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Licensed Unlicensed Requires Authentication Published by De Gruyter December 20, 2019

Renal tubular epithelial cells add value in the diagnosis of upper urinary tract pathology

  • Matthijs Oyaert EMAIL logo , Marijn Speeckaert , Jerina Boelens and Joris R. Delanghe



Diagnosis of upper urinary tract infections (UTI) is challenging. We evaluated the analytical and diagnostic performance characteristics of renal tubular epithelial cells (RTECs) and transitional epithelial cells (TECs) on the Sysmex UF-5000 urine sediment analyzer.


Urinary samples from 506 patients presenting with symptoms of a UTI were collected. Only samples for which a urinary culture was available were included. Analytical (imprecision, accuracy, stability and correlation with manual microscopy) and diagnostic performance (sensitivity and specificity) were evaluated.


The Sysmex UF-5000 demonstrated a good analytical performance. Depending on the storage time, storage conditions (2–8 °C or 20–25 °C) and urinary pH, RTECs and TECs were stable in urine for at least 4 h. Using Passing-Bablok and Bland-Altman analysis, an acceptable agreement was observed between the manual and automated methods. Compared to TECs, RTECs demonstrated an acceptable diagnostic performance for the diagnosis of upper UTI.


While TECs do not seem to serve as a helpful marker, increased urinary levels of RTECs add value in the diagnosis of upper UTI and may be helpful in the discrimination between upper and lower UTIs.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


1. Stein R, Dogan HS, Hoebeke P, Kocvar R, Nijman RJ, Tekgüul S. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015;67:546–58.10.1016/j.eururo.2014.11.007Search in Google Scholar

2. Grabe M, Bartoletti R, Bjerklund-Johansen TE, Bartoletti R, Cek M, Naber KG, et al. Guidelines on urological infections. European Association of Urology 2015. Accessed: 12 Aug 2019.Search in Google Scholar

3. Penders J, Fiers T, Everaert K, Barth J, Dhondt A, Delanghe J. Diagnostic performance of combined specific urinary proteins and urinary flow cytometry in urinary tract pathology. Clin Chem Lab Med 2007;45:499–504.10.1515/CCLM.2007.090Search in Google Scholar

4. Penders J, Delanghe J. Alpha 1 microglobulin: laboratory and clinical aspects. Clin Chim Acta 2004;346:107–18.10.1016/j.cccn.2004.03.037Search in Google Scholar

5. Fogazzi GB. The urinary sediment: an integrated view. p57. Milano: Elsevier, 2010.Search in Google Scholar

6. Becker GJ, Garigali G, Fogazzi GB. Advance in urine microscopy. Am J Kidney Dis 2016;67:954–64.10.1053/j.ajkd.2015.11.011Search in Google Scholar

7. Oyaert M, Delanghe JR. Semiquantitative, fully automated urine test strip analysis. J Clin Lab Anal 2019;33:e22870.10.1002/jcla.22870Search in Google Scholar

8. Previtali G, Ravasio R, Seghezzi M, Buoro S, Alessio MG. Performance evaluation of the new fully automated urine particle analyser UF-5000 compared to the reference method of the Fuchs-Rosenthal chamber. Clin Chim Acta 2017;472:123–30.10.1016/j.cca.2017.07.028Search in Google Scholar

9. Orsonneau HL, Douet P, MAssoubre C, Lustenberger P, Bernard S. An improved pyrogallol red-molybdate method for determining total urinary protein. Clin Chem 1989;35:2233–6.10.1093/clinchem/35.11.2233Search in Google Scholar

10. Korsten CB, Persijn JP, Van der Slik W. The application of the serum gamma-glutamyl transpeptidase and the 5’ nucleotide assay in cancer patients: a comparative study. Z Klin Chem Klin Biochem 1974;12:116–20.10.1515/cclm.1974.12.3.116Search in Google Scholar

11. Aspevall O, Hallander H, Gant V, Kouri T. European guidelines for urinalysis: a collaborative document produced by European clinical microbiologists and clinical chemists under ECLM in collaboration with ESCMID. Clin Microbiol Infect 2001;7:173–8.10.1046/j.1198-743x.2001.00237.xSearch in Google Scholar

12. Enko D, Stelzer I, Böckl M, Derler B, Schnedl WJ, Anderssohn P, et al. Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy. Clin Chem Lab Med 2020;58:268–73.10.1515/cclm-2019-0919Search in Google Scholar

