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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 57, Issue 11


Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment

Jooyoung ChoORCID iD: https://orcid.org/0000-0002-9628-2334 / Kyeong Jin Oh / Beom Chan Jeon / Sang-Guk Lee / Jeong-Ho Kim
Published Online: 2019-07-08 | DOI: https://doi.org/10.1515/cclm-2019-0211



While the introduction of automated urine analyzers is expected to reduce the labor involved, turnaround time and potential assay variations, microscopic examination remains the “gold standard” for the analysis of urine sediments. In this study, we evaluated the analytical and diagnostic performance of five recently introduced automated urine sediment analyzers.


A total of 1016 samples were examined using five automated urine sediment analyzers and manual microscopy. Concordance of results from each automated analyzer and manual microscopy were evaluated. In addition, image and microscopic review rates of each system were investigated.


The proportional bias for red blood cells (RBCs), white blood cells (WBCs) and squamous epithelial cells in the automated urine sediment analyzers were within ±20% of values obtained using the manual microscope, except in the cases of RBCs and WBCs analyzed using URiSCAN PlusScope and Iris iQ200SPRINT, respectively. The sensitivities of Roche Cobas® u 701 and Siemens UAS800 for pathologic casts (73.6% and 81.1%, respectively) and crystals (62.2% and 49.5%, respectively) were high, along with high image review rates (24.6% and 25.2%, respectively). The detection rates for crystals, casts and review rates can be changed for the Sysmex UF-5000 platform according to cut-off thresholds.


Each automated urine sediment analyzer has certain distinct features, in addition to the common advantages of reducing the burden of manual processing. Therefore, laboratory physicians are encouraged to understand these features, and to utilize each system in appropriate ways, considering clinical algorithms and laboratory workflow.

This article offers supplementary material which is provided at the end of the article.

Keywords: automated urine sediment analyzer; Cobas® u 701; Iris iQ200SPRINT; UAS800; UF-5000; URiSCAN PlusScope


  • 1.

    Carlson DA, Statland BE. Automated urinalysis. Clin Lab Med 1988;8:449–61.PubMedCrossrefGoogle Scholar

  • 2.

    Riley RS, McPherson RA. Basic examination of urine. In: McPherson RA, Pincus MR, editors. Henry’s clinical diagnosis and management by laboratory methods. St. Louis, MO: Elsevier Saunders, 2017:442–80.Google Scholar

  • 3.

    Lee W, Ha JS, Ryoo NH. Comparison of the automated cobas u 701 urine microscopy and UF-1000i flow cytometry systems and manual microscopy in the examination of urine sediments. J Clin Lab Anal 2016;30:663–71.CrossrefWeb of SciencePubMedGoogle Scholar

  • 4.

    Cho E-J, Ko D-H, Lee W, Chun S, Lee HK, Min W-K. The efficient workflow to decrease the manual microscopic examination of urine sediment using on-screen review of images. Clin Biochem 2018;56:70–4.CrossrefWeb of SciencePubMedGoogle Scholar

  • 5.

    Haber MH, Blomberg D, Galagan KA, Glassy EF, Ward PC. Color atlas of the urinary sediment: an illustrated field guide based on proficiency testing. Northfield, IL: College of American Pathologists, 2010.Google Scholar

  • 6.

    Ben-Ezra J, Bork L, McPherson RA. Evaluation of the Sysmex UF-100 automated urinalysis analyzer. Clin Chem 1998;44:92–5.PubMedGoogle Scholar

  • 7.

    Altekin E, Kadicesme O, Akan P, Kume T, Vupa O, Ergor G, et al. New generation IQ-200 automated urine microscopy analyzer compared with KOVA cell chamber. J Clin Lab Anal 2010;24:67–71.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 8.

    Lamchiagdhase P, Preechaborisutkul K, Lomsomboon P, Srisuchart P, Tantiniti P, Khan-u-Ra N, et al. Urine sediment examination: a comparison between the manual method and the iQ200 automated urine microscopy analyzer. Clin Chim Acta 2005;358:167–74.CrossrefPubMedGoogle Scholar

  • 9.

    Chien TI, Kao JT, Liu HL, Lin PC, Hong JS, Hsieh HP, et al. Urine sediment examination: a comparison of automated urinalysis systems and manual microscopy. Clin Chim Acta 2007;384:28–34.Web of SciencePubMedCrossrefGoogle Scholar

  • 10.

    Delanghe JR, Kouri TT, Huber AR, Hannemann-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.PubMedCrossrefGoogle Scholar

  • 11.

    Zaman Z, Fogazzi GB, Garigali G, Croci MD, Bayer G, Kranicz T. Urine sediment analysis: analytical and diagnostic performance of sediMAX – a new automated microscopy image-based urine sediment analyser. Clin Chim Acta 2010;411:147–54.CrossrefWeb of SciencePubMedGoogle Scholar

  • 12.

