Detection of glomerular bleeding by phase-contrast microscopy.

Midstream urine specimens from 303 consecutive patients with haematuria were examined with phase-contrast microscopy to determine whether the source of the haematuria could be predicted on the basis of urinary red-cell morphology. In 253 patients a definite diagnosis was made but the data for the other 50 were inadequate to allow a definite diagnosis. With phase-contrast microscopy the origin of haematuria was considered to be glomerular in 120 patients (115 had proven glomerulonephritis and 5 had lesions of the lower urinary tract) and non-glomerular in 105 patients (100 had lesions of the lower urinary tract and 5 had proven glomerulonephritis). A mixed picture of glomerular and non-glomerular red cells was seen in 28 patients, most commonly in association with IgA nephropathy and renal calculi. The assessment of urinary red-cell morphology by means of phase-contrast microscopy can add importantly to clinical information and, together with the presence of red-cell casts and protein in the urine, can help the clinician decide on initial investigations in patients with haematuria.