Dr. Natasha Sharda (NS), from the Division of Nephrology, University of Arizona, discusses her abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Manual Microscopy: Not a Lost Art, with Dr. Kenar Jhaveri (eAJKD), eAJKD Editor.
eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meeting?
NS: We currently live in the era of technology, constantly surrounded by man-made machines, hand held devices and internet access to which the hospital is no exception. In many ways technology has enhanced the practice of medicine from electronic medical records to automated urinanalysis machines. These advances have been made in attempts to enhance efficacy and reduce human error. However, this begs the question what about computer error? Although advantageous in many ways, can a computer system surpass direct observation and cerebral reasoning? Our research project “Manual Microscopy: Not a Lost Art” sets out to answer this question. It compares reported ranges of granular and muddy brown casts using manual microscopy to that obtained by an automated system in a population of admitted patients experiencing acute kidney injury. Overall it is important to quantify these casts as they may provide prognostic insight.
eAJKD: Do you think the technique is taught well in fellowship in current era or it’s an art that is being lost gradually? If so, How do you suggest to ignite interest amongst the fellows to learn this art?
NS: It is difficult for me to comment on fellowship given the fact that I am currently still an internal medicine resident; however I will try to answer this question to the best of my ability. Throughout my residency I have noticed a growing dependency on technology. It is my belief that this reliance steams from a lack of confidence in clinical skills such as manual microscopy and do believe that unless an effort is made by educators such practices will gradually become extinct. I believe that the training of such skills should begin in medical school and reinforced during each stage of training, because as we all know “practice makes perfect”. Manual microscopy is a diagnostic tool which can be utilized by all and thus should not be limited to only nephrologists. By reinforcing the diagnostic utility of manual microscopy and implementing early exposure we can ignite interest in all doctors.
eAJKD: Where do you and your group go from here?
NS: This project is really only the beginning, and there is a lot more work to be done. First and foremost I think it’s imperative that we reinforce the statistical significance of our findings by increasing the power of the study which means including a greater number of urine specimen’s examined. In addition, all of the urine samples were observed by the same person, future data will focus on demonstrating inter-observer reliability. From here studies should be conducted to investigate the clinical and prognostic implications for renal recovery, dependency on hemodialysis and mortality.
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Check out more eAJKD coverage of the NKF’s 2014 Spring Clinical Meetings!