Phase Contrast Microscopy of the Urine Sediment for the Diagnosis of Glomerular and Nonglomerular Bleeding-Data in Children and Adults with Normal Creatinine Clearance

Santo, Natale G. De; Nuzzi, F; Capodicasa, G; Lama, Giuliana; Caputo, Gregory M.; Rosati, P.; Giordano, C

doi:10.1159/000184068

Cited by 48 publications

(25 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This correlation was confirmed in numerous studies using phase contrast-microscopy [5][6][7][8][9][10][11], electron mi croscopy [5,12] or light microscopy with or without staining [13][14][15][16], The sensitivity of dysmorphia for GN disease was approximately 85% in these studies, but if populations with roughly equal ('mixed') proportions of isomorphic and dysmorphic cells were included, sensi tivity approached 100% and specificity ranged from 90 to 100% [2, 4-7, 10, 11, 13]. Reports oflower specificity [9,17] and sensitivity [15,[17][18][19], discordant observa tions on serial specimens [6], interobserver variation [ 17], as well as the lack of readily available sophisticated phase contrast microscopy for most clinicians [10], indi cate some difficulties with this method.…”

Section: Introductionsupporting

confidence: 54%

See 1 more Smart Citation

Urinary Red Cell Size: Diagnostic Value and Determinants

et al. 1990

View full text Add to dashboard Cite

Urinary red blood cells (RBC) are usually small and morphologically abnormal in glomerular (GN) hematuria, and slightly enlarged and morphologically normal in nonglomerular (NG) hematuria. This study was performed to evaluate the diagnostic value of urinary red cell size and morphology and to investigate the mechanism of the alteration in cell size. In 34 consecutive patients with hematuria we examined the urinary RBC size distribution and mean corpuscular volume (MCV) by electronic sizing of suspensions of RBC in an isotonic medium and, in 28 cases, compared it with the presence of 50% or greater dysmorphia. In 15 consecutive cases, we correlated MCV values with urine chemistries. In two GN cases we recorded the urine MCV serially during a furosemide-induced diuresis. In vitro incubations of peripheral or urinary RBC in various electrolyte solutions prior to sizing were also performed. The MCVs were significantly lower in GN (p < 10∼⁶) and probable GN (p < 10–⁴) than NG hematuria. A cutoff of 72 fl completely separated GN and probable GN from NG cases. Fifty percent or more ‘dysmorphic’ RBC were seen in 12 of 13 GN, 3 of 4 probable GN but in no NG sediments. In patients with NG hematuria, the ratio of urinary to peripheral MCV tended to be greater than unity and correlated strongly with pH (r = -0.97; p < 0.002). The effect of pH was confirmed in vitro. Furosemide diuresis induced a partial correction of the microcytosis of GN RBC, which correlated with the changes in urine composition. Furosemide had no effect on GN cells in vitro. Incubation of venous RBC in saline ranging from 0.5 to 6% did not alter MCV. Saline of 0.45% or less caused partial to total hemolysis and the appearance of RBC fragments with extremely low ‘MCV values. We conclude that electronic RBC sizing is a highly accurate and objective method for differentiating GN from NG hematuria. Urinary pH is an important determinant of MCV for NG RBC. A hypothesis is proposed to explain the microcytosis of GN RBC.

show abstract

Section: Introductionsupporting

confidence: 54%

“…It should be pointed out that our study and almost all the studies of urinary morphology that included the clin ical diagnoses of their cases [2,[4][5][6][7][9][10][11][12][13][14][15] have very few cases of NG bleeding of renal origin. The extension of either sizing or morphology to this category of hematuria is not yet warranted.…”

Section: Discussionmentioning

confidence: 99%

Urinary Red Cell Size: Diagnostic Value and Determinants

et al. 1990

View full text Add to dashboard Cite

show abstract

“…Many reports have confirmed this procedure's validity [5][6][7], while oth ers have questioned its reliability, leading to major modi fications in the technique and the need to identify more accurate markers of glomerular and nonglomerular bleed ing [8][9][10], We evaluated the validity of morphological analysis of urinary erythrocytes by means of phase-con trast microscopy in a group of patients with persistent microhematuria who were followed for a 6-year period.…”

Section: Introductionmentioning

confidence: 99%

Is the Red Cell Morphology Really Useful to Detect the Source of Hematuria?

