Marcussen N, Schumann J L, Schumann G B, Parmar M, Kjellstrand C
Department of Pathology, University of Alberta Hospital, Edmonton, Canada.
Am J Kidney Dis. 1992 Dec;20(6):618-28. doi: 10.1016/s0272-6386(12)70229-9.
We investigated the value of cytodiagnostic urinalysis in detecting and scoring the severity of the four types of renal lesions (glomerular, interstitial, tubular, and vascular). Both cytodiagnostic urinalysis and concurrent renal biopsy were performed in 77 patients (47 from native kidneys and 30 from transplants) and the scoring and findings assessed in a double-blinded fashion. Evaluation of the reproducibility for the counting of renal cells showed a low intraobserver and interobserver variation. Cytodiagnostic urinalysis correlated with the renal biopsy with respect to primary lesions in 42 (89%) of the native kidney cases, and in 23 (77%) of the transplant kidney cases. The accuracy of diagnosis of glomerular lesions in both native and transplanted kidneys was 0.91, and for acute rejection in transplanted kidneys, the accuracy of diagnosis was 0.73. Severity scores showed good correlation between cytodiagnostic urinalysis and renal biopsy in both transplanted and in native kidneys and cytodiagnostic urinalysis correlated well with the increase in creatinine levels. The most important components of cytodiagnostic urinalysis for the diagnosis of glomerular lesions were dysmorphic erythrocytes and proteinuria. The specificity and sensitivity of dysmorphic erythrocytes for a glomerular lesion were 0.89 and 0.88, respectively. In cases with biopsy-proven glomerular lesions, more severe changes were found by cytodiagnostic urinalysis when the biopsy showed proliferative lesions in the glomeruli than when normal glomeruli were found by light microscopy. Cytodiagnostic urinalysis has the advantage over renal biopsy that it can be repeated as often as necessary and thus allows observation of the development or regression of the renal lesion over time. We conclude that cytodiagnostic urinalysis is well correlated with the renal biopsy and that it provides valuable and quantitative information regarding the disease process in the kidney.
我们研究了细胞诊断性尿液分析在检测和评估四种类型肾损伤（肾小球、间质、肾小管和血管）严重程度方面的价值。对77例患者（47例来自自体肾，30例来自移植肾）同时进行了细胞诊断性尿液分析和肾活检，并采用双盲方式评估评分和结果。肾细胞计数的可重复性评估显示观察者内和观察者间的差异较低。在42例（89%）自体肾病例和23例（77%）移植肾病例中，细胞诊断性尿液分析与肾活检在原发性病变方面具有相关性。自体肾和移植肾中肾小球病变的诊断准确性均为0.91，对于移植肾急性排斥反应，诊断准确性为0.73。严重程度评分显示，在移植肾和自体肾中，细胞诊断性尿液分析与肾活检之间具有良好的相关性，并且细胞诊断性尿液分析与肌酐水平的升高具有良好的相关性。细胞诊断性尿液分析诊断肾小球病变的最重要组成部分是畸形红细胞和蛋白尿。畸形红细胞对肾小球病变的特异性和敏感性分别为0.89和0.88。在经活检证实为肾小球病变的病例中，当活检显示肾小球有增殖性病变时，细胞诊断性尿液分析发现的变化比光镜下发现正常肾小球时更为严重。细胞诊断性尿液分析相对于肾活检的优势在于它可以根据需要多次重复进行，从而能够观察肾损伤随时间的发展或消退情况。我们得出结论，细胞诊断性尿液分析与肾活检具有良好的相关性，并且它提供了有关肾脏疾病过程的有价值的定量信息。
