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Diagnostic impact of dysmorphic red blood cells on evaluating microscopic hematuria: the urologist's perspective.

 Kyo Chul Koo  ;  Kwang Suk Lee  ;  Ah Ran Choi  ;  Koon Ho Rha  ;  Sung Joon Hong  ;  Byung Ha Chung 
 International Urology and Nephrology, Vol.48(7) : 1021-1027, 2016 
Journal Title
 International Urology and Nephrology 
Issue Date
Aged ; Cohort Studies ; Erythrocyte Count ; Erythrocytes, Abnormal/pathology* ; Female ; Hematuria/blood ; Hematuria/diagnosis* ; Humans ; Kidney Diseases/diagnosis* ; Kidney Diseases/epidemiology ; Kidney Glomerulus/pathology* ; Kidney Glomerulus/physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Urologists
Dysmorphism ; Erythrocytes ; Guideline ; Hematuria ; Neoplasms
PURPOSE: Dysmorphic red blood cells (dRBCs) are indicative of glomerular disease and considered a first step in evaluating microscopic hematuria (MH). The predominance of dRBCs does not preclude urological disease; however, some contemporary guidelines advise nephrological evaluation without further urological evaluation, in contrast to the American Urological Association guideline. We investigated the feasibility and safety of omitting urological evaluation in patients presenting with MH. METHODS: A retrospective analysis was performed on 411 consecutive patients who presented with MH between January 2012 and December 2014. MH was defined as ≥3 RBCs per high-power field. All patients received full urological and nephrological evaluations including history and physical assessment, renal function, urine cytology, %dRBC, cystoscopy, computed tomography (CT) imaging, and renal biopsy when indicated. RESULTS: The median %dRBC was higher in patients with glomerular disease than in those with urological disease (40.4 vs. 21.1 %; p < 0.001). Among patients exhibiting %dRBC ≥ 40, 33/97 (34.0 %) had urological and 28/97 (28.9 %) had glomerular diseases. Urological diseases included 9/33 (27.3 %) clinically meaningful malignancies and 17/33 (51.5 %) conditions requiring immediate treatment. The rate of malignancy was comparable between %dRBC groups (p = 0.087). Among patients with final diagnoses who exhibited %dRBC ≥ 40, 32/61 (52.5 %) treatment-requiring conditions would have been unrecognized had cystoscopy and/or CT not been performed. For predicting glomerular disease, the presence of proteinuria demonstrated higher AUC than %dRBC ≥ 40 (0.77 vs. 0.65; p < 0.001). CONCLUSIONS: Identification of %dRBC ≥ 40 had modest diagnostic value in identifying glomerular disease, and concomitant presence of proteinuria was more indicative of glomerular origin in patients presenting with MH. Urological evaluation should not be omitted in these patients considering the prevalence of treatment-requiring urological disease.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
구교철(Koo, Kyo Chul) ORCID logo https://orcid.org/0000-0001-7303-6256
나군호(Rha, Koon Ho) ORCID logo https://orcid.org/0000-0001-8588-7584
이광석(Lee, Kwang Suk) ORCID logo https://orcid.org/0000-0002-7961-8393
정병하(Chung, Byung Ha) ORCID logo https://orcid.org/0000-0001-9817-3660
최아란(Choi, Ah Ran)
홍성준(Hong, Sung Joon) ORCID logo https://orcid.org/0000-0001-9869-065X
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