrepancies (34.9%). The results of carry over analysis for erythrocyte and leukocyte were 21.85% and 13.64%, respectively. Conclusions: Sixteen (1.09%) of 1459 patients’ results in FUS-100 were discrepant with manual microscopy. Commonly, yeasts and crystals affected erythrocyte counts and calcium oxalate and amorphous crystals affected the leukocyte counts. Images should be reviewed for every sample when automated systems are used for urine analysis. Especially if discrepancy is detected between chemical and microscobic analysis, the results should also be confirmed with manual microscopy. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with adverse short- and long-term outcomes. AKI is diagnosed by serum creatinine (SCr)-based consensus definitions that capture an abrupt decrease in glomerular filtration rate associated with AKI. However, SCr-based AKI definitions lack sensitivity and specificity for diagnosing structural kidney injury. Moreover, AKI is a heterogeneous condition consisting of distinct phenotypes based on its etiology, prognosis, and molecular pathways, and that may potentially require different therapies. SCr-based AKI definitions provide no information on these AKI phenotypes. This review highlights traditional and novel tools that overcome the limitations of SCr-based AKI definitions to improve AKI phenotyping. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection is a common condition which needs laboratory evaluation of urine to substantiate the clinical diagnosis and initiate treatment. The conventional urinalysis consists of using a test strip for chemical examination to identify the various urine sediments after which visual microscopy is done. We evaluate the analytical performance of automated microscopic technique (UF 500i) and compare results with those from manual microscopy. Materials and Methods: A total of 382 urine specimens were collected during a period of one month out of which 128 samples which had abnormal cell counts were analyzed for cells and particles by manual and automated microscopy by UF-500i flow cytometer. Results: The concordance of UF 500i and the manual microscopy which is considered to be the gold standard for urine microscopic examination was 90.6% for white blood cells, red blood cell, epithelial cells, cast and bacterial count. Conclusion: Automated urine sediment analyzer, UF 500i was considered reliable in the measurement of white blood cells, red blood cells, epithelial cells, cast and bacteria. Automation will surely reduce the work load, increase accuracy and reliability, and increase the throughput and turn-around time of the laboratory DOI: http://dx.doi.org/10.3126/jpn.v4i7.10316 Journal of Pathology of Nepal (2014) Vol. 4, 576-579

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a new class of medications that target the transporter that reabsorbs ~90% of glucose in the S1 segment of the proximal convoluted tubule. As a result, SGLT2 inhibition increases urinary glucose excretion, effectively lowering plasma glucose levels. In addition to reducing hemoglobin A1c levels, these drugs also lower body weight, blood pressure, and uric acid levels in Type 2 diabetes mellitus (T2DM) patients. Importantly, empagliflozin has been observed to slow progression of kidney disease and reduce dialysis requirements in T2DM patients. However, the Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS) has collected over 100 cases of acute kidney injury (AKI) for canaglo- flozin and dapagliflozin since their approval. Of the 101 patients, 96 required hospitalization, 22 required intensive care unit admission, and 15 underwent hemodialysis. The FDA now requires that AKI be listed as a potential side effect of the SGLT2 inhibitors along with cautious prescription of these drugs with other medications, such as renin-angiotensin-system antagonists, diuretics, and NSAIDs. It is unclear, however, whether this FAERS reported "AKI" actually represents structural kidney injury, as randomized, controlled trials of these drugs do not describe AKI as an adverse event despite coprescription with RAS blockers and diuretics. As a result of this FDA warning, diabetic patients with early-stage CKD may not be prescribed an SGLT2 inhibitor for fear of AKI. Thus, it is imperative to ascertain whether the reported AKI represents true structural kidney injury or a functional decline in glomerular filtration rate. We propose using readily available clinical tools with experimental biomarkers of kidney injury and kidney-on-a-chip technology to resolve this question and provide solid evidence about the AKI risk of these drugs for healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury. Materials and methods: The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI. Results: AKI is defined by the rate of rise of serum creatinine and a decline in urine output. The pathophysiology is diverse and requires a careful and systematic assessment of predisposing factors and localization of site of injury. The majority of AKIs are due to prerenal causes such as fluid volume deficit, sepsis, or renal as in acute tubular injury. The use of central venous and arterial blood pressure monitoring and inferior vena cava echocardiography complemented by urine analysis and microscopy allows assessment of fluid volume status and AKI etiology. Conclusions: Timely intervention by avoidance of fluid volume deficit and nephrotoxic agents and blood pressure support can reduce the incidence of AKI in critically ill patients. [ABSTRACT FROM AUTHOR]

