Comparison of Manual Urine Sediment Examination and Urine Particle Analyzer with Sysmex UF-4000

Urine sediment examination is a fundamental microscopic diagnostic technique used to identify renal, urinary tract abnormalities, and systemic diseases. This study aimed to compare the accuracy and reliability of manual urine sediment examination and the Sysmex UF-4000 Fully Automated Urine Particle Analyzer at Dr. Cipto Mangunkusumo Hospital. A cross-sectional study was conducted at the Integrated Laboratory Service Installation from November to December 2023. Fifty urine samples from patients aged 3 to 82 years (13 males, 37 females) were analyzed. Evaluated components included red blood cell (RBC) and white blood cell (WBC) counts, squamous epithelial cells (SEC), bacteria, crystals, hyaline casts, and pathological casts. Concordance was assessed using Kappa analysis for semi-quantitative RBC, WBC, and squamous epithelial cell counts, as well as qualitative bacterial examination, with manual examination serving as the reference standard. Urine sediment examination results concordance rates were 74% for RBC, 80% for WBC and SEC, 82% for bacteria, 90% for crystals, 80% for hyaline casts, and 84% for pathological casts. Kappa analysis indicated good agreement, with kappa values RBC (0.700), WBC (0.800), SEC (0.635), and bacteria (0.641) (p < 0.001). The Sysmex UF-4000 diagnostic performance showed sensitivity, specificity, positive predictive value, and negative predictive value as follows: RBC (82.6%, 92.6%, 90.5%, 86.2%), WBC (96.8%, 100%, 100%, 95%), squamous epithelial cells (69.2%, 91.9%, 75%, 89.5%), and bacteria (77.8%, 87%, 87.5%, 76.9%). These findings indicated strong concordance between manual and automated methods, supporting the implementation of Sysmex UF-4000 in the central laboratory of Dr. Cipto Mangunkusumo Hospital.