Getting the most from urine and sediment analysis

Urine sediment examination is an important preliminary investigation for the nephrologist and helps him decide whether the patient has a proliferative or non-proliferative glomerular pathology. Recently, there is an increasing trend of using easier, non-specific dipstick method for urine examination leading to a decline in the importance of urine sediment examination. Here, we attempt to define guidelines for bio-chemical and microscopic parameters in order to develop a uniform and clinically relevant reporting system for urine sediment examination. Urine samples were reported as inactive or active sediment. A tiered system of reporting urine sediments was developed including inactive sediment, Inactive sediment with moderate/significant proteinuria, glomerular hematuria, and active sediment, active sediment with significant proteinuria / features of proliferative activity. The urine sediment was compared to kidney biopsies of these patients which were grouped into non proliferative and proliferative glomerulopathy. 795 paired samples of urine sediment and kidney biopsies were examined and compared. Patients of non-proliferative glomerulopathy (Minimal change disease, Focal segmental glomerulosclerosis, amyloid and membranous nephropathy) showed features of Inactive sediment. Patients with proliferative glomerulopathy (focal proliferative glomerulonephritis [GN], Diffuse proliferative GN, Membranoproliferative GN, Mesangio-proliferative GN and crescentic GN) predominantly showed active sediment, with increase in percentage of dysmorphic red blood cells and formed elements. The sensitivity of this urine reporting system was 82.0%, specificity 74.4% with p value <0.001. This system of reporting urine sediment is a sensitive and efficient method of predicting the severity of underlying kidney disease and need for performing renal biopsy.

Introduction: Trichomoniasis is a curable sexually transmitted infection (STI) caused by a facultative anaerobic flagellate eukaryotic parasite called Trichomonas vaginalis, in its trophozoite form. It is a prevalent STI among women of reproductive age, causing vaginal discharge, increased risk of pelvic inflammatory disease and poor obstetric outcomes. According to the World Health Organization, in 2020, there were approximately 156 million new cases of the disease among people aged 15 to 49 years. One of the methods of visualizing T. vaginalis is through fresh microscopy, which is widely used to diagnose vaginitis. However, the parasite also infects the urinary tract and little has been studied about this site, although urinary sediment examination is a tool for its identification. Objective: To analyze the prevalence and characteristics associated with the diagnosis of T. vaginalis in the urinary sediment of women treated in the public sector in the municipality of Maranguape, Ceará. Methods: This is an observational, cross-sectional, quantitative clinical study carried out at the Municipal Hospital of Maranguape, Brazil, from February to December 2024, in which patients diagnosed with T. vaginalis infection were analyzed and their urine sediment exemined. Results: During the indicated period, 3,680 urine samples from patients of both genders and various age groups were analyzed. T. vaginalis was identified in nine patients (0.24%). Several trophozoites and their movements were visualized in all the positive urines. Most of the parasites were found between the leukocyte blocks, still with an apparent flagellum. They lost their strength of movement around 4 to 5 hours after collection. In the analysis of the urinary sediment, the positive samples had an acid pH (&lt;7), with a density varying between 1015 and 1030 g/mL, and the presence of protein in 44.4% of the samples. All the analyses showed some degree of leukocyte esterase, ranging from + (22.2%), ++ (33.3%) and +++ (44.4%), with leukocytes arranged in blocks on the slide. They also had bacteriuria associated with T. vaginalis, ranging from mild (88.8%) to moderate (11.1%). Hemoglobin was found in four of the nine positive samples (44.4%), and red blood cells were visualized in all of these samples, ranging from rare to numerous. It is believed that the visualization of trophozoites in urine slides is due to the fact that the microorganism grows and maintains itself in acidic media, with temperatures varying between 20° and 40°C, and can survive for a few hours in secretions, which would make it possible to diagnose it using urine sediment. Conclusion: The prevalence of T. vaginalis in urine tests was relatively low (0.24%). The parasite keeps moving for up to 5 hours. The characteristics of the urine sediment in these cases were low pH, bacteriuria and an increased number of leukocytes.

Urine sediment examination: A comparison of automated urinalysis systems and manual microscopy

Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019

The examination of urine sediment is a diagnostic test which is frequently neglected by nephrologists. With this review the authors wanted to demonstrate that it can provide useful and relevant information in a wide spectrum of clinical situations. The authors reviewed the main contributions dealing with urine sediment examination, published in international journals in the period from January 2002 to April 2003. After a section on methodological aspects, they described the importance of urine sediment examination in various diseases of the urinary tract. These included bladder B-lymphoma, systemic histoplasmosis, urate nephropathy, Fabry disease, myeloma cast nephropathy, giant cell arteritis, and lupus nephritis. The significance of 'decoy cells' in the urine as a marker of polyomavirus BK reactivation was also discussed, both in renal transplantation and other conditions such as solitary pancreas transplantation, chronic lymphatic leukaemia, and HIV infection. In the section devoted to urine sediment changes caused by drugs the authors dealt with leukocyturia induced by indinavir, and crystalluria, which can follow amoxycillin and acyclovir administration. Finally, they reported on the utility and limits of flow cytometry for the automated analysis of urine sediments. The review of the recent literature on urine sediment examination shows that this test has important clinical implications in a large spectrum of diseases. Therefore, it should be more widely used by nephrologists.

Urinanalysis, considered the “liquid biopsy” of the kidney, is rapidly becoming a lost art among nephrologists. A well-performed urinanalysis provides information on the presence of kidney disease, identifies the affected compartment, and helps monitor disease activity. The three main components of urine analysis are gross examination, dipstick tests, and urine sediment examination under microscopy. The urine sediments should be analyzed under a bright-field, dark-field, phase-contrast, and polarization microscope for better visualization and categorization of cells, casts, and crystals. The Sternheimer-Malbin (SM) stain can enhance urine sediments under a microscope. The urine sediment, like in a kidney biopsy, should be systematically analyzed for evidence of glomerular (dysmorphic RBCs, acanthocytes, RBC casts, lipid casts) and tubulointerstitial (RTE cell casts, Granular casts, Leucocyte casts, broad waxy casts) injury. For crystal identification in sediments, knowledge of urinary pH, morphology, and birefringence features under polarized light is essential.

Urine sediment examination is a time-tested and non-invasive diagnostic tool. Thisstudy investigated the characteristics of urine sediment and its association with severity and renal outcomes in diabetic nephropathy (DN) patients. A total of 201 biopsy-proven diabetic nephropathy patients (according to the pathological classification of diabetic nephropathyproposed by the Renal Pathology Society in 2010)who underwent manual urine sediment microscopic examination were included. We compared the clinicopathologicalcharacteristics of diabetic nephropathy patients with and without urinary renal tubular epithelial cells (RTECs) or renal tubular epithelial cell casts. The predictive value of urinary renal tubular epithelial cells or renal tubular epithelial cell casts for renal outcomes in diabetic nephropathy was analyzed. Fifty of 201 (24.9%) diabetic nephropathy patients had renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment. Diabetic nephropathy patients with renal tubular epithelial cells or renal tubular epithelial cell casts in urine sediment had a significantly higher level of proteinuria [6.0 (3.1, 9.7)vs.3.6 (1.8, 6.8) g/24h, p = 0.001], higher serum creatinine [227.9 (151.6, 338.1)vs.177.0 (104.4, 288.4) μmol/L, p = 0.016] and lower estimated glomerular filtration rate (eGFR) [25.8 (15.8, 44.8)vs.35.7 (19.9, 65.0) mL/min/1.73m2, p = 0.025] than those without.Cox regression analysis demonstrated that the presence of urinaryrenal tubular epithelial cells or renal tubular epithelial cell casts was independently associated with the development of end-stage kidney disease (ESKD) in diabetic nephropathy patients [HR 1.670, 95% CI (1.042, 2.676), p = 0.033]. Adding the presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts to the predictive model could improve the effectiveness of the model for predicting the risk of ESKD within one year after renal biopsy. The presence of urinary renal tubular epithelial cells or renal tubular epithelial cell casts was associated with more severe kidney injury and worse renal outcomes in patients with diabetic nephropathy, thus perhaps providing a noninvasive biomarker for predicting diabetic nephropathy.

PurposeThe aim of our study was to evaluate a procedure in which urine culture was only being performed based on fixed cut-off values of urine sediment analysis with intention to prevent unnecessary negative urine cultures.MethodsFrom January 2018 to August 2018, all urine samples from patients visiting the urology outpatient department were analyzed. Urine culture was only performed if urine sediment contained more than 130 bacteria per microliter and/or more than 50 leukocytes per microliter.ResultsIn total, 2821 urine cultures with accompanying urine sediments were analyzed. 2098 cultures (74.4%) were defined negative and 723 (25.6%) positive. By adjusting cut-off values of sediment analysis > 20 per microliter or bacteria more than 330 per microliter, 1051 cultures would have been saved with an estimated cost reduction of € 31.470. Eleven clinically relevant urine cultures would have been missed (1%).ConclusionUsing cut-offs values leads to a notable decrease of the total number of urine cultures. According to our analysis, adjusting cut-off values could result in 37% less urine cultures and almost 50% less negative cultures. Hereby, unnecessary cost can be prevented [in our department estimated €31.470 in eight months (€ 47.205/year)].

