Four cases of rapidly progressive glomerulonephritis with difficulty in the detection of glomerular-type red blood cells on urinary sediment examination

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  • HATTORI Ryosuke
    Department of Clinical Laboratory, Nihon University Surugadai Hospital
  • HARA Mitsuo
    Department of Clinical Laboratory, Nihon University Surugadai Hospital
  • ANDO Hidemi
    Department of Clinical Laboratory, Nihon University Surugadai Hospital
  • MIKAMI Chiaki
    Department of Clinical Laboratory, Nihon University Surugadai Hospital
  • SATOYOSHI Kazuya
    Department of Clinical Laboratory, Nihon University Surugadai Hospital
  • ARAKI Hideo
    Department of Clinical Laboratory, Nihon University Surugadai Hospital

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Other Title
  • 尿沈渣検査において糸球体型赤血球の判定が困難であった4例の急速進行性糸球体腎炎
  • ニョウチンサケンサ ニ オイテ シキュウ タイケイ セッケッキュウ ノ ハンテイ ガ コンナン デ アッタ 4レイ ノ キュウソク シンコウセイ シキュウタイジンエン

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Abstract

<p>Rapidly progressive glomerulonephritis (RPGN) is a condition of the kidney characterized by a rapid loss of renal function with acute or subclinical gross hematuria or proteinuria. On urinary sediment examination, glomerular hematuria due to glomerulonephritis and other conditions often shows various types of cast, including glomerular-type red blood cells (RBCs) and RBC cast. We encountered four cases of RPGN with difficulty in the detection of glomerular-type RBCs on urinary sediment examination. Their common findings include: (1) a mixture of RBCs in a dehemoglobin status, with little variety and difference in size in the overall pattern of appearance; (2) the appearance of various types of cast, including RBC cast, granular cast, and wax cast; (3) a marked decline in renal function, as indicated by a low estimated glomerular filtration rate (eGFR); and (4) strong positivity for protein and occult blood in qualitative urinary examination. In two cases, morphological information on RBCs (RBC-Info.) of UF-1000i (Sysmex) was “Mixed?”. On the basis of these results, it was possible to infer the pathogenesis and suspect glomerular hematuria. With severely impaired renal function, the RBC morphology in the urinary sediment may not show any change despite glomerular hematuria, and care should be taken in determining the RBC morphology. In addition, if glomerular hematuria is suspected on the basis of the pattern of the urine sediment image (RBC morphology, appearance of various types of cast) and other test results, it is important to perform a detailed speculum examination considering the possibility of appearance of a few RBC casts associated with glomerular hematuria.</p>

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