UPDATE IN URINALYSIS
Diane Gaspari, SH(ASCP)
Division Manager, Core Lab
York Hospital, York, PA ggaspari@wellspan.org

Program Objectives
• Enhance knowledge of CKD and the NKF’s guidelines for laboratory diagnosis & monitoring of CKD.
• Identify pre-analytic variables of urinalysis testing & analytic variables of manual urine sediment testing.
•
Understand the technology, software features, and flagging parameters of the Sysmex
UF-1000i automated urine sediment analyzer.
•
Identify the benefits of automated urine sediment analysis.

Did You Know . . .
“Urinalysis is the most valuable single test of the anatomic integrity of the kidneys that is readily available to the clinician”
Schreiner
From J. Szwed, The Importance of Microscopic
Examination of the Urinary Sediment, American Journal of
Medical Technology, 48:2, Feb. 1982

Functions of Kidney
•
Remove waste products & drugs from body.
• Balance body’s fluid, release hormones to regulate blood pressure, and produce active vitamin D.
• Regulation of body’s salt, potassium, & acid content

National Kidney Foundation
• http://www.kidney.org/kls/index/cfm
• http://www.kidney.org/professionals/kdo qi/guidelines
•
New Guidelines February 2002
•
Addition to Guidelines in 2003, 2005,
2006, 2007, 2008, and 2012.

Incidence and Prevalence of
End-Stage Renal Disease in the
U.S.

CHRONIC KIDNEY
DISEASE
•
CKD is a world-wide public health problem that is under-diagnosed and under-treated.
•
Early diagnosis is critical as kidney disease is often silent in the early stages.
•
Most common causes of CKD in North
America is diabetes, hypertension, and glomerular disease.

CHRONIC KIDNEY
DISEASE
•
Presence of excessive amounts of urine protein is most common clinical sign of early kidney dysfunction.
•
Other markers of kidney damage
– abnormal urine sediment
– abnormal findings on imaging studies
– abnormal blood & urine chemistry results that identify renal tubular syndromes

CHRONIC KIDNEY
DISEASE
•
Symptoms
– fatigue
– difficulty concentrating
– poor appetite
– sleeplessness
– muscle cramping at night
– swollen feet and ankles

CHRONIC KIDNEY
DISEASE
•
Symptoms (cont.)
–
Puffiness around the eyes, especially in the morning
–
Dry, itchy skin
– Frequent urination, especially at night

Complications of CKD
•
Result of reduction of GFR, disorder of tubular function, or reduction in endocrine function of the kidney
– Hypertension
–
Malnutrition
– Anemia
–
Low serum albumin and serum calcium

Complications of CKD
– High serum phosphate concentration and high serum parathyroid hormone concentration
–
Reduced activities of daily living
–
Lower quality of life
–
Increased risk of cardiovascular disease and stroke

Laboratory Diagnosis and
Monitoring of CKD
•
Definitive diagnosis of the type of kidney disease is based on biopsy or imaging studies
– Biopsy and invasive imaging procedures are associated with a risk or serious complications and are usually avoided unless a definitive diagnosis would change treatment or prognosis

Laboratory Diagnosis and
Monitoring of CKD
•
GFR is the best overall index of kidney function
–
Decreased GFR precedes the onset of kidney failure and persistently reduced GFR is a specific indicator of CKD.
–
Drug dosing in CKD is based on GFR levels

Laboratory Diagnosis and
Monitoring of CKD
•
GFR cannot be measured directly
–
Serum creatinine is used to measure GFR in most cases
•
Use of an international standard or traceable standard for creatinine calibration is recommended.
• Creatinine clearance is considered too inaccurate due to difficulties in obtaining a correctly timed specimen.

Laboratory Diagnosis and
Monitoring of CKD
•
The NKF guidelines recommend that clinical labs report an estimate of GFR using the MDRD prediction equation in addition to the serum creatinine.
•
Variables that will affect the estimation of GFR include: age, sex, race, diet, body build, medication, and pregnancy.
•
If the variables are significant, use the creatinine clearance.

