Differential Diagnosis between Glomerular and Nonglomerular Hematuria by Automated Urinary Flow Cytometer

Abstract

Objective, fast and easy methods have not been established in the examination of urine sediment to differentiate between glomerular and nonglomerular hematuria. In this study, we used a newly developed automated urinary flow cytometer that can clearly recognize red blood cells (RBC), white blood cells, epithelial cells, bacteria and crystals by their size and fluorescence intensity without sedimentation. 98 urine samples from 31 glomerular and 67 nonglomerular lesions were analyzed by the device, and the criteria to determine the origin of hematuria were established based on the results. Additional 108 cases were tested to evaluate the validity of these criteria. According to the analysis of histograms of urinary RBC size distribution, cases in whom ≥80% of all RBC have forward scatter (FSC) intensities ≦126 and <80% of all RBC have FSC intensities ≥84 were regarded as representing the glomerular type. Cases in whom ≥80% of all RBC have intensities FCS ≥84 and <80% all RBC have FSC intensities ≦126 were regarded as representing the nonglomerular type. Cases in whom <80% of all RBC have FSC intensities ≦126 and <80% of all RBC have FCS intensities ≥84 were regarded as the mixed type. Cases in whom ≥80% of all RBC have FSC intensities ≦126 and ≥80% of all RBC have FSC intensities ≥84 were regarded as the nonglomerular type. The sensitivity for glomerular RBC in the first 98 cases was 90.3% and the specificity 92.5%, and in the second 108 cases the values were 100 and 86.6%, respectively. The automated urinary flow cytometer is useful as a means for routine differential diagnosis of hematuria, and at least it is promising as the screening test for differentiation between glomerular and nonglomerular hematuria, because it can examine numerous samples within a short time and does not necessitate any special skill or knowledge.

Stability of N-Terminal Pro-Brain Natriuretic Peptide after Storage Frozen for One Year and after Multiple Freeze-Thaw Cycles

“…We also tried to evaluate whether flow cytometry is useful in the analysis of erythrocyte dysmorphism by applying the Kitasato criteria (6,7 ). However, this system relies on erythrocyte volume and size, and the flow cytometer distinguishes erythrocytes on the basis of cellular diameter but cannot recognize dysmorphic erythrocytes with altered shape, such as acanthocytes or codocytes (8 ).…”

H�maturie beim Harnblasenkarzinom

“…Auch die Volumenbestimmung der im Urin gefundenen Erythrozyten [26], die Untersuchung mittels Flow-Zytometrie [27] und die Proteinuriedifferenzierung [28] können wertvolle Hinweise auf die Hämaturiequelle geben, sind jedoch vergleichsweise aufwendig und der konventionellen Mikroskopie des Geübten hinsichtlich Sensitivität und Spezifität nicht überlegen.…”

Diagnosis of Glomerular Haematuria by Imagecytometry of Urinary Red Cells

“…Phase contrast microscopy of red blood cells (RBCs) in urine is the standard practice for diagnosis of haematuria, but the method is subjective, less accurate and the criteria are variable [2]. Recently automated urine flowcytometer is being used for diagnosis of origin of haematuria where the size of the red cells is determined by estimating the forward scatter (FSC) intensity of the cells without taking into account the variation in their shape and hemoglobin content [4]. We have undertaken a study to evaluate the urine red cells with the help of an automated computerized image analysis system [5] for determination of (1) size (area, area equivalent diameter and perimeter), (2) variation in shape in the form of form factor and (3) hemoglobin content by integrated optical density (IOD).…”