Glomerular Hematuria and the Utility of Urine Microscopy: A Review

Saha, Manish; Massicotte‐Azarniouch, David; Reynolds, Monica L.; Mottl, Amy K.; Falk, Ronald J.; Jennette, J. Charles; Derebail, Vimal K.

doi:10.1053/j.ajkd.2022.02.022

Cited by 19 publications

(7 citation statements)

References 88 publications

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“…First, although specific for glomerular disease, the sensibility of dysmorphic hematuria can be variable. 18 Second, our population presents a high prevalence of dysmorphic hematuria (found in 54% of patients) and glomerular histologic lesions (present in 92% of patients). In such a population, dysmorphic hematuria may be a poor discriminator of which glomerular lesions one can expect to find.…”

Section: Discussionmentioning

confidence: 82%

Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed

et al. 2022

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Background: Urinary sediment is a non-invasive laboratory test that can be performed by an automated analyzer, or manually by trained personnel. Manual examination remains the diagnostic standard because it excels at differentiating isomorphic from dysmorphic red blood cells, and identifying other urinary particles such as renal tubular epithelial cells (RTECs), lipids, crystals, and the composition of casts. This study aimed to investigate the prevalence of a complete profile of urinary sediment particles and its associations with histological lesions on kidney biopsy, regardless of diagnosis. Methods: Single center, observational retrospective study of 131 patients who had contemporary manual urinary sediment evaluation and kidney biopsy. A comprehensive set of urinary particles and histological lesions were quantified, and their associations were analyzed. Results: In our samples, we found an elevated frequency of findings suggestive of proliferative kidney disease, and a low frequency of particles evoking urological damage. The association of histological lesions and urinary particles was explored with a multivariate model. We identified urinary sediment characteristics that independently correlated with the presence of some histological lesions: urinary lipids with mesangial expansion [OR 2.86 (1.30-6.30)], mesangial hypercellularity [OR 2.44 (1.06-5.58)], and wire loops and/or hyaline deposits [OR 2.89 (1.13-7.73)], and urinary renal tubular epithelial cells with endocapillary hypercellularity [OR 3.17 (1.36-7.39)], neutrophils and/or karyorrhexis [OR 4.51 (1.61-12.61)], fibrinoid necrosis [OR 4.35 (1.48-12.74)], cellular/fibrocellular crescents [OR 5.27 (1.95-14.26)] and acute tubular necrosis [OR 2.31 (1.08-4.97)]. Conclusion: In a population of patients submitted to kidney biopsy, we found that the presence of some urinary particles (renal tubular epithelial cells, lipids, and dysmorphic erythrocytes), which are seldom reported by automated analyzers, is associated with active proliferative histological lesions. In this regard, manual urinary sediment evaluation may help to shape the indications for performing a kidney biopsy.

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Section: Discussionmentioning

confidence: 82%

Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed

et al. 2022

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“…Due to differing strati cations for proteinuria and eGFR, these factors cannot be compared and summarized directly. [34] Such factors as female gender, age, cardiovascular disease, UPCR, and CRP in the included studies did not show signi cant associations with the outcome, which indicated more studies are needed.…”

Section: Discussionmentioning

confidence: 88%

Adverse renal outcomes associated with hematuria and its associated factors: A systematic review and meta-analysis

Li,

FANG,

et al. 2024

Preprint

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Background Longitudinal evidence of the prognostic value of hematuria and associated factors predicting the risk of renal outcome vary. Objective This systematic review and meta-analysis investigated the association of hematuria and adverse kidney events and summarized the associated factors. Methods A comprehensive search of PubMed, Web of Science, EMBASE, and Cochrane was conducted from January 1, 2010, to December 20, 2022. Longitudinal studies focusing on the prognostic value of hematuria on renal outcome were included in the analysis (PROSPERO registration CRD42023387845). Results The search generated 34 studies, of which 20 studies involving 1,047,171 participants were included in the systematic review. Baseline hematuria showed a 64% increased risk of adverse kidney outcome (risk ratio (RR) 1.77, 95% confidence interval (CI) 1.43 − 2.19). Hematuria remission showed a 63% decreased risk of adverse kidney outcomes (RR 0.37, 95% CI 0.24 − 0.55). Conclusions Hematuria increases the risk of adverse kidney events. Hematuria remission has a favorable effect on renal outcome.

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“…Evaluation of haematuria is commonly used in the assessment of glomerular disease, but studies on the role of haematuria in monitoring and predicting adverse outcomes have shown inconsistent results, possibly due to the failure to consider dysmorphic RBCs or RBC casts [ 28 ]. The occurrence of haematuria patients with SLE is highly correlated with short-term renal and non-renal disease activity [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

A nomogram predicting the histologic activity of lupus nephritis from clinical parameters

Gao,

Bian,

et al. 2023

Nephrology Dialysis Transplantation

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Background The 2021 clinical guidelines of the Kidney Disease: Improving Global Outcomes emphasize the importance of the histological activity index (AI) in the management of lupus nephritis (LN). Patients with LN and a high AI have poor renal outcomes and high rates of nephritic relapse. In this study we constructed prediction models for the AI in LN. Methods The study population comprised 337 patients diagnosed with LN using kidney biopsy. The participants were randomly divided into training and testing cohorts. They were further divided into high-activity (AI >2) and low-activity (AI ≤2) groups. This study developed two clinical prediction models using logistic regression and least absolute shrinkage and selection operator (LASSO) analyses with laboratory test results collected at the time of kidney biopsy. The performance of models was assessed using 5-fold cross-validation and validated in the testing cohort. A nomogram for individual assessment was constructed based on the preferable model. Results Multivariate analysis showed that higher mean arterial pressure, lower estimated glomerular filtration rate, lower complement 3 level, higher urinary erythrocytes count and anti-double-stranded DNA seropositivity were independent risk factors for high histologic activity in LN. Both models performed well in the testing cohort regarding the discriminatory ability to identify patients with an AI >2. The average area under the curve of 5-fold cross-validation was 0.855 in the logistic model and 0.896 in the LASSO model. A webtool based on the LASSO model was created for clinicians to enter baseline clinical parameters to produce a probability score of an AI >2. Conclusions The established nomogram provides a quantitative auxiliary tool for distinguishing LN patients with a high AI and helps physicians make clinical decisions in their comprehensive assessment.

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Glomerular Hematuria and the Utility of Urine Microscopy: A Review

Cited by 19 publications

References 88 publications

Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed

Urinary Sediment Microscopy and Correlations with Kidney Biopsy: Red Flags Not To Be Missed

Adverse renal outcomes associated with hematuria and its associated factors: A systematic review and meta-analysis

A nomogram predicting the histologic activity of lupus nephritis from clinical parameters

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