Rol de la hematuria dismórfica en las enfermedades glomerulares

The analysis of urine sediment is a tool that has been used for many years in clinical practice to evaluate kidney diseases. De-ecting dysmorphic red blood cells (RBC’s) in urine is useful for the diagnosis of glomerular diseases. Objetives: To divide the cases of glo-merular hematuria into two groups, depending on the presence or absence of acanthocytes, and to compare this factor with the histological fin-dings of renal biopsies. Methods: In this obser-vational, retrospective, analytical study, urine sediments of 276 patients were included. Two groups of subjects with glomerular hematuria were analyzed: D1 (presence of acanthocytes) and D2 (absence of acanthocytes). The results were compared with the renal biopsy histological findings, i.e. proliferative glomerulonephritis and non-proliferative glomerulonephritis, consi-dered separately. The formed elements of the uri-ne (red blood cell, white blood cell, waxy, granu-lar and fatty casts), plasma creatinine concen-tration and 24-hour urinary protein were tested in the two groups. A logistic regression analysis was later performed to assess the independent variables among urine sediment findings, with the corresponding odds ratio (OR) and confi-dence intervals (CI 95%). Results: The samples were collected from 172 women (62.3 %) and 104 men (37.7 %). The presence of acanthocytes (D1) was 17 times more frequent in proliferative glomerulonephritis (PGN) than in non-proli-ferative glomerulonephritis (NPGN) [OR 17.7, CI 95% (9.6-32.5), p 0.001]. The presence of red blood cell casts was 8 times more frequent in PGN [OR 8, CI 95% (3.1-20.9)]. Cases of he-maturia with no acanthocytes (D2) were 5 times more frequent in NPGN [OR 5.2, CI (2.4-11.3), p 0.001]. Fatty casts appeared more frequently in patients with NPGN, whereas white blood cell casts were more common in PGN cases. Conclusions: Renal histological findings revea-led a significant correlation between glomerular hematuria without acanthocytes (D2) and non-proliferative glomerulonephritis (NPGN), while the presence of acanthocytes and red blood cell casts was associated with proliferative glomerulo-nephritis (PGN). The existence of acanthocytes in urine constitutes a useful tool to make a cli-nical distinction between these two conditions, but it does not replace renal biopsy to establish an accurate diagnosis and prognosis. Introducción: El sedimento de orina es una herramienta en la práctica clínica empleada desde hace muchos años para la evaluación de e