Diagnostic Value of Urinary Dysmorphic Erythrocytes in SLE Patients with Three Different Methods

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with various clinical manifestations. Lupus nephritis isthe most common severe manifestation with a poor prognosis. Hematuria is included in the Lupus Activity Criteria Count(LACC) and SLE Disease Activity Index (SLEDAI). Phase Contrast Microscope (PCM) availability as a recommended instrumentfor dysmorphic erythrocytes evaluation is exclusive, thus causing this examination to be performed rarely. This study aimedto investigate the diagnostic value of dysmorphic erythrocytes in SLE patients with hematuria using Low Condenser LightMicroscope (LCLM), PCM, and UF-500i. This research was a cross-sectional study with consecutive sampling; 58 fresh urinesamples were examined with UF-500i during May-July 2019. Percentage of dysmorphic erythrocytes were evaluated usingLCLM and PCM. Difference percentages of dysmorphic erythrocytes were analyzed using the Wilcoxon Signed Ranks test,degree of agreement by Kappa coefficient, cut-off, sensitivity, and specificity by ROC curve. Dysmorphic erythrocytepercentage in LCLM and PCM showed a significant difference (p < 0.001) and a low degree of agreement (Kappa=0.373).Dysmorphic erythrocyte cut-off with LCLM was 7.5% (sensitivity 70%, specificity 68%) and PCM was 6.5% (sensitivity 74%,specificity 65%). Dysmorphic? flagging from UF-500i showed a sensitivity, specificity, PPV, NPV of 78%, 52%, 58% and 73%,respectively. LCLM can be considered a substitute for PCM for evaluating dysmorphic erythrocytes with its cut-off, so theclinician will be more alert to abnormalities that cause hematuria. Further research with larger samples and definitediagnosis with a kidney biopsy is needed to obtain more accurate results.

PERUBAHAN BENTUK ERITROSIT DI GLOMERULONEFRITIS

In glomerulonephritis there are intraglomerular inflammation, cell proliferation, and hematuria. Hematuria is characterized by more than 3 (three) erythrocytes per high-power field in the urine, which indicates the pathological processes in kidney or urinary tract. The combination of mechanical damage of erythrocyte membrane through the damaged glomerular basement membrane followed by the osmotic damage when it passes through the tubular system in the hypotonic osmotic solutions causes dysmorphic morphology. Erythrocytes trapped in the Tamm-Horsfall protein will form erythrocyte casts. Dysmorphic erythrocytes and or erythrocyte casts in the urine indicate glomerular hematuria. Various forms of dysmorphic erythrocytes in the urine can be found. Acanthocytes (G1-cells) are specific for glomerular hematury. The examination of these urinary sediments can be done natively or by using automated urinalysis analyzers.

Association of hereditary elliptocytosis and Gilbert’s syndrome as the cause of biliary calculosis: Case report

Introduction. Biliary calculosis is rare in children. It occurs associated with different haemolytic and non-haemolytic disorders, which are sometimes also combined. Case Outline. A 15-year-old male was hospitalized due to biliary calculosis and non-conjugated hyper-bilirubinemia. A mild non-conjugated hyperbilirubinemia, without anaemia and other symptoms of liver dysfunction, was registered at age 8 years, and 7 years later cholelithiasis with transitory choledocholithiasis. The finding of ellyptocytes in blood smear, which was also verified in mother, normal haemoglobin count and the absence of diseases followed by secondary dysmorphic erythrocytes of this type, indicated a clinically milder (compensated) hereditary ellyptocytosis, while more than a double increase of non-conjugated serum bilirubin fracture after a three-day hypocaloric diet (400 kcal per day) showed the concurrent presence of Gilbert?s syndrome. In the laparascopically removed gallbladder a larger number of small pigmented calculi were disclosed. Conclusion. Gilbert?s syndrome is an essential precipitating factor of biliary calculosis in patients with chronic haemolytic condition. Thus, in all cases of biliary calculosis and non-conjugated hyperbilirubinemia with absent clinical and laboratory parameters of liver disorders and anaemia, except in compensated haemolytic disease and Gilbert?s syndrome as isolated disorders, a possibility of their association should be taken into consideration.

Quantitative Urine Particle Analysis: Integrative Approach for the Optimal Combination of Automation with UF-100 and Microscopic Review with KOVA Cell Chamber

Background: Automated systems have enabled the counting of particles in urine to be standardized. Their superiority over traditional sediment analysis has been well documented, but they have not gained wide acceptance. The reasons for this are that sediment analysis has been performed and interpreted for decades. Additionally, pathologic casts and other unknown particles still must be confirmed under the microscope. Furthermore, comparison between the methods has revealed outliers and thus decreased confidence in automation. Methods: We used the standardized KOVA cell chamber system