Crompton C H, Ward P B, Hewitt I K
Department of Nephrology, Princess Margaret Hospital for Children, Subiaco, Western Australia.
Clin Nephrol. 1993 Jan;39(1):44-9.
Urinary red cell morphology has been used to indicate the source of renal tract bleeding. A double blind study was undertaken to evaluate the reliability of urinary red cell morphology in predicting the source of hematuria in a pediatric population. Two independent observers used phase-contrast microscopy, one also using Nomarski differential interference microscopy, to examine 101 urine specimens from 90 pediatric patients with hematuria. 28 cases were subsequently excluded because the clinical diagnosis was uncertain. In the remaining 62 patients the laboratory diagnosis based on the erythrocyte morphology was compared with the primary clinical diagnosis. Observer 1 documented dysmorphic red cells in 40 of 42 patients with glomerulonephritis, and isomorphic red cells in 19 of the 20 cases of non-glomerular bleeding. Observer 2 documented dysmorphic red cells in 39 of the 42 glomerular lesions, and isomorphic red cells in all of the non-glomerular lesions. This represents a sensitivity for predicting glomerular hematuria of 95% for observer 1 and 93% for observer 2, and a specificity of 95% and 100% respectively. There was no definite advantage in the use of Nomarski compared to phase-contrast microscopy. These results confirm the accuracy of this technique in predicting the source of hematuria in pediatric patients.
尿红细胞形态已被用于指示尿路出血的来源。开展了一项双盲研究，以评估尿红细胞形态在预测儿科人群血尿来源方面的可靠性。两名独立观察者使用相差显微镜进行检查，其中一人还使用诺马斯基微分干涉显微镜，对90例血尿儿科患者的101份尿液标本进行检查。随后排除了28例，因为临床诊断不明确。在其余62例患者中，将基于红细胞形态的实验室诊断与初步临床诊断进行比较。观察者1记录到，42例肾小球肾炎患者中有40例存在异形红细胞，20例非肾小球性出血患者中有19例存在同形红细胞。观察者2记录到，42例肾小球病变中有39例存在异形红细胞，所有非肾小球病变中均存在同形红细胞。这表明观察者1预测肾小球性血尿的敏感性为95%，观察者2为93%，特异性分别为95%和100%。与相差显微镜相比，使用诺马斯基显微镜并没有明显优势。这些结果证实了该技术在预测儿科患者血尿来源方面的准确性。
