Non-glomerular Hematuria Research Articles

Diagnosis and Treatment of Hematuria

Hematuria is a common manifestation caused by various factors such as infection, inflammation, trauma, urinary stone and malignancy. Hematuria reflects pathological state of urinary system. Isolated microscopic hematuria without any abnormalities besides of hematuria on urine microscopic examination usually presents a good clinical course or outcome. However, significant proteinuria or hypertension, which accelerates renal dysfunction, can often develop during follow-up period in patients with isolated microscopic hematuria. Compared with non-glomerular hematuria, glomerular hematuria shows several characteristic findings such as dysmorphic red blood cell (RBC) or RBC casts or significant proteinuria on urinalysis. If glomerular hematuria is strongly suspected, a kidney biopsy may be required to differentiate the cause of glomerulonephritis. In this review, we tried to review the differential diagnosis and diagnostic approach and treatment of hematuria.

Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study

Introduction: Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA. Methods: This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis. Results: A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29–0.89, p = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28–0.91, p = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06–5.66, p < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34–4.33, p = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria. Conclusion: Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.

Calcium-creatinine ratio in a morning urine sample for the estimation of hypercalciuria associated with non-glomerular hematuria observed in children and adolescents

Calcium-creatinine ratio in a morning urine sample for the estimation of hypercalciuria associated with non-glomerular hematuria observed in children and adolescents

Renal diseases causing hematuria

Background: Hematuria is a common laboratory finding in clinical practice, occurring mostly in the kidneys. However, it can occur in the rest of the urinary system, including the ureters, bladder, and urethra, as well as in the prostate in men. This paper will discuss cases of hematuria observed in various diseases, especially kidney disease.Current Concepts: Hematuria is diagnosed when three or more red blood cells are found in a high-power field microscopic urinalysis. Identifying urine sediment is critical in differentiating between glomerular and nonglomerular hematuria, classified according to location. If hematuria is accompanied by proteinuria, dysmorphic red blood cells, or cellular casts in urine microscopy, as well as hypertension or renal function decline, glomerular disease may be present; thus, a nephrologist should be consulted. Hematuria is also observed in renal vascular diseases, including renal infarction, renal artery dissection, and nutcracker syndrome. In polycystic kidney disease, hematuria may present in combination with renal stones or malignancy. Diabetic nephropathy can manifest hematuria, which is a negative prognosticator of end-stage kidney disease.Discussion and Conclusion: Hematuria is a laboratory finding for various diseases, and appropriate diagnosis and treatment should be provided according to its clinical features.

Determining Glomerular and Non-Glomerular Hematuria Dysmorphic Red Blood Cell: Study on Automatic Urine Analyzer

Hematuria is a sign of glomerular and non-glomerular kidney disease. Erythrocytes that pass through the glomerulus will change shape to become dysmorphic. Dysmorphic red blood cells (dRBC) can be screened using an automatic urine analyzer based on flowcytometry to distinguish the source of hematuria from glomerular or non-glomerular. The purpose of this study was to determine the diagnostic performance of the flowcytometry-based dRBC automatic urine analyzer in differentiating glomerular and non-glomerular hematuria. This study used a cross-sectional research design at the Clinical Pathology Installation at RSUD Dr. Moewardi in Surakarta. The subjects of the study were patients with hematuria at the Polyclinic and Internal Medicine Ward, Nephrology sub-division, Pediatric Polyclinic, nephrology sub-division, Urology Surgery Polyclinic in March – July 2021. The diagnostic test was carried out after determining the cut-off value of dRBC with ROC curve and AUC value. The results showed that the cut-off value of dRBC for glomerular and non-glomerular hematuria was 67% and had the best analytical performance with sensitivity 91.07%, specificity 85.36%, AUC 0.890 (95%CI: 0.832–0.947; p=0.000). In this study, dRBC parameters can be used for screening and diagnostics of patients with glomerular and non-glomerular hematuria. Further research needs to be done with other more specific gold standards such as examination of urine sediment with a phase contrast microscope.

