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Annals of Laboratory Medicine Jan 2019New technological advances have paved the way for significant progress in automated urinalysis. Quantitative reading of urinary test strips using reflectometry has... (Review)
Review
New technological advances have paved the way for significant progress in automated urinalysis. Quantitative reading of urinary test strips using reflectometry has become possible, while complementary metal oxide semiconductor (CMOS) technology has enhanced analytical sensitivity and shown promise in microalbuminuria testing. Microscopy-based urine particle analysis has greatly progressed over the past decades, enabling high throughput in clinical laboratories. Urinary flow cytometry is an alternative for automated microscopy, and more thorough analysis of flow cytometric data has enabled rapid differentiation of urinary microorganisms. Integration of dilution parameters (e.g., creatinine, specific gravity, and conductivity) in urine test strip readers and urine particle flow cytometers enables correction for urinary dilution, which improves result interpretation. Automated urinalysis can be used for urinary tract screening and for diagnosing and monitoring a broad variety of nephrological and urological conditions; newer applications show promising results for early detection of urothelial cancer. Concomitantly, the introduction of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has enabled fast identification of urinary pathogens. Automation and workflow simplification have led to mechanical integration of test strip readers and particle analysis in urinalysis. As the information obtained by urinalysis is complex, the introduction of expert systems may further reduce analytical errors and improve the quality of sediment and test strip analysis. With the introduction of laboratory-on-a-chip approaches and the use of microfluidics, new affordable applications for quantitative urinalysis and readout on cell phones may become available. In this review, we present the main recent developments in automated urinalysis and future perspectives.
Topics: Automation; Flow Cytometry; Humans; Lab-On-A-Chip Devices; Microfluidics; Microscopy; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Urinalysis; Urinary Tract Infections
PubMed: 30215225
DOI: 10.3343/alm.2019.39.1.15 -
Annales de Biologie Clinique Feb 2019The typing of proteinuria is one of the complementary examinations carried out during the exploration of proteinuria. It aims to separate and identify the different... (Review)
Review
The typing of proteinuria is one of the complementary examinations carried out during the exploration of proteinuria. It aims to separate and identify the different proteins, or fractions of proteins, that make up proteinuria. The nature and relative importance of the proteins present reflect the location of the renal involvement and help to determine the etiology. The typing of a proteinuria also allows the detection of a monoclonal component in urine and its quantification. Finally, it allows highlighting the existence of a proteinuria of overload that can occur in the absence of kidney damage. Many methods allow the typing of proteinuria, and these have benefited in recent years from technological advances. The purpose of this review is to summarize typing methods currently used, their benefits and limitations, and the help that these diagnostic tools can provide to the management of patients.
Topics: Diagnosis, Differential; Glomerular Filtration Rate; Humans; Kidney Diseases; Kidney Function Tests; Patient Selection; Proteinuria; Urinalysis
PubMed: 30799294
DOI: 10.1684/abc.2018.1401 -
Pediatrics in Review Dec 2018Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria. (Review)
Review
PRACTICE GAP
Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria.
OBJECTIVES
After completing this article, readers should be able to: 1. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. 2. Describe screening techniques for initial evaluation of hematuria and proteinuria. 3. Recognize the criteria for diagnosis of proteinuria and hematuria. 4. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. 5. Recognize serious causes of hematuria and proteinuria that warrant immediate referral.
