Determining Glomerular and Non-Glomerular Hematuria Dysmorphic Red Blood Cell: Study on Automatic Urine Analyzer

Abstract

Hematuria is a sign of glomerular and non-glomerular kidney disease. Erythrocytes that pass through the glomerulus undergo a change of shape to become dysmorphic. Dysmorphic Red Blood Cells (dRBC) can be screened using a urine analyzer based on flow cytometry to distinguish between the glomerular and non-glomerular causes of hematuria. The purpose of this study was to determine the diagnostic performance of the flow cytometry-based dRBC urine analyzer to distinguish glomerular hematuria from non-glomerular hematuria. This study used a cross-sectional research design at the Clinical Pathology Installation of Dr. Moewardi Hospital in Surakarta. The subjects of the study were patients with hematuria at the Outpatient Clinic and Internal Medicine Ward, Nephrology sub-division, Pediatric Outpatient Clinic, nephrology sub-division, and Urology Surgery Outpatient Clinic from March to July 2021. The diagnostic test was carried out after the determination of the cut-off value of dRBC using the ROC curve and AUC value analysis. The results showed that the cut-off value of dRBC for glomerular and non-glomerular hematuria was 67% and had the best analytical performance with a sensitivity of 91%, specificity of 85%, AUC of 0.890 (95% CI: 0.832–0.947; p=<0.001). In this study, dRBC parameters can be used for screening and diagnosis of glomerular and non-glomerular hematuria. Further research needs to be carried out using other more specific methods such as the examination of urine sediment with a phase contrast microscope.