A useful new classification of dysmorphic urinary erythrocytes

Area of Science:

• Nephrology
• Urology
• Pathology

Background:

• Dysmorphic urinary erythrocytes (D cells), particularly G1 cells (doughnut-shaped with blebs), are established markers for glomerular diseases.
• The clinical significance of D cells with cytoplasmic color loss and without blebs remains unclear.
• A novel classification system for D cells was developed to investigate their relationship with urinalysis findings.

Purpose of the Study:

• To classify dysmorphic urinary erythrocytes (D cells) into distinct types.
• To examine the correlation between these D cell types and urinalysis data.
• To determine the diagnostic value of different D cell types for glomerular diseases.

Main Methods:

• D cells were classified into three types: D1 (severe color loss, blebs), D2 (moderate color loss, blebs), and D3 (mild color loss, no blebs).
• Bright-field microscopy was used to count D cell types in 45 patients with glomerular diseases and 303 general outpatients.
• Statistical analysis correlated D cell counts with urinalysis parameters like proteinuria, hematuria, and cast excretion.

Main Results:

• D1, D2, and D3 cell counts correlated with proteinuria, hematuria, and urinary casts in glomerular disease patients.
• D1 and D2 cell proportions increased with glomerular disease activity, correlating with albumin and N-acetyl-beta-D-glucosaminidase levels.
• D3 cells showed 73% sensitivity and 93% specificity for detecting glomerular diseases, while D1/D2 cells had 46% sensitivity and 99% specificity.

Conclusions:

• The D3 cell type serves as a sensitive indicator for the presence of glomerular diseases.
• D1 and/or D2 cells are indicative of severe glomerular disease activity.
• This classification system enhances the diagnostic utility of dysmorphic urinary erythrocytes in nephrology.