Urinary red blood cell-derived microparticles and phosphatidylserine-exposing red blood cells in glomerular and non-glomerular hematuria patients.

Distinguishing glomerular hematuria (GH) from non-glomerular hematuria (NGH) is important for treating the cause of hematuria. We aimed to determine red blood cell-derived microparticles (RMPs) and phosphatidylserine (PS)-exposing red blood cells (RBCs) and evaluate their use for diagnosing GH and NGH patients. All patients received a physical assessment and urological examination. Dysmorphic RBCs (dRBCs) and acanthocytes were examined using a light microscope. The urinary RMPs and PS-exposing RBCs were determined using flow cytometry. The ratio of RMPs to RBCs was higher in GH patients (n=29) than in NGH patients (n=29) (1.06 vs. 0.18). The value of the sum of the PS-exposing RBCs plus RMPs divided by the number of RBCs was higher in GH patients than in NGH patients (48.3% vs. 19.4%). The percentage of RBCs was higher in GH patients than in NGH patients (54.5% vs. 21.8%). Similarly, both the percentages of acanthocytes and of non-acanthocytes were higher in GH patients than in NGH patients (29% vs. 7.7% and 25.4% vs. 14.2%, respectively). The ROC-AUC of the number of PS-exposing RBCs plus RMPs divided by the number of RBCs was 0.9 (95% CI, 0.82-0.97), and the RMPs:RBCs ratio was 0.88 (95% CI, 0.79-0.98). The ROC-AUCs of the dRBCs and acanthocytes were 0.85 (95% CI, 0.78-0.95) and 0.88 (95% CI, 0.8-0.97), respectively. Patients with GH have higher numbers of urinary RMPs and PS-exposing RBCs. These parameters have the potential to be predictive tools for classifying GH in the future.

Evaluation of Etiological Causes in Children with Symptomatic Hematuria

Hematuria is an important and common symptom of urinary system pathologies in children, and careful evaluation is required for its definitive diagnosis. In this study, we aimed to determine the demographic and clinical characteristics and etiological causes of patients who applied to our pediatric nephrology clinic with hematuria. In this study, the record of 434 patients who were followed up in our clinic for macroscopic and/or microscopic hematuria were evaluated retrospectively. Demographic data, clinical findings, laboratory and imaging examinations and final diagnosis of the patients were recorded. Out of 434 patients with hematuria, 239 (55%) were male and 195 (45%) were female. Of the patients, 291 (67%) had macroscopic hematuria and 83 (19.1%) had glomerular hematuria. Non-glomerular causes were found in 80.9%, with a significantly higher rate. Most of the causes of non-glomerular hematuria were urinary tract infection and renal stones. Acute poststreptococcal glomerulonephritis (APSGN) was found to be responsible for the majority of glomerular diseases. This study shows that most of the pathologies that may cause hematuria can be detected with a detailed history, careful physical examination and simple laboratory tests.

Diagnostic Characteristics of Urinary Red Blood Cell Distribution Incorporated in UF-5000 for Differentiation of Glomerular and Non-Glomerular Hematuria.

BackgroundAutomated urine sediment analysis has been developed to address the limitations of microscopic examination of dysmorphic red blood cells (RBCs). We evaluated the urinary RBC distribution (URD) parameter of a recently launched automated urinary flow cytometry analyzer, UF-5000 (Sysmex, Kobe, Japan), to differentiate glomerular hematuria (GH) from non-GH (NGH).MethodsSamples submitted for urine sediment analysis from patients with hematuria (>20 RBCs/μL) were divided into derivation (N=156; 101 GH, 55 NGH) and validation cohorts (N=107; 60 GH, 47 NGH). The clinical diagnosis of GH or NGH was established based on clinical data review. Differences in UF-5000 parameters (URD, small RBC, lysed RBC, RBC-P70FSC, RBC-SF-FSC-W, mean forward-scattered light, and mean side-scattered light) between GH and NGH, and areas under the ROC curves (AUC) were analyzed in the derivation cohort. The derived ideal cut-off value was evaluated in the validation cohort. We applied the Kitasato criteria to compare the diagnostic performance.ResultsURD (%), differed significantly between GH and NGH (P<0.001) in the two cohorts. The AUC of URD was 0.814 and 0.806 in the derivation and validation cohorts, respectively. Using a cut-off of >20.1%, the sensitivity was 99.0%/89.4% and the specificity was 50.9%/63.3% in the derivation/validation cohort. When the Kitasato criteria were applied, the sensitivity and specificity were 80.2% and 52.7%, respectively.ConclusionsURD is a rapid, objective, and quantitative measure that can be used to differentiate GH and NGH.

