Evaluation of clinical cases in External Quality Assessment Scheme (EQAS) for the urinary sediment
-
Giovanni B. Fogazzi
,
Sandra Secchiero
Abstract
Background: The few available External Quality Assessment (EQA) programs on urinary sediment rarely include an evaluation of clinical cases. The present paper provides a descriptive analysis of clinical cases included in the Italian EQA program on urinary sediment.
Methods: Ten cases were presented over a 5-year period (2007–2011). Each clinical case included a brief clinical history, some key laboratory data and four key urinary sediment particles obtained by phase contrast microscopy. The clinical diagnoses indicated by participants, chosen among four or five proposed, were evaluated only for those who had been able to correctly identify all four urinary sediment particles. The results of each survey were then evaluated, scored and commented on.
Results: The numbers of participants for the 10 surveys ranged from 268 to 325. Throughout surveys, only 63.9%±17.0% (range 39.6%–88.7%) of participants achieved access to clinical diagnosis. Of these, 90.2%±8.5% (range 73.7%–98.1%) were able to indicate the correct diagnosis.
Conclusions: Our findings demonstrate that once the correct identification of urinary sediment particles is obtained, most participants are able to associate urinary findings with the respective clinical conditions, thus establishing the correct diagnosis.
References
1. Kouri T, Fogazzi G, Gant V, Hallander H, Hofmann W, Guder WG. European urinalysis guidelines. Scand J Clin Lab Invest 2000;60(Suppl 231):0–3.10.1080/00365513.2000.12056993Suche in Google Scholar
2. Clinical and Laboratory Standard Institute (ex NCCLS). GP16-A3 – Urinalysis; Approved guideline, 3rd ed. Wayne, PA: CLSI, 2009.Suche in Google Scholar
3. Guder WG, Boisson RC, Fogazzi G, Galimany R, Kouri T, Malakhov VN, et al. External quality assessment of urine analysis in Europe. Results of a round table discussion during the symposium ‘From uroscopy to molecular analysis’, Seeon, Germany, September 18–20, 1999. Clin Chim Acta 2000;297:275–84.10.1016/S0009-8981(00)00253-9Suche in Google Scholar
4. Cwiklińska A, Kakol J, Kuchta A, Kortas-StempakB, Pacanis A, Rogulski J, et al. The standardization of urine particle counting in medical laboratories – a Polish experience with the EQA programme. Scand J Clin Lab Invest 2012:72:52–8.10.3109/00365513.2011.628688Suche in Google Scholar
5. Appendix B. Origin and application of proficiency testing: why we do it. In: Haber MH, Blomberg D, Galagan KA, Glassy EF, Ward PC, editors. Color atlas of the urinary sediment. An illustrated field guide based on proficiency testing. Northfield, MN: CAP Press, 2010:403–9.Suche in Google Scholar
6. Fogazzi GB, Secchiero S, Consonni D, Sciacovelli L, Zardo L, Garigali G, et al. An Italian External Quality Assessment (EQA) program on urinary sediment. Clin Chim Acta 2010;411:859–67.10.1016/j.cca.2010.02.073Suche in Google Scholar
7. Vasikaran SD, Penberthy L, Gill J, Scott S, Sikaris KA. Review of a pilot quality-assessment program for interpretative comments. Ann Clin Biochem 2002;39:250–60.10.1258/0004563021901955Suche in Google Scholar
8. Sciacovelli L, Zardo L, Secchiero S, Zaninotto M, Plebani M. Interpretative comments and reference ranges in EQA programs as a tool for improving laboratory appropriateness and effectiveness. Clin Chim Acta 2003;333:209–19.10.1016/S0009-8981(03)00188-8Suche in Google Scholar
9. Lim EM, Vasikaran SD, Gill J, Calleja J, Hickman PE, Beilby J, et al. A discussion of cases in the 2001 RCPA-AQAP chemical pathology case reports comments program. Pathology 2003;35:145–50.10.1016/S0031-3025(16)34359-8Suche in Google Scholar
10 Sciacovelli L, Secchiero S, Zardo L, D’Osualdo A, Plebani M. Risk management in laboratory medicine: quality assurance programs and professional competence. Clin Chem Lab Med 2007;45:756–65.10.1515/CCLM.2007.165Suche in Google Scholar PubMed
