Abstract
Hematuria, either glomerular or extraglomerular, is defined as 3 or more red blood cells (RBCs)/high power field. Currently, urinalyses are commonly performed using automated urine sediment analyzers. To assess whether RBC counting by automated urine sediment analyzers is reliable for defining hematuria in glomerular disease, random specimen urinalyses of men with nephritic glomerular disease (7674 urinalyses) and bladder cancer (12,510 urinalyses) were retrospectively reviewed. Urine RBCs were counted by an automated urine sediment analyzer based on flow cytometry (UF-1000i, Sysmex Corporation) or digital image analysis (Cobas 6500, Roche Diagnostics GmbH). In about 20% of urine specimens, the specific gravity was less than 1.010, making the RBC counts unreliable. In the urine specimens with specific gravity ≥ 1.010, RBC counts measured using either UF-1000i or Cobas 6500 were well correlated with the positive grades in the dipstick blood test. However, at a trace, 1+, or higher positive dipstick tests for blood, RBC counts were graded significantly lower in glomerular disease than in bladder cancer. The findings suggest that RBC counting by UF-1000i or Cobas 6500 underestimates the severity of hematuria in glomerular disease, possibly because dysmorphic RBCs in glomerular disease are susceptible to hemolysis and/or fail to be properly recognized.
Highlights
IntroductionEither glomerular or extraglomerular, is defined as 3 or more red blood cells (RBCs)/ high power field
Hematuria, either glomerular or extraglomerular, is defined as 3 or more red blood cells (RBCs)/ high power field
In the data obtained via the UF-1000i urine analyzer, 330 patients were diagnosed with nephritic glomerular disease (235, IgA nephropathy; 39, pauci-immune crescentic glomerulonephritis; 35, lupus nephritis; 13, membranoproliferative glomerulonephritis; 6, Henoch-Schönlein purpura; and 2, postinfectious glomerulonephritis)
Summary
Either glomerular or extraglomerular, is defined as 3 or more red blood cells (RBCs)/ high power field. To assess whether RBC counting by automated urine sediment analyzers is reliable for defining hematuria in glomerular disease, random specimen urinalyses of men with nephritic glomerular disease (7674 urinalyses) and bladder cancer (12,510 urinalyses) were retrospectively reviewed. Urine RBCs were counted by an automated urine sediment analyzer based on flow cytometry (UF-1000i, Sysmex Corporation) or digital image analysis (Cobas 6500, Roche Diagnostics GmbH). In the urine specimens with specific gravity ≥ 1.010, RBC counts measured using either UF-1000i or Cobas 6500 were well correlated with the positive grades in the dipstick blood test. Hematuria can occur in glomerular diseases as well as extraglomerular diseases, including urologic malignancies It is detected in the urinalysis by either a dipstick test or microscopic examination of urine sediment. More attention has been paid to hematuria in glomerular disease because hematuria was shown to have a negative prognostic impact
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