Differentiating glomerular from non-glomerular hematuria: role of urinary albumin-total protein ratio

Background: Hematuria is one of the most common and early signs of diseases related to genitourinary system and can be classified as either glomerular or non-glomerular in origin. Percentage of dysmorphic RBC (%dRBC) in urine has been in practice as a diagnostic tool for differentiating glomerular from non-glomerular hematuria. Recent studies indicate that, urinary albumin-total protein ratio (uAPR) can also be used as a diagnostic tool in this regard. This study aimed to evaluate the sensitivity and specificity of uAPR as a diagnostic tool for detecting glomerular hematuria in comparison to %dRBC in urine. Methods: This cross-sectional study enrolled 96 patients with hematuria. Fresh urine samples were collected from each subject to determine the %dRBC and to calculate uAPR. Receiver operating characteristic curve analysis was done on these results to evaluate the sensitivity and specificity of uAPR and %dRBC in differentiating glomerular from non-glomerular hematuria. Results: uAPR and %dRBC were significantly (p&lt;0.001) higher among patients with glomerular hematuria than non-glomerular hematuria. At the cutoff value of 0.57 mg/mg, uAPR showed sensitivity of 81.8% and specificity of 95.5%. At the cutoff value of 22.5%, %dRBC showed sensitivity of 54.5% and specificity of 86.4%. Conclusion: uAPR has higher sensitivity and specificity than %dRBC in differentiating glomerular from nonglomerular hematuria and can be used as a diagnostic tool. BIRDEM Med J 2022; 12(1): 51-56

Clinico-Etiologic Profile of Macroscopic Hematuria in Children: A Single Center Experience

To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital. This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria. Of the 62 children (44 males) enrolled, (mean (SD) age of 7.3 (2.6) years), glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies. Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.

Evaluation Of Etiological Causes of Hematuria in Children

Amaç: Hematüri çocuklarda üriner sistem hastalıklarının önemli bir bulgusudur. Altta yatan ciddi hastalıkların belirtisi olabileceğinden ayırıcı tanı için dikkatli bir değerlendirme ve iyi bir klinik yaklaşım gerektirmektedir. Bu çalışmada pediatrik nefroloji kliniğimize hematüri nedeni ile başvuran hastaların demografik ve klinik özellikleri nin incelenmesi ve tanıya yol gösterecek özelliklerin belirlenmesi amaçlandı. Hastalar ve Yöntem: Bu çalışma, kliniğimizde makroskopik ve/veya mikroskopik hematüri nedeniyle izlenmiş olan 370 hastanın dosyası retrospektif olarak değerlendirilerek gerçekleştirildi. Hastaların demografik verileri,l aboratuar sonuçları ve klinik bulguları, görüntüleme tetkikleri ve nihai tanıları araştırıldı. Bulgular: Hastaların 195’i (%52.7) erkek, 175 (%47.7)’si kızdı ve çoğunluğu 6-10 yaş grubunda yer almaktaydı. Hastaların 234 ‘ü (%63.2) makroskopik hematüri ile başvururken , 44’ünde (%15.3) glomerüler hematüri saptandı. Makroskopik hematüri grubunda non-glomerular nedenler anlamlı olarak yüksek bulundu. Glomerüler hematüri nedenleri arasında ülkemizde halen yaygın olarak saptanan akut poststreptokokkal glomerülonefrit (APSGN), non glomerüler nedenlerden de üriner sistem enfeksiyonu en yüksek oranda görülen hastalıkları oluşturmaktaydı. Tartışma: Bu çalışma dikkatli bir öykü, ayrıntılı fizik muayene ve klinik değerlendirme ile hematüri ile başvuran hastaların büyük çoğunluğunda etiyolojinin aydınlatılabileceğini göstermektedir. İleri görüntüleme tetkikleri ve renal biyopsi sadece seçilmiş vakalarda endikedir.