Laboratory Diagnosis and
Monitoring of CKD
•
Serum creatinine is recommended at least yearly in patients with CKD.
•
The rate of decline in GFR can be used to estimate the interval until onset of kidney failure and facilitate planning for therapy, diet, or kidney replacement.
•
An acute decline in GFR may be superimposed on CKD and result in acute deterioration of kidney function.

Laboratory Diagnosis and
Monitoring of CKD
•
Most common causes of deterioration of kidney function are:
–
Reduced blood flow to the kidney, usually related to volume depletion.
– Toxic insult
–
Obstruction from tumors, stones, or blood.
–
Inflammation and infection

Cystatin C
• 13 kDa cysteine protease inhibitor constantly produced by all nucleated cells
•
Advantages over creatinine
–
Constant rate of production, freely filtered by the glomerulus
–
Unaffected by muscle mass, diet or gender
–
No renal tubular secretion
– Good assay precision (~3% CV throughout assay range)
– Assay unaffected by spectral interferences

NKF Guidelines for Adults and
Children
•
Under most circumstances, untimed
(“spot”) urine samples should be used to detect and monitor proteinuria.
•
First morning urines preferred but random specimens are acceptable. Timed urine collection (overnight or 24 hr) is not necessary.

NKF Guidelines (cont.)
•
In most cases, screening with urine dipsticks is acceptable for detecting proteinuria
– Standard urine dipsticks are acceptable for detecting increased total urine protein.
–
Albumin-specific dipsticks are acceptable for detecting albuminuria

NKF Guidelines (cont.)
•
Patients with a positive dipstick (1+ or greater): confirm proteinuria by a quantitative measurement (protein-tocreatinine ratio >200 mg/g or albumin-tocreatinine ratio >30 mg/g) within 3 mos.
•
Patients with 2 or more positive quantitative tests temporally spaced by
1-2 weeks: diagnosed as persistent proteinuria; further evaluation needed

NKF Guidelines (cont.)
•
Monitoring proteinuria in patients with
CKD should be performed using quantitative measurements.
•
Children Without Diabetes:
– orthostatic proteinuria must be excluded by repeat measurement on a first morning specimen if the initial proteinuria was obtained on a random specimen.

NKF Guidelines (cont.)
•
Children Without Diabetes:
–
Screen spot urine sample for total urine protein using either: standard urine dipstick or total protein-to-creatinine ratio
– When monitoring proteinuria for CKD, total protein-to-creatinine ratio should be measured in spot urine specimens.

NKF Guidelines (cont.)
•
Children With Diabetes:
–
Screening and monitoring of post-pubertal children with diabetes of 5+ years duration should follow the adult guidelines.
– Screening and monitoring other children with diabetes should follow the guidelines for children without diabetes.

2005 Additions to NKF Guidelines
• Bone Metabolism & Disease in Children with
Chronic Kidney Disease: 10/05
–
Warns that bone disease begins early in the course of CKD in children & calcium balance must be in order for growth & cardiovascular development
– Physicians need to place greater emphasis on vitamin D nutrition, levels of parathyroid hormone, & excesses of calcium intake which can lead to development of vascular calcifications.

2005 Additions to NKF Guidelines
•
Cardiovascular Disease in Dialysis
Patients: 4/05
–
Warns that CVD is leading cause of death among dialysis patients but treatment is not as effective as in general population
–
Dialysis patients are more prone to sideeffects of treatment
–
More research is needed to better manage
CVD in dialysis patients

2006 Additions to NKF Guidelines
•
Treatment of Anemia in Chronic Kidney
Disease: 5/06
–
Patients with all stages of CKD should be evaluated for anemia
– Definition of anemia is <13.5 g/dL for males
& <12.0 g/dL for females
– Treat patients with ESA(erythropoiesis stimulating agent) &/or iron when Hgb is
<11g/dL

