European Urinalysis Guidelines-2023

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Timo Kouri a*, Walter Hofmann b, Rosanna Falbo c, Matthijs Oyaert d,
Sören Schubert e, Jan Berg Gertsen f, Audrey Merens g, and Martine Pestel-Caron h,on behalf of the EFLM European Urinalysis Group.
a Department of Clinical Chemistry, University of Helsinki, and HUSLAB, HUS Diagnostic Center,
Hospital District of Helsinki and Uusimaa, Helsinki, Finland
b Synlab MVZ, Augsburg and Dachau, Germany
c University Department of Laboratory Medicine, ASST Brianza, Pio XI Hospital, Desio (MB), Italy
d Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
e Max von Pettenkofer Institute of Hygiene and Medical Microbiology, Faculty of Medicine, Ludwig
Maximilian University, Munich, Germany


Background: The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on laboratory procedures in urinalysis and urine bacterial culture. We aim to improve accuracy of urine examinations in European clinical laboratories, and to support diagnostic industry to develop new technologies.
Recommendations: Graded recommendations were built in the following areas:
Medical needs and test requisition: Strategies of urine testing were described to patients with low and high-risk to urinary tract infection (UTI) or kidney disease.
Specimen collection: Patient preparation, and urine collection are now supported with two quality indicators: contamination rate (cultures), and density of urine (chemistry, particles).
Chemistry: Measurements of both urine albumin and α1-microglobulin are recommended for sensitive detection of renal disease in high-risk patients. Performance specifications for urine protein measurements and quality control of multiproperty strip tests were given.
Particles: Procedures for microscopy were reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting were updated with advice how to verify new instruments with the reference microscopy.
Bacteriology: Chromogenic agar was recommended as primary medium in urine cultures. Limits of significant growth were reviewed, with an optimised workflow for routine specimens, using leukocyturia to reduce less important antimicrobial susceptibility testing. Automation in bacteriology is encouraged to shorten turn-around times. Matrix assisted laser desorption ionization time-of-flight mass spectrometry is applicable for rapid identification of uropathogens.
Aerococcus urinae, A. sanguinicola and Actinotignum schaalii were taken into the list of uropathogens. Moreover, a reference examination procedure was developed for urine bacterial cultures.
Key words: automation; laboratory practice guidelines; reference measurement procedures; standardisation; urinalysis; urine bacterial culture

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