0
November 1996, Vol 150, No. 11 >
Article | November 1996

Inability of Community-Based Laboratories to Identify Pathological Casts in Urine Samples FREE

Majid Rasoulpour, MD; Leonard Banco, MD; Jeffrey M. Laut, MD; Georgine S. Burke, PhD
Arch Pediatr Adolesc Med. 1996;150(11):1201-1204. doi:10.1001/archpedi.1996.02170360091015.
Text Size: A A A
Published online
Article
References
Comments

Objective:  To determine the accuracy of microscopic examination of urine from patients with known renal disease, performed by community-based laboratories.

Design:  Twenty-six urine specimens from 7 children with Alport syndrome, lupus nephritis, and IgA nephropathy were simultaneously submitted to 4 investigative sites: 2 community-based medical laboratories (laboratories A and B), and the offices of 2 nephrologists (nephrologists C and D). Participants A, B, and C were unaware of the nature of this investigation and blinded to the diagnosis associated with each specimen.

Results:  Twenty-six specimens from 7 children were analyzed. Pathological casts were identified in the 26 submitted specimens in the following order: 1 (4%) by laboratory A, 2 (8%) by laboratory B, 20 (77%) by nephrologist C, and 26 (100%) by nephrologist D. Four-way and 3-way (A, B, C) comparisons using the χ2 test are significant at the P<.001 level.

Conclusions:  The 2 community-based medical laboratories participating in this study did not accurately identify pathological casts in urine specimens routinely submitted to them. In addition to raising quality assurance issues, these misleading reports may result in inaccurate diagnosis and unnecessary laboratory and diagnostic investigations.Arch Pediatr Adolesc Med. 1996;150:1201-1204