2007 Additions to NKF Guidelines
•
Chronic Kidney Disease and Diabetes: 2/07
–
Emphasizes diabetes prevention, screening & management of kidney disease
–
New term: diabetic kidney disease (DKD)

2012 Additions to NKF Guidelines
•
Diabetes and Chronic Kidney Disease
–
Target HbA1c of ~7.0% to prevent or delay progression of microvascular complications of diabetes, including DKD.
– Lipid-lowering treatment with statins suggested for patients with diabetes and
CKD, including kidney transplant recipients

2012 Additions to NKF Guidelines
(cont.)
•
Diabetes and Chronic Kidney Disease
–
Withholding statin treatment initiation in dialysis patients is suggested.
–
Treatment of normotensive patients with diabetes & elevated levels of albuminuria by
ACE inhibitors or angiotensin receptor blockers (ARB).
–
Statin combination therapy reduces risk of
CVD events.

International Classification of
Diseases, 9 th Revision Clinical
Modification (ICD-9-CM)
•
Diagnosis codes for CKD to be based on
NKF’s KDOQI Guidelines
–
Codes allow medical professionals to clearly note the stage of kidney disease
–
Ability to identify CKD patients who are kidney transplant recipients
– Ability to link specific treatments to appropriate CKD stage

Legislative Mandate for Labs to
Report eGFR
• States with laws requiring reporting of eGFR
–
New Jersey, Tennessee, Michigan, Louisiana,
Connecticut, and Pennsylvania
•
PA General Assembly House Bill 2639
–
Passed into PA state law in November, 2006
– eGFR must be calculated for serum creatinine for patients > 18 years
–
All labs had to comply within 2 years of passage

Facts of Kidney Disease
•
More than 26 million Americans have
CKD. More than 20 million more are at increased risk for developing kidney disease and most do not know it.
•
At the end of 2010, there were 651,000
Americans receiving treatment for kidney failure (end stage renal disease or
ESRD).

Facts of Kidney Disease
•
Each year, more than 70,000 Americans die from causes related to kidney failure.
•
Every month, the number of Americans waiting for kidney transplants increases.
Approximately 96,292 patients are awaiting kidney transplants and >2,500 are waiting for kidney-pancreas transplants.

Facts of Kidney Disease
•
Shortage of organ donations is major contributing factor to the growing number of people on the waiting list. A new name is added every 12 minutes and eighteen people die daily while waiting.
•
CKD has a disproportionate impact on minority populations, especially African
Americans, Hispanics, Asians, and
American Indians.

Facts of Kidney Disease
•
Diabetes is the leading cause of kidney failure: 51% of new cases and 45% of all cases of kidney failure in U.S.
•
Uncontrolled or poorly controlled high blood pressure is the second leading cause of kidney failure in U.S: 28% of new cases and 25% of kidney failure in
U.S.

Facts of Kidney Disease
•
Third & fourth leading causes of kidney failure in U.S. are glomerulonephritis and polycystic kidney disease: 8.2% and
2.2% of new cases in U.S.
•
Kidney and urologic diseases continue to be major causes of work loss, physician visits, and hospitalizations among men and women.

Laboratory’s Involvement
With NKF Guidelines
•
Good creatinine calibration
•
Add GFR prediction equation to report
•
Understand limits of urine test strip protein
•
Add urine test with good low end sensitivity to urine albumin
(microalbumin)
•
Improve urine sediment testing

Preventing Kidney Disease
• Blood glucose & blood pressure checks
•
Regular physician check-ups
• Taking medications as prescribed by physician
•
Regular exercise; lose weight if overweight; low-fat diet
•
Avoid tobacco use; moderate alcohol consumption
•
Cholesterol levels in target range