The technique of supernatant removal in urine sediment examination using the Shih-Yung method can be done by aspirating and decanting. The aspirated technique is the recommended technique. The Central Laboratory Installation of Dr. M. Djamil Hospital, Padang used decanted supernatant removal technique. The variety of preanalytical procedures affect the results of urine sediment examination. This study aimed to analyze the agreement of erythrocyte, leukocyte, and non-hyaline cast sediment examination results using the Shih-Yung method in aspirated and decanted supernatant removal technique. This study was an analytical observational study with a cross-sectional design of 37 urine specimens that met the inclusion and exclusion criteria at the Central Laboratory Installation of Dr. M. Djamil Hospital, Padang from July to September 2020. Examination of erythrocyte, leukocyte, and non-hyaline cast sediment using Shih-Yung method with aspirated and decanted supernatant removal technique. Numeric data were analyzed using the Mann-Whitney U test and Cohen's Kappa test for the degree of agreement, p-value &lt; 0.05 was considered significant. The agreement test results for erythrocyte, leukocyte, and non-hyaline cast sediment in aspirated and decanted supernatant removal technique were (Kappa=0.88, p &lt; 0.05), (Kappa=0.83, p &lt; 0.05), and (Kappa=0.86, p &lt; 0.05), respectively. The degree of agreement test results for erythrocyte, leukocyte, and non-hyaline cast sediment using the Shih-Yung method in aspirated and decanted supernatant removal technique were almost perfect and statistically significant. The technique for supernatant removal in urine sediment examination using the Shih-Yung method can be done by decanting.

Urinary sediment is an important part of routine urine test, which plays an irreplaceable role in the diagnosis of diseases, monitoring of treatment effect, and prognosis judgment [1]. Through the results of urine dry chemistry and microscopic examination of urinary sediment, we inter-preted and analyzed the clinical significance of urinary casts in urinary sediment. In patients with new urinary system diseases abnormal urine results appear earlier than changes in serum renal function indicators, especially when the urine sediment shows typical casts, which can provide an important basis for clinical diagnosis. Clinical laboratory personnel should attach great importance to the morphological examination of urinary sediment and master the diagnostic significance of the formed components of urinary sediment for various diseases, so as to better assist clinical disease diagnosis.

Objective To investigate the clinical effect of automatic urine sediment analyzer combined with urine dry chemical analysis on the diagnosis of glomerular hematuria. Methods According to the results of pathological diagnosis, the blood and urine samples of 110 cases in hospital from March 2017 to March 2018 were divided into two groups, with 43 cases in glomerular hematuria group, and 67 cases in glomerular hematuria group. Each sample was divided into two parts, respectively detected by dry urine chemical analysis method + automatic urine sediment analyzer and microscope manual microscopic examination. Mean corpuscular hemoglobin (MCH) and Mean corpusular volume (MCV) were analyzed and compared between the non-glomerular hematuria patients and the glomerular hematuria patients. Comparison of the two detection methods for the RBC norphologlcal parameters and the positive detection rate of urine RBC were compared. Results The urine MCH and urine MCV levels in the glomerular hematuria group were lower than those in the non-glomerular hematuria group, and the difference was significant (P 0.05). The automatic urinary sediment analyzer urine dry chemical analysis inspection and microscope artificial microscopy method for all type of specificity were 81.40% (35/43), 83.72% (36/43), the sensitivity was 94.03% (63/67), 97.01% (65/67), there were no significant differences (P>0.05). Conclusions Urine dry chemical analysis in patients with glomerular hematuria+ automatic urinary sediment analyzer test examination can obtain similar diagnosis effect of microscope artificial microscopy method, the possibility of misdiagnosis was smaller, and feasibility was strong, which can be used as a common way of glomerular hematuria screening. Key words: Glomerular hematuria; Automatic urinary sediment analyzer; Urine dry chemical analysis

