Abstract: PO0263
Urine Sediment Examination: Comparison Between Laboratory-Performed vs. Nephrologist-Performed Microscopy
Session Information
- AKI: Clinical, Outcomes, and Trials
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Fawaz, Adam, Cleveland Clinic, Cleveland, Ohio, United States
- Bassil, Elias, Cleveland Clinic, Cleveland, Ohio, United States
- Simon, James F., Cleveland Clinic, Cleveland, Ohio, United States
- Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
- Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
- Daou, Remy, Universite Saint-Joseph, Beirut, Lebanon
- Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
- Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
- Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
Background
Urinalysis is a commonly performed diagnostic test in clinical laboratories and automated urine technology is becoming the standard for providing urinalysis data to clinicians. Time constraints, and use of automated technology has resulted in clinicians no longer performing their own urine sediment exam. We believe that there is a critical value in performing this important unappreciated skill to improve patient care.
Methods
Using our Electronic Medical Records, we identified 140 adult in-patients with acute kidney failure that had urine microscopy with sediment analysis performed both by the laboratory and by a nephrologist within 72 hours of each other. We performed a chart review to determine the following: number of RBCs (< 5 or > 5 HPF), number of WBCs (< 5 or > 5 HPF), presence of casts (<1 or > 1 LPF), type of casts (hyaline, fine granular, coarse granular, muddy brown, WBC casts, RBC casts and mixed cellular casts), and presence of dysmorphic RBCs. We used Kappa statistics to evaluate agreement between urine microscopy by lab versus by nephrologist reviews.
Results
The reported agreement was moderate for RBCs with 79% of samples in agreement (Kappa 0.54 – 95% CI: 0.39, 0.69), fair for WBCs with 74% of samples in agreement (Kappa 0.39 – 95% CI: 0.23, 0.54), and there was no agreement for casts (Kappa 0). Nephrologist detected 8 dysmorphic RBC’s (Kappa 0) while the laboratory did not detect any. Additionally, the laboratory only detected hyaline and fine granular casts, while the nephrologist reported coarse Granular / muddy brown casts, RBC and WBC casts.
Conclusion
Urine sediment exam is an important procedure that provides evaluative information about kidney disease. In our study, we report a disagreement between laboratory vs. nephrologist performed analysis, notably for the recognition of structures that can provide important information in the diagnosis of acute tubular ischemia and glomerulonephritis. This highlights the importance of clinicians continuing to perform sediment exam.