Papers by Giuseppe Garigali
American Journal of Kidney Diseases, Aug 1, 2012
Acute interstitial nephritis (AIN) is a condition characterized by acute kidney injury associated... more Acute interstitial nephritis (AIN) is a condition characterized by acute kidney injury associated with acute cellular infiltrate of the renal interstitium due to various causes. 1,2 Published data for urinary sediment findings in AIN are few. In this case series, we describe detailed findings observed in 21 patients with biopsy-proven AIN due to different causes. We reviewed all reports of biopsies performed on native kidneys at our institution during a 14-year period (January 1, 1997, to February 1, 2011) and identified AIN cases. All patients with AIN were considered for inclusion. All microscopic slides arising from these kidney biopsies were reviewed by 2 of us for the presence or absence of interstitial cellular infiltrate, tubulitis, tubular necrosis, tubular basement membrane gaps, interstitial red blood cell (RBC) extravasation, RBCs, and intratubular RBC casts. Of 839 kidney biopsies, 23 (2.7%) were found to have AIN in the absence of significant glomerular lesions. We included 21 patients (Table 1), having excluded one because of bacteria (2ϩ) in the urinary sediment and another for focal glomerular immunoglobulin A and C3 by immunofluorescence (which was negative at the glomerular level in all other cases).
Clinical Chemistry and Laboratory Medicine, Jul 6, 2021
Objectives The search in the urinary sediment (U-sed) of fat particles with peculiar morphology i... more Objectives The search in the urinary sediment (U-sed) of fat particles with peculiar morphology is a simple and inexpensive tool for the diagnosis of Fabry disease (FD) nephropathy. In this study we investigated the morphology of a high number of such fat particles with the aim to obtain a morphological classification to be used for their identification. Methods Study of the morphology of fat particles in the U-sed of a cohort of FD patients using: bright field plus phase contrast microscopy (BF + PC), polarized light microscopy (POL), and transmission electron microscopy (TEM). Comparison of these results with those obtained for the fat particles seen in the U-sed of a control group (CG) of patients with non-FD glomerulopathies. Results FD: 18 U-sed from six patients (three samples/patient) were prospectively investigated and 506 fat particles identified. With BF + PC, these were classified in eight morphological categories (seven of which were confirmed by TEM), and with POL in 10 others. CG: eight U-sed from eight patients were investigated and 281 fat particles identified. These fell into four BF + PC morphological categories and into eight POL categories. While some categories were significantly more frequent in FD others were more frequent in the CG. Conclusions Our study demonstrates that 1. The morphology of fat particles found in the U-sed of FD patients is much wider and complex than that described so far 2. Several significant differences exist in the morphology of such fat particles between FD and CG patients.
Nephron Clinical Practice, Nov 12, 2010
pants found the course to be useful and practicable and a UM program was actually started in 1 Ni... more pants found the course to be useful and practicable and a UM program was actually started in 1 Nigerian center a few days after the course. Conclusion: This course demonstrated that nephrological skills can be transferred from the developed to the developing world without large financial investments.
Clinical Chemistry and Laboratory Medicine, 2015
Manual microscopy still represents the gold standard for urinary sediment (US) examination. We re... more Manual microscopy still represents the gold standard for urinary sediment (US) examination. We report the results obtained in the period 2012–2015 by the EQA Italian program on US, which today involves about 260 laboratories.The program includes four surveys per year. In two surveys, participants are asked to supply identification and clinical association of US particles. In two other surveys, they are asked to supply the diagnosis of clinical cases, presented with images, some key laboratory findings and a short clinical history. Sixty-six images of US particles (21 cells, 2 lipids, 21 casts, 10 crystals, 3 microorganisms, 15 contaminants) and seven clinical cases were presented.The correct identification rate for each category of particles, in decreasing order, was: micro-organisms (mean±SD: 92.4%±4.5%), lipids (92.0%±1.8%), casts (82.8%±8.8%), crystals (79.4%±29.8%), cells (77.3%±13.5%), and contaminants (70.9%±22.2%). For 13 particles, a correct clinical association was indicated by 91.5%±11.7% of participants, while it was 52.7% for particles associated with urinary tract infection. For clinical cases, due to a high rate of particles misidentification, only 44.3%±10.1% of participants achieved access to clinical diagnosis, which was then correctly indicated by 92.5%±5.3% of them.The results of the EQA program confirm that, while some US particles are well known in terms of identification, clinical association and clinical meaning, others particles still are not, and this represents an important reason to encourage EQA programs on US.
