A new morphological classification of urinary erythrocytes for differential diagnosis of glomerular hematuria.

A new morphological classification of urinary erythrocytes was instituted in order to differentiate glomerular from urological hematuria. One hundred and thirteen hematuric patients including 73 glomerular and 40 urological disease patients were examined. The former group consisted of IgA nephropathy (n = 45), lupus nephritis (6), membrano-proliferative glomerulonephritis (5), non-IgA mesangial proliferative glomerulonephritis (4), Henoch-Schoenlein purpura nephritis (4), membranous nephropathy (4), endocapillary proliferative glomerulonephritis (3), and minimal change nephrotic syndrome (2). The latter group included bladder cancer (n = 15), renal calculi (15), prostate cancer (3), urethral cancer (1) and post-transurethral resection (6). In each urine sample, 100 urinary erythrocytes were observed under differential interference microscopy and classified into 10 concretely defined shapes (5 "glomerular" and 5 "urological" shapes) and unclassified shapes. Using percentage of "glomerular" shape erythrocytes and setting the cut-off at 15%, 90.4% of sensitivity and 97.5% of specificity for the diagnosis of glomerular disease were obtained. When percentage of one specific shape (G1), [i.e. doughnut-like cell with one or more blebs] was used at a cut-off of 1%, sensitivity and specificity were 89.0% and 95.0% respectively. These results were satisfactory as compared with most previous reports. Moreover, our classification is so concrete that it is more objective, accurate, and easily understandable, even for beginners. Distinct shape "G1" is particularly important for morphological investigation of hematuria.