HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Supplemental Data All Versions of this Article: CJN.05331008v1 4/3/567    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wald, R. Articles by Jaber, B. L. Search for Related Content PubMed PubMed Citation Articles by Wald, R. Articles by Jaber, B. L.

Interobserver Reliability of Urine Sediment Interpretation

Ron Wald^*,, Chaim M. Bell^,,, Rosane Nisenbaum^,||, Samuel Perrone^¶, Orfeas Liangos^¶, Andreas Laupacis^,,, and Bertrand L. Jaber^¶

Divisions of ^* Nephrology and General Internal Medicine, St. Michael's Hospital and University of Toronto, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Health Policy, Management, and Evaluation, University of Toronto, and ^|| Center for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada; and ^¶ Division of Nephrology, Caritas St. Elizabeth's Medical Center and Tufts University School of Medicine, Boston, Massachusetts

Correspondence: Dr. Ron Wald, Division of Nephrology, Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Phone: 416-867-3703; Fax: 416-867-3709; E-mail: ron.wald{at}utoronto.ca

Background and objectives: Urine sediment interpretation is frequently used in the evaluation of patients with kidney disease. There has been no systematic evaluation of the reliability of this diagnostic maneuver.

Design, setting, participants, & measurements: Digital photographs of urine sediment images were acquired from 165 consecutive patients being evaluated by the nephrology consultation service at a tertiary care hospital. Urine sediment images of 100 patients were randomly selected; 86 patients had images that were deemed to be of sufficient quality, and one image per patient was chosen for inclusion in an internet-based questionnaire. For each image, the presence or absence of 14 potential urinary structures was ascertained. Ten nephrologists (senior readers [n = 3]: >10 yr of experience; intermediate readers [n = 3]: 1 to 10 yr of experience; and junior readers [n = 4]: first year of practice) completed the questionnaire. For each urinary structure, we measured the rate of complete agreement among the readers as well as the statistic as a marker of agreement beyond chance.

Results: Unanimous agreement was highest (79.1%) regarding the presence of broad and fatty casts and poorest (31.4%) for the identification of dysmorphic red blood cells and white blood cells. Interobserver agreement was best for squamous epithelial cells ( = 0.54) and hyaline casts ( = 0.52) and worst for transitional epithelial cells ( = 0.14) and fatty casts ( = 0.06). When assessed within strata of physician experience, interobserver agreement was not associated with seniority.

Conclusions: Nephrologists achieved slight to moderate agreement in the identification of structures that are commonly observed in the urine sediment.

This article has been cited by other articles:

				S. S. Waikar, R. A. Betensky, and J. V. Bonventre Creatinine as the gold standard for kidney injury biomarker studies? Nephrol. Dial. Transplant., November 1, 2009; 24(11): 3263 - 3265. [Full Text] [PDF]