SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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C. Ottiger 1 , R. Savoca 1 , A.R. Huber 1

1 Department of Laboratory Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland

Routinely detection of proteinuria, haematuria and pathological particles in the urine is used for initial diagnosis of nephropathies. The quantitation of albumin, transferrin, IgG, or a1-microglobulin and retinol binding protein differentiate glomerulopathies from tubulo-interstitial diseases, while a2-macroglobulin distinguishes renal from postrenal haematuria. Prerenal proteinuria, i.e. Bence Jones, can be detected by immunofixation. Pathological casts are detected in the microscopic urine sediment analysis in certain stages of nephropathies, and dysmorphic erythrocytes are seen in glomerulopathies. To date, it is still widely believed that dipstick analysis and the microscopic evaluation of the urine sediment are sufficient for the early detection of renal diseases. A precise comparison between the methods became only available since the introduction of the quantitative analysis of complete protein profiles (BCS, Dade Behring), and the automation of urine sediment anlysis with flowcytometry (Sysmex UF-100, Digitana), combined with automated dipstick reading (Atlas, Bayer) and a standardised microscopic urine sediment analysis (KOVA cell chamber, AxonLab). In one fourth of the samples a normal protein profile was obtained, whereas the remaining samples showed an even distribution between glomerular and tubulo-interstitial involvement. Positive dipstick results (protein and/or haemoglobin) were obtained with a sensitivity and specificity of only 75% each. Urine sediment analysis was performed with the aim to detect dysmorphic erythrocytes, cellular, granular, waxy and lipid casts, and resulted in a sensitivity of only 27% and a specificity of 94%. Therefore, apart from the manual work in analysing the urine by microscope, many renal diseases are missed if the traditional urinalysis is used. Thus, we recommend quantitative measurement of single proteins in the urine, which will not only be useful in the diagnosis but also in the follow-up of nephropathies

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