Erythrocyte morphology by phase contrast microscopic examination (PCM) of the urine is widely employed in distinguishing glomerular from nonglomerular bleeding. The proposed percentages of dysmorphic red cells are significant for glomerular bleeding in the range of 10 to 80% in the literature, because there is no clear cut definition of "dysmorphism." In the present study midstream urine samples of 351 patients with hematuria (greater than 8 erythrocytes/microliters) and of 33 healthy controls were examined. The various dysmorphic red cells were analyzed by PCM according to a detailed hematological classification. Most of the dysmorphic red cells, such as echinocytes, anulocytes, ghost cells, schizocytes, stomatocytes, codocytes and knizocytes, occurred in glomerular or nonglomerular disease as well, and proved to be uncharacteristic for glomerular bleeding. In contrast, a unique red cell deformity, a ringform with vesicle-shaped protrusions (acanthocyte) closely correlated to glomerular disease. In biopsy proven glomerulonephritis acanthocytes comprised 12.4% of all excreted red cells, whereas in nonglomerular diseases or in healthy subjects acanthocytes were seen very rarely (less than 2%) or not at all. Acanthocyturia greater than or equal to 5% (of excreted red cells) was seen in 75 out of 143 patients with proven glomerulonephritis (sensitivity 52%) and in four out of 187 patients with nonglomerular disease (specificity 98%). To improve the diagnostic value of erythrocyte morphology the diagnostic workup should focus on acanthocyturia, which is also indicative in very low erythrocyte counts.

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A 29-year-old woman died from a right hemispheric infarction caused by dissection and subsequent thrombosis of the internal carotid artery after chiropractic manipulations of the neck. Pathologic study of several arteries of muscular and elastic type revealed a mediolytic arteriopathy with widespread mucoid degeneration and cystic transformation of the vessel wall caused by segmental degeneration of smooth muscle cells of the tunica media. We hypothesize that mediolytic arteriopathy was a predisposing factor for the dissection of the internal carotid artery after chiropractic manipulations in our patient.

We demonstrate that monocyte-associated immunosuppression in ESRD leads to reduced secretion of proinflammatory cytokines in response to stimuli such as MSU crystals. This may be one of the factors preventing many ESRD patients from the manifestation of acute gout despite often severe hyperuricaemia.

These data provide evidence that nonhematopoetic renal parenchymal cells express PR-3 and that glomerular expression of PR-3 is associated with crescent formation in WG. Our findings suggest that renal parenchymal cells may directly be involved in the pathogenesis of CGN in WG.