Glomerular Hematuria and the Utility of Urine Microscopy: A Review

医学 肾小球肾炎 镜下血尿 狼疮性肾炎 病理 肾病 肾脏疾病 抗中性粒细胞胞浆抗体 蛋白尿 肾活检 肾脏病理学 间质性肾炎 血管炎 内科学 活检 疾病 内分泌学 糖尿病
作者
Manish K. Saha,David Massicotte‐Azarniouch,Monica L. Reynolds,Amy K. Mottl,Ronald J. Falk,J. Charles Jennette,Vimal K. Derebail
出处
期刊:American Journal of Kidney Diseases [Elsevier]
卷期号:80 (3): 383-392 被引量:24
标识
DOI:10.1053/j.ajkd.2022.02.022
摘要

Evaluation of hematuria and microscopic examination of urine sediment are commonly used tools by nephrologists in their assessment of glomerular diseases. Certain morphological aspects of urine red blood cells (RBCs) seen by microscopy may help in identifying the source of hematuria as glomerular or not. Recognized signs of glomerular injury are RBC casts or dysmorphic RBCs, in particular acanthocytes (ring-shaped RBCs with protruding blebs). Despite being a highly operator-dependent test, urine sediment examination revealing these signs of glomerular hematuria has demonstrated specificities and positive predictive values ranging between 90%-100% for diagnosing glomerular disease, although sensitivity can be quite variable. Hematuria is a commonly used tool for diagnosing patients with proliferative glomerulonephritis such as IgA nephropathy, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and lupus nephritis, sometimes even as a surrogate for kidney involvement. Studies examining the role for hematuria in monitoring and predicting adverse outcomes in these diseases have shown inconsistent results, possibly due to inconsistent definitions that often fail to consider specific markers of glomerular hematuria such as dysmorphic RBCs, acanthocytes, or RBC casts. A consensus definition of what constitutes glomerular hematuria would help standardize use in future studies and likely improve the diagnostic and prognostic value of hematuria as a marker of glomerulonephritis.
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