11 Plebani M. Interpretative commenting: a tool for improving the laboratory-clinical interface. Clin Chim Acta 2009:401:46–51.10.1016/j.cca.2009.03.012Suche in Google Scholar PubMed
12 Kilpatrick ES, Freedman DB, National Clinical Biochemistry Audit Group. A national survey of interpretative reporting in UK. Ann Clin Biochem 2011:48:317–20.10.1258/acb.2011.011026Suche in Google Scholar PubMed
13 ISO 15189:2012. Medical laboratories – Requirements for quality and competence. Geneva: ISO, 2012.Suche in Google Scholar
14 Fogazzi GB, Garigali G. The clinical art and science of urinary microscopy. Curr Opin Nephrol Hypertens 2003;12:625–32.10.1097/00041552-200311000-00009Suche in Google Scholar PubMed
15 Fogazzi GB, Garigali G, Pirovano B, Muratore MT, Raimondi S, Berti S. How to improve the teaching of urine microscopy. Clin Chem Lab Med 2007;45:407–12.10.1515/CCLM.2007.079Suche in Google Scholar PubMed
16 Fogazzi GB, Verdesca S, Garigali G. Urinalysis: core curriculum 2008. Am J Kidney Dis 2008;51:1052–67.10.1053/j.ajkd.2007.11.039Suche in Google Scholar PubMed
17 Fogazzi GB. The urinary sediment. An integrated view, 3rd ed. Milano: Elsevier, 2010.Suche in Google Scholar
18 Rasoulpour M, Banco L, Laut JM, Burke GS. Inability of community based laboratories to identify pathological casts in urine samples. Arch Pediatr Adolesc Med 1996;150:1201–4.10.1001/archpedi.1996.02170360091015Suche in Google Scholar PubMed
19 Tsai JJ, Yeun JY, Kumar VA, Don BR. Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory. Am J Kidney Dis 2005;46:820–9.10.1053/j.ajkd.2005.07.039Suche in Google Scholar PubMed
20 Wald R, Bell CM, Nisenbaum R, Perrone S, Liangos O, Laupacis A, et al. Interobserver reliability of urine sediment interpretation. Clin J Am Soc Nephrol 2009;4:567–71.10.2215/CJN.05331008Suche in Google Scholar PubMed PubMed Central
21 Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. New Engl J Med 2003;348:2330–8.10.1056/NEJMcp012694Suche in Google Scholar PubMed
22 Perazella MA, Coca SG, Kanbay M, Brewster UC, Parikh CR. Diagnostic value of urine microscopy for differential diagnosis of acute kidney injury in hospitalized patients. Clin J Am Soc Nephrol 2008;3:1615–9.10.2215/CJN.02860608Suche in Google Scholar PubMed PubMed Central
23 Chawla LS, Dommu A, Berger A, Shih S, Patel SS. Urinary sediment casts scoring index for acute kidney injury: a pilot study. Nephron Clin Pract 2008;110:c145–50.10.1159/000166605Suche in Google Scholar PubMed PubMed Central
24 Spinelli B, Consonni D, Garigali G, Fogazzi GB. Waxy casts in the urinary sediment of patients with different types of glomerular diseases: results of a prospective study. Clin Chim Acta 2013;424:47–52.10.1016/j.cca.2013.05.009Suche in Google Scholar PubMed
25 Fogazzi GB. Crystalluria: a neglected aspect of urinary sediment analysis. Nephrol Dial Transplant 1996;50:1058–68.10.1093/oxfordjournals.ndt.a027276Suche in Google Scholar PubMed
26 Bonsib SM. Scanning electron microscopy investigation of acellular glomeruli. Am J Pathol 1985;119:357–60.Suche in Google Scholar
©2014 by Walter de Gruyter Berlin/Boston
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- Editorials
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- Translational researchers beware! Unreliable commercial immunoassays (ELISAs) can jeopardize your research
- Reviews
- Tracing a roadmap for vitamin B12 testing using the health technology assessment approach
- Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide 2 antibody and anti-cyclic citrullinated peptide 3 antibody in rheumatoid arthritis
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- Characterization of a complex CYP2D6 genotype that caused an AmpliChip CYP450 Test® no-call in the clinical setting
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