    Wah DT, Wises PK, Butch AW. Analytic performance of the iQ200 automated urine microscopy analyzer and comparison with manual counts using Fuchs-Rosenthal cell chambers. Am J Clin Pathol 2005;123:290–6.PubMedCrossrefGoogle Scholar

  • 13.

    Chien TI, Lu JY, Kao JT, Lee TF, Ho SY, Chang CY, et al. Comparison of three automated urinalysis systems – Bayer Clinitek Atlas, Roche Urisys 2400 and Arkray Aution Max for testing urine chemistry and detection of bacteriuria. Clin Chim Acta 2007;377:98–102.Web of SciencePubMedCrossrefGoogle Scholar

  • 14.

    Hannemann-Pohl K, Kampf SC. 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.PubMedGoogle Scholar

  • 15.

    Wesarachkitti B, Khejonnit V, Pratumvinit B, Reesukumal K, Meepanya S, Pattanavin C, et al. Performance evaluation and comparison of the fully automated urinalysis analyzers UX-2000 and Cobas 6500. Lab Med 2016;47:124–33.Web of SciencePubMedCrossrefGoogle Scholar

  • 16.

    Ko DH, Ji M, Kim S, Cho EJ, Lee W, Yun YM, et al. An approach to standardization of urine sediment analysis via suggestion of a common manual protocol. Scand J Clin Lab Invest 2016;76:256–63.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 17.

    Jiang T, Chen P, Ouyang J, Zhang S, Cai D. Urine particles analysis: performance evaluation of Sysmex UF-1000i and comparison among urine flow cytometer, dipstick, and visual microscopic examination. Scand J Clin Lab Invest 2011;71:30–7.Web of ScienceCrossrefPubMedGoogle Scholar

  • 18.

    Delanghe J, Speeckaert M. Preanalytical requirements of urinalysis. Biochem Med (Zagreb) 2014;24:89–104.PubMedGoogle Scholar

  • 19.

    Langlois MR, Delanghe JR, Steyaert SR, Everaert KC, De Buyzere ML. Automated flow cytometry compared with an automated dipstick reader for urinalysis. Clin Chem 1999;45:118–22.PubMedGoogle Scholar

  • 20.

    Bakan E, Ozturk N, Baygutalp NK, Polat E, Akpinar K, Dorman E, et al. Comparison of Cobas 6500 and Iris IQ200 fully-automated urine analyzers to manual urine microscopy. Biochem Med (Zagreb) 2016;26:365–75.PubMedGoogle Scholar

  • 21.

    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.Web of SciencePubMedCrossrefGoogle Scholar

  • 22.

    Lewis MA, editor. CLSI Document GP16-A3. Urinalysis; approved guideline, 3rd ed. Wayne, PA: Clinical and Laboratory Institute (CLSI), 2009.Google Scholar

  • 23.

    Ottiger C, Huber AR. Quantitative urine particle analysis: integrative approach for the optimal combination of automation with UF-100 and microscopic review with KOVA cell chamber. Clin Chem 2003;49:617–23.CrossrefPubMedGoogle Scholar

  • 24.

    KOVA International. KOVA® GLASSTIC® SLIDE 10 WITH GRIDS – Instructions for use. https://www.kovaintl.com/downloads/DI-91064-17-final.pdf. Accessed: 19 Dec 2018.

  • 25.

    Wang J, Zhang Y, Xu D, Shao W, Lu Y. Evaluation of the Sysmex UF-1000i for the diagnosis of urinary tract infection. Am J Clin Pathol 2010;133:577–82.CrossrefWeb of ScienceGoogle Scholar

  • 26.

    Budak YU, Huysal K. Comparison of three automated systems for urine chemistry and sediment analysis in routine laboratory practice. Clin Lab 2011;57:47–52.PubMedGoogle Scholar

  • 27.

    Ince FD, Ellidag HY, Koseoglu M, Simsek N, Yalcin H, Zengin MO. The comparison of automated urine analyzers with manual microscopic examination for urinalysis automated urine analyzers and manual urinalysis. Pract Lab Med 2016;5:14–20.CrossrefPubMedGoogle Scholar

About the article

Corresponding author: Sang-Guk Lee, MD, PhD, Department of Laboratory Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea, Phone: +82-2228-2455, Fax: +82-2-364-1583

Received: 2019-02-22

Accepted: 2019-06-01

Published Online: 2019-07-08

Published in Print: 2019-10-25

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

Research funding: This work was supported by five companies – Sysmex Corporation (Kobe, Japan), Roche Diagnostics International (Rotkreuz, Switzerland), Siemens Healthineers (Erlangen, Germany), Beckman Coulter (Brea, CA, USA), and YD diagnostics (Yongin, Korea).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organizations played no role in designing the study, collection, analysis and interpretation of data, writing of the report, or in the decision to submit the findings for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 11, Pages 1744–1753, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2019-0211.

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