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Despite being easily operated and displaying reduced costs and short turnaround time, urine osmolality still remains rarely used in the majority of clinical laboratories. Nevertheless, urine osmolality may add significant information and value in specific clinical settings, including differential diagnosis of polyuria and hyponatremia and in the estimation of ammonium urine concentration by urine osmolal gap calculation. Clinical laboratories and clinicians must work closely together to identify and share specific diagnostic paths. [ABSTRACT FROM AUTHOR]

The term "laboratory stewardship" refers to the proper ordering and evaluation of laboratory tests. The inappropriateness of the request is not only the overuse of laboratory tests, ordering low-value tests that have no impact on patient outcomes, but also the underuse of tests that would be necessary for the patient. In addition, the large number of tests offered by the laboratory, sometimes highly specialized, can cause difficult or incomplete interpretation of results. Accordingly, errors in requesting and interpreting results can lead from suboptimal patient management to very negative consequences for the patient. Communication and collaboration between clinicians and laboratory specialists can be an important tool in providing the right test, for the right patient, at the right time as well as the right interpretation and use. In this opinion paper, we propose a strategic plan aimed at strengthening the biunivocal clinical-laboratory interaction with the ultimate goal of improving the quality of patient care and reducing costs for both patients and the health care system. [ABSTRACT FROM AUTHOR]

The report of the medical laboratory is the final result of the complex analytical activity that requires technology, automation, organization and competence. The content of the report has been defined since 2015, but the application of the legislative requirements is still incomplete. The need for interoperability of the medical laboratory reports in order to be easily accessible and understandable throughout Europe, increases the requirements for the development of standards for reporting of test names, units of measurement, qualitative expressions. The adoption of LOINC codes may improve interoperability, but the codes have to be used correctly and a stewardship from Scientific Societies is needed. The laboratory reports are moving from paper to electronic format, and this should help the readability and simplicity favoring the interpretation, but the increasing amount of data and information may make them more difficult to read. This aspect together with the rapid development of new analytical technologies increases the need for interpretative comments, that should be clear, avoid acronyms or excessive technical terms and tackle the real relevant aspects. Being the final product of our activity, the report deserves more attention from our profession. [ABSTRACT FROM AUTHOR]

The pathogenesis of urolithiasis is related to the presence of physico-chemical abnormalities in the urine environment. These anomalies can be highlighted and evaluated through specific biochemical investigations, often not included in the usual activities of a hospital laboratory. The laboratory activities include the adoption of the most appropriate procedures for the evaluation of urine saturation with respect to lithogenic salts (propensity to stone formation), the identification and analysis of precursors and inhibitors of crystallization, the biochemical investigation for the identification of pre-existing diseases, including the genetic ones, and the analysis of kidney stones. Over the years, in the medical approach to nephrolithiasis, the need for specialized analytical techniques has increasingly raised, requiring the use of versatile technology (HPLC, GC-LC/MS, FTIR), adaptable to the investigation of substances belonging to the most varied classes and present in different biological matrices. In this paper we describe the main analytical activities carried out by a specialized laboratory for the study of renal stone disease. [ABSTRACT FROM AUTHOR]

Cystinuria is one of the unrecognized causes of nephrolithiasis. As other stones, cystine stones can present with flank pain, haematuria, dysuria, as well as systemic symptoms such as nausea and vomiting. This report describes the case of a 36-years-old pregnant woman, admitted at Emergency Department for severe vomiting and weight loss (6 kilograms in one month), soon after being treated for hyperemesis gravidarum. Failure of response to conventional management prompted further clinical and laboratory investigations. Urinary sediment analysis by automated analyser and intelligent verification rules, allowed to highlight cysteine casts, recognized by well trained staff. Cooperation between laboratory staff and clinicians allowed diagnosing cystinuria and starting therapy with vomiting remission. [ABSTRACT FROM AUTHOR]