Urinary red blood cells: not only glomerular or nonglomerular

Two main types of red blood cells, isomorphic and dysmorphic, are found in the urine sediment, indicating nonglomerular and glomerular hematuria, respectively. Occasionally, however, other types of red blood cells such as sickle cells, anisocytes, poikilocytes, elliptocytes and dacryocytes can be seen in the urine sediment of patients with hematuria. This paper describes such cases reported in the literature in which such unusual urinary red blood cells have been found and the experience of the authors on this subject.     

尿红细胞形态分析在血尿诊断中的意义

目的 :应用尿红细胞形态检测分析肾脏血尿的临床意义。方法 :应用普通光学显微镜观察尿红细胞形态 ,鉴别肾小球血尿或非肾小球血尿。结果 :5 0例肾小球性血尿患者中变形红细胞血尿阳性率为 90 % (45 / 5 0 ) ,混合性红细胞血尿阳性率为 10 % (5 / 5 0 ) ;5 0例非肾小球性血尿患者中均一红细胞血尿阳性率为 96 % (48/ 5 0 ) ,混合性红细胞血尿阳性率为 4 % (2 / 5 0 )。结论 :普通光镜下检测红细胞形态操作简便 ,对鉴别血尿来源和诊断具有一定的临床价值     

Hematuria. When is it cause for alarm?

The urine of less than 3% of healthy persons shows more than three red cells per high-power field, which is about the limit of sensitivity of test strips for occult blood. Even minimal hematuria may herald serious problems and must be investigated. Common causes include infection, urethritis, and urethrotrigonitis (25%); stone (20%); and tumor (15%). Although hematuria may be caused by coagulopathy, patients with anticoagulant-induced hematuria must be examined for anatomic defects. Hematuria may originate from the kidney or the urinary tract; red cell casts and dysmorphic red cells suggest a renal source. Hematuria arising from the kidney is classified as glomerular (eg, various forms of glomerulonephritis) or nonglomerular (eg, polycystic kidney disease, cancer). If the urine is pigmented but test strips are negative, or test strips are negative but no red cells are seen, pseudohematuria must be considered.     

尿沉渣检测分析仪联合血细胞分析仪在鉴别血尿来源中的应用

目的探讨尿沉渣检测分析仪和血细胞分析仪联合检测在鉴定肾小球性血尿和非肾小球性血尿中的应用价值。方法利用US-2020尿沉渣检测分析仪和血细胞分析仪对81例不同来源血尿标本进行检测。结果 42例肾小球性血尿中红细胞畸形率为(81.70±9.29)%,39例非肾小球性血尿中红细胞畸形率为(19.0±12.0)%,利用红细胞形态鉴别血尿来源敏感性71.4%,特异性94.8%,诊断符合率82.7%,血细胞分析仪测定肾源性和非肾性血尿中红细胞平均体积和红细胞体积分布宽度分别为(64.00±7.98)fL,(24.90±3.98)%和(89.00±11.89)fL,(14.90±2.45)%,二者差异有统计学意义(P0.05)。结论利用尿沉渣检测分析仪对尿中有形成分的测定和红细胞形态观察,利用血细胞分析仪测定尿红细胞相关参数等对血尿的诊断均有指导意义,二者联合应用提高了诊断符合率,可更加客观准确的鉴别血尿来源,为基层医院提供了很好的鉴别诊断策略。     

尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检测的临床意义

目的：探讨尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检验的临床价值。方法：用AVE-763尿沉渣分析仪观察尿毒症组、肾小球肾炎血尿组和非肾小球血尿组患者的尿红细胞形态并计算畸形率,再用XT-2000i全自动血细胞分析仪检测尿红细胞及外周血红细胞MCV。结果：尿毒症组尿红细胞畸形率、MCV及血MCV／尿MCV与肾小球肾炎血尿组比较差异有统计学意义（P〈0．01）,与非肾小球血尿组比较差异无统计学意义（P〉0．05）。结论：尿毒症患者尿红细胞形态、MCV与非肾小球性血尿接近,临床医生诊断和观察病情变化时必须重视。     

