The morphological assessment of urinary erythrocytes (uRBC) is a convenient screening tool for the differentiation of nephrological (dysmorphic) and urological (isomorphic) causes of hematuria. Considering the morphological heterogeneity, this analysis is often perceived as difficult. There is no clear (inter)national consensus and there is a lack of external quality assessment programs. To gain insight into the heterogeneity within and between laboratories, we scrutinized the current state of this analysis in Dutch medical laboratories.
The laboratories, affiliated with the Dutch Foundation for Quality Assessment in Medical Laboratories, were invited to participate in a web-based survey, consisting of two questionnaires. The first one provided information about the institution and laboratory organization, and the second explored the variability in the morphological analysis of uRBC on the basis of categorization of 160 uRBC images. Statistical analysis was premised on binomial significance testing and principal component analysis.
Nearly one third of the Dutch medical laboratories (65/191) with 167 staff members participated in the survey. Most of these laboratories (83%) were an integral part of secondary care. The statistical analysis of the evaluations of the participants in comparison to the consensus (three experts from two different medical laboratories) suggested a great degree of heterogeneity in the agreement. Nearly half of the participants consciously disagreed with the consensus, whereas one fifth demonstrated a random relationship with it.
In Dutch medical laboratories, results from morphological analysis of uRBC are heterogeneous, which point out the necessity for standardization and harmonization.
The authors thank Prof. Dr. Giovanni B. Fogazzi and Dr. Giuseppe Garigali (Research Laboratory on Urine, Nephrology Unit, Fondazione IRCCS, Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy) for their contribution to the questionnaire, including the preparation of the images.
Author contributions: J.J. Luimstra, manuscript preparation; A. Jerman, concept and study design, data collection; R.G. Koçer, data collection and analysis; J. Klein Gunnewiek, concept and study design; K. Gijzen, manuscript preparation; L.H.J. Jacobs, manuscript preparation; A.Y. Demir, concept and study design, conduction of experiments, data analysis, manuscript preparation. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: None.
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