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What makes red cells dysmorphic in glomerular haematuria?
1Evelina Children's Department, United Medical School, Guy's Hospital, London, UK.
Pediatric Nephrology (Berlin, Germany)
|September 1, 1992
Summary
Red blood cell deformity in urine, or haematuria, is caused by dual injury. Mechanical damage from the glomerulus followed by osmotic stress in the tubules creates the characteristic dysmorphic red blood cells.
Area of Science:
- Nephrology
- Urology
- Hematology
Background:
- Red blood cell (RBC) morphology is utilized to determine the location of hematuria within the urinary tract.
- The precise mechanisms causing RBC deformity remain largely speculative.
Purpose of the Study:
- To investigate the in vitro mechanisms of RBC deformity, specifically hypochromia and dysmorphism.
- To determine the factors contributing to the characteristic dysmorphic RBCs observed in glomerular hematuria.
Main Methods:
- Experiments were conducted in vitro using venous RBCs.
- RBCs were exposed to simulated renal tubular fluid compositions.
- Hypochromia was assessed based on sodium concentration, and cell morphology changes were analyzed.
Main Results:
- Hypochromia was primarily dependent on sodium concentration, occurring below 75 mmol/l.
- Simulated passage through renal tubules induced anisocytosis and hypochromia, but not the typical bizarre deformity.
- A dual-injury model was proposed to explain the formation of dysmorphic RBCs.
Conclusions:
- Glomerular hematuria-associated dysmorphic RBCs result from a combination of mechanical and osmotic injury.
- Mechanical damage occurs during passage through the glomerular basement membrane.
- Osmotic injury occurs in the hypotonic segments of the renal tubule.