title: [Dysmorphic erythrocytes in urinary sediment in differentiating urological from nephrological causes of hematuria].
abstract: OBJECTIVE
  To determine the significance of dysmorphic erythrocytes in the urinary sediment for discrimination between urological and nephrological causes of haematuria.
  
  
  METHODS
  Evaluation of diagnostic test.
  
  
  METHODS
  Departments of Nephrology and Pathology, University Hospital Nijmegen.
  
  
  METHODS
  Of 107 patients with haematuria in whom renal parenchymal or urological disease was diagnosed, the percentage of dysmorphic erythrocytes was estimated in the unstained urinary sediment with normal light microscopy. By using a Receiver Operating Characteristic curve the cutoff point that provided the highest diagnostic value of the erythrocyte morphology was determined. In addition, the inter-observer variation was estimated in a separate series of 26 urinary sediments.
  
  
  RESULTS
  At a cutoff value of 40% dysmorphic erythrocytes the sensitivity for urological pathology was 100% and the specificity 66.7%. When presence of erythrocyte, haemoglobin or fatty casts was also considered as a criterion for a nephrological diagnosis, the specificity for urological pathology rose to 88.1%. The inter-observer variation showed a correlation coefficient of 0.90 (kappa: 0.77).
  
  
  CONCLUSIONS
  Evaluation of the erythrocyte morphology in the urinary sediment is a reliable aid in determining the strategy to be followed in patients with haematuria. It is important, however, that strict criteria for establishing erythrocyte dysmorphism are applied.
authors.affiliation: Katholieke Universiteit, vakgroep Huisartsgeneeskunde, Nijmegen.
authors.forename: B E
authors.initials: BE
authors.lastname: van der Snoek
authors.forename: A J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: C
authors.initials: C
authors.lastname: van Weel
authors.forename: R A
authors.initials: RA
authors.lastname: Koene
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004906:Erythrocyte Count; D004913:Erythrocytes, Abnormal; D005260:Female; D006417:Hematuria / Q000209:etiology / Q000652:urine*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014556:Urine / Q000166:cytology*; D014570:Urologic Diseases / Q000150:complications / Q000175:diagnosis
vernacular_title: Dysmorfe erytrocyten in het urinesediment bij het onderscheiden van urologische en nefrologische oorzaken van hematurie.