相差显微镜下红细胞形态在鉴别血尿来源中的临床价值

目的探讨相差显微镜下血尿中红细胞形态改变在鉴别血尿来源中的临床价值。方法收集肾小球性疾病血尿215例;非肾小球性血尿233例;正常对照组210例,用相差显微镜观察尿红细胞形态与临床肾活检诊断血尿进行比较,评价相差显微镜下尿红细胞形态判定血尿来源的可靠性。结果215例肾小球性血尿患者中非均一红细胞血尿阳性率为96.3%,均一性红细胞血尿阳性率为3.7%,233例非肾小球性血尿患者中均一红细胞血尿阳性率为96.1%,非均一性红细胞血尿阳性率为3.9%。相差显微镜法的灵敏度为96.3%,特异度为96.1%。结论在相差显微镜下检测红细胞形态操作简便,结果与临床符合率较高,敏感性和特异性都较高,对鉴别血尿来源和定位诊断具有一定的临床应用价值。     

尿红细胞形态及平均体积在在血尿定位应用分析

目的探讨尿红细胞形态及尿红细胞平均体积(MCV)检查在判定血尿来源定位应用价值。方法选取100例血尿的标本作为考察对象,Sysmex XN-1000全自动血球分析仪检测尿红细胞平均体积(MCV),并用相差显微镜检查尿红细胞形态学,观察和分析肾小球性血尿组(glomerular hematuria,GH)和非肾小球血尿组(non glomerular hematuria,NGH)尿红细胞形态及尿红细胞平均体积的差异。结果肾小球性血尿(GH)组尿MCV值(63.71±6.03)fl明显低于非肾小球性血尿(NGH)组MCV值(92.37±12.11)fl(P0.05)且尿MCV不高于72.0fl,变形红细胞80%呈多形型。结论尿中红细胞形态及红细胞平均体积特征分析可作为血尿定位诊断和鉴别诊断的方法之一,有助于判断血尿的来源提供临床参考依据。     

尿液红细胞相位分析在肾病诊断中的应用

目的探讨尿波中红细胞的形态差异对临床肾病的鉴别诊断价值。方法利用AVE-763B全自动尿液沉渣分析系统,我们对228例血尿结果的红细胞相位指标进行统计分析,包括畸形红细胞率（Rs）,尿红细胞宽度分布（Rd）,尿于二细胞形状分布（Rv）,尿红细胞色度分布（Rc）,从而寻找区分非小球性血尿与非肾小球性血屎的医学决定水平。结果Rs〉70％,Rv〈50％时,肾小球性血尿与临床的符合率可达95%;Rs〈30％,Rv〉80％,非肾小球性血尿与临床的符合率可达93%。     

Assessment of microscopic hematuria in adults

Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guidelines can complicate the family physician's decision about the best way to proceed. Patients with proteinuria, red cell casts, and elevated serum creatinine levels should be referred promptly to a nephrology subspecialist. Microscopic hematuria with signs of urinary tract infection should resolve with appropriate treatment of the underlying infection. Patients with asymptomatic microscopic hematuria or with hematuria persisting after treatment of urinary tract infection also need to be evaluated. Because upper and lower urinary tract pathologies often coexist, patients should be evaluated using cytology plus intravenous urography, computed tomography, or ultrasonography. When urine cytology results are abnormal, cystoscopy should be performed to complete the investigation.     

Hematuria: a clinical approach

Microscopic hematuria is no less significant than gross hematuria, since either may signify such pathology as a neoplastic lesion, urinary tract infection, renal calculus, prostatic disease or glomerulonephritis. Anatomic imaging of the urinary tract with intravenous urography and cystoscopy is often indicated in the evaluation of the patient with hematuria. When hematuria is associated with red blood cell casts and/or heavy proteinuria, think of renal parenchymal lesions, particularly of glomerular origin.     

