Home Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy
Article
Licensed
Unlicensed Requires Authentication

Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy

  • Dietmar Enko EMAIL logo , Ingeborg Stelzer , Michael Böckl , Brigitta Derler , Wolfgang J. Schnedl , Petra Anderssohn , Andreas Meinitzer and Markus Herrmann
Published/Copyright: October 12, 2019
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 58 Issue 2

Abstract

Background

Recently, several manufacturers have launched automated urinalysis platforms. This study aimed to compare the diagnostic performance of the UF-5000 (Sysmex Corporation, Kobe, Japan) and the cobas® u 701 (Roche Diagnostics, Rotkreuz, Switzerland) urine sediment analyzers with manual phase-contrast microscopy as the reference method.

Methods

A total of 195 urine samples were analyzed on both automated platforms and subjected to manual microscopic examination. Agreement was assessed by Cohen’s kappa (κ) analysis. Sensitivities and specificities were calculated.

Results

The agreement of the UF-5000 with manual microscopy was almost perfect (κ > 0.8) for red (RBC) and white blood cells (WBC), renal tubular epithel cells, hyaline casts, bacteria (BACT) and yeast (YLC), substantial (κ = 0.61–0.80) for squamous epithel cells (SEC) and pathologic casts, and moderate (κ = 0.41–0.60) for transitional epithel cells. The cobas® u 701 showed substantial agreement (κ = 0.61–0.80) for WBC, moderate agreement (κ = 0.41–0.60) for hyaline casts, and fair agreement (κ = 0.21–0.40) for RBC, SEC, non-squamous epithel (NEC), pathologic casts, BACT and YLC. The UF-5000 sensitivities ranged between 98.5% for RBC and 83.3% for pathological casts. The cobas® u 701 showed sensitivities between 83.0% for WBC and 31.6% for YLC.

Conclusions

The UF-5000 (Sysmex) analyzer showed a better diagnostic agreement with manual phase-contrast microscopy compared to the cobas® u 701 (Roche) module. The Sysmex platform showed reliable results for urine sediment analysis. However, pathological samples should be verified with manual microscopy.

Keywords: automation; microscopy; urinalysis; urine sediment
Corresponding author: Dietmar Enko, MD, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; and Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Hochsteiermark, Leoben, Austria, Phone: +43 316 385-13145, Fax: +43 316 385-13430

  1. Author contributions: DE wrote the manuscript and supervised this study project. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. European Confederation of Laboratory Medicine. European urinalysis guidelines. Scand J Clin Lab Invest Suppl 2000;231:1–86.10.1080/00365513.2000.12056993Search in Google Scholar

2. Cavanaugh C, Perazella MA. Urine sediment examination in the diagnosis and management of kidney disease: core curriculum 2019. Am J Kidney Dis 2019;73:258–72.10.1053/j.ajkd.2018.07.012Search in Google Scholar

3. 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

4. Fogazzi GB, Delanghe J. Microscopic examination of urine sediment: phase contrast versus bright field. Clin Chim Acta 2018;487:168–73.10.1016/j.cca.2018.09.036Search in Google Scholar

5. Shayanfar N, Tobler U, von Eckardstein A, Bestmann L. Automated urinalysis: first experiences and a comparison between the Iris iQ200 urine microscopy system, the Sysmex UF-100 flow cytometer and manual microscopic particle counting. Clin Chem Lab Med 2007;45:1251–6.10.1515/CCLM.2007.503Search in Google Scholar

6. Ince FD, Ellidağ HY, Koseoğlu 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

7. Becker GJ, Garigali G, Fogazzi GB. Advances in urine microscopy. Am J Kidney Dis 2016;67:954–64.10.1053/j.ajkd.2015.11.011Search in Google Scholar

8. 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

9. Cho J, Oh KJ, Jeon BC, Lee SG, Kim JH. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment. Clin Chem Lab Med 2019;57:1744–53.10.1515/cclm-2019-0211Search in Google Scholar PubMed

10. 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.2005.07.039Search in Google Scholar PubMed

11. 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

12. Fairley KF, Birch DF. Hematuria: a simple method for identifying glomerular bleeding. Kidney Int 1982;21:105–8.10.1038/ki.1982.16Search in Google Scholar PubMed

13. Ren C, Jin M, Wu J, Wang X, Wang Y, Cao H. Improving the detection of urine sediment with a modified urinalysis review procedure. Clin Lab 2019;65:507–15.10.7754/Clin.Lab.2018.180830Search in Google Scholar PubMed

14. Fogazzi GB, Grignani S, Colucci P. Urinary microscopy as seen by nephrologists. Clin Chem Lab Med 1998;36:919–24.10.1515/CCLM.1998.159Search in Google Scholar PubMed