Siemens Clinitek
Microalbumin 2 Reagent Strips
• Provide albumin, creatinine, and albumin to creatinine ratio results in 1 minute
• Can be used by POC or physicians’ offices
•
Use with Clinitek 50 or Clinitek Status analyzers
–
Sensitivity as low as 2mg/dL for urine protein
– More reliable; less affected by interferences
(e.g. specific gravity and pH)

Siemens Clinitek
Microalbumin 9 Reagent Strips
• Provide albumin, blood, creatinine, glucose, ketone, leukocyte, nitrite, pH, & protein and albumin to creatinine ratio & protein to creatinine ratio
•
Use with Clinitek Status or Advantis analyzers
–
Random sample; no timed or 24 hr urine sample required
– Accurate identification of microalbuminuria

Urinalysis Testing
•
Pre-analytic variables
–
Specimen collection: need written or clearcut oral instructions on specimen collection
–
Type of specimen collection (random, clean catch, cath)
–
Delay in specimen delivery
– Specimen storage conditions

Manual Urine Sediment
Analysis
•
Analytic variables
–
Mixing of samples by inversion, not swirling
–
Standardized volume for centrifugation; note volume if less than 12mL
– Time and G force for centrifugation; do not use brake
– Inconsistent decantation and re-suspension steps after centrifugation

Manual Urine Sediment
Analysis
•
Analytical variables (cont.)
–
Reduced recovery rate of urine elements after centrifugation
–
Variability in concentration ratio
• Supernatant removal
• Mixing of suspension
•
Filling of chamber; technique-dependent
•
Distributional errors

Manual Urine Sediment Analysis
•
Commercial slide systems
–
Provide some standardization
–
Technique-dependent
–
Vary in concentration ratios: 1:5 to 1:48
– Addition of drop of stain also varies concentration ratio
– Low & high power fields of view are microscope dependent; reporting unit inequity

Manual Urine Sediment
Microscopy
•
Subjective element identification
•
Poor reproducibility
•
Lack of standardization
•
Time consuming/labor intensive

Sysmex UF-1000i

Sysmex UF-1000i
• Laser-based flow cytometer utilizing 2 stains with fluorescent dyes to stain cellular elements
• Separate bacteria channel for improved discrimination
•
Forward scatter, hydrodynamic focusing, forward fluorescent light, conductivity measurements, and adaptive cluster analysis

Sysmex UF-1000i System
Components
•
Main unit with integrated pneumatic unit
•
IPU (information processing unit)
Windows XP operating system
•
Sampler unit with tube rotator unit
•
Bar code reader
•
Laser Jet graphic printer/line printer
(1 device, 2 settings)
•
Handheld bar code reader

UF-1000i Tube Rotator

UF-1000i Reagents
UFII PACK™-BAC
UFII SHEATH™
UFII PACK™-SED
UFII SEARCH™ -BAC
UFII SEARCH™-SED

UF II PACK-SED / UF II
SEARCH-SED
• UF II PACK-SED
– Removal of amorphous salts together with heating (up to 35°C)
• UF II SEARCH-SED
– Polymethine dye
– Chromogen chain with electron donor and acceptor group
–
Stains parts of nucleus, parts of cytoplasm and membranes
– Excitation wavelength is 635 nm
– Emission wavelength is over 660 nm

UF II PACK-BAC / UF II
SEARCH-BAC
•
UF II PACK-BAC
– UF II PACK-BAC (e.g. its pH value) together with heating to >40°C suppresses non-specific staining of particles other than bacteria
•
UF II SEARCH-BAC
–
Polymethine dye
– Distinctively stains nucleic acid elements in bacteria

UF-1000i Sample Volumes
•
Minimum sample volume:
– Manual mode: 1 mL
– Sampler mode: 4 mL
• Aspiration volume:
– Manual mode: 800 µL
– Sampler mode: 1,200 µL
•
Processed sample volume (SRV) in sampler and manual mode:
– 150 µL for the sediment analysis
– 62.5 µL for the bacteria analysis

