Preanalytics of urine sediment examination: effect of relative centrifugal force, tube type, volume of sample and supernatant removal

Abstract

Introduction: Laboratories often modify procedures recommended by the European Urinalysis Guidelines for urine sediment analysis. The aim of this study was to compare the recommended protocol with our routine laboratory procedure and to evaluate the possible impact of modifications in the relative centrifugal force, type of tube, method of supernatant aspiration and urine volume on patient's results.

Material and methods: Firstly, relative centrifugal force was investigated using 20 pairs of samples examined after centrifugation at 400xg and 1358xg. In phase two, 110 samples were examined, paired as: round bottom vs conical tube (N = 46), decanting vs suction of supernatant (N = 100) and 10 mL vs 5 mL of urine sample (N = 101).

Results: The number of erythrocytes, leukocytes and squamous epithelial cells was significantly lower after centrifugation at 400xg (P = 0.001, 0.002 and 0.004, respectively). The number of leukocytes was significantly lower in conical tubes (P = 0.010), after the suction of supernatant (P = 0.045) and in 5 mL urine (P < 0.001). The number of squamous epithelial cells was significantly lower after the suction of supernatant (P < 0.001) and in 5 mL urine (P < 0.001). The number of erythrocytes (P < 0.001), total non-hyaline casts (P < 0.001) and the frequency of granular casts (P = 0.039) was significantly lower in 5 mL urine.

Conclusion: Lower results of leukocytes, erythrocytes, squamous cells and non-hyaline casts were recorded in recommended procedures (centrifugation at 400xg, suction of supernatant, conical tube, 5 mL of sample) than in routine procedure (centrifugation at 1358xg, decanting of supernatant, round bottom tube, 10 mL) used in our laboratory.

Keywords: laboratory error; preanalytical phase; urinalysis; urine sediment.

Figure 1

Study protocol of investigation modifications in urine sediment examination.
*Cobas u411 (Roche Diagnostics, Basel, Switzerland). ^†Rotofix 32A (Hettich, Tuttlingen, Germany). ^‡Opton Standard (Zeiss, Oberkochen, Germany). RT- round bottom tube, decanting, 10 mL. CT- conical bottom tube, decanting, 10 mL. ST- round bottom tube, suction, 10 mL. VT- round bottom tube, decanting, 5 mL.