13. Delanghe JR, Kouri TT, Huber AR, Hanneman-Pohl K, Guder WG, Lun A, et al. The role of automated urine particle flow cytometry in clinical practice. Clin Chim Acta 2000;301:1–18.10.1016/S0009-8981(00)00342-9Search in Google Scholar

14. Langlois MR, Delanghe JR, Stefaert SR, Everaert KV, De Buyzere ML. Automated flow cytometry compared with an automated dipstick reader for urinalysis. Clin Chem 1999;45:118–22.10.1093/clinchem/45.1.118Search in Google Scholar

15. Yesel EE, Paker N, Yesel A, Kayatas K, Laleli Y, Ari E. Urinary gamma-glutamyl transferase to creatinine ratio as an indicator of tubular function in bence jones proteinuria. Ren Fail 2014;36:390–2.10.3109/0886022X.2013.867784Search in Google Scholar PubMed

16. Urbschat A, Obermüller N, Paulus P, Reissig M, Hadji P, Hofman R, et al. Upper and lower urinary tract infections can be detected early but not be discriminated by urinary NGAL in adults. Int Urol Nephrol 2014;46:2243–9.10.1007/s11255-014-0831-xSearch in Google Scholar PubMed

17. Yilmaz A, Sevketogly E, Gedikbasi A, Karyagar S, Kiyak A, Mulazimoglu M, et al. Early prediction of urinary tract infection with urinary neutrophil gelatinase associated lipocalin. Pediatr Nephrol 2009;24:2387–92.10.1007/s00467-009-1279-6Search in Google Scholar PubMed

18. Han WK, Bailly V, Abichandani R, Thadhani R, Bonventre JV. Kidney injuring molecule 1: a novel biomarker for human renal proximal tubule injury. Kidney Int 2002;62:237–44.10.1046/j.1523-1755.2002.00433.xSearch in Google Scholar PubMed

19. Cantaluppi V, Quercia AD, Dellepiane S, Ferrario S, Camussi G, Biancone L. Interaction between systemic inflammation and renal tubular epithelial cells. Nephrol Dial Transplant 2014;29:2004–11.10.1093/ndt/gfu046Search in Google Scholar PubMed

20. Mantur M, Kemona H, Dabrowska M, Dabrowska J, Sobolewski S, Prokopowicz J. Alpha1-microglobulin as a marker of proximal tubular damage in urinary tract infection in children. Clin Nephrol 2000;53:283–7.Search in Google Scholar

21. Fenili D, Pirovano B. The automation of sediment analysis using a new urine flow cytometer (UF-100). Clin Chem Lab Med 1998;36:909–17.10.1515/CCLM.1998.158Search in Google Scholar PubMed

22. Hanneman-Pohl K, Kampf SK. Automation of urine sediment examination: a comparison of the Sysmex UF-100 automated flow cytometer with routine manual diagnosis (microscopy, test strips, and bacterial culture). Clin Chem Lab Med 1999;37: 753–64.10.1515/CCLM.1999.116Search in Google Scholar PubMed

23. Delanghe J, Speeckaert M. Preanalytics in urinalysis. Clin Biochem 2016;49:1346–50.10.1016/j.clinbiochem.2016.10.016Search in Google Scholar PubMed

24. Kouri T, Fogazzi G, Gant V, Hallander H, Hofmann W, Guder WG. European Confederation of Laboratory Medicine. European urinalysis guidelines. Scand J Clin Lab Invest 2000;231(Suppl):1–86.10.1080/00365513.2000.12056993Search in Google Scholar

25. Kouri T, Fogazzi G, Gant V, Hallander H, Hofmann W, Guder WG. European Urinalysis guidelines. Scand J Clin Lab Invest 2000;60:1–96.10.1080/00365513.2000.12056993Search in Google Scholar

26. Oyaert M, Speeckaert MM, Delanghe JR. Estimated urinary osmolality based on combined urinalysis parameters: a critical evaluation. Clin Chem Lab Med 2019;57:1169–76.10.1515/cclm-2018-1307Search in Google Scholar PubMed

Received: 2019-10-15
Accepted: 2019-11-23
Published Online: 2019-12-20
Published in Print: 2020-03-26

©2020 Walter de Gruyter GmbH, Berlin/Boston

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