UF-1000i
Manual Sample Page

Sample Volumes and Dilution
•
Addition of reagent leads to a dilution of the urine
– for the SED analysis exactly by the factor 4:
• 150 µL sample plus 435 µL diluent plus 15 µL dye equals 600 µL
– for the BAC analysis exactly by the factor 8:
• 62.5 µL sample plus 425 µL diluent plus
12.5 µL stain equals 500 µL

Sample Incubation
•
Incubation time at certain temperature ranges needed for staining
– for the SED analysis:
•
10 seconds at 35
°
C
– for the BAC analysis:
• 20 seconds at 42
°
C

Laminar Flow
Laser light
Flow cell particles
Sheath nozzle
Scattered light
Sheath reagent

UF-1000i Scattergram
Information
•
Forward Scatter (FSC)
•
Fluorescence High (FLH)
•
Fluorescence Low (FLL)
•
Fluorescence Low Width 2 (FLLW2)
•
Fluorescence Low Width (FLLW)
•
Side Scatter (SSC)
•
Forward Scatter Width (FSCW)

UF-1000i Detection Parameters
RBC
WBC
Enumerated Parameters
Epithelial Cells
Hyaline Casts
Bacteria
Flagged Parameters
Pathological Casts
Crystals
Small Round Cells
Yeast
Mucus
Sperm

S_Fsc
S1: FLH / Fsc - Scattergram
Large Fsc
X’TAL
Fl
Small - large size
WBC no fluorescence
Small
Fsc
Small - medium size
Fsc
Medium - large size
Fl
RBC
Bacteria
Low fluorescence
Fsc
Fsc
Fl
Fl
Small size
Low to medium fluorescence Fl
Very small size
Sperm Fsc
Fl
Low fluorescence
Small size
Medium - high fluorescence
Medium fluorescence
Low Fluorescence High S_FLH

S_Fsc
S2: FLL / Fsc - Scattergram
Medium – very large size
Fsc
Large
Medium - high fluorescence
Fl
EC
Fsc
Small - medium size
WBC Fsc
Medium - large size
Fl
Small
RBC
Fsc
Bacteria
Fl
Fl
Low fluorescence
Medium - high fluorescence
Fsc Small size
Fl
Low to medium fluorescence
Fsc
Sperm
Very small size
Small size
Medium fluorescence
Low fluorescence
Fl
Low Fluorescence High S_FLL

S_FLLW2
S3: FLLW2 / FLLW -
Scattergram
Large
FLLW2
FLLW2
Little to more stainable inclusions
FLLW
More stainable inclusions
FLLW
Short – medium length of inclusions
Path. casts
Casts (no inclusions)
Small WBC
SRC
Mucus
Length of stained inclusions
FLLW2
No to little inclusions
FLLW
FLLW2
FLLW
No inclusions
Long
Short Length of stained particle Long
S_FLLW

B_FSC
B1: Fsc / FLH - Scattergram
Large
FSC
Small to big size
No fluorescence FLH
Debris
Small
Low
BACT Fsc
FlH
Small size
Weak fluorescence
Stainability of particles High B_FLH

UF-1000i
Sediment
1

UF-1000i
Sediment 2

UF-1000i
Sediment
3

UF-1000i
Sediment
4

UF-1000i
Sediment
5

UF-1000i
Bacteria 1

UF-1000i
Bacteria
2

UF-1000i
Bacteria
3

UF-1000i Technology
Improved determination of bacteria
Bacteria
Diluents
Sediments
Detection unit
Red semiconductor laser
•Down sizing
•Long life
•Reduced power consumption
Sediments Bacteria
Incubation
Bacteria
Stain
Sediments
Two chambers for stain and dilution

UF-1000i Technology
1) Enhanced detection of bacteria
2) Staining bacteria nuclei
Non-specific staining with debris
Dye
Dye
Dye
Dye
Dye
Dye
Dye
Dye
Dye
Dye
Specific stain for Nucleic Acid
Polymethine dye
Stain DNA/RNA
Fluorescence