Hematuria

The emergency physician can expect to commonly evaluate patients with hematuria, and the differential diagnosis will include both benign and life-threatening causes. This differential is divided into the following categories: glomerular or nonglomerular, coagulopathy-related, traumatic, and factitious causes. Nonglomerular causes account for the majority of hematuria evaluated in the ED, with infection and stones being the most prevalent diagnoses. Glomerular causes will have associated red cell casts and proteinuria present on urinalysis. Painless atraumatic gross hematuria in the elderly is caused by a malignancy until proven otherwise. A focused history, physical exam, and appropriate diagnostic testing in the ED usually yields a diagnosis. If the patient is discharged home, proper follow-up with the primary care physician, urologist, or nephrologist is indicated, depending upon the diagnosis.     

尿红细胞直径测量对血尿诊断的临床价值

目的　探讨一种简便、可靠的鉴别血尿来源的实验诊断方法。方法　对 5 7例血尿 (肾小球性血尿 36例 ,非肾小球性血尿 2 1例 )患儿的尿红细胞分别进行直径测定、相差显微镜检查及容积曲线测定 ,并对其鉴别血尿来源的敏感性及特异性进行了分析比较。结果　三种方法中 ,直径法无论在敏感性及特异性均优于其它两种方法。结论　尿红细胞直径测定用于鉴别血尿来源操作简便、结果可靠 ,适宜基层医院推广。     

外周血和尿液红细胞平均体积差值在血尿定位诊断中的应用

目的探讨采用血、尿中红细胞平均体积差值(ΔMCV)鉴别肾性和非肾性血尿的诊断价值。方法采用BAY-120血细胞分析仪检测100例肾小球性疾病和非肾小球性疾病患者外周血和尿中ΔMCV,计算二者之间的差值,利用受试者工作曲线(ROC曲线)确定临界值;同时应用相差显微镜观察尿液异常红细胞情况。结果肾性与非肾性血尿患者自身血和尿中ΔMCV差异有统计学意义(P<0.01),ROC曲线下面积为0.978,以ΔMCV≥10fL鉴别肾性、非肾性血尿约登指数为0.82,敏感度为92%,特异性为90%。相差显微镜法的敏感度为94%,特异性为92%,两种方法诊断血尿来源差异无统计学意义(P>0.05)。结论采用血、尿中ΔMCV鉴别肾性和非肾性血尿具有较高的敏感度和特异性,可以作为筛查血尿来源较好的诊断指标。     

尿红细胞Tamm-Horsfall蛋白检测在儿童血尿诊断中的意义探讨

目的 :探讨尿红细胞Tamm Horsfall蛋白 (THP)检测在确定血尿来源上的诊断意义。方法 :对诊断明确的 86例肾小球性血尿和 2 6例非肾小球性血尿患儿尿样本同时进行尿红细胞THP间接免疫荧光法检测和尿红细胞的形态检测 ,比较这两种确定血尿来源方法的差异。结果 :在 86例肾小球性血尿中 ,红细胞THP检测法确定肾小球性血尿 79例 ,7例与诊断不符 ,在 2 6例非肾小球性血尿中 ,红细胞THP检测法确定为非肾小球性血尿 2 4例 ,2例与诊断不符 ,灵敏度为 91 9% ,特异性为 92 3 % ,准确性为 92 0 % ,漏诊率为 8 1% ,误诊率为 7 7% ,尿红细胞的形态检测法敏感性为 77 9% ,特异性为 69 2 % ,准确性为 76 7% ,漏诊率为 2 2 1% ,误诊率为 2 2 1% ,两者在灵敏性、准确性和漏诊率上的差异有极显著意义 (P <0 0 1) ,在特异性及误诊率上的差异有显著意义 (P <0 0 5 )。结论 :尿红细胞THP检测法确定血尿来源优于红细胞形态检查法 ,值得临床上推广应用。     