Clinical Chemistry and Laboratory Medicine, 2007
Urinary microscopy is difficult to teach. This paper describes a 1-day course on urine microscopy... more Urinary microscopy is difficult to teach. This paper describes a 1-day course on urine microscopy, which was based on both theoretical and practical sessions at the microscope, during which real urine samples were examined. The course was based on: a) an introductory presentation with slides on the main components of urinary sediments and their clinical correlates; b) examination of fixed urine samples under the guidance of two experts; and c) the use of two microscopes, each equipped with a co-observation device for up to 15 observers. Throughout 2005, four courses were held in four Italian towns. Altogether, there were 97 participants (20-27 per course) from 75 laboratories, all graduates with wide but variable experience in the field. During each course, 17-22 urinary sediment components were shown by both bright-field and phase-contrast microscopy and, when indicated, by polarized light. Tests set before and after the course showed a significant improvement (p<0.01) in the identification of erythrocyte subtypes, epithelial cells, fatty components, various types of casts and drug crystals. A questionnaire conducted with participants by phone several months after the course demonstrated that 51.6% and 32.3% of laboratories have introduced or formally requested phase-contrast and polarized-light microscopy, respectively; 45.2% have changed the terminology for urinary epithelial cells; and 87.1% have identified for the first time urinary sediment components that were not recognized or not considered before the course. Our course demonstrates that it is possible to improve the teaching of urinary microscopy.
Nephrology Dialysis Transplantation, Jul 7, 2006
American Journal of Kidney Diseases, Jun 1, 2016
Urine microscopy is an important tool for the diagnosis and management of several conditions affe... more Urine microscopy is an important tool for the diagnosis and management of several conditions affecting the kidneys and urinary tract. In this review, we describe the automated instruments, based either on flow cytometry or digitized microscopy, that are currently in use in large clinical laboratories. These tools allow the examination of large numbers of samples in short periods. We also discuss manual urinary microscopy commonly performed by nephrologists, which we encourage. After discussing the advantages of phase contrast microscopy over bright field microscopy, we describe the advancements of urine microscopy in various clinical conditions. These include persistent isolated microscopic hematuria (which can be classified as glomerular or nonglomerular on the basis of urinary erythrocyte morphology), drug- and toxin-related cystalluria (which can be a clue for the diagnosis of acute kidney injury associated with intrarenal crystal precipitation), and some inherited conditions (eg, adenine phosphoribosyltransferase deficiency, which is associated with 2,8-dihydroxyadenine crystalluria, and Fabry disease, which is characterized by unique urinary lamellated fatty particles). Finally, we describe the utility of identifying "decoy cells" and atypical malignant cells, which can be easily done with phase contrast microscopy in unfixed samples.
American Journal of Kidney Diseases, Jun 1, 2008
Kidney International, Apr 1, 2023
Journal of Nephrology, Dec 10, 2018
Background Isolated microscopic hematuria is a condition characterized by the presence in the uri... more Background Isolated microscopic hematuria is a condition characterized by the presence in the urine of an "abnormal" number of erythrocytes in the absence of proteinuria. Several studies have been published on this condition, but with heterogeneous inclusion criteria and variable outcomes at follow-up. In this retrospective study, we describe a selected and homogenous cohort of patients who presented with isolated microscopic hematuria of glomerular origin. Methods We included in the study patients with isolated microscopic hematuria of glomerular origin (> 1 erythrocyte/high power field at 400× and ≥ 40% dysmorphic erythrocytes and/or ≥ 5% acanthocytes and proteinuria ≤ 150 mg/24 h) with a follow-up of > 60 months from the first documentation of microscopic hematuria. Results Forty-two patients (M 12, F 30, age at presentation 14-68 years, eGFR < 60 ml/min/1.73 m 2 : 1 patient) were included. During a medium term follow-up, microscopic hematuria was persistent in 25 patients (59.5%), transiently absent in 17 (40.5%), always glomerular in 16 patients (38.1%), and occasionally non-glomerular in 26 (61.9%); proteinuria, observed in 16 patients (38.1%), was always transient and < 500 mg/24 h. At the end of a follow-up of 181.8 ± 97.9 (median 168) months, only 2 patients (4.8%) had eGFR < 60 ml/min/1.73 m 2 , one of whom had reduced eGFR already at presentation. Conclusions This study on a small but selected and homogeneous cohort of patients with isolated microscopic hematuria of glomerular origin demonstrates that urinary features can transiently change over time and that the renal outcome is good.