It has been postulated that erythrocyte cell lysis in urine is common in the case of low urine specific gravity and high urine pH. We aimed to verify the influence of urine dipstick pH and specific gravity on erythrocyturia in the urine sediment in the case of positive dipstick hemoglobinuria. We retrospectively collected data on dipstick specific gravity, pH, and urine sediment analysis done by nephrologists in the clinical and research urine laboratory at the Department of Nephrology, University Medical Center Ljubljana. During the 6-year observation period, we analyzed 843 second morning midstream urine samples with positive dipstick hemoglobinuria. Erythrocyturia in urinary sediment was detected significantly less often in urine samples with concomitant hemoglobinuria 1+ and pH < 6.0, (odds ratio (OR) 0.40; 95% confidence interval (CI) 0.21-0.76, p = 0.005). The difference was maintained in multivariate analysis including patient age, gender, and specific gravity (OR 0.32; 95% CI 0.15-0.65, p = 0.002). In samples with higher grade of hemoglobinuria (≥2+), the impact of cell lysis in the case of low pH was negligible. Specific gravity did not have any influence on erythrocyte detection in urinary sediment. Urinary pH <6.0 impaired the detection of erythrocytes in urinary sediment, while the dipstick measured urine specific gravity did not have any impact on it. Urine samples with low-grade hemoglobinuria and low pH without erythrocyte detection in urinary sediment should be evaluated again to avoid false-negative results. .

Clinical implications of p53 mutation analysis in bladder cancer tissue and urine sediment by functional assay in yeast.

The diagnostic techniques based on polymerase chain reaction (PCR) for the detection of Schistosoma spp. DNA in stool, serum, plasma and urine has shown high sensitivity and specificity solving the problems for the low worm burdens and low transmission rates facing the routine microscopic diagnosis. Since PCR assays require efficient unbiased procedures of extraction and purification of nucleic acids. This study compared the efficiencies of simple, manual and feasible DNA extraction methods; a salting out and resin method, phenol/chloroform method to a commercial extraction kit through PCR analysis of human urine and serum samples spiked with known amounts of adult Schistosoma mansoni DNA confirmed by the application on real samples from patients. In artificially spiked urine gradient, the best mean diagnostic performance was that of salting out and resin then phenol/chloroform and last for the commercial kit. All three methods gave positive results in all tested urine samples which insures comparable high efficiency for DNA detection. In artificially spiked serum gradient, the highest mean diagnostic performance was obtained by the kit then salting out and resin and last by phenol chloroform. In patients' urine samples the phenol/chloroform method showed the highest mean diagnostic performance followed by the resin and then the kit. Using patients' serum samples the resin method showed equal mean diagnostic performance with the phenol/chloroform method which was higher compared to the kit. As regards sensitivity from urine samples the resin and phenol/chloroform showed equal results using artificial gradients and patients' samples. In serum samples the resin and phenol/chloroform showed equal results using artificial gradients while the resin showed better results in patients' samples. It is recommended to extract DNA from urine samples and to use the salting out and resin as a manual DNA extraction method from patients' samples for the molecular diagnosis of Schistosoma mansoni infection.

BackgroundIt is generally acknowledged that the determination of harmful chemical compounds excreted into saliva is useful for assessing their exposure levels. The aim of the present study was to compare the total arsenic and its species in saliva and urine samples collected from the people residing in an arsenic-contaminated area of China and to further verify the feasibility of using salivary arsenic as a new biomarker of arsenic exposure.MethodsTotal arsenic and speciation analyses in urine and saliva samples among 70 residents exposed to arsenic from drinking water in Shanxi, China were carried out by high-performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC-ICP/MS).ResultsThe result showed that, total arsenic concentration in saliva was relatively lower than in urine samples, but it existed a strong positive correlation with total urinary arsenic, drinking water arsenic and different skin lesions. For arsenic metabolism analyses, AsIII, AsV, MMA, and DMA were detected in all of the urine samples with the dominating species of DMA (73.2%). Different with urinary arsenic species, most arsenic species in saliva were not methylated. The major species in saliva was iAs (AsIII + AsV, 76.18%), followed by DMA (13.08%) and MMA (9.13%). And the primary methylation index (PMI), second methylation index (SMI) and proportion of the four different species (AsIII, AsV, MMA, and DMA) in saliva showed no significant positive relationship with that of in urine.ConclusionsThese findings indicated saliva may be used as a useful tool for biological monitoring of total arsenic exposure in the crowd rather than an efficient tool for assessing arsenic metabolism in human body after exposed to arsenic.