Survey on reporting of epithelial cells in urine sediment as part of external quality assessment programs in Brazilian laboratories.

INTRODUCTION: Epithelial cells (ECs) are structures regularly observed during urine microscopy analysis. The correct identification of EC subtypes can be useful since renal tubular epithelial cells (RTECs) are clinically relevant. We investigate the urinary ECs report and the judgement of its clinical importance by Brazilian laboratories. MATERIALS AND METHODS: A survey with four questions was made available to participants of the Urinalysis External Quality Assessment Program (EQAP) from Controllab. Laboratories composed 3 groups: (1) differentiating ECs subtypes: "squamous", "transitional" and "RTECs"; (2) differentiating ECs subtypes: "squamous" or "non-squamous" cells; (3) without ECs subtype identification. Participants did not necessarily answer to all questions and the answers were evaluated both within the same laboratory's category and within different categories of laboratories. RESULTS: A total of 1336 (94%) laboratories answered the survey; Group 1, 119/140 (85%) reported that ECs differentiation is important to the physician and 62% want to be evaluated by EQAP, while in Group 3, 455/1110 (41%) reported it is useful to them, however only 25% want be evaluated by EQAP. Group 2 laboratories 37/51 (73%) reported that the information is important, but only 13/52 (25%) are interested in an EQAP with differentiation of the 3 ECs subtypes. CONCLUSION: Most of the laboratories do not differentiate ECs in the three subtypes, despite the clinical importance of RTECs. Education of laboratory staff about the clinical significance of urinary particles should be considered a key priority.

Vancomycin-induced hypokalemia: A proof-of-concept case report.

BACKGROUND: Vancomycin is used on a large scale in medical practice, mostly for the treatment of serious gram-positive bacterial infection. Many adverse effects have been linked to vancomycin use with nephrotoxicity being one of its most prevalent side effects. CASE REPORT: We present the case of an 81 years-old woman who had sustained vancomycin-induced hypokalemia while treating an infected surgical wound. She was under chronic use of losartan for high blood pressure but she was not diabetic. Potassium in serum reached critically low levels during the use of this antibiotic - despite intravenous reposition - and returned to normal right after the drug was stopped, in two different occasions. Elevated urinary potassium levels indicated renal potassium wasting, though serum creatinine levels remained within the normal range throughout hospitalization. CONCLUSIONS: Vancomycin must be considered as a possible cause for hypokalemia of unknown etiology and physicians should be aware of this potential severe adverse effect.

Utility of a urine sediment score in hyperbilirubinemia/hyperbilirubinuria
.

AIMS: Acute and chronic kidney dysfunction is common in patients with end-stage liver disease. Differentiation between acute kidney injury (AKI) due to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) remains difficult, however urine cast scoring systems using renal tubular epithelial cells (RTECs) and granular casts (GCs) can help to identify intrinsic kidney diseases. The objective of this study was to evaluate the urine sediment profile of patients with liver disease and hyperbilirubinemia/hyperbilirubinuria and the use of a urine sediment scoring system to identify the most common score in AKI patients and high urine bilirubin concentrations. MATERIALS AND METHODS: A retrospective study in the database of a large laboratory that assists a hospital-complex in Brazil was performed. RESULTS: Urinary casts, in particular GCs, as well as RTECs were observed more frequently in patients with hyperbilirubinemia/hyperbilirubinuria, while hyaline casts were observed in patients without hyperbilirubinemia/hyperbilirubinuria. Regardless of the AKI or non-AKI condition, the relative risk for scores 2 or 3 (sediment consistent with tubular damage, with GCs and/or RTECs in different quantities) in group 4 was 3.61 times higher compared to patients in group 1. CONCLUSION: In patients with higher urinary bilirubin levels, the urine sediment had greater numbers of GCs and RTECs and higher urine sediment scores (scores 2 or 3). The presence of a larger number of urine particles (RTECs and GCs) originating in the kidneys in the groups with higher levels of urinary bilirubin suggests an association between hyperbilirubinemia/hyperbilirubinuria and tubular injury independent of AKI or non-AKI.

Bright Field Microscopy to Detect Decoy Cells Due to BK Virus Infection in the Fresh and Unstained Urine Sediment in Kidney Allograft Recipients.

BACKGROUND: BK virus (BKV) may reactivate in kidney allograft recipients ultimately leading to BKV nephropathy and graft loss. Decoy cells (DCs) are one of the early marks of BKV reactivation, and these can be detected in the urine sediment. METHODS: A cohort of 102 kidney transplant patients was followed during months 3 and 6 after the transplant procedure. Urine samples were obtained to detect the presence of DC in the fresh and unstained urine sediment under bright field microscopy (BFM), in concomitance to the determination of the amount of BK viruria by qPCR. RESULTS: Decoy cells were found in 14.7% of patients (15/102). There was a strong agreement (P < 0.001) between qualitative DC detection by two experienced analysts and by qPCR. The positive predictive value, negative predictive value, specificity, and accuracy of BFM were 80%, 75%, 97%, and 75%, respectively. Test sensitivity was 16%. The comparative method was the qPCR. CONCLUSIONS: Despite its limited sensitivity, BFM of unstained urine sediment is an easily available, fast and cheap method to identify DCs in the population of kidney allograft recipients. The diagnostic performance of BFM on the hands of less experienced analysts deserves further investigation.

Avaliação do efeito do ácido ascórbico sobre o dano hepático secundário à pancreatite aguda / Ascorbic acid effect in hepatic damage during acute pancreatitis

O dano hepático é uma manifestação da resposta inflamatória sistêmica durante a pancreatite aguda (PA). O ácido ascórbico (AA) é um importante antioxidante que protege o corpo do dano da inflamação. Este estudo tentou avaliar o possível efeito protetor do AA sobre o dano hepático decorrente da indução da PA em ratos. Ratos Wistar machos (200-250 g) foram divididos em 3 grupos contendo 6 animais por grupo (grupo controle; grupo com PA; grupo com PA e administração de AA 100mg/ Kg via intraperitoneal). Após 12 horas os animais foram mortos para coleta de sengue. Determinações laboratoriais: amilase, proteínas totais, transaminase glutâmica pirúvica (TGP), transaminase glutâmica oxalacética (TGO), desidrogenase láctica (LHD), fosfatase alcalina (FAL) e gamaglutamil transpeptidase (GGT)> Determinação de lipoperoxidação: realizada pela medida das substâncias reativas ao ácido tiobarbitúrico (TBARS). Amilase, TGP e TGO, apresentaram elevação significativa (p < 0,05) nos animais com indução de PA, e o AA não foi eficaz para diminuir este aumento. Proteínas totais, LDH e GGT não apresentaram alterações significativas com relação ao grupo controle. FAL e TBARS apresentaram elevações significativas (p < 0,05) nos animais com PA e o tratamento com AA restabeleceu os valores destes parâmetros a níveis iguais aos controles. O AA foi eficiente no combate a peroxidação lipídica, porém, apesar de ter diminuído a atividade da FAL, não é possível afirmar que este composto apresentou efeito protetor sobre o dano hepático.