The clinical art and science of urine microscopy

Current Opinion in Nephrology and Hypertension

Volumn 12, Issue 6, 2003, Pages 625-632

  Fogazzi, Giovanni B ^a   Garigali, Giuseppe ^a  

^a FONDAZIONE IRCCS CA GRANDA OSPEDALE MAGGIORE POLICLINICO   (Italy)

Author keywords

Decoy cells; Flow cytometry; Urinalysis; Urine microscopy; Urine sediment

Indexed keywords

ACICLOVIR; AMOXICILLIN; CLAVULANIC ACID; CREATINE; CYCLOPHOSPHAMIDE; HEMOGLOBIN; IMMUNOSUPPRESSIVE AGENT; INDINAVIR; MARKER; METHYLPREDNISOLONE; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; PROTEINASE INHIBITOR; TACROLIMUS; URATE;

AUTOMATION; B CELL LYMPHOMA; CHRONIC LYMPHATIC LEUKEMIA; CREATININE BLOOD LEVEL; CRYSTALLURIA; CYTOLOGY; DEVICE; DIAGNOSTIC TEST; DISEASE EXACERBATION; ERYTHROCYTE; FABRY DISEASE; FLOW CYTOMETRY; GIANT CELL ARTERITIS; GRAFT REJECTION; GRANULAR CELL; HISTOPLASMOSIS; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HYPERTENSION; INFLAMMATION; INTERSTITIAL NEPHRITIS; KIDNEY DISEASE; KIDNEY DYSFUNCTION; KIDNEY FAILURE; KIDNEY FUNCTION; KIDNEY TRANSPLANTATION; LEUKOCYTURIA; LUPUS ERYTHEMATOSUS NEPHRITIS; LYMPHATIC LEUKEMIA; METHODOLOGY; MICROSCOPY; MYELOMA; PANCREAS TRANSPLANTATION; POLYOMA VIRUS; PRIORITY JOURNAL; PUBLICATION; REVIEW; SCIENCE; SIDE EFFECT; SYSTEMIC LUPUS ERYTHEMATOSUS; URINALYSIS; URINARY TRACT DISEASE; URINARY TRACT OBSTRUCTION; URINE; URINE CYTOLOGY; URINE SEDIMENT; UROLITHIASIS; UROTHELIAL INFLAMMATION; UROTHELIUM; VIREMIA; VIRUS INFECTION; VIRUS REACTIVATION;

BK VIRUS; HUMANS; MICROSCOPY; URINE; UROLOGIC DISEASES;

EID: 0442307760     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-200311000-00009     Document Type: Review

References (36)

1. Fogazzi GB, Cameron SJ. Urine microscopy form the seventeenth century to the present day. Kidney Int 1996; 50:1059-1068.
2. Fogazzi GB, Testanera G. The farsighted studies of the Italian Carlo L. Rovida (1844-1877) on the nature of urinary casts. Am J Nephrol 2002; 22:300-308. This historical paper describes the intense research applied to urine sediments in the second half of the 19th century to identify the nature of the urinary casts-urine particles of particular importance in renal diseases.
3. Fogazzi GB, Grignani S, Colucci P. Urinary microscopy as seen by the nephrologist. Clin Chem Lab Med 1998; 36:919-924.
4. Piccoli GB, Gai M, Mezza E, et al. Biochemical and microscopic urinalysis: time and cost in a nephrology laboratory. J Nephrol 2002; 15:575-579.
5. Rasoulpour M, Banco L, Laur JM, et al. Inability of community-based laboratories to identify pathological casts in urine samples. Arch Pediatr Adolesc Med 1996; 150:1201-1204.
6. Fogazzi GB, Ponticelli C, Ritz E. The urinary sediment: an integrated view. 2nd ed. Oxford: Oxford University Press; 1999.
7. Kouri T, Fogazzi G, Gant V et al. European urinalysis guidelines. European Confederation of Laboratory Medicine. Scand J Clin Lab Invest 2000; 60 (Suppl 231):1-96.
8. Kouri T, Vuotari L, Pohjavaara S et al. Preservation of urine flow cytometric and visual microscopic testing. Clin Chem 2002; 48:900-905. This paper analyses in detail the effects of four different preservatives on six urine particles and identifies the best ones for both flow cytometry and manual microscopy.
9. Kim Y, Jin DC, Lee EJ. Quantitative analysis of urine sediment using newly designed centrifuge tubes. Ann Clin Lab Sci 2002; 32:55-60.
10. Jiménez-Hernández-M, Guillermo-López A, Cobo F, et al. Bladder involvement of diffuse large B-cell lymphoma diagnosed by a cytological study of the urine. Leuk Lymphoma 2002; 43:187-189.
11. Mukunyadzi P, Johnson M, Wyble JG, et al. Diagnosis of histoplasmosis in urine cytology: reactive uroepithelial changes, a diagnostic pitfall. Case report and literature review of urinary tract infections. Diagn Cytopathol 2002; 26:243-246. This describes a case of histoplasmosis which was identified by the examination of the urine sediment. Of importance also is the review of the microorganisms which can be identified by urine microscopy.
12. Randall RE Jr. Urate nephropathy following chronic ileostomy acidosis. Am J Nephrol 2002; 22:373-375.
13. Sessa A, Meroni M, Battini G, et al. Renal transplantation in patients with Fabry disease. Nephron 2002; 91:348-351.
14. Dehmel B, Schneider W, Kettritz R, et al. Not so acute renal failure with crystals in the urine. Nephrol Dial Transplant 2003; 18:209-211.
15. Vanderschueren S, Depoot I, Knockaert DC, et al. Microscopic haematuria in giant cell arteritis. Clin Rheumatol 2002; 21:373-377. These authors demonstrate that microscopic haematuria of glomerular type is frequent in patients with giant cell arteritis. This finding, associated with the presence of proteinuria, demonstrates that the kidneys are frequently involved in this condition.
16. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25:1271-1277.
17. Illei GG, Takada K, Parkin D, et al. Renal flares are common in patients with severe proliferative lupus nephritis treated with pulse immunosuppressive therapy. Arthritis Rheum 2002; 46:995-1002. This is an important study devoted to the significance of renal flares in the long-term outcome of lupus nephritis. This paper is also relevant because it shows that the examination of the urine sediment is necessary to identify the renal flares.
18. Zabaleta-Lanz M, Vargas-Arenas RE, Tápanes F et al. Silent nephritis in systemic lupus erythematosus. Lupus 2003; 12:26-30. This confirms that there can be severe cases of lupus nephritis with only mild or no urine sediment changes.
19. Nickeleit V, Hirsch HH, Zeiler M, et al. BK-virus nephropathy in renal transplants: tubular necrosis, MHC-class II expression and rejection in a puzzling game. Nephrol Dial Transplant 2000; 15:323-331.
20. Drachemberg CB, Beskow CO, Cangro CB, et al. Human polyoma virus in renal allograft biopsies: morphological findings and correlation with urine cytology. Human Pathol 1999; 39:970-977.
21. Fogazzi GB, Cantù M, Saglimbeni L. 'Decoy cells' in the urine due to polyomavirus BK infection: easily seen by phase contrast microscopy. Nephrol Dial Transplant 2001; 16:1496-1498.
22. Hirsch HH, Knowles W, Dickenmann M, et al. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. New Engl J Med 2002; 347:488-496. This important study describes the prevalence and significance of 'decoy cell' shedding in the urine, polyomavirus BK viremia, and BK nephropathy in renal transplant recipients treated with immunosuppressive drugs, which included tacrolimus or mycophenolate mofetil.
23. Haririan A, Ramos ER, Drachemberg CB, et al. Polyomavirus nephropathy in native kidneys of a solitary pancreas transplant recipient. Transplantation 2002; 73:1350-1353. This shows that decoy cells in the urine sediments can also be found in the urine of solitary pancreas transplant recipients due to the reactivation of polyomavirus BK in the native urinary tract.
24. Fogazzi GB, Furione M, Saglimbeni L, et al. BK and JC polyomavirus infection in a patient with chronic lymphocytic leukaemia and renal failure [letter]. Nephrol Dial Transplant 2002; 17:534-535.
25. Filie AC, Wilder AM, Brosky WK, et al. Urinary cytology associated with human polyomavirus and indinavir therapy in HIV-infected patients. Am J Clin Pathol 2002; 117:922-926. This demonstrates that 'decoy cells' in the urine sediment can also be found in HIV patients.
26. Kopp JB. Renal dysfunction in HIV-1-infected patients. Current Infect Dis Rep 2002; 4:449-460. This review paper contains an excellent section on indinavir-associated renal syndromes with a detailed description of all the urinary changes which can be induced by the drug.
27. Kopp JB, Falloon J, Filie A, et al. Indinavir-associated interstitial nephritis und urothelial inflammation: clinical and cytologic findings. Clin Inf Dis 2002; 34:1122-1128. This is a study on the prevalence and significance of indinavir-induced leukocyturia, which in some patients is associated with interstitial nephritis and transient renal function impairment.
28. Dieleman JP, van Rossum AMC, Stricker BCH, et al. Persistent leukocyturia and loss of renal function in a prospectively monitored cohort of HIV-infected patients treated with indinavir. J Acquir Immune Defic Syndr 2003; 32:135-142. This study on persistent leukocyturia in patients treated with indinavir identified the risk factors for this urine abnormality.
29. Hanabusa H, Tagami H, Hataya H. Renal atrophy associated with long-term treatment with indinavir. N Engl J Med 1999; 340:392-393.
30. Fogazzi GB, Cantu̇ M, Saglimbeni L, et al. Amoxycillin, a rare but possible cause of crystalluria. Nephrol Dial Transplant 2003; 18:212-214. This paper describes in detail, and with several images, amoxycillin crystalluria. It also shows how to deal with a patient with unusual crystalluria.
31. Blossom AP, Cleary JD, Paley WP. Acyclovir-induced crystalluria. Ann Pharmacother 2002; 36:526.
32. Lyon AW, Mansoor A, Trotter MJ. Urinary gems: acyclovir crystalluria. Arch Pathol Lab Med 2002; 126:753-754.
33. Delanghe JR, Kouri TT, Huber AR, et al. The role of automated urine particle flow cytometry in clinical practice. Clin Chim Acta 2000; 301:1-18.
34. Dimech W, Roney C. Evaluation of an automated urinalysis system for testing urine chemistry, microscopy and culture. Pathology 2002; 34:170-177.
35. Ottiger C, Huber AR. Quantitative urine particle analysis: integrative approach for the optimal combination of automation with UF-100 and microscopic review with KOVA cell chamber. Clin Chem 2003; 49:617-623. This describes the utility and limits of UF-100 - an instrument based on flow cytometry for the automated analysis of urine sediments. It also describes the situations in which traditional urine microscopy is still necessary.
36. Manoni F, Valverde S, Antico F, et al. Field evaluation of a second-generation cytometer UF-100 in diagnosis of acute urinary tract infections in adult patients. Clin Microbiol Infect 2002; 8:662-668. This paper describes the performances of UF-100 compared with dipstick and urine culture in the diagnosis of acute urinary tract infections.