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Análise comparativa de duas metodologias para a identificação de cilindros hemáticos urinários. Carmen Antonia Sanches ItoI; Roberto Pecoits-FilhoII; Larissa. Vasculitis/ glomerulonefritis, Enfermedad multisistémica o clínica compatible, Cilindros hemáticos o granulosos, hematíes dismórficos, proteinuria, C3, ANCA, . English term or phrase: RBC casts. Portuguese translation: cilindros hemáticos. Entered by: Michele Bittencourt.

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Comparative analysis of two methodologies for the identification of urinary red blood cell casts. Dysmorphic red blood cells RBCs in the urine are a strong indicator of hdmaticos glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria.

This study tested the superiority of a urine concentration technique CT over the standard method SM for RBC cast identification in a group of patients suspected of glomerular hematuria.

Of a total of 4, routine urinary samples, with dysmorphic hematuria were selected. The samples were processed according to two techniques: The percentages of RBC cast identification hematios to each method were compared. We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded.

The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification cilincros glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.

Dysmorphic red blood cells. Red blood cell casts. The presence of dysmorphic red blood cells RBCs in the urine is a strong indicator of a glomerular source for the bleeding, being an important tool for the diagnosis of glomerulonephritides.

In addition, the presence of RBC casts in the urine of patients with dysmorphic hematuria is directly associated with a cilindroe source for the bleeding; therefore, the finding of a single RBC cast is enough to indicate the glomerular nature of the hematuria. An abnormal number of RBCs on urine microscopy is a relatively common finding in laboratory practice, and definition of its origin makes it easier to identify its source in the urinary tract.

Besides clinical history and physical examination, laboratory hemaricos of RBC morphology is the initial step towards diagnosis. In the s, some studies, such as those by Kohler et al. In spite of these ciilndros, complementary methods for identification of RBC casts may increase our sensitivity in the diagnosis of glomerulopathies, once urine, a colloidal suspension, may have some elements in the supernatant of a spun sample which will not be seen in the sediment, 8 justifying the low rate of RBC casts in urine samples from patients with hematuria.

The hypothesis of this study is that the low rate of RBC cast identification is due to the hematicoe concentration reached with conventional urinalysis methods.

Compare the two techniques for sample analysis, conventional method CM and concentration technique CTin a series of urine exams presenting dysmorphic hematuria.

We assessed urine samples from patients referred for several medical reasons, without a suspicion of glomerulopathy, within the routine of the Clinical Analysis Laboratory of the State Hematicks of Ponta Grossa.

After microscopy of the sediment, samples with hematuria were selected for investigation of RBC dysmorphism and casts. The study was undertaken with bright-field microscopy. Routinely, the SM uses a 10 mL aliquot dilindros urine which has undergone 5-minute low-speed centrifugation relative centrifugal force g. The urine is concentrated to 1: In the CT, after sample analysis with the SM, those samples with dysmorphic hematuria underwent a further step, which ciilindros of hematicks addition of 10 ml urine to the initial cone-shaped tube, which was centrifuged at a relative centrifugal force of 2, g for 10 minutes, that is, concentrating the urine to 1: After the supernatant was discarded, we searched for casts, including RBC casts, analyzing the sediment between slide and coverslip, under light microscopy, with X magnification.


The latter were always associated with the presence of other RBC casts, once in isolation they may indicate hemoglobinuria, myoglobinuria or the presence of other similar pigments. Of a total of 4, processed samples, Women had a higher prevalence rate Of the samples with hematuria, The samples with dysmorphic hematuria were submitted to the two techniques for RBC cast investigation: The SM was positive in 8.

Since then, other studies have confirmed the importance of urinary RBC morphometry.

However, there has been disagreement concerning the cut-off values to be observed, once these varied among the studies. Yet, because the absence of these cells does not rule out the glomeruli as the source of hematuria, these markers have high specificity but low sensitivity. In the following year, Tomita et al. G1 cells are similar to acanthocytes, and considered very specific. Even when these criteria are used, analysis is at times inconclusive, the association of other parameters, such as the presence of RBC casts, being necessary.