Clinica Chimica Acta, 2015
Urinary cytology (Ucytol), which is performed in pathology laboratories on fixed and stained samp... more Urinary cytology (Ucytol), which is performed in pathology laboratories on fixed and stained samples, represents the gold standard for the identification of atypical/malignant urothelial cells (A/MUC) due to urothelial carcinoma. In this paper we describe three patients in whom A/MUC, due to a bladder carcinoma, were identified with conventional urine sediment (Used) examination on unfixed and unstained samples. Included are urine samples prepared with conventional and standardized techniques as currently used in general clinical laboratories. Samples were examined with phase contrast microscopy. A/MUC were identified according to the criteria currently used for Ucytol. A/MUC (i.e., cells with unusual and pleomorphic size and shape, increased nuclear/cytoplasmic ratio, increased number of nuclei, irregular nuclear borders and irregular chromatin patterns, either isolated or in clusters) were identified in the urine of three patients, all of whom were found to have bladder carcinoma by cystoscopy. At variance with the common and widespread view, A/MUC can also be identified with conventional Used examination, even though Ucytol still represents the gold standard method.
Clinical Laboratory, 2020
BACKGROUND External Quality Assessment (EQA) programs on urinary sediment (U-sed) examination are... more BACKGROUND External Quality Assessment (EQA) programs on urinary sediment (U-sed) examination are recommended by international guidelines to improve the quality of this diagnostic tool. However, no such programs have been carried out so far in developing countries of sub-Saharan Africa. This paper describes an EQA program on U-sed which was realized in 2017 and 2018 by means of innovative communication technologies in Benin Republic, a small country of West Africa. METHODS On Monday morning, weekly in 2017 and fortnightly in 2018, the image of one U-sed element was sent from Italy with a smartphone, via WhatsApp application, to a group of 13 professionals (11 bachelors of science, 2 medical doctors) working in different institutions of Benin Republic. The image showed one U-sed element, for which the participants were asked the identification and, in 2018, also a clinical association. RESULTS The images of 33 elements were submitted over the two-year period. Particle identification. Altogether 283 answers were received (8.5 ± 2.3/single image), 200 of which were correct (70.7%), 53 incorrect (18.7%), 17 partially correct (6.0%), and 13 "I don't know" (4.6%). Correct identification of elements presented twice (2nd answer vs. 1st). No change: 9/18 (50.0%); improvement: 5/18 (27.8%); worsening: 4/18 (22.2%). Clinical association. Correct answers: 8/17 (47%); incorrect: 8/17 (47.0%); no answer: 1/17 (5.6%). CONCLUSIONS This paper demonstrates: 1. The need and utility of an EQA program on U-sed in developing countries of sub-Saharan Africa; 2. The feasibility of such programs by means of easily available and inexpensive smartphone applications.
Clinica Chimica Acta, Sep 1, 2018
Other very rare and poorly known uric acid crystals for the first time also shown by polarized li... more Other very rare and poorly known uric acid crystals for the first time also shown by polarized light and definitively identified by infrared spectroscopy.