Parameter
RBC
WBC
EC
CAST
B ACTERIA
UF-1000i Technology Method Comparison
UF-1000i Parameters
Correlation r
0.9921
0.9669
0.9777
0.9558
0.4831
Regression r 2
0.9842
0.9348
0.9558
0.9136
0.2334
Regression Equation y = 0.9544 x – 3.0009
y = 0.8622 x – 1.6818
y = 0.864 x – 0.1134
y = 0.6125 x + 0.0629
y = 0.1465 x – 51.865
Range
0.0 – 4628.1
0.0 – 2557.5
0.0 – 176.5
0.00 – 28.04
0.0 – 9383.4
The sediment parameters, RBC, WBC, EC and CAST, demonstrate excellent correlation with the UF-100 system.
Source: Clinical Data for FDA submission

UF-1000i Technology Method Comparison
UF-100 vs UF-1000i
BACT (Range 1-10,000/μL) r = 0.4831
y = 0.1465x - 51.865
R
2
= 0.2334
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
0 1000 2000 3000 4000 5000
UF-100
6000 7000 8000 9000 10000
Percent Agreement
Positive Predictive Value
Negative Predictive Value
UF-1000:
~1200/ µ L
UF-100: ~
2800/ µ L
83.22%
91.66%
84.30%
A comparison of the data was performed to determine the percent agreement (bacteria count) of the samples based upon the different reference intervals listed below.
The bacteria reference intervals for the UF-1000i were significantly lower than the UF-
100.
Source: Clinical Data for FDA submission

UF-1000i Technology
UF-1000 i
REVIEW rate ： 2.6%
N=120
UF-100
REVIEW rate ： 6.0%
RBC/X’TAL discrimination error
RBC/BACT、DEBRIS discrimination error
RBC/YLC discrimination error
0
2
0
0.0%
1.7%
0.0%
Total count error
Discrimination error
Conductivity error
SRC*
2
0
1
5
1.7%
0.0%
0.9%
4.3%
1 0.9% Conductivity error
CARRYOVER 0 0.0%
P.CAST*
* Review setting is default
1 0.9%
Source: SCJ R&D Study

Scattergram
UF-1000i Technology
UF-1000i
Reduction of false-positive by X
’
TAL interference to RBC
S-FSC
UF-100 false-positive by X
’
TAL interference
Microscopy :
RBC 5.6/
µ
L
X
’
TAL (2+)
UF-1000i: RBC 3.3/
µ
L
X
’
TAL 102.7/
µ
L
The more complex the surface or inner construction, the more intensive SSC signal is.
UF-100 :
RBC 119.8/
µ
L
X
’
TAL 0.0 /
µ
L

UF-1000i Technology
Scattergram
UF-1000i
Reduced false positive EC with high positive WBC
WBC is accurately classified by SSC signals.
UF-100
WBC cluster can be detected as EC. It is false positive of EC.
Microscopy
:
EC
24.5/
µ
L
SSC parameters can help UF to distinguish
WBC and EC.
UF-1000i: EC 18.2/
µ
L
UF-100 :
EC 83.4/
µ
L

UF-1000i Data Storage
• HDD with minimum 20 GB for data storage including graphics
•
Sample Explorer/Data Browser: 10,000 samples measurement data including histograms & scattergrams
• Work List: 3,000 orders
•
Patient information: 5,000 patients data
•
100 reagent logs & error logs
•
Doctor & ward master

UF-1000i Sample with No Flagging

UF-1000 i Sample with Flagging

UF-1000i “Cumulative” screen

UF-1000i “Service 1” screen

UF-1000i “Service 2” screen

UF-1000i Anti-Carryover Action
• Trigger: bacteria count only
•
Sequential mode:
– If the bacteria count exceeds the cut-offs preset in the anti-carry-over settings, additional autorinse cycles are performed before the next sample is aspirated.
• Overlapping mode:
–
If the bacteria count exceeds the cut-offs preset in the anti-carry-over settings, additional autorinse cycles are performed. The next sample will be aspirated twice.