Approach to Diagnosis and Management of Hematuria.

Hematuria is one of the alarming manifestations of a renal disease. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or non-glomerular disorders. Clinical presentation and urine microscopy can differentiate glomerular from non-glomerular hematuria. In the majority, a good clinical examination and basic investigations including a urine microscopic examination withsophisticated tools like phase contrast and automated microscopescan help differentiate glomerular from non-glomerular causes for hematuria. Drug induced hematuria, especially secondary to use of analgesics needs to be recognized in routine clinical practice. Rarer causes of hematuria may need more detailed evaluation with a renal biopsy, electron microscopy, urine biochemical testing and imaging. There is no specific treatment to resolve or prevent hematuria. Resolution of hematuria usually occurs with appropriate management of the underlying disorder. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation. Prompt referral to a pediatric nephrologist is indicated in situations when hematuria does not resolve within 2 weeksof onset of glomerulonephritis, there is a need for a renal biopsy, in the presence of persistent microscopic hematuria andneed for specific urine biochemistry testing or imaging studies.

A Child Presenting with Persistent Asymptomatic Microscopic Hematuria: a Case Report

Tuberculosis (TB) is a serious and important infectious disease worldwide. Children commonly develop renal tuberculosis (TB) as a complication of primary pulmonary infection with Mycobacterium tuberculosis characterized by hilar lymphadenopathy often with lung opacity. Renal TB accounts for up to 27% of extra-pulmonary cases. The disease is more prevalent in children with immunodeficiency syndromes and the recipients of organ transplantations. The signs and symptoms of renal TB are non-specific and challenging. Most patients present with persistent non-glomerular microscopic hematuria without abdominal or flank pain. Some may have signs and symptoms of the lower urinary tract such as voiding dysfunction. A diagnosis of renal TB is suspected upon detecting pyuria in the absence of common bacterial infections and is confirmed by isolation of acid-fast lactobacillus in the urine or tissue biopsy. Anti-tuberculosis drugs most frequently used in the pediatric age group are a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol.Keywords: Non-glomerular hematuria; Renal tuberculosis; Diagnosis; Treatment; Child; Mycobacterium tuberculosis.

Calcium-creatinine ratio in a morning urine sample for the estimation of hypercalciuria associated with non-glomerular hematuria observed in children and adolescents.

Hypercalciuria might be revealed during the differential diagnosis of hematuria accompanying renal lithiasis (RL). In spite of this, diagnostic accuracy of calcium urinary excretion might be affected by incomplete 24-hour urine collections. In the present study, the diagnostic utility of calcium/creatinine (ICaCre) index for determining hypercalciuria associated with non-glomerular hematuria (NGH) and RL was assessed. ICaCre (mg/mg) index was calculated from calcium (mmol/l) and creatinine (µmol/l) concentrations in an aliquot from a 24-hour urine collection in 169 children and adolescents with NGH or RL. Calciuria values > 4.0 mg/kg in 24 hours were distributed according to the presence of NGH or RL. Mean ICaCre index was 0.2 ± 0.1 mg/mg. Calciuria values estimated from ICaCre were statistically higher to those from 24-hour urine collection (p < 0.05). The frequency of hypercalciuria was independent from the measurement method (estimated from ICaCre 39.5% vs. 24 h collection 32.1%; p > 0.05). Hypercalciuria distribution was as follows: no NGH + no RL: 59.0%; no NGH + RL: 60.0% (∆ = +1.0%); NGH + no RL: 68.2% (∆ = +9.2%); NGH + RL: 73.3% (∆ = +14.4%). The use of ICaCre index for determining calcium urine excretion might be effective in the study of hypercalciuria associated with NGH and RL.