Topics: Adolescent; Child; Child, Preschool; Hematuria; Humans; Proteinuria; Urinalysis
PubMed: 30504250
DOI: 10.1542/pir.2017-0300 -
Clinical Chemistry and Laboratory... Nov 2015The morphological analysis of urine sediment is an essential part of urinalysis and casts are important elements of urinary sediment. Their shape is typically... (Review)
Review
The morphological analysis of urine sediment is an essential part of urinalysis and casts are important elements of urinary sediment. Their shape is typically cylindrical, with extremities often rounded. Casts form within the renal tubules and are made of Tamm-Horsfall glycoprotein (THG). Under some physiological or pathological conditions THG fibrils aggregate giving rise to casts, whose formation is favoured by a number of factors including high urine osmolality and/or low pH. Casts can be found in normal subjects, in non-renal conditions, such as fever, dehydration, and acute heart failure as well as in virtually all renal diseases. Casts can be classified on the basis of their morphology as hyaline, granular, waxy, fatty, cellular (leukocytic, erythrocytic, epithelial), containing crystals or microorganisms, pigmented and mixed. As the correct identification of casts is crucial for an accurate and timely diagnosis of renal disorders, laboratory professionals should be trained to identify and classify casts properly.
Topics: Humans; Kidney Diseases; Kidney Tubules; Microscopy; Urinalysis; Uromodulin
PubMed: 26079824
DOI: 10.1515/cclm-2015-0480 -
Deutsches Arzteblatt International Sep 2014Urinalysis is the most commonly performed biochemical test in infancy and early childhood. The urine sample should be correctly obtained, age-specific aspects should be... (Review)
Review
BACKGROUND
Urinalysis is the most commonly performed biochemical test in infancy and early childhood. The urine sample should be correctly obtained, age-specific aspects should be considered, and age-dependent reference values should be used.
METHOD
This review is based on a selective literature search in electronic databases, textbooks, and guidelines from Germany and abroad on the acquisition of urine samples and the performance of urinalysis in infancy and early childhood.
RESULTS
The timing and mode of acquisition of the urine sample affect the assessment of hematuria, proteinuria, leukocyturia, nitrituria, and the uropathogenic bacterial colony count in the urine culture. Dipstick tests can be used for targeted screening for these features. The test results should be interpreted together with the findings of urine microscopy, the medical history, and the physical examination. Proteinuria should be quantified and differentiated; both of these things can be done either from collected urine or (especially in infants and young children) from a spontaneously voided urine sample, by determination of the protein/creatinine quotient. Orthostatic proteinuria in an adolescent requires no further evaluation or treatment. Hematuria should be characterized as either glomerular or non-glomerular erythrocyturia. Asymptomatic, isolated microhematuria in childhood is not uncommon and often transient; in the absence of a family history, it usually does not require an extensive work-up. Proteinuria combined with hematuria should arouse the suspicion of glomerulonephritis.
CONCLUSION
Urinalysis in infancy and early childhood is a simple and informative diagnostic test as long as the urine sample has been obtained properly and the results are interpreted appropriately for this age group.
Topics: Adolescent; Biomarkers; Child; Child, Preschool; Female; Germany; Humans; Infant; Infant, Newborn; Male; Pediatrics; Practice Guidelines as Topic; Reference Values; Urinalysis; Urologic Diseases; Urology
PubMed: 25283761
DOI: 10.3238/arztebl.2014.0617 -
Biochemia Medica 2014Urine may be a waste product, but it contains an enormous amount of information. Well-standardized procedures for collection, transport, sample preparation and analysis... (Review)
Review
Urine may be a waste product, but it contains an enormous amount of information. Well-standardized procedures for collection, transport, sample preparation and analysis should become the basis of an effective diagnostic strategy for urinalysis. As reproducibility of urinalysis has been greatly improved due to recent technological progress, preanalytical requirements of urinalysis have gained importance and have become stricter. Since the patients themselves often sample urine specimens, urinalysis is very susceptible to preanalytical issues. Various sampling methods and inappropriate specimen transport can cause important preanalytical errors. The use of preservatives may be helpful for particular analytes. Unfortunately, a universal preservative that allows a complete urinalysis does not (yet) exist. The preanalytical aspects are also of major importance for newer applications (e.g. metabolomics). The present review deals with the current preanalytical problems and requirements for the most common urinary analytes.
