Saudi Journal of Kidney Diseases and Transplantation

: 2016  |  Volume : 27  |  Issue : 1  |  Page : 181--182

National survey of the availability and use of urine microscopy in the United Kingdom

Shafi Malik1, Stuart Robertson2,  
1 University Hospital of Wales, Cardiff, CF10 4QL, United Kingdom
2 Wrexham Maelor Hospital, Wrexham, LL13 7TD, United Kingdom

Correspondence Address:
Dr. Shafi Malik
University Hospital of Wales, Cardiff, CF10 4QL
United Kingdom

How to cite this article:
Malik S, Robertson S. National survey of the availability and use of urine microscopy in the United Kingdom.Saudi J Kidney Dis Transpl 2016;27:181-182

How to cite this URL:
Malik S, Robertson S. National survey of the availability and use of urine microscopy in the United Kingdom. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2022 Jan 19 ];27:181-182
Available from:

Full Text

To the Editor,

Urine microscopy has been used as a diagnostic tool since the 17 th century. However, recently, its use has been steadily declining. Studies have shown its use in differentiating between the causes of acute kidney injury. [1] Casts found on urine microscopy have been found to correlate with suspected clinical diagnosis on renal histology, [2] e.g. white cell casts can be representative of interstitial nephritis and granular casts of acute tubular necrosis. Urine microscopy is considered a basic and essential skill for a nephrologist.

We conducted a national survey of all the renal centers, both adult and pediatric, in the United Kingdom (UK), aiming to study the availability and use of urine microscopy by nephrologists. We also aimed to study whether its use helped in management decisions and the importance of it being included in the nephrology training curriculum as an essential skill. Current nephrology trainees (2011-2012) were also surveyed to get their view on urine microscopy being included in the training curriculum.

For the purpose of this study, a web-based survey was created. A link to the survey was sent by email to clinical directors of renal units and to nephrology trainees in the country. All answers were anonymously collected.

Of 70 renal units, 26 responded (37%). Fortytwo percent of the respondents were from district general hospitals and 58% were from university teaching hospitals. In five (20%) of the 26 hospitals, nephrologists routinely performed urine microscopy. In eight (38%) of the hospitals where nephrologists did not perform urine microscopy, urine specimens were sent to microbiology laboratories for microscopy. In centers where urine microscopy was performed, 63% said it helped in management decisions. In 80% of the hospitals that responded, nephrology trainees were not encouraged to learn and perform urine microscopy. Fifty-three percent of renal unit clinical directors wanted urine microscopy to be included as an essential skill in the renal training curriculum. Seventy-eight percent of the trainees who responded said that urine microscopy helped in management decisions and 57% said that it should be included in the training curriculum.

To the best of our knowledge, this is the first national survey studying the use of urine microscopy in the UK. Only 20% of the hospitals that responded currently use urine microscopy. When performed, majority felt it helped in management decisions and more than 50% of the trainees and nephrology department clinical leads wanted it to be included in the nephrology training curriculum. Urine microscopy is a simple, inexpensive and bedside diagnostic test that can help in narrowing the differential diagnosis. It can especially be useful in cases of anti-neutrophil cytoplasmic antibody (ANCA)-negative, rapidly progressive glomerulonephritis (RPGN) as the reported incidence of ANCA-negative RPGN is around 27%. [3] In centers where the turn-around time for ANCA and anti-glomerular basement membrane testing is more than 24 h, urine microscopy when performed for casts can be invaluable in initiating treatment for RPGN.

Conflict of Interest: None declared.


1Perazella MA, Coca SG, Kanbay M, Brewster UC, Parikh CR. Diagnostic value of urine microscopy for differential diagnosis of acute kidney injury in hospitalized patients. Clin J Am Soc Nephrol 2008;3:1615-9.
2Györy AZ, Hadfield C, Lauer CS. Value of urine microscopy in predicting histological changes in the kidney: Double blind comparison. Br Med J (Clin Res Ed) 1984;288:819-22.
3Hedger N, Stevens J, Drey N, Walker S, Roderick P. Incidence and outcome of pauciimmune rapidly progressive glomerulonephritis in Wessex, UK: a 10-year retrospective study. Nephrol Dial Transplant 2000;15:1593-9.