A new technique to localize the origin of idiopathic microscopic hematuria

Clinical prevalence of glomerular hematuria: a nine-year retrospective study

The authors evaluated red blood cell (RBC) morphology by phase contrast microscopy and identified casts and lipidic material in 4,448 urine sediments (US). Microhematuria was discovered on systematic examination in 1,186 apparently healthy patients (group I). Another 4,362 patients (group II) with microscopic or gross hematuria were being treated or evaluated for various renal or extrarenal diseases (renal transplantation excepted). Glomerular hematuria (GH) was observed in 93.1% of group I patients and in 58.0% of group II patients. GH and non-GH were observed together in 0.6% of cases. The origin of hematuria remained uncertain in 11.6% of cases. In GH, the other cytological findings were as follows: RBC casts were seen in 5.3% of group I and 20.5% of group II; granular and/or cellular casts were seen in 12.8% of group I and 39.6% of group II; and lipidic material was seen in 0.6% of group I and 8.8% of group II. Both groups showed a higher frequency of RBC casts, granular and/or cellular casts, and lipidic material in patients under 20. This method of investigation of urine, which is simple, rapid, inexpensive, and noninvasive, provides useful information for the clinician and avoids unnecessary investigations.

Value of urinary erythrocyte morphology in assessment of symptomless microhaematuria

To assess the value of microscopic analysis of urinary erythrocyte morphology as the initial step in the investigation of patients with isolated symptomless microhaematuria, 316 consecutive patients were grouped according to whether they excreted eumorphic or mixed forms of erythrocytes or only dysmorphic forms. The former group was investigated fully, and urological disease was found in 85% of 123 patients. The 192 patients with exclusively dysmorphic erythrocytes in their urine and normal renal function (benign renal microhaematuria) were assigned to annual follow-up examinations of urinary red cell morphology and renal function, and subjected to invasive diagnostic procedures when a change was noted. In only 2 of the 132 patients followed up for at least 2 years did a new disease develop; this was easily identified at one of the annual examinations. Microscopic analysis of urinary erythrocyte morphology is therefore an effective method for identifying patients with symptomless microhaematuria needing specific diagnostic investigation.

Isolated asymptomatic hematuria in the adult

The term "isolated asymptomatic hematuria," as it relates to both gross and microscopic hematuria, is defined; and the pros and cons of detection techniques used to localize the source of the hematuria are discussed. An algorithm is provided to optimize detection of structural defects and intrinsic renal disease in an effort to avoid subjecting the patient with this difficult-to-diagnose problem to unnecessary invasive tests. Although invasive tests should be performed where deemed necessary in the clinician's aggressive search to detect any structural abnormality, controversial areas of the evaluation of these patients are addressed. To justify various branch points of the algorithm, a discussion of both renal cell carcinoma and primary renal hematuria is proffered.