Clinical Chemistry
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Clinical Chemistry 33: 1791-1795, 1987;
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Clinical Chemistry, Vol 33, 1791-1795, Copyright © 1987 by American Association for Clinical Chemistry

Differentiation of renal from non-renal hematuria by microscopic examination of erythrocytes in urine

TJ Pillsworth Jr, VM Haver, CK Abrass and CJ Delaney
Department of Laboratory Medicine, Veterans Administration Medical Center, University of Washington, Seattle 98195.

Recent studies indicate that hematuria of renal parenchymal origin can be differentiated from hematuria of other origin by the presence of dysmorphic urinary erythrocytes (cells exhibiting irregular membranes or small surface blebs). We investigated the utility of this simple screening assay in a routine clinical laboratory. Dysmorphic erythrocytes in urine from 69 patients (18 with renal-parenchymal disease) were quantified on unstained slides by medical technologists using phase-contrast microscopes. Samples stored at 4 degrees C or 23 degrees C for up to 5 h had no significant changes in percentages of dysmorphic erythrocytes (PDE). PDE was also not modified by urea nitrogen concentration, osmolality, or pH over the physiological ranges of these variables. Receiver-operating characteristic (ROC) curves indicated an optimal sensitivity of 88% and specifity of 94% at a decision level of 14% dysmorphic erythrocytes per high-power field. Thus, the presence of fewer than 14% dysmorphic cells is suggestive of extra-renal disease; more than 14% is suggestive of intra-renal disease.


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J. M. Sutton
Evaluation of Hematuria in Adults
JAMA, May 9, 1990; 263(18): 2475 - 2480.
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Copyright © 1987 by the American Association for Clinical Chemistry.