Stark Anabella, Kanduri Swetha R, Ramanand Akanksh, Rosenbloom Sarah, Varghese Vipin, Chalmers Dustin R, Velez Serenella A, Gonzalez-Fuentes Carolina, Wickman Terrance J, Mohamed Muner, Shueib Ali, Zarm Ayaa, Lukitsch Ivo, Velasco-Gonzalez Cruz, Seltzer Jay R, Velez Juan Carlos Q
Department of Nephrology, Ochsner Health, New Orleans, LA, USA.
Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia.
Glomerular Dis. 2025 Apr 10;5(1):206-218. doi: 10.1159/000545051. eCollection 2025 Jan-Dec.
Reports on the performance of glomerular hematuria for the diagnosis of glomerulonephritis (GN) show heterogeneity in the results and used urological pathologies as controls. We hypothesized that identification of urinary acanthocytes (uACANTHO) and/or urinary red blood cell casts (uRBCCs) by comprehensive microscopic examination of the urinary sediment (uMICRO) can differentiate glomerular disease from non-glomerular renal pathology.
Records of patients seen for consultation for acute kidney injury or proteinuria/hematuria who had specimens examined by uMICRO and a kidney biopsy performed within 2 weeks of uMICRO were extracted. We assessed the sensitivity (SENS), specificity (SPEC), and positive and negative predictive value (PPV, NPV) of uACANTHO and/or uRBCC for the diagnosis of biopsy-proven GN or for any glomerulopathy (GP).
Of 915 patients who completed uMICRO, 276 patients were included (mean age 53, 54% women). Median serum creatinine was 3.5 mg/dL. A total of 219 (79%) were categorized as GP, whereas 57 (21%) had non-GP diagnosis (e.g., tubular). Within the GP category, 114 (41%) had GN (e.g., IgA nephropathy, pauci-immune GN), whereas 105 (38%) had non-GN GP (e.g., podocytopathies). The SENS, SPEC, PPV, and NPV of uACANTHO for diagnosing GN were 68%, 86%, 78%, and 79%, respectively, whereas for GP SENS, SPEC, PPV, and NPV were 45%, 100%, 100%, and 32%, respectively. For GN, combining uACANTHO and/or uRBCC resulted in improvement of the SENS, SPEC, PPV, and NPV to 75%, 86%, 79%, and 83%, respectively. Either uACANTHO or uRBCC were found in 47/51 (92%) cases of crescentic/necrotizing GN.
Identification of glomerular hematuria by uMICRO aids in the diagnosis of GN. Combining the identification of uACANTHO and uRBCC enhances the diagnostic yield of uMICRO for GN and offers good NPV for crescentic/necrotizing GN. uACANTHO are pathognomonic for GP.
关于肾小球性血尿在肾小球肾炎（GN）诊断中的表现的报告显示结果存在异质性，且将泌尿系统疾病作为对照。我们假设通过对尿沉渣进行全面显微镜检查（uMICRO）来识别尿棘形红细胞（uACANTHO）和/或尿红细胞管型（uRBCC）可以区分肾小球疾病与非肾小球性肾脏病变。
提取因急性肾损伤或蛋白尿/血尿前来咨询且接受了uMICRO检查并在uMICRO检查后2周内进行了肾活检的患者记录。我们评估了uACANTHO和/或uRBCC对经活检证实的GN或任何肾小球病（GP）诊断的敏感性（SENS）、特异性（SPEC）以及阳性和阴性预测值（PPV、NPV）。
在915例完成uMICRO检查的患者中，纳入了276例患者（平均年龄53岁，54%为女性）。血清肌酐中位数为3.5mg/dL。共有219例（79%）被归类为GP，而57例（21%）诊断为非GP（如肾小管疾病）。在GP类别中，114例（41%）患有GN（如IgA肾病、寡免疫性GN），而105例（38%）患有非GN的GP（如足细胞病）。uACANTHO诊断GN的SENS、SPEC、PPV和NPV分别为68%、86%、78%和79%，而诊断GP的SENS、SPEC、PPV和NPV分别为45%、100%、100%和32%。对于GN，联合uACANTHO和/或uRBCC可使SENS、SPEC、PPV和NPV分别提高到75%、86%、79%和83%。在51例新月体性/坏死性GN病例中，47例（92%）发现了uACANTHO或uRBCC。
通过uMICRO识别肾小球性血尿有助于GN的诊断。联合识别uACANTHO和uRBCC可提高uMICRO对GN的诊断率，并为新月体性/坏死性GN提供良好的NPV。uACANTHO是GP的特征性表现。