UF-1000i Anti-Carryover

UF-1000i Quality Control
•
UF II Control: two level commercial controls containing particles representing
RBC, WBC, EC, casts, and bacteria
•
Controls also monitor conductivity plus the high level monitors sensitivity parameters-FSC, FSCW, FLH, FLL,
FLLW, SSC.
•
Levy Jennings & Radar Charts

UF-1000i 24 Control Files

L-J Charts
Radar Charts
300 data points
UF-1000i QC Charts

UF-1000i Flagging
(Review Settings)
• X’TAL:
•
YLC:
25.0/uL
25.0/uL
•
SRC: 10.0/uL
•
Path.CAST: 1.5/uL
•
MUCUS: 10.0/uL
•
SPERM: 10.0/uL

UF-1000i Q-Flags

UF-1000i Factory Defined
Review Flags
• RBC/X’TAL Abn. Cls.: RBC*
•
RBC/BACT Abn. Cls.: RBC*, BACT*
•
RBC/YLC Abn. Cls.: RBC*
•
Debris High?: BACT*
•
Abn. DC Sensitivity:
≤3.0 or ≥39.0 mS/cm
•
Carryover?: BACT*

UF-1000i Linearity
•
RBC: 1.0-5000.0/uL
•
WBC: 1.0-5000.0/uL
•
EC: 1.0-200.0/uL
•
Casts: 1.0-30.0/uL
•
Bacteria: -5.0-10,000.0/uL

UF-1000i Reference Intervals
•
RBC: ≤23.0/uL
•
WBC: ≤28.0/uL
•
EC: ≤31.0/uL
•
Casts: ≤1.00/uL
•
Bacteria: ≤358.0/uL

UF-1000i Maintenance
• Daily
– Perform shutdown
– Check for fluid in trap chamber of Pneumatic Unit & empty if needed
• Monthly or every 9000 cycles
–
Clean the sample rotor valve (SRV)
•
As Needed
–
Clean or replace sample filter if clogged or aspiration is affected
–
Empty waste container if not connected to floor drain

UF-1000i
•
Walk-away system
•
Uses uncentrifuged urine sample
•
No interference with amorphous urates
•
Results in 1 minute; cells reported/uL or
/HPF or /LPF
•
Review only by exception; no image review

Benefits of Automated Urine
Microscopy
•
Objective, analytical measurements
•
Reduction of subjective identification of elements
•
Reduction of tech to tech variability
•
Improved accuracy and reproducibility
•
Improved workflow, productivity, efficiency, turnaround time
•
Decreased labor expense

YH Urinalysis Automation
Objectives
• Annual UA volume: 58,000; 78% microscopics
• Automated dipstick analysis with Clinitek
Atlas system (sample tray) in 8/95.
•
Updated to Clinitek Atlas Rack system in
4/03.
•
Decision to automate urine sediment analysis with the Sysmex UF-100. “Live date” June 4, 2001. UF-1000i installed
12/07.

YH Benefits Using Automated
Sediment Analysis
• Reduced manual microscopic review rate to ~11%
•
Reduced turnaround time to <30 minutes from
>60 minutes
•
Reduction of 1 FTE through attrition
•
Improved workflow: can operate Urinalysis
Department with ~1.5 FTE instead of 3.0 FTE
•
Reduction in number of urine cultures
•
Culture criteria: WBC >28/uL, bacteria >358/uL,
& positive urine nitrite

YH Benefits Using Automated
Sediment Analysis
(cont.)
•
~15% volume increase since 2001 with no additional staffing required; current fiscal year-no volume increase
•
Minimal maintenance
•
>99% uptime
•
Smooth transition; very few physician concerns or questions

Thank You!

Questions?