As reported in other studies, 16 women had a higher general rate of hematuria. Yet, when only dysmorphic hematuria was considered, there was no significant gender difference. This fact may be explained by the presence of several interfering factors that were not excluded in the first group, such as urinary tract infection and contamination by menstrual blood and vaginal secretions.


These factors were hejaticos by the investigation and selection of samples with dysmorphic RBC. As for age, our study showed that Hematuria may, therefore, be related to nephrologic or urologic problems. Once hematuria is confirmed, investigation of the bleeding source, undertaken with a search for RBC dysmorphism and RBC casts in the urine, is warranted.

The additional presence of proteinuria, glycosuria and hematidos pathological casts is helpful. Several authors have found it difficult to establish a cut-off point to characterize glomerular hematuria. Unfortunately, low sensitivity hrmaticos that a number of cases remain, in which the bleeding source is unknown.

Besides dysmorphism, the presence of RBC casts, which although associated to non-glomerular bleeding at times are strongly associated with glomerular hematuria, may help with the diagnosis of the bleeding source.

RBC casts | English to Portuguese | Other

RBC casts are not frequently visualized in routine urinalysis. We proposed to use a CT to investigate the presence of RBC casts in samples with dysmorphic hematuria. The presence of specific cells, such as codocytes, acanthocytes and G1 cells was investigated, but.

The SM showed an 8. The negative samples on the SM were submitted to the CT, in which the sediment was re-processed under high speed rotation for a longer period, aiming to increase the concentration of the urinary elements. The CT was positive in It must be highlighted that no lysis of the RBC casts happened during high speed rotation centrifugation 2, gcontrary to the literature, which recommends that sedimentoscopy should be performed on uncentrifuged urine, or on urine which has been submitted to a lower rotation speed g.



These data point to the possibility that a myth surrounding cast cilindfos by urine centrifugation has been created. Although this concept of centrifugation-associated destruction of urinary elements has been widely accepted by the laboratory community, our data show that this is not valid as far as casts are concerned.

We cannot infer about the existence of glomerulopathies in the study population, but we can certainly state that the CT increases the positivity for RBC casts. Our population was composed of random samples not specified hemxticos glomerulopathy suspicion and without cilindroz investigation of a bleeding source. Indeed, this was a typical primary care population, for which cilindris assessment may avoid delay in the referral to a nephrologist, that is, when end-stage CKD is established and dialysis is necessary.

In spite of the absence of epidemiologic studies on the occurrence of glomerular diseases in Brazil, recent studies 19 have shown glomerular disorders to be the second cause of end-stage CKD in the country. These data show the importance of referral of persons with RBC casts, 18 cilihdros being consensus on the primary care responsibility for diagnosing and adequately referring patients with hematuria, aiming the early detection of urologic and nephrologic conditions.

Inter-laboratory methodological variation and inter-examiner variability may be obstacles to laboratory quality control. Therefore, greater attention should be paid to standardized urinalysis, while new techniques for identification of markers of renal disease are sought.

While other methods are not available, we suggest the association of the CT-based RBC cast investigation and the search for RBC dysmorphism for the assessment of renal diseases in the laboratory investigation of the bleeding origin, in patients with confirmed hematuria. This study opens new perspectives towards hematiicos study of new ways for the urinalysis-based early detection of renal diseases.

The CT-based search for RBC casts must be associated with the presence of dysmorphism on routine urinalysis to prove the glomerular origin of the hematuria.

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Automation of urine sediment examination: Clin Chem Lab Med ; Diagnosis of glomerular haematuria: Scand J Clin Lab Invest ; A blind controlled trial of phase-contrast microscopy by two observers for evaluating the source of hematuria. Asymptomatic microscopic hematuria in adults: Am Fam Physician ; The significance of asymptomatic microhematuria in men 50 or more years old: Asymptomatic microhematuria and urologic disease. Assessment of microscopic hematuria in adults. Can J Urol ; Diagnostic algorithm for the evaluation of hematuria.

J Am Acad Nurse Pract ; The authors report no conflict of interest. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. How to cite this article.