15. Bunjevac A, Gabaj NN, Miler M, Horvat A. Preanalytics of urine sediment examination: effect of relative centrifugal force, tube type, volume of sample and supernatant removal. Biochem Med (Zagreb) 2018;28:010707.10.11613/BM.2018.010707Search in Google Scholar PubMed PubMed Central

16. Mohammad KS, Bdesha AS, Snell ME, Witherow RO, Coleman DV. Phase contrast microscopic examination of urinary erythrocytes to localise source of bleeding: an overlooked technique? J Clin Pathol 1993;46:642–5.10.1136/jcp.46.7.642Search in Google Scholar PubMed PubMed Central

17. Martinez MG, dos S Silva V, do Valle AP, Amaro CR, Corrente JE, Martin LC. Comparison of different methods of erythrocyte dysmorphism analysis to determine the origin of hematuria. Nephron Clin Pract 2014;128:88–94.10.1159/000367848Search in Google Scholar PubMed

18. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37:360–3.Search in Google Scholar

19. Bakan E, Bayraktutan Z, Baygutalp NK, Gul MA, Umudum FZ, Bakan N. Evaluation of the analytical performances of Cobas 6500 and Sysmex UN series automated urinalysis systems with manual microscopic particle counting. Biochem Med (Zagreb) 2018;28:020712.10.11613/BM.2018.020712Search in Google Scholar PubMed PubMed Central

20. 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

21. Akin OK, Serdar MA, Cizmeci Z, Genc O, Aydin S. Comparison of LabUMat-with-UriSed and iQ200 fully automatic urine sediment analysers with manual urine analysis. Biotechnol Appl Biochem 2009;53:139–44.10.1042/BA20080188Search in Google Scholar PubMed

22. Yüksel H, Kilic E, Ekinci A, Evliyaoğlu O. Comparison of fully automated urine sediment analyzers H800-FUS100 and LabUMat-UriSed with manual microscopy. J Clin Lab Anal 2013;27:312–6.10.1002/jcla.21604Search in Google Scholar PubMed PubMed Central

23. Oyaert M, Delanghe J. Progress in automated urinalysis. Ann Lab Med 2019;39:15–22.10.3343/alm.2019.39.1.15Search in Google Scholar PubMed PubMed Central

24. 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

25. 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.02860608Search in Google Scholar PubMed PubMed Central

26. Chu-Su Y, Shukuya K, Yokoyama T, Lin WC, Chiang CK, Lin CW. Enhancing the detection of dysmorphic red blood cells and renal tubular epithel cells with a modified urinalysis protocol. Sci Rep 2017;7:40521.10.1038/srep40521Search in Google Scholar PubMed PubMed Central

27. Crop MJ, de Rijke YB, Verhagen PC, Cransberg K, Zietse R. Diagnostic value of urinary dysmorphic erythrocytes in clinical practice. Nephron Clin Pract 2010;115:c203–12.10.1159/000313037Search in Google Scholar PubMed

Received: 2019-08-30
Accepted: 2019-09-22
Published Online: 2019-10-12
Published in Print: 2020-01-28

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Towards a personalized assessment of vitamin D status
  4. Reviews
  5. Circulating tumor DNA and their added value in molecular oncology
  6. Telomere length determinants in childhood
  7. Opinion Papers
  8. Serum or plasma? An old question looking for new answers
  9. Evaluating sample stability in the clinical laboratory with the help of linear and non-linear regression analysis
  10. General Clinical Chemistry and Laboratory Medicine
  11. Simultaneous measurement of 25(OH)-vitamin D and 24,25(OH)2-vitamin D to define cut-offs for CYP24A1 mutation and vitamin D deficiency in a population of 1200 young subjects
  12. How well do Croatian laboratories adhere to national recommendations for laboratory diagnostics of chronic kidney disease (CKD)?
  13. Underfilling of vacuum blood collection tubes leads to increased lactate dehydrogenase activity in serum and heparin plasma samples
  14. Calcium state estimation by total calcium: the evidence to end the never-ending story
  15. The use of faecal immunochemical testing in the decision-making process for the endoscopic investigation of iron deficiency anaemia
  16. Measurement uncertainty of β-lactam antibiotics results: estimation and clinical impact on therapeutic drug monitoring
  17. Practical approach to method verification in plasma and validation in cerebrospinal fluid under accreditation using a flexible scope in molecular virology: setting up the HIV, HBV and HCV Aptima™ Quant Dx assays
  18. Plasma neurofilament light chain is associated with mortality after spontaneous intracerebral hemorrhage
  19. Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy
  20. Development and validation of LC-MS/MS methods to measure tobramycin and lincomycin in plasma, microdialysis fluid and urine: application to a pilot pharmacokinetic research study
  21. Reference Values and Biological Variations
  22. Cord blood S100B: reference ranges and interest for early identification of newborns with brain injury
  23. Hematology and Coagulation
  24. Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need
  25. Cancer Diagnostics
  26. Next-generation sequencing for tumor mutation quantification using liquid biopsies
  27. Cardiovascular Diseases
  28. Evolution of the slopes of ST2 and galectin-3 during marathon and ultratrail running compared to a control group
  29. Letters to the Editor
  30. Biological variation of two serum markers for preeclampsia prediction
  31. Daily monitoring of a control material with a concentration near the limit of detection improves the measurement accuracy of highly sensitive troponin assays
  32. Are patients adequately informed about procedures for 24-h urine collection?
  33. Interferences in free thyroxine concentration using the Roche analytical platform: improvement of the third generation?
  34. Procedures for the diagnosis of macro-follicle stimulating hormone (FSH) in a patient with high serum FSH concentrations
  35. False-positive result of immunochromatographic (IC) strip test for the diagnosis of α-thalassemia in samples with autoantibodies
  36. Sample dilution for soluble interleukin-2 receptor α measurement: comparison of two different matrices
  37. The growing problem of predatory publishing: a case report
  38. Cerebrospinal fluid lactate levels according to the site of puncture
https://doi.org/10.1515/cclm-2019-0919
Keywords for this article
automation; microscopy; urinalysis; urine sediment

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Towards a personalized assessment of vitamin D status
  4. Reviews
  5. Circulating tumor DNA and their added value in molecular oncology
  6. Telomere length determinants in childhood
  7. Opinion Papers
  8. Serum or plasma? An old question looking for new answers
  9. Evaluating sample stability in the clinical laboratory with the help of linear and non-linear regression analysis
  10. General Clinical Chemistry and Laboratory Medicine
  11. Simultaneous measurement of 25(OH)-vitamin D and 24,25(OH)2-vitamin D to define cut-offs for CYP24A1 mutation and vitamin D deficiency in a population of 1200 young subjects
  12. How well do Croatian laboratories adhere to national recommendations for laboratory diagnostics of chronic kidney disease (CKD)?
  13. Underfilling of vacuum blood collection tubes leads to increased lactate dehydrogenase activity in serum and heparin plasma samples
  14. Calcium state estimation by total calcium: the evidence to end the never-ending story
  15. The use of faecal immunochemical testing in the decision-making process for the endoscopic investigation of iron deficiency anaemia
  16. Measurement uncertainty of β-lactam antibiotics results: estimation and clinical impact on therapeutic drug monitoring
  17. Practical approach to method verification in plasma and validation in cerebrospinal fluid under accreditation using a flexible scope in molecular virology: setting up the HIV, HBV and HCV Aptima™ Quant Dx assays
  18. Plasma neurofilament light chain is associated with mortality after spontaneous intracerebral hemorrhage
  19. Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy
  20. Development and validation of LC-MS/MS methods to measure tobramycin and lincomycin in plasma, microdialysis fluid and urine: application to a pilot pharmacokinetic research study
  21. Reference Values and Biological Variations
  22. Cord blood S100B: reference ranges and interest for early identification of newborns with brain injury
  23. Hematology and Coagulation
  24. Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need
  25. Cancer Diagnostics
  26. Next-generation sequencing for tumor mutation quantification using liquid biopsies
  27. Cardiovascular Diseases
  28. Evolution of the slopes of ST2 and galectin-3 during marathon and ultratrail running compared to a control group
  29. Letters to the Editor
  30. Biological variation of two serum markers for preeclampsia prediction
  31. Daily monitoring of a control material with a concentration near the limit of detection improves the measurement accuracy of highly sensitive troponin assays
  32. Are patients adequately informed about procedures for 24-h urine collection?
  33. Interferences in free thyroxine concentration using the Roche analytical platform: improvement of the third generation?
  34. Procedures for the diagnosis of macro-follicle stimulating hormone (FSH) in a patient with high serum FSH concentrations
  35. False-positive result of immunochromatographic (IC) strip test for the diagnosis of α-thalassemia in samples with autoantibodies
  36. Sample dilution for soluble interleukin-2 receptor α measurement: comparison of two different matrices
  37. The growing problem of predatory publishing: a case report
  38. Cerebrospinal fluid lactate levels according to the site of puncture
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 23.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2019-0919/html?lang=en
Scroll to top button