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Web End = Int Urol Nephrol (2016) 48:10211027 DOI 10.1007/s11255-016-1265-4
UROLOGY - ORIGINAL PAPER
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Web End = Diagnostic impact of dysmorphic red blood cells on evaluating microscopic hematuria: the urologists perspective
Kyo Chul Koo1 Kwang Suk Lee1 Ah Ran Choi2 Koon Ho Rha1 Sung Joon Hong1 Byung Ha Chung1http://orcid.org/0000-0003-0048-5717
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Abstract
Purpose Dysmorphic red blood cells (dRBCs) are indicative of glomerular disease and considered a rst step in evaluating microscopic hematuria (MH). The predominance of dRBCs does not preclude urological disease; however, some contemporary guidelines advise nephrological evaluation without further urological evaluation, in contrast to the American Urological Association guideline. We investigated the feasibility and safety of omitting urological evaluation in patients presenting with MH.
Methods A retrospective analysis was performed on 411 consecutive patients who presented with MH between January 2012 and December 2014. MH was dened as 3
RBCs per high-power eld. All patients received full uro-logical and nephrological evaluations including history and physical assessment, renal function, urine cytology, %dRBC, cystoscopy, computed tomography (CT) imaging, and renal biopsy when indicated.
Results The median %dRBC was higher in patients with glomerular disease than in those with urological disease (40.4 vs. 21.1 %; p < 0.001). Among patients exhibiting %dRBC 40, 33/97 (34.0 %) had urological and 28/97
(28.9 %) had glomerular diseases. Urological diseases included 9/33 (27.3 %) clinically meaningful malignancies and 17/33 (51.5 %) conditions requiring immediate treatment. The rate of malignancy was comparable between
* Byung Ha Chung [email protected]
1 Department of Urology, Yonsei University Collegeof Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Republic of Korea
2 Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
Received: 1 February 2016 / Accepted: 9 March 2016 / Published online: 28 March 2016 Springer Science+Business Media Dordrecht 2016
%dRBC groups (p = 0.087). Among patients with nal
diagnoses who exhibited %dRBC 40, 32/61 (52.5 %)
treatment-requiring conditions would have been unrecognized had cystoscopy and/or CT not been performed. For predicting glomerular disease, the presence of proteinuria demonstrated higher AUC than %dRBC 40 (0.77 vs.
0.65; p...