Aims & Objectives: The purpose of the current study was to evaluate the role of urine microscopy and urine sediment examination in the differential diagnosis and outcome prediction of AKI in hospitalized patients. Methods: In this cross-sectional study, fresh urine samples were obtained from 100 consecutive patients who were seen for diagnosis of AKI by the nephrology consult service at indoor in Medicine Department at N R S Medical College and Hospital. AKI was defined as a 50% increase in serum creatinine concentration above baseline. In reality, most patients had much more severe increases in serum creatinine concentration at the time of nephrology consultation. The consultant nephrologist was asked to assess the probable cause of AKI at two time points: (1) After clinical assessment of the patient but before urine microscopy (pre-urine microscopy diagnosis) and (2) after patient discharge, renal biopsy, or death (final diagnosis). Instruction included both didactic education about the various cellular elements and casts found in the urine, which included proper collection, preparation, and viewing of the urine. Results: The urinary sediment scoring system was highly predictive of the final diagnosis of ATN. The odds ratio (OR) for ATN incrementally increased with an increase in severity of the scoring system (all compared with score 0; score 1: OR 9.7, 95% CI 5.3 to 18.6; score ≥2: OR 74.0, 95% CI 16.6 to 329.1. In patients with a high pretest probability of ATN (initial diagnosis of ATN), any granular casts or RTEC (score ≥2) resulted in very high PPV (100%) and low NPV (44%) for a final diagnosis of ATN. In patients with a low pretest probability of ATN (initial diagnosis of prerenal AKI), the lack of granular casts or RTEC on urinary sediment examination had a sensitivity of 0.73 and a specificity of 0.75 for a final diagnosis of ATN. The NPV of lack of granular casts or RTEC in patients with low pretest probability of disease was 91%. Conclusion:Urine microscopy and examination of the sediment has some advantages on the basis of widespread availability, technique simplicity with conventional equipment, and low cost. Our cross-sectional study of urine microscopy in the setting of hospital-acquired AKI suggests that ATN (sustained AKI) can be confidently differentiated from pre-renal AKI. This was based on determining the presence of granular casts and using a scoring system based on the number of casts and RTEC. Further studies using other urinary indices such as fractional excretion of sodium and biomarkers (e.g., NGAL, IL-18, KIM-1) are warranted to elucidate better the role of granular casts, RTEC, and a scoring system in diagnosis and prognosis of ATN. [ABSTRACT FROM AUTHOR]

Background Clinical laboratories are under growing pressure to provide faster turn-around-time and maintain high quality while decreasing costs. In a setting of rising test volumes, implementation of evidence-based protocols with physician cooperation and feedback may provide frameworks and support for laboratory utilization optimization. The purpose of this study was to eliminate wasteful urine microscopy by targeting physician ordering behavior, and to ensure quality of care with physician satisfaction surveys. Methods We evaluated how physicians use the laboratory for routine urine testing. Urinalysis requisition was redesigned with emphasis on clinical indications for testing. In collaboration with requesting physicians, restriction in reflex microscopy testing was applied with exceptions. Cost saving analysis was conducted based on test volume. After policy change, 2 physician satisfaction surveys were conducted 5 year apart to address potential complaints. Results Over 47,000 urine microscopies have been eliminated annually, while the number of urine dipsticks and cultures remained stable. This translated into a 95% reduction in manual microscopy performed, and an estimated annual saving of $200,000. In both satisfaction surveys, 9 out of 10 physicians considered the change to have “no” or “a beneficial effect” on their clinical practice. Our laboratory did not receive any formal complaints in regards to the protocol change. Conclusion By implementing changes to the way physicians order urinalysis, the number of tests can be substantially reduced. Satisfaction survey proved to be an effective tool for obtaining physician feedback, and support. The results of surveys indicated that new policy achieved significant savings without compromising on patient care. This experience has provided us with strategies on taking initiatives to further optimize utilization of laboratory tests. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy. [ABSTRACT FROM AUTHOR]