Abstract
Introduction: Haematuria is one of the most
common presentations of renal disease Urinary
sediment examination by urine phase contrast
microscopy (PCM) is a useful diagnostic marker
for glomerular bleeding if correctly interpreted
and used. Although PCM is simple and cost
effective the percentage of dysmorphic red cells
regarded as diagnostic of glomerular haematuria
is controversial and varied from (10-90)% cases in
different series. This study is done with the aim to
evaluate urine phase contrast microscopy as a tool
in differentiating glomerular haematuria in patients
with glomerulonephritis confirmed by renal biopsy
and non-glomerular haematuria in patients with
renal stone disease.
Materials and Methods: In this study, 175 patients
with haematuria were taken and were divided
into two groups; Group I with diagnosed
cases of glomerulonephritis with haematuria
confirmed with renal biopsy and Group II with
patients of renal stone disease with haematuria.
After diagnosing haematuria, all patients were
undergone for urine phase contrast microscopy.
Renal biopsy was done in patients suspected for
glomerulonephritis.
Results: This study showed that the mean
percentage of dysmorphic RBCs in group I by
urine PCM was (35.8%) which was significantly
higher than in group II (6.8%). A comparison
was done between the different cut off values for
percentages of dysmorphic RBCs to differentiate
glomerular from non-glomerular haematuria. For
a cut off value of 20%, the present study showed
the most agreeable sensitivity 80.7% and specificity
90.6%.Receiver-operator characteristic curve for
percentage of dysmorphic RBCs, area under the
curve was 0.934, which gave an optimal sensitivity
80.7% and specificity 90.6% for a decision level
cut off of 20% dysmorphic RBCs. It was found
that patients of group I had higher serum creatinine
level (mean 1.6 mg/dl) in comparison to group
II (mean 1.1mg/dl). Similarly patient of group
I had higher level of proteinuria in comparison
to group II. It was also ovbserved that patients
with proliferative glomerulonephritis had higher
percentage of dysmorphic RBCs in comparison
to non-proliferative type of glomerulonephritis.
Conclusion: Urine phase contrast microscopy
is a simple, cost effective, non invasive and
reliable investigation. Patients with proliferative
glomrulonephritis may have a higher percentage of
dysmorphic RBCs in comparison to those with non
proliferative glomerulonephrits.
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