Favaro¹,

Bonfante²,

D’Angelo³

et al. 1997

Am J Nephrol

View full text Add to dashboard Cite

Morphological analysis of urinary red blood cells by phase-contrast microscopy to identify the source of bleeding was, and still is, widely used also as a starting point for workup. To evaluate the reliability of this approach, we studied 129 outpatients presenting with persistent isolated microhematuria; 31 subjects also had mild proteinuria (1 g/day), while 21 had pathological albumin levels. All patients were followed for a period of 6 years. During this time, 6 patients underwent renal biopsy for the onset of macrohematuria episodes and proteinuria of 2-3 g/day. Glomerular bleeding was identified in only 14.7% of the patients, despite the persistent microhematuria and the presence of proteinuria or microalbuminuria. The renal origin of the urinary erythrocytes correlated with histological findings in only 2 of 6 patients with dysmorphic erythrocytes who developed proteinuria (exceeding 1 g/day), and none with isomorphic erythrocytes showed urological abnormalities. These results challenge the validity and reliability of morphological analysis to identify the source of bleeding along the urinary tract.

show abstract

“…They showed this very important findings on the basis of a clinical study using renal biopsy in adults. The usefulness of their classification of urinary RBC was later supported by many studies [2][3][4][5]. Their hypothesis was supported by results obtained in 253 adults by Fassett et al [2], According to their criteria, the morphology of the urinary RBC was recorded as glomerular if more than 80% of the RBC were distorted with variations in size, shape and fragmentation.…”

Section: Introductionmentioning

confidence: 87%

Analysis of Urinary Red Blood Cells of Healthy Individuals by an Automated Urinary Flow Cytometer

Hyodo

Kumano²,

Haga³

et al. 1997

Nephron

View full text Add to dashboard Cite

A newly developed automated urinary flow cytometer allows clear discrimination of erythrocytes from other solid components of urine. In this study, the normal range of the urinary erythrocyte count and the source of urinary erythrocytes in healthy individuals were investigated using this analyzer. For the diagnosis of the source of the urinary erythrocytes, Kitasato University Kidney Center criteria for this analyzer were applied. The subjects were 133 regularly employed volunteers (age range 20-48 years, mean 30.5) who noted no urinary tract symptoms and showed normal blood pressure, consisting of 41 females not in their menstrual period (age range 20-39 years, mean 24.8) and 92 males (age range 20-48 years, mean 33.1). Mid-stream voided urine was collected from these subjects using urine sampling cups, immediately transferred to 50-ml sterilized Spitz tubes, and analyzed within 30 min using the automated urinary flow cytometer. Urinary erythrocytes were derived from glomeruli in all samples of healthy subjects. The urinary erythrocyte count showed a logarithmic normal distribution. Values 2 SD of the urinary erythrocyte count in healthy individuals or higher were regarded as abnormal, and hematuria was considered to be positive when 11.0/μl or more erythrocytes were observed by this analyzer. The finding by this analyzer corresponded to the report of Birch et al.

show abstract

Phase Contrast Microscopy of the Urine Sediment for the Diagnosis of Glomerular and Nonglomerular Bleeding-Data in Children and Adults with Normal Creatinine Clearance

Cited by 48 publications

References 3 publications

Urinary Red Cell Size: Diagnostic Value and Determinants

Urinary Red Cell Size: Diagnostic Value and Determinants

Is the Red Cell Morphology Really Useful to Detect the Source of Hematuria?

Analysis of Urinary Red Blood Cells of Healthy Individuals by an Automated Urinary Flow Cytometer

Contact Info

Product

Resources

About