REFERENCES

1 +
Churg J, Sobin LH.  Berger's disease (IgA nephropathy) . In: Churg J, Sobin LH, eds. Renal Disease: Classification and Atlas of Glomerular Diseases . Tokyo, Japan: Igaku-Shoin; 1982;:156-157.
2 +
Martin CG, Atkin CL.  Alport syndrome . In: Schrier RW, Gottschalk CW, eds. Diseases of the Kidney . 5th ed. Boston, Mass: Little, Brown & Co; 1993;:571-591.
3 +
Churg J, Sobin LH.  World Health Organization (WHO) morphologic classification of lupus nephritis (modified) . In: Churg J, Sobin LH, eds. Renal Disease: Classification and Atlas of Glomerular Diseases . Tokyo, Japan: Igaku-Shoin; 1982;:127-149.
4 +
Fairley KF, Birch DF.  Hematuria: a simple method for identifying glomerular bleeding . Kidney Int . 1982;;21:105-108.
5 +
Birch DF, Fairley KF, Whitworth JA, et al.  Urinary erythrocyte morphology in the diagnosis of glomerular hematuria . Clin Nephrol . 1983;;20:78-84.
6 +
Crompton CH, Ward PB, Hewitt IK.  The use of urinary red cell morphology to determine the source of hematuria in children . Clin Nephrol . 1993;;39:44-49.
7 +
Tsukahara H, Yoshimoto M, Morikawa K, Okada T, Kuroda M, Sudo M.  Urinary erythrocyte volume analysis: a simple method for localizing the site of hematuria in pediatrics . J Pediatr . 1989;;115:433-436.
8 +
Oner A, Ahmad TM, Besbas N, Yelmazoglu G, Saatei U.  Identification of the source of haematuria by automated measurement of mean corpuscular volume of urinary red cells . Pediatr Nephrol . 1991;;5:54-55.
9 +
Schuetz E, Schaefer RM, Heidbreder E, Heidland A.  Effects of diuresis on urinary erythrocyte morphology in glomerulonephritis . Klin Wochenschr . 1985;; 63:575-577.
10 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind controlled trial of phasecontrast microscopy by two observers for evaluating the source of hematuria . Nephron . 1986;;44:304-308.
11 +
Gibbs DD, Lynn KL.  Red cell volume distribution curves in the diagnosis of glomerular and non-glomerular hematuria . Clin Nephrol . 1990;;33:143-147.
12 +
McQueen EG, Sydney MB.  Composition of urinary casts . Lancet . 1966;;1:397-398.
13 +
Morrin PAF.  Urinary sediment in the interpretation of proteinuria . Ann Intern Med . 1983;;98:254-255.
14 +
Gyory AZ, Hadfield C, Lauer CS.  Value of urine microscopy in predicting histological changes in the kidney: double blind comparison . BMJ . 1984;;288: 819-822.
15 +
Free AH, Free HM.  Microscopic examination of urine sediment . In: Free AH, Free HM, eds. Urinalysis in Clinical Laboratory Practice . Cleveland, Ohio: CRC Press Inc; 1975;:91-95.
16 +
Gadeholt H.  Quantitative estimation of urinary sediment with special regard to sources of error . BMJ . 1964;;1:1547-1549.
17 +
Kiel DP, Moskowitz MA.  The urinalysis: a critical appraisal . Med Clin North Am . 1987;;71:607-623.
18 +
Haber MH.  Quality assurance in urinalysis . Clin Lab Med . 1988;;8:431-447.
19 +
Schuman AJ.  Office labs: still worth it under CLIA? Contemp Pediatr . 1993;;4: 50-74.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Churg J, Sobin LH.  Berger's disease (IgA nephropathy) . In: Churg J, Sobin LH, eds. Renal Disease: Classification and Atlas of Glomerular Diseases . Tokyo, Japan: Igaku-Shoin; 1982;:156-157.
2 +
Martin CG, Atkin CL.  Alport syndrome . In: Schrier RW, Gottschalk CW, eds. Diseases of the Kidney . 5th ed. Boston, Mass: Little, Brown & Co; 1993;:571-591.
3 +
Churg J, Sobin LH.  World Health Organization (WHO) morphologic classification of lupus nephritis (modified) . In: Churg J, Sobin LH, eds. Renal Disease: Classification and Atlas of Glomerular Diseases . Tokyo, Japan: Igaku-Shoin; 1982;:127-149.
4 +
Fairley KF, Birch DF.  Hematuria: a simple method for identifying glomerular bleeding . Kidney Int . 1982;;21:105-108.
5 +
Birch DF, Fairley KF, Whitworth JA, et al.  Urinary erythrocyte morphology in the diagnosis of glomerular hematuria . Clin Nephrol . 1983;;20:78-84.
6 +
Crompton CH, Ward PB, Hewitt IK.  The use of urinary red cell morphology to determine the source of hematuria in children . Clin Nephrol . 1993;;39:44-49.
7 +
Tsukahara H, Yoshimoto M, Morikawa K, Okada T, Kuroda M, Sudo M.  Urinary erythrocyte volume analysis: a simple method for localizing the site of hematuria in pediatrics . J Pediatr . 1989;;115:433-436.
8 +
Oner A, Ahmad TM, Besbas N, Yelmazoglu G, Saatei U.  Identification of the source of haematuria by automated measurement of mean corpuscular volume of urinary red cells . Pediatr Nephrol . 1991;;5:54-55.
9 +
Schuetz E, Schaefer RM, Heidbreder E, Heidland A.  Effects of diuresis on urinary erythrocyte morphology in glomerulonephritis . Klin Wochenschr . 1985;; 63:575-577.
10 +
Raman GV, Pead L, Lee HA, Maskell R.  A blind controlled trial of phasecontrast microscopy by two observers for evaluating the source of hematuria . Nephron . 1986;;44:304-308.
11 +
Gibbs DD, Lynn KL.  Red cell volume distribution curves in the diagnosis of glomerular and non-glomerular hematuria . Clin Nephrol . 1990;;33:143-147.
12 +
McQueen EG, Sydney MB.  Composition of urinary casts . Lancet . 1966;;1:397-398.
13 +
Morrin PAF.  Urinary sediment in the interpretation of proteinuria . Ann Intern Med . 1983;;98:254-255.
14 +
Gyory AZ, Hadfield C, Lauer CS.  Value of urine microscopy in predicting histological changes in the kidney: double blind comparison . BMJ . 1984;;288: 819-822.
15 +
Free AH, Free HM.  Microscopic examination of urine sediment . In: Free AH, Free HM, eds. Urinalysis in Clinical Laboratory Practice . Cleveland, Ohio: CRC Press Inc; 1975;:91-95.
16 +
Gadeholt H.  Quantitative estimation of urinary sediment with special regard to sources of error . BMJ . 1964;;1:1547-1549.
17 +
Kiel DP, Moskowitz MA.  The urinalysis: a critical appraisal . Med Clin North Am . 1987;;71:607-623.
18 +
Haber MH.  Quality assurance in urinalysis . Clin Lab Med . 1988;;8:431-447.
19 +
Schuman AJ.  Office labs: still worth it under CLIA? Contemp Pediatr . 1993;;4: 50-74.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems