PHYSICAL, CHEMICAL AND MORPHOLOGICAL URINE EXAMINATION: RECOMMENDATIONS FOR THE POST ANALYTICAL PHASE FROM THE INTERDISCIPLINARY URINALYSIS GROUP (GIAU)

Abstract

With these recommendations the Interdisciplinary Urinalysis Group (GIAU) aims to stimulate the following aspects:

  • improvement and standardization of the post analytical approach to physical, chemical and morphological urine examination (ECMU).
  • Emphasize the value added to ECMU by selection of clinically significant parameters, indication of analytical methods, of units of measurement, of reference values
  • Improvement of interpretation of dip stick urinalysis with particular regard to the reconsideration of the diagnostic significance of the evaluated parameters together with an increasing awareness of the limits of sensitivity and specificity of this analytical method. Accompanied by the skills to propose and carry out in-depth investigations with analytical methods that are more sensitive and specific.
  • Increase the awareness of the ‘importance of professional skills in the field of urinary morphology and their relationships with the clinicians. through the introduction, in the report, of descriptive and interpretative comments depending on the type of request, the complexity of the laboratory, the competence of the pathologist.
  • Implement a policy of evaluation of the analytical quality by using, in addition to traditional internal and external controls, a program for the evaluation of morphological competence.

The hope is to revalue the enormous potential diagnostic of ‘ECMU, implementing a urinalysis on personalized diagnostic needs that each patient brings with it.

 

Key Words: Recommendations, Post Analytical Phase, Urinalysis

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Introduzione

Il Referto

Per la medicina di Laboratorio il referto è la traduzione di accertamenti diagnostici in un’informazione utilizzabile clinicamente. Nel classico schema del “Brain-to-brain loop” di Lundberg (1), accanto al cervello del clinico, Burlina (2) inseriva un secondo cervello, quello del laboratorista a simboleggiare il processo di professionalità e di competenze che guidava una catena di eventi caratterizzati da una forte matrice culturale e organizzativa, a snodarsi dalla fase pre-pre-analitica, fino alla fase post-postanalitica sintetizzando una risposta sotto forma di referto.

 

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An alternative proposal for managing morphological examination of urinary sediment and increasing its appropriateness

Abstract

Background. The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution.

Methods. Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service. We evaluated results in the 2009-2016 period, in which our hospital did not undergo any change both in the number of beds and in the clinical case-mix.

Results. From 2009 to 2013 an average of 2264 MEUS and 10,204 UA per year were ordered, respectively, with an average ratio of 22.2%. Since 2014, a change on computerized order entry involving MEUS caused a further decrease of its requests (in average, 923 per year), which was not associated to a decrease in UA (in average, 9810 per year) (in average, MEUS/UA 9.4%). MEUS requests came mainly from Paediatrics (47.8%), Nephrology (20.9%) and Rheumatology (18.3%) wards. By filling a satisfaction survey, clinical wards evaluated the provided service as satisfactory, while highlighting some critical issues, mainly referred to preanalytical phase.

Conclusions. The alternative proposal for managing MEUS presented in this paper markedly reduces the number of requests and increases their appropriateness. This is achieved without any negative impact on patient care.

Keywords: Clinical governance, Patient safety, Urinalysis

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INTRODUZIONE

L’esame morfologico del sedimento urinario (EMS) rappresenta tuttora uno strumento insostituibile per la diagnosi delle malattie del rene e delle vie urinarie [1]. Si tratta di un esame di semplice ma non banale esecuzione, effettuabile in ogni laboratorio. Infatti, l’unico strumento richiesto è un microscopio a contrasto di fase con almeno due livelli di ingrandimento, uno basso (ad es., 20x), per una valutazione generale della cellularità del sedimento, e uno più elevato (ad es., 40x), per la valutazione morfologica e semi-quantitativa dei singoli elementi.

 

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REPORT FOR THE WORLD KIDNEY DAYS IN ITALY 2015-2016

Abstract

World Kidney Day (WKD) is a global campaign, promoted by International Federation of Kidney Foundations (IFKF) and International Society of Nephrology (ISN) aimed at raising awareness among people on importance of our kidneys. This campaign includes many events across the globe. The main purpose of WKD is to create and spread awareness about preventive behaviours and risk factors for renal diseases. In Italy WKD is organized by the Italian Kidney Foundation (FIR) in collaboration with Italian Society of Nephrology (SIN) and the Red Cross of Italy. It takes place in hospitals, public spaces and in schools, where each participant is provided with informative material together with blood pressure and urine dipstick testing. Here, we present the data collected during the 2015 and 2016 WKD campaigns.

KEYWORDS: World Kidney Day, Prevention, Hypertension, Urinalysis

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Introduzione

La giornata mondiale del rene (GMR) è un’iniziativa internazionale che mira all’informazione e alla sensibilizzazione dell’opinione pubblica circa le patologie renali, focalizzando l’attenzione sui fattori di rischio e sulle possibilità di cura e trattamento delle stesse (1). In Italia tale evento viene organizzato dalla Fondazione Italiana del Rene (FIR), con la collaborazione della Società Italiana di Nefrologia (SIN) e la Croce Rossa Italiana (CRI). L’iniziativa, che coinvolge numerose Unità di Nefrologia distribuite sul territorio nazionale, si articola su due progetti distinti, quello che si svolge nelle piazze o negli ambulatori di Nefrologia, detto anche “progetto camper” (2, 3), e quello che si tiene nelle scuole, rivolto in particolare a studenti del quarto e quinto anno di scuola superiore.

In questo articolo riportiamo i dati ricavati dai partecipanti alla GMR negli anni 2015 e 2016.
 

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