Topics: Clinical Laboratory Techniques; Humans; Specimen Handling; Urinalysis
PubMed: 24627718
DOI: 10.11613/BM.2014.011 -
Cancer Cytopathology Apr 2019The Paris System for Urine Cytopathology (the Paris System) has succeeded in making the analysis of liquid-based urine preparations more reproducible. Any algorithm...
BACKGROUND
The Paris System for Urine Cytopathology (the Paris System) has succeeded in making the analysis of liquid-based urine preparations more reproducible. Any algorithm seeking to automate this system must accurately estimate the nuclear-to-cytoplasmic (N:C) ratio and produce a qualitative "atypia score." The authors propose a hybrid deep-learning and morphometric model that reliably automates the Paris System.
METHODS
Whole-slide images (WSI) of liquid-based urine cytology specimens were extracted from 51 negative, 60 atypical, 52 suspicious, and 54 positive cases. Morphometric algorithms were applied to decompose images to their component parts; and statistics, including the NC ratio, were tabulated using segmentation algorithms to create organized data structures, dubbed rich information matrices (RIMs). These RIM objects were enhanced using deep-learning algorithms to include qualitative measures. The augmented RIM objects were then used to reconstruct WSIs with filtering criteria and to generate pancellular statistical information.
RESULTS
The described system was used to calculate the N:C ratio for all cells, generate object classifications (atypical urothelial cell, squamous cell, crystal, etc), filter the original WSI to remove unwanted objects, rearrange the WSI to an efficient, condensed-grid format, and generate pancellular statistics containing quantitative/qualitative data for every cell in a WSI. In addition to developing novel techniques for managing WSIs, a system capable of automatically tabulating the Paris System criteria also was generated.
CONCLUSIONS
A hybrid deep-learning and morphometric algorithm was developed for the analysis of urine cytology specimens that could reliably automate the Paris System and provide many avenues for increasing the efficiency of digital screening for urine WSIs and other cytology preparations.
Topics: Algorithms; Cytodiagnosis; Humans; Neoplasms; Research Personnel; Urinalysis
PubMed: 30951265
DOI: 10.1002/cncy.22116 -
Kidney International Oct 2007
Topics: Drama; History, 16th Century; Humans; Literature, Modern; Machiavellianism; Urinalysis
PubMed: 17882245
DOI: 10.1038/sj.ki.5002496 -
Expert Review of Molecular Diagnostics Jan 2020: The development of point-of-care testing (POCT) has made clinical diagnostics available, affordable, rapid, and easy to use since the 1990s.The significance of this... (Review)
Review
: The development of point-of-care testing (POCT) has made clinical diagnostics available, affordable, rapid, and easy to use since the 1990s.The significance of this platform rests on its potential to empower patients to monitor their own health status more frequently, in the convenience of their home, so that diseases can be diagnosed at the earliest possible time-point. Recent advances have expanded traditional formats such as qualitative or semi-quantitative dipsticks and lateral flow immunoassays to newer platforms such as microfluidics and paper-based assays where signals can be measured quantitatively using handheld devices.: This review discusses: (1) working principles and operating mechanisms of both existing and emerging POCT platforms, (2) urine analytes measured using POCT in comparison to the laboratory or clinical 'gold standard,' and (3) limitations of existing POCT and expectations of emerging POCT in urinalysis.: Currently, a variety of biological samples such as urine, saliva, serum, plasma, and other fluids can be applied to POCT for quick diagnosis, especially in resource-limited settings. Emerging platforms will increasingly empower individuals to monitor their health status through frequent urine analysis even from their homes. The impact of these emerging technologies on healthcare is likely to be transformative.
Topics: Humans; Immunoassay; Microfluidics; Molecular Diagnostic Techniques; Point-of-Care Systems; Urinalysis
PubMed: 31795785
DOI: 10.1080/14737159.2020.1699063 -
Annals of Laboratory Medicine Jan 2019
Topics: Flow Cytometry; Microscopy; Urinalysis
PubMed: 30215223
DOI: 10.3343/alm.2019.39.1.1