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Diagnostic value of urinary dysmorphic erythrocytes in clinical practice.
MedLine Citation:
PMID:  20413998     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: In clinical practice, discriminating between glomerular and nonglomerular causes of hematuria is often difficult. Dysmorphic red blood cells (dRBC) in the urinary sediment are claimed to be effective, but the cutoff points in the literature vary. This follow-up study aimed to determine the diagnostic value of dRBC. METHODs: We investigated 134 hematuria patients in the departments of nephrology and urology. To diagnose the origin of hematuria, urological and/or nephrological examination was performed and the %dRBC identified by microscopy. Follow-up was performed after 3.5 years.
RESULTS: The cause of hematuria was proven in 68 patients (35% glomerular; 65% nonglomerular). Patients with glomerular disease had significantly more albuminuria and dRBC than patients with nonglomerular disease, but the %dRBC ranged from 1 to 50% and no optimal cutoff could be identified. Logistic regression analysis showed that %dRBC had a predicted probability to diagnose glomerular disease of 77.9% (area under the curve, AUC, 0.85). When %dRBC was combined with other risk factors such as serum creatinine, sex, age, dipstick erythrocyte or proteinuria score and number of casts, the predictive probability increased to 90.6% (AUC 0.97). Follow-up of the included patients showed no benefit of dRBC to identify patients at risk for glomerular disease.
CONCLUSIONS: The diagnostic value of routinely collected urinary dRBC to diagnose glomerular disease in patients presenting with hematuria is modest. However, including dRBC with other variables, such as age and erythrocyte score on dipstick testing may increase the sensitivity, but needs to be confirmed in another, preferably larger, population.
Authors:
Meindert J Crop; Yolanda B de Rijke; Paul C M S Verhagen; Karlien Cransberg; Robert Zietse
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-04-23
Journal Detail:
Title:  Nephron. Clinical practice     Volume:  115     ISSN:  1660-2110     ISO Abbreviation:  Nephron Clin Pract     Publication Date:  2010  
Date Detail:
Created Date:  2010-07-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101159763     Medline TA:  Nephron Clin Pract     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  c203-12     Citation Subset:  IM    
Copyright Information:
Copyright 2010 S. Karger AG, Basel.
Affiliation:
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
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