Nephrology Dialysis Transplantation, Mar 8, 2005
Clinica Chimica Acta, Aug 1, 2017
Background: Crystals are well known structures of urinary sediment, most of which are identified ... more Background: Crystals are well known structures of urinary sediment, most of which are identified by the combined knowledge of crystal morphology, birefringence features at polarized light, and urine pH. In this paper, we report on a cohort of subjects whose urine contained a very rare type of crystal, which we first described in 2004 and which, based on its peculiar morphology, we define as "daisy-like crystal" (DLcr). Methods: Reports on DLcr were spontaneously sent to our laboratory over a 10.5-year period by different laboratory professionals and by one veterinary clinician who, in their everyday work, had come across DLcr. After the examination of DLcr images submitted, a number of other information were requested and partly obtained. Results: DLcr were found in 9 human beings in 7 different laboratories, located in 4 countries (Italy, Belgium, Croatia, France). DLcr were found mostly in female (8/9), at all ages (3.5 to 93 years), mostly in alkaline urine (pH 6.0 to 7.5), at variable specific gravity values (1.010 to 1.030), either as isolated particles (2/8) or in association with other crystals (5/8) and/or leucocytes or bacteria (3/8). In addition, DLcr were found in the urine of a 1-year-old dog, examined in a veterinary clinic of Czech Republic. In 3 cases, DLcr were identified by manual microscopy, while in 7 cases by automated urine sediment analyzers. Conclusions: This paper confirms the possible presence in the urine of DLcr. However, further cases are needed to clarify their frequency, clinical meaning, and composition.
Clinica Chimica Acta, Mar 1, 2017
Nephrology Dialysis Transplantation, Jun 15, 2004
Fig. 2. The infrared spectroscopy of the crystals. Only stretching and bending vibrations of carb... more Fig. 2. The infrared spectroscopy of the crystals. Only stretching and bending vibrations of carbonate ions are observed, the location of them depending on the cations, which are linked to the carbonate group and on the crystal system. The spectrum differs from carbonate salts usually found in urine and other biological fluids.
Clinica Chimica Acta, 2016
Clinical Chemistry and Laboratory Medicine (CCLM), 2021
Objectives The search in the urinary sediment (U-sed) of fat particles with peculiar morphology i... more Objectives The search in the urinary sediment (U-sed) of fat particles with peculiar morphology is a simple and inexpensive tool for the diagnosis of Fabry disease (FD) nephropathy. In this study we investigated the morphology of a high number of such fat particles with the aim to obtain a morphological classification to be used for their identification. Methods Study of the morphology of fat particles in the U-sed of a cohort of FD patients using: bright field plus phase contrast microscopy (BF + PC), polarized light microscopy (POL), and transmission electron microscopy (TEM). Comparison of these results with those obtained for the fat particles seen in the U-sed of a control group (CG) of patients with non-FD glomerulopathies. Results FD: 18 U-sed from six patients (three samples/patient) were prospectively investigated and 506 fat particles identified. With BF + PC, these were classified in eight morphological categories (seven of which were confirmed by TEM), and with POL in 10...
Clinical Laboratory, 2020
BACKGROUND External Quality Assessment (EQA) programs on urinary sediment (U-sed) examination are... more BACKGROUND External Quality Assessment (EQA) programs on urinary sediment (U-sed) examination are recommended by international guidelines to improve the quality of this diagnostic tool. However, no such programs have been carried out so far in developing countries of sub-Saharan Africa. This paper describes an EQA program on U-sed which was realized in 2017 and 2018 by means of innovative communication technologies in Benin Republic, a small country of West Africa. METHODS On Monday morning, weekly in 2017 and fortnightly in 2018, the image of one U-sed element was sent from Italy with a smartphone, via WhatsApp application, to a group of 13 professionals (11 bachelors of science, 2 medical doctors) working in different institutions of Benin Republic. The image showed one U-sed element, for which the participants were asked the identification and, in 2018, also a clinical association. RESULTS The images of 33 elements were submitted over the two-year period. Particle identification. Altogether 283 answers were received (8.5 ± 2.3/single image), 200 of which were correct (70.7%), 53 incorrect (18.7%), 17 partially correct (6.0%), and 13 "I don't know" (4.6%). Correct identification of elements presented twice (2nd answer vs. 1st). No change: 9/18 (50.0%); improvement: 5/18 (27.8%); worsening: 4/18 (22.2%). Clinical association. Correct answers: 8/17 (47%); incorrect: 8/17 (47.0%); no answer: 1/17 (5.6%). CONCLUSIONS This paper demonstrates: 1. The need and utility of an EQA program on U-sed in developing countries of sub-Saharan Africa; 2. The feasibility of such programs by means of easily available and inexpensive smartphone applications.
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Papers by Giuseppe Garigali