血清中性粒细胞明胶酶相关载脂蛋白对过敏性紫癜早期肾损害诊断的价值

目的研究血清中性粒细胞凝胶酶载脂蛋白（NGAL）对过敏性紫癜患儿早期肾损伤诊断的价值。方法对42例过敏性紫癜患儿其中男26例、女16例,根据24h尿蛋白定量或尿红细胞分为三组：H1组（18例）：尿蛋白、尿红细胞正常;轻度肾损害组H2组（14例）：尿微量白蛋白〈40 mg/m2/h或镜下血尿;H3组（10例）：大量蛋白尿〉40 mg/m2/h;另取同期门诊健康体检患儿12例做C组对照组。每组均采用ELISA法检测患者血清NGAL（sNGAL）水平,全自动生化仪检测血肌酐及尿素氮。结果过敏性紫癜患儿血清NGAL水平随着尿蛋白排除增加而升高,各组之间比较差异均有统计学意义（P〈0.05）;血清NGAL在肌酐和尿素氮正常时就可明显升高;尿蛋白正常组和尿蛋白异常组的血清NGA水平差异有统计学意义（P〈0.05）。结论血清NGAL的测定对过敏性紫癜早期肾损伤的诊断具有良好的临床价值。     

Acanthocytes in the urine: useful tool to differentiate diabetic nephropathy from glomerulonephritis?

OBJECTIVE: The presence of hematuria has been suggested to indicate nondiabetic nephropathy in diabetic patients with proteinuria. However, hematuria is frequently found in patients with biopsy-proven diabetic glomerulosclerosis without nondiabetic nephropathy. Urine microscopy allows discrimination of glomerular hematuria, which is defined as acanthocyturia (urinary excretion of acanthocytes, which are dysmorphic erythrocytes with vesicle-like protrusions), from nonglomerular hematuria. We hypothesized that acanthocyturia is an uncommon finding in diabetic nephropathy, which suggests the presence of a nondiabetic nephropathy in diabetic patients with proteinuria. RESEARCH DESIGN AND METHODS: Urine samples of patients with the clinical diagnosis of diabetic nephropathy (n = 68), of patients with biopsy-proven glomerulonephritis (n = 43), and of age-matched healthy control subjects (n = 20) were examined by phase-contrast microscopy for the presence of hematuria (>/=8 erythrocytes/ micro l) and acanthocyturia. Acanthocyturia of >/=5% (5 acanthocytes among 100 excreted erythrocytes) was classified as glomerular hematuria; acanthocyturia of 2-4% was classified as suspected glomerular hematuria. RESULTS: Hematuria was found in 62% of patients with the clinical diagnosis of diabetic nephropathy, in 84% of patients with glomerulonephritis, and in 20% of the healthy control subjects upon a single urine examination. In contrast, glomerular hematuria occurred in 4% of patients with diabetic nephropathy and in 40% of patients with glomerulonephritis (P < 0.001). CONCLUSIONS: In contrast to hematuria, acanthocyturia is uncommon in patients with the clinical diagnosis of diabetic nephropathy. In diabetic patients with proteinuria, the finding of acanthocyturia points to nondiabetic glomerulopathies, and renal biopsy should be considered.     

球形小红细胞不均一性血尿的临床意义分析

目的探讨球形小红细胞不均一性血尿的临床意义。方法回顾性地对213例首都医科大学附属北京友谊医院非重复性球形小红细胞不均一性血尿标本的患者科室来源、临床初步诊断进行统计分析;比较临床确诊的108例肾小球疾病组和63例泌尿系感染组尿白细胞镜检、尿蛋白检查和肾功能等检查结果的差异。结果 213例标本来源主要为肾内科门诊(33.80%,72/213)、泌尿科门诊(21.60%,46/213)、肾内科病房(16.43%,35/213);197例明确诊断者以原发性肾小球疾病和泌尿系感染最为常见,分别占40.38%(86/213)和29.58%(63/213)。肾小球疾病组红细胞平均前向散射光强度(RBC-MFsc)、尿70%红细胞前散射光强度(RBC-P70 Fsc)和红细胞前散射光分布宽度(RBCFsc-DW)分别为(55.5±16.3)、(55.2±16.5)、(35.9±13.5) ch,泌尿系感染组分别为(57.2±17.2)、(57.4±16.8)、(35.2±13.1) ch,两组比较,差异无统计学意义(P>0.05)。肾小球疾病组尿干化学蛋白检查阳性率和24 h尿蛋白定量阳性(≥0.15 g/24 h)分别为95.37%(103/108)和80.56%(87/108),均显著高于泌尿系感染组(34.92%,22/63和4.76%,3/63),差异具有明显统计学意义(P<0.01);肾小球疾病组尿白细胞镜检(≥5/HP)阳性率显著低于泌尿系感染组(24.07%,26/108 vs.87.30%,55/63),差异具有明显统计学意义(P<0.01)。结论球形小红细胞不均一性血尿疾病来源广泛,结合尿白细胞镜检、尿蛋白检查等指标对其来源鉴别具有重要作用。     

Acute gram-negative urosepsis mimicking an acute hemolytic transfusion reaction

BACKGROUND: The acute hemolytic transfusion reaction (AHTR) is one of the most feared complications of blood transfusion. Over the years, several clinical conditions, as well as errors in blood component preparation and administration, that mimic AHTR have been identified. This report describes a novel variation on the theme of pseudo-AHTR. CASE REPORT: A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion. The passage of bright red urine immediately after the transfusion virtually confirmed for the clinicians administering the transfusion that an AHTR had occurred. In the laboratory, the hematuria was shown to be due principally to red cells and not to free hemoglobin. Further posttransfusion work-up showed a urinary tract infection and overwhelming bacterial sepsis with Escherichia coli. CONCLUSION: As a pseudo-AHTR, gram-negative bacterial sepsis of urinary tract origin may surpass other forms of sepsis. Urosepsis should be considered in the work-up of a suspected AHTR in a pancytopenic patient with a urinary tract infection.     

Evaluating adult hematuria.

Hematuria, the presence of an increased number of red blood cells in the urine, may be a sign of a serious underlying genitourinary disease. The causes of hematuria may be classified as systemic disorders, those involving the renal parenchyma (glomerular versus tubulointerstitial), or those involving the urinary collecting system. The history, physical examination, and microscopic urinalysis are the key elements in reaching a diagnosis. Further testing is based on these results. The primary care provider's role in hematuria evaluation involves detection, confirmation, and initiation of the evaluation process, including appropriate laboratory studies and referral as necessary. The primary care provider's prompt referral and facilitation of the hematuria evaluation is critical in achieving the best possible outcome and avoiding renal failure or the other sequelae of genitourinary disorders.     

Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations

The American Urological Association (AUA) convened the Best Practice Policy Panel on Asymptomatic Microscopic Hematuria to formulate policy statements and recommendations for the evaluation of asymptomatic microhematuria in adults. The recommended definition of microscopic hematuria is three or more red blood cells per high-power microscopic field in urinary sediment from two of three properly collected urinalysis specimens. This definition accounts for some degree of hematuria in normal patients, as well as the intermittent nature of hematuria in patients with urologic malignancies. Asymptomatic microscopic hematuria has causes ranging from minor findings that do not require treatment to highly significant, life-threatening lesions. Therefore, the AUA recommends that an appropriate renal or urologic evaluation be performed in all patients with asymptomatic microscopic hematuria who are at risk for urologic disease or primary renal disease. At this time, there is no consensus on when to test for microscopic hematuria in the primary care setting, and screening is not addressed in this report. However, the AUA report suggests that the patient's history and physical examination should help the physician decide whether testing is appropriate.