Identification and Significance of Dysmorphic Versus Isomorphic Hematuria

Sayer, Jeanie; McCarthy, Michael; Schmidt, Joseph D.

doi:10.1016/s0022-5347(17)40015-2

Cited by 25 publications

(12 citation statements)

References 13 publications

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“…The presence of dysmorphic cells was reported to be indicative of glomerular hematuria. This has since been largely corroborated using phase-contrast microscopy [5,7,9,14,15,16], scanning electron microscopy [17], and light microscopy [6,18,19,20,21]. However, the clinical usefulness of this technique remains controversial, since there is no agreement over the criteria for the interpretation of the urinary dysmorphic erythrocytes [3,4] or the minimum number of dysmorphic erythrocytes deemed to indicate glomerular hematuria.…”

Section: Discussionmentioning

confidence: 99%

Dysmorphic erythrocytes and G1 cells as markers of glomerular hematuria

Zaman¹,

Proesmans

2000

Pediatric Nephrology

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We aimed to assess the utility of the percentage of G cells and dysmorphic erythrocytes in the diagnosis of glomerular hematuria in pediatric patients. We determined the percentage of dysmorphic erythrocytes and G1 cells in urine samples from patients with glomerulonephritis and other renal diseases of non-glomerular origin. There was excellent correlation and agreement between results obtained by counting the cells in counting chambers and in urine sediments. With cut-off values of > or =1%, > or =2%, > or =5%, and 10% for G1 cells, sensitivities for the detection of glomerulonephritis were 62%, 40%, 28%, and 10% and specificities were 89%, 95%, 95%, and 98%. For the dysmorphic erythrocytes cut-off values of > or =10%, > or =20%, 50%, and > or =90% gave respective sensitivities of 95%, 95%, 93%, and 62% and specificities of 24%, 34%, 43%, and 85%. In 38% of cases of biopsy-proven glomerulonephritis no G1 cells were found. For cut-off values of > or =50% dysmorphic erythrocytes and > or =1% G1 cells, the sensitivity and specificity were 60% and 91%. For cut-off values of > or =50% dysmorphic or > or =1% G1 cells, sensitivity and specificity were 93% and 44%. Our results show that neither the percentage of dysmorphic erythrocytes nor the G1 cell count is of adequate sensitivity and specificity to enable reliable differentiation of glomerular and non-glomerular hematurias. Both tests are needed to achieve >90% sensitivity and specificity.

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Section: Discussionmentioning

confidence: 99%

Dysmorphic erythrocytes and G1 cells as markers of glomerular hematuria

Zaman¹,

Proesmans

2000

Pediatric Nephrology

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“…However, it is important to minimize the rate of negative biopsy findings, which in the present series was 32%). Identification of glomerular dysmorphic erythrocytes in the urine by conventional phase contrast or light microscopy [23], or Coulter counter analysis [24] can provide more information about the origin of haematuria and may facilitate diagnosis. This should further reduce the number of needless investigations and uncertain diagnoses, and might enable glomerulonephritis to be detected earlier, with a potential therapeutic benefit.…”

Section: Discussionmentioning

confidence: 99%

Significance of the evaluation of asymptomatic microscopic haematuria in young men

Sparwasser

Cimniak

Treiber

et al. 1994

British Journal of Urology

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“…Previous studies have involved the assess ment of volume frequency distribution widths [ 18]. mean [16.…”

Section: Discussionmentioning

confidence: 99%

“…This has in cluded measurement of RBC volumes in uncentrifuged [11,12] and resuspended centrifuged urinary deposits [10], analysis of mean [16. 17] and modal [11,12] cell volumes, differential urinary minus peripheral blood erythrocyte volumes [ 10,13] and volume frequency histo gram distribution widths [ 18]. The purpose of this study was to clarify the optimal sample selection, preparation and measurement parame ters required to enhance the diagnostic accuracy of this test and to provide guide-lines for its application in clini cal practice.…”

Section: Introductionmentioning

confidence: 99%

Volumetric Analysis of Urinary Erythrocytes: A Standardized Methodology to Localize the Source of Haematuria

Caestecker

Ballardie²

1992

Am J Nephrol

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Volumetric analysis of urinary red blood cells (RBCs) was performed in two groups of patients: (a) 91 with glomerulonephritis (GN), 158 with non-glomer-ular diseases (non-GN) and 53 controls without haematuria; (b) 97 with GN and 41 with non-GN diagnoses and ≧ 2+ haematuria, analysed after modified sample preparation (isotonic dilution and haemolysis to eliminate non-RBC debris). In group A, diagnostic ranges were established for modal, mean and differential (urinary-peripheral blood modal) RBC volumes to differentiate GN from non-GN sources of blood loss according to RBC size. 54% (135/249) of modal volumes and 68% (124/183) with ≧2+ haematuria were within a diagnostic range of values, i.e. 40-180 fl (sensitivity ), and the source of haematuria was correctly identified in 85% (115/135) and 87% (108/124) of these, respectively (specificity). Of the remainder, with modal volumes < 40 or > 180 fl, 45% (51/114) were from GN and 55% (63/114) from non-GN specimens, along with 94% (48/53) controls without haematuria (non-diagnostic analyses). In contrast, whilst 90% (74/82) of mean volumes ≧ 110 fl and 94% (62/66) of differential volumes ≧ 0 fl were from non-GN specimens, values below these were common to both diagnostic groups so that diagnostic sensitivities were reduced to 38% (82/219) and 34% (66/193), respectively. In group B, haemolysis enabled extension of the diagnostic range of GN modal volumes down to 30 fl, whilst specificity of the test was enhanced with the modified sample preparation to 100% (86/86) versus 87% for those with ≧ 2+ haematuria from group A (p < 0.001). These findings illustrate the value of a standardized methodology for the assessment of urinary RBC volumes in the investigation of patients with unexplained urinary blood loss: diagnostic accuracy is enhanced with a classification of modal volumes and modified sample preparation in specimens with ≧ 2+ dipstick haematuria.

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Identification and Significance of Dysmorphic Versus Isomorphic Hematuria

Cited by 25 publications

References 13 publications

Dysmorphic erythrocytes and G1 cells as markers of glomerular hematuria

Dysmorphic erythrocytes and G1 cells as markers of glomerular hematuria

Significance of the evaluation of asymptomatic microscopic haematuria in young men

Volumetric Analysis of Urinary Erythrocytes: A Standardized Methodology to Localize the Source of Haematuria

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