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Licensed Unlicensed Requires Authentication Published by De Gruyter July 8, 2019

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

  • Jooyoung Cho ORCID logo , Kyeong Jin Oh , Beom Chan Jeon , Sang-Guk Lee EMAIL logo and Jeong-Ho Kim

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.


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

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

  2. 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).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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.

References

1. Carlson DA, Statland BE. Automated urinalysis. Clin Lab Med 1988;8:449–61.10.1016/S0272-2712(18)30667-XSearch in Google 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.Search in 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;30:663–71.10.1002/jcla.21919Search in Google 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;56:70–4.10.1016/j.clinbiochem.2018.04.008Search in Google 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.Search in Google Scholar

6. Ben-Ezra J, Bork L, McPherson RA. Evaluation of the Sysmex UF-100 automated urinalysis analyzer. Clin Chem 1998;44:92–5.10.1093/clinchem/44.1.92Search in Google 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;24:67–71.10.1002/jcla.20319Search in Google 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;358:167–74.10.1016/j.cccn.2005.02.021Search in Google 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;384:28–34.10.1016/j.cca.2007.05.012Search in Google 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;301:1–18.10.1016/S0009-8981(00)00342-9Search in Google 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;411:147–54.10.1016/j.cca.2009.10.018Search in Google Scholar PubMed

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;123:290–6.10.1309/VNGU9Q5V932D74NUSearch in Google 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;377:98–102.10.1016/j.cca.2006.08.033Search in Google Scholar PubMed

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;37:753–64.10.1515/CCLM.1999.116Search in Google Scholar PubMed

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;47:124–33.10.1093/labmed/lmw002Search in Google Scholar PubMed

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;76:256–63.10.3109/00365513.2016.1144141Search in Google Scholar PubMed

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;71:30–7.10.3109/00365513.2010.535011Search in Google Scholar PubMed

18. Delanghe J, Speeckaert M. Preanalytical requirements of urinalysis. Biochem Med (Zagreb) 2014;24:89–104.10.11613/BM.2014.011Search in Google Scholar PubMed PubMed Central

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;45:118–22.10.1093/clinchem/45.1.118Search in Google 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;26:365–75.10.11613/BM.2016.040Search in Google Scholar PubMed PubMed Central

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;472:123–30.10.1016/j.cca.2017.07.028Search in Google Scholar PubMed

22. Lewis MA, editor. CLSI Document GP16-A3. Urinalysis; approved guideline, 3rd ed. Wayne, PA: Clinical and Laboratory Institute (CLSI), 2009.Search in 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;49:617–23.10.1373/49.4.617Search in Google Scholar PubMed

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.Search in Google Scholar

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;133:577–82.10.1309/AJCP1GT2JXOCQBCZSearch in Google Scholar PubMed

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.Search in Google 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;5:14–20.10.1016/j.plabm.2016.03.002Search in Google Scholar PubMed PubMed Central


Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2019-0211).


Received: 2019-02-22
Accepted: 2019-06-01
Published Online: 2019-07-08
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

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