Cytomorphological Features Of Urinary Erythrocytes Of Glomerular Disease And The Clinical Use

Objective:Observing the cytomorphological features of urinary erythrocytes of glomerular disease and analyze the relevant parameters (the size and the shape of erythrocytes) with renal biopsy result, to investigate the relationship between them and the clinical value of it.Method:115 patients with biopsy-proven glomerular disease were enrolled in the prospective study. All of them were initially diagnosed with glomerular disease from October 2014 to October 2015 in PLA General Hospital. Urine samples of patients were collected in each case before they had renal biopsy, after samples be tested, the cytomorphological features of urinary erythrocytes and the relevant parameters would be analyze.Results:1. The total number of cases collected was 115.Among these cases,87 cases have primary glomerular disease (membranous nephropathy 41 cases, IgA nephropathy 28 cases, minimal change nephropathy 10 cases, and other primary glomerular disease 8 cases),28 cases have secondary glomerular disease (diabetic nephropathies 13 cases, lupus nephritis 5 cases, hypertensive renal damage 4 cases, and other secondary glomerular disease 6 cases).2. Acanthocyturia is a more common finding in primary glomerular disease than in secondary glomerular disease(42.53% vs 17.86%, P=0.018); Acanthocyturia range from 0 to 50% in primary glomerular disease, and 0 to 20% in secondary glomerular disease.3. Logistic regression showed that mesangial hypercellulary was related to the presence of acanthocytes (P=0.034).4. Acanthocyturia of≥5% was found in 14.29% of patients with the mesangial mild hypercellulary(MO) of IgA nephropathy, in 66.67% of patients with the mesangial severe hypercellulary(M1) of IgA nephropathy(P=0.036). The percentage of acanthocytes in M1 have a wider range than MO.5. Acanthocyturia of<5% was a common observation in membranous nephropathy with GBM moderately thickening, differs from that in GBM mild thickening or severe thickening; Acanthocyturia of< 10% was a common observation in membranous nephropathy with vacuolar degeneration and (or not) rete pegs, and of <20% was a common observation in membranous nephropathy with railroad track sign.6. Glomerular hematuria was a frequent finding in 95% patients with primary glomerular disease, mixed hematuria was finding in other 5%. At the same time, glomerular hematuria, mixed hematuria, and non-glomerular hematuria all can be found in patients with secondary glomerular disease(62.5%,25%,12.5%).7. Acanthocyturia occurred in 95.24% of patients with glomerular hematuria and in 4.76% of patients with mixed hematuria, acanthocyturia is uncommon in patients with non-glomerular hematuria. Acanthocytes are always showed with other glomerular erythrocyte.8. The picture of size-shape phase were classified as strip-type, inverted triangle-type, hanging tail-type and scatter diagram type. The occurence rate of 4 kinds of size-shape phase in primary glomerular disease differs from that in secondary glomerular disease(P=0.009). All kinds of size-shape phase can be found in primary glomerular disease, only strip-type and hanging tail-type can be found in secondary glomerular disease.9. In patients with primary glomerular disease, strip-type is a common observation in in patients with membranous nephropathy (86.36%). The occurrence rate of inverted triangle-type, hanging tail-type and strip-type are 38.10%,28.57%and 23.81% in patients with IgA nephropathy, respectively.Conclusion:1. The occurrence rate of acanthocyturia in primary glomerular disease is higher than in secondary glomerular disease. The percentages of acanthocytes in primary glomerular disease have a wider range than in secondary glomerular disease.2. Mesangial hypercellulary in patients with glomerular disease is a very influential factor of the occurrence rate of acanthocyturia, particularly in the patients with the mesangial severe hypercellulary.3. Acanthocyturia of IgA nephropathy patients with mesangial severe hypercellulary often>5%,and was easily diagnosed as glomerular hematuria, and in patients with mesangial mild hypercellulary, the lower occurrence rate of acanthocyturia may go unnoticed.4. Lower percentages of acanthocytes often appeared in membranous nephropathy patients with GBM moderately thickening and immune complexes moderate deposited in the mesangium. When Acanthocyturia of≥20% was observed in membranous nephropathy, it tends to indicate severe thickening of GBM and immune complex severely depositing.5. Only after exposed to different osmotic pressure solution and hemolysis environment, can the acanthocytes be found. It tends to indirectly indicate pathological change of glomerular filtration barrier.6. The mainly size-shape phases of patients with primary glomerular disease are strip-type and inverted triangle-type, the mainly size-shape phases of patients with secondary glomerular disease is hanging tail-type. In patients with primary glomerular disease, strip-type and inverted triangle-type are common observation in patients with membranous nephropathy and with IgA nephropathy, respectively...