Blood pressure and urolithiasis in children

Urolithiasis is a condition that is most commonly found in adults, but is becoming increasingly prevalent in children. Little is known about the relationship between blood pressure (BP) and urolithiasis in children. The aim was to evaluate the relationship between urolithiasis and BP, and to determine the association of BP with 24-h urine parameters in children. We retrospectively analyzed BP and 24-h urine data from children <18 years with and without urolithiasis from 2004 to 2015at a single tertiary center. Children with a diagnosis of non-glomerular hematuria without history of urolithiasis were chosen as the control group. Non-stone formers were excluded if they presented with any abnormal 24-h urine data or kidney disease. Casual BP, BP index (BPi), and 24-h urine parameters were compared between groups using t-tests. Multiple regression analyses adjusting for age, sex and body mass index (BMI) z-score evaluated the association of BP with urolithiasis and urine electrolytes. The urolithiasis group (N=71) was significantly older, taller and heavier than the non-stone former group (N=53) (Table). Systolic BP and diastolic BP in stone formers were significantly greater than in non-stone formers, respectively (p=0.019). Additionally, systolic BPi was significantly higher in the urolithiasis group (p=0.03) but there was no significant difference in diastolic BPi (p=0.45). Urolithiasis was a significant predictor of systolic BPi in the adjusted model (β=0.04, 95% CI 0.001-0.07). In stone formers, systolic BP and systolic BPi were directly associated with 24-h urine sodium, oxalate/1.73m2, and uric acid (all p<0.05). Urine calcium was not associated with any BP parameter. The findings are consistent with previous studies in adults that examined the correlation between blood pressure and kidney stones. The results of this study also showed that blood pressure was positively associated with urine sodium, oxalate, and uric acid. Interestingly, contrary to adult literature, our hypothesis which postulated that blood pressure would be associated with an increase in urine calcium was not supported by our findings. The small sample size is a study limitation and the use of healthy controls as a comparison would have been ideal. Blood pressure was directly associated with urolithiasis children. Greater BP values were also associated with abnormalities in 24-h urine oxalate, uric acid, and sodium values. Interestingly, BP was not associated with urine calcium in this population.

Japanese guidelines of the management of hematuria 2013.

Japanese guidelines of the management of hematuria 2013.

The expression of renal Epstein-Barr virus markers in patients with lupus nephritis.

The aim of this study was to investigate the role of renal Epstein-Barr virus (EBV) infection in the pathogenesis of lupus nephritis (LN). A total of 58 renal tissue samples from patients with LN, seven normal renal tissue samples from patients with non-glomerular hematuria and 37 renal tissue samples from patients with minimal change nephropathy were collected. The expression of EBV-latent membrane protein-1 (EBV-LMP1) and EBV-encoded RNA 1 (EBER-1) in the renal tissue was examined by immunohistochemistry (IHC) and in situ hybridization (ISH), respectively. The sera levels of anti-nuclear antibody as well as antibodies to extractable nuclear antigen in patients with LN were also measured. An equivalence test showed that the results from the IHC and the ISH analyses had strong agreement. The positive rates of renal EBER-1 and EBV-LMP1 in the LN patients were significantly higher than those of the normal and minimal change nephropathy patients (P<0.001), while no significant difference was identified between those of the normal and minimal change nephropathy groups (P>0.05). The positive rates of EBV-LMP1 and EBER-1 in the renal tissues of patients with LN were not determined to be significantly different between the relapse (immunosuppressant-treated) and initial onset (non-treated) patients, between the patients with and without concurrent infection, and among the patients with different age ranges (P>0.05). The proportion of LN patients positive for anti-Sm antibody was significantly higher in the renal EBV-positive group than in the EBV-negative group (P<0.05), while the proportions of LN patients positive for the other autoantibodies that were examined were not identified to be significantly different between these two groups (P>0.05). The present study shows that renal EBV infection may contribute to the pathogenesis of LN by inducing anti-Sm antibody production.

Evaluation of left renal vein entrapment using multidetector computed tomography.

