Ward J F, Kaplan G W, Mevorach R, Stock J A, Cilento B G
Department of Urology, Naval Medical Center, San Diego, California 92134-5000, USA.
J Urol. 1998 Oct;160(4):1492-5.
The use of refined microscopic urinalysis for the presence of dysmorphic red blood cells (RBCs) has been evaluated in children and adults with a known source of hematuria. We examined the clinical usefulness of this study in a pediatric population with an unknown source of hematuria.
Children 12 years old or younger referred for evaluation of asymptomatic microscopic hematuria exhibiting 4 or more RBCs per high power field were enrolled in this study. Patients provided a first morning urine sample subjected to refined urinalysis for RBC morphology. Standard evaluation of patients was performed until a final diagnosis of the hematuria source was identified.
A total of 44 patients completed the study. Refined urinalysis revealed pure dysmorphic RBCs in 22 patients, pure isomorphic RBCs in 8 and mixed isomorphic/dysmorphic RBCs in 14. The presence of dysmorphic RBCs correctly predicted a glomerulotubular source of hematuria in 29 of 36 patients (sensitivity 83%, specificity 81%), while the presence of isomorphic RBCs predicted a uroepithelial source of hematuria in 2 of 8 patients (sensitivity 25%, specificity 22%). Hematuria and 2+ proteinuria (100 mg./dl.) were more sensitive (100%) and specific (83%) than the presence of dysmorphic RBCs in predicting glomerulotubular hematuria.
We believe that this is a costly test offering little additional information to the evaluation of microscopic hematuria in children. A thoughtful history and physical examination with microscopic urinalysis and dipstick for proteinuria provide an equal amount of diagnostic information. We do not recommend its routine use in the evaluation of microscopic hematuria in children.
在已知血尿来源的儿童和成人中，对使用精细显微镜下尿液分析检测异形红细胞（RBC）的情况进行了评估。我们研究了这项检查在血尿来源不明的儿科人群中的临床实用性。
本研究纳入了12岁及以下因无症状显微镜下血尿前来评估且每高倍视野显示4个或更多红细胞的儿童。患者提供首次晨尿样本，进行红细胞形态的精细尿液分析。对患者进行标准评估，直至确定血尿来源的最终诊断。
共有44名患者完成了研究。精细尿液分析显示，22名患者为单纯异形红细胞，8名患者为单纯同形红细胞，14名患者为同形/异形红细胞混合。异形红细胞的存在在36名患者中的29名中正确预测了肾小球肾小管源性血尿（敏感性83%，特异性81%），而同形红细胞的存在在8名患者中的2名中预测了尿路上皮源性血尿（敏感性25%，特异性22%）。血尿和2+蛋白尿（100mg/dl）在预测肾小球肾小管性血尿方面比异形红细胞的存在更敏感（100%）和特异（83%）。
我们认为这项检查成本高昂，在评估儿童显微镜下血尿时几乎没有提供额外信息。详细的病史、体格检查、显微镜下尿液分析和蛋白尿试纸检测可提供等量的诊断信息。我们不建议在评估儿童显微镜下血尿时常规使用此项检查。
