Urinalysis: Potential And New Technologies
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through urine. If you could have only one test in a patient with small vessel vasculitis, what would it be? A urinalysis. To my mind, few tests have the ability to provide information that can detect and potentially prevent the presence of organ and life-threatening diseases the way a urinalysis can.
Moreover, urinalysis is a test that has meaning not only at diagnosis but throughout the patient’s course. A lot of people have fallen into the trap of thinking, it is just urine. No other laboratory test can provide as much information on the status of metabolic, renal, infectious, and urologic functions in the body.
Chemistry alone cannot detect casts, crystals, cells, and bacteria, which are critical for early diagnosis of many disease states. Indeed, in an era when failure to quickly detect hospital-acquired infections such as catheter-associated urinary tract infections (CAUTIs) means the loss of significant revenue to a hospital, the need to integrate urine chemistry testing with urine particle analysis is paramount. Urine qualitative/semi-quantitative tests with reagent-strip and microscopic examination (sediments) are most popular and basic clinical laboratory tests.
However, the accuracy and precision of those tests have not been more reliable than that of clinical chemistry or hematology, mainly due to the instability of urine specimen and subjective analysis procedure. Automated analyzers with compact size and high quality of both reagent-strip method and sediments (formed elements or particles) have been commonly used in many laboratories and guidelines on urinalysis of JCCLS (Japan), NCCLS (USA), and ECLM (EU) are being published in succession.
These advances are expected to lead to a solution for those problems in the urinalysis field. Automated systems have enabled the counting of particles in urine to be standardized. Their superiority over traditional sediment analysis has been well-documented, but they have not gained wide acceptance. The reasons for this are that sediment analysis has been performed and interpreted for decades. There is also the potential for new biomarkers for ATN, such as NGAL and KIM-1, and urologic cancers along with more traditional urine chemistry tests such as creatinine and µALB to be added to routine urinalysis.
In the cost and space-conscious laboratory, urinalysis workstations tend to be compact by necessity. It can be difficult to carve out the space needed for multiple stations, which can lead to difficult choices. Rather than eagerly embracing the new integrated, automated platforms available, many labs stick with manual methods, missing out on opportunities to significantly reduce labor and turnaround time and increase the accuracy of results. All three of these directly and indirectly drive total cost; any decision to evaluate urinalysis systems must include a value calculation for these costs.
Many labs conclude that the benefit of upgrading a urinalysis workstation will offset the space required. Moreover, there are new systems looming on the horizon which will truly do more with less – less space. These integrated platforms require half the bench space of older platforms. Urinalysis has a dynamic future. New technology for instrumentation, new biomarkers, and new appreciation for the importance of urinalysis in modern medicine are combining to bring the focus back to where laboratory testing started so long ago – while also bringing urinalysis into the 21st century.