Nutcracker syndrome, also called left renal vein entrapment syndrome, is a cause of non-glomerular hematuria with difficulties in diagnosis. Multidetector computed tomography (MDCT) is a powerful tool to prevent unnecessary diagnostic procedures. To retrospectively determine the prevalence of nutcracker phenomenon and nutcracker syndrome seen in MDCT in consecutive patients. The institutional review board approved the study and waived the requirement for informed consent. Abdominal contrast-enhanced MDCT scans were reviewed from 1000 consecutive patients. MDCT scan assessment included renal vein diameter measurements and evaluation for the presence of anterior or posterior left renal vein entrapment. Electronic medical records and urine analysis reports of patients with left renal vein entrapment were reviewed. Student's t test was used to assess differences in renal vein diameter in patients with left renal vein entrapment. Left renal vein entrapment was observed in 10.9% (109), retro-aortic left renal vein in 6.5% (65), entrapment of left renal vein between superior mesenteric artery and aorta in 4.1% (41), and circumaortic left renal vein in 0.3% (3) of patients. Mean diameters of right (8.8 ± 1.9 mm) and unentrapped left (8.9 ± 1.8 mm) renal veins were not significantly different (P = 0.1). The mean diameter of anterior entrapped left renal veins (10.3 ± 2 mm) was significantly greater (P = 0.04) than contralateral renal veins (8.6 ± 2.1 mm) in their widest portion. In 8.8% of patients with the left renal vein entrapment, urine analysis showed isomorphic hematuria or proteinuria with no other known cause. Varicocele and pelvic congestion were seen in 5.5% of patients with the left renal vein entrapment. Left renal vein entrapment is not a rare entity and renal nutcracker phenomenon might be underdiagnosed.

The Study of the Value of Mean Corpuscular Volume in the Urine Red Blood Cell Phase in the Differential Diagnosis of Hematuria

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The changes of urinary red blood cell morphology and the average volume of red blood cell were examined by MCV. &lt;strong&gt;Method:&lt;/strong&gt; In 100 cases of patients with urinary sediment microscopy of hematuria, and used blood cell analyzer for determination for MCV in urinary RBC. &lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;Renal hematuria MCV and the outer peripheral blood MCV has significant difference (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.01) and non-renal hematuria and peripheral blood MCV had no significant difference, glomerular hematuria and non-glomerular hematuria erythrocyte deformity was significantly different (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.01), renal hematuria MCV is less than or equal to 73 fL, abnormal red blood cells with 2 or more, deformity rate is more than or equal to 76%. &lt;strong&gt;Conclusion:&lt;/strong&gt; RBC phase combined with MCV detection of urine RBC is the practical value in diagnosis of glomerular hematuria.&lt;/p&gt;

Evaluation of erythrocyte dysmorphism by light microscopy with lowering of the condenser lens: A simple and efficient method

To demonstrate that the evaluation of erythrocyte dysmorphism by light microscopy with lowering of the condenser lens (LMLC) is useful to identify patients with a haematuria of glomerular or non-glomerular origin. A comparative double-blind study between phase contrast microscopy (PCM) and LMLC is reported to evaluate the efficacy of these techniques. Urine samples of 39 patients followed up for 9 months were analyzed, and classified as glomerular and non-glomerular haematuria. The different microscopic techniques were compared using receiver-operator curve (ROC) analysis and area under curve (AUC). Reproducibility was assessed by coefficient of variation (CV). Specific cut-offs were set for each method according to their best rate of specificity and sensitivity as follows: 30% for phase contrast microscopy and 40% for standard LMLC, reaching in the first method the rate of 95% and 100% of sensitivity and specificity, respectively, and in the second method the rate of 90% and 100% of sensitivity and specificity, respectively. In ROC analysis, AUC for PCM was 0.99 and AUC for LMLC was 0.96. The CV was very similar in glomerular haematuria group for PCM (35%) and LMLC (35.3%). LMLC proved to be effective in contributing to the direction of investigation of haematuria, toward the nephrological or urological side. This method can substitute PCM when this equipment is not available.