| [Objective]The purpose of this investigation is to evaluate the clinical application of phase-contrast microscopy and UF-100 in the localization of the sites of hematuria.[Methods]We selected 152 patients with hematuria from the wards of nephrology and urology.101 patients were diagnosed as glomerular diasese by kidney biopsy, including 45 male and 56 female patients.Through the examination of serum,urine, imagin and cystoscope(if necessary),52 patients were diagnosed as non-glomerular disease,including 33 male patients and 18 female patients.Patients who may have both glomerular and nonglomerular disease were excluded.All patients had gross or microscopic hematuria.They were examined by both phase-contrast microscopy and automated urine flowmetry(UF-100) using the same urine sample.Fresh midstream urine samples of first morning urine were obtained from each patient.81 glomerular and 13 non-glomerular disease patients had the urine tests for three times(including one second morning urine).Under microscopy the urine erythrocytes were classified into 10 shapes including large discocytes,small discocytes,echinocytes,anulocytes, ghost cells,schizocytes,codocytes,stomatocytes,knizocytes and acanthocytes.The first 5 type of erythrocyte shapes were defined as isomorphic erythrocytes,and the latters were dysmorphic erythrocytes.UF-100 classified hematuria as isomorphic, dysmorphic and mixed type.These results were compared to the patients' clinical or pathologic diagnosis as golden standard.We used the receiver operating characteristic (ROC) curve analysis to find out the most valuable urine erythrocyte morphology to localize the source of hematuria.We also analyzed the influential factor of urine erythrocyte morphology. [Results]1.The percentages of the 5 dysmorphic erythrocytes in the group of glomerular hematuria were all higher than those in the nonglomerular hematuria group (P＜0.05).Ancanthocytes are the most common cells among all the dysmorphic erythrocytes(5(1～19)/100RBC vs.0(0～0)/100RBC,P=0.000).The percentage of all the dysmorphic erythrocytes in the group of glomerular hematuria was also higher than that in the nonglomerular hematuria group(17(4～31)/100RBC vs.0(0～2)/100RBC, P=0.000).If the percentage of acanthocytes higher than 2%or percentage of total dysmorphic erythrocytes higher than 8%were used for the diagnosis of glomerular hematuria,sensitivity and specificity were 77.2%and 90.2%,positive and negative predictive value were 84%and 66.7%.Repeating the test of phase-contrast microscopy for three times,the sensitivity was raised to 95.7%.2.With regard to UF-100 if the dysmorphic erythrocyte type was considered as the source of glomerular hemturia,isomorphic erythrocyte type was classified as the source of nonglomerular hematuria,the sensitivity and specificity of UF-100 were 88.2%and 52.9%,positive and negative predictive value were 91.2%and 93.1%.If both the dysmorphic and mixed type of erythrocytes were considered as the source of glomerular hemturia,the sensitivity of UF-100 was raised to 97%.3.There was no significant difference between the first and second morning urine in the number and morphology of urine erythrocytes,osmotic pressure and pH.The osmotic pressure in the glomerular and nonglomerular hematuria group was 543.09±186.72mOsm and 537.39±179.49mOsm(P＞0.05).Linear correlation showed that the osmotic pressure didn't have significant impact on the morphology of the urine eythrocytes.Echinocytes were positive correlated with pH(r=0.4,P＜0.001) while ancanthocytes were negative correlated with pH(r=-0.3,P＜0.001).When pH is lower than 6.5,sensitivity of phase-contrast microscopy in the diagnosis of glomerular disease was raised obviously(89.4%vs.54.3%,P=0.000),but no difference was found in the specificity(86.4%vs.93.1%,P＞0.05).PH of the urine didn't have impact on the red cell information of UF-100.The severity of hematuria had no impact on the diagnostic result of phase-contrast microscopy.But while urine RBC＜100/ul,the specificity of UF-100 in the diagnosis of glomerular disease was lowered(25.0%vs. 65.7%,P=0.007).Nonglomerlular hematuria was easily misdiagnosed as mixed or negative result.Except for urine pH,other factors such as urine calcium,renal funcetion and blood glucose didn't have much effect on the urine erythrocytes especially the acanthocytes. 4.If the phase-contrast microscopy and UF-100 were combined under the algorithm mentioned in this research,the sensitivity and specificity were raised to 94.2%and 93.8%.[Conclusion]Both phase-contrast microscopy and UF-100 are the useful method to evaluate the source of hematuria.Combination of UF-100 and phase-contrast microscopy can improve the diagnosis of hematuia.The pH value of urine has significant impact on the morphology of erythrocytes. |
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