Glomerular Hematuria and the Utility of Urine Microscopy: A Review.
Am J Kidney Dis
; 80(3): 383-392, 2022 09.
Article
em En
| MEDLINE
| ID: mdl-35777984
ABSTRACT
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.
Palavras-chave
ANCA-associated vasculitis (AAV); Acanthocytes; IgA nephropathy (IgAN); RBC casts; anti-neutrophil cytoplasmic antibody (ANCA); dysmorphic RBC; glomerular disease; hematuria; liquid biopsy; lupus nephritis (LN); nephritic syndrome; red blood cell (RBC); review; sensitivity and specificity; urine microscopy
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos
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Glomerulonefrite
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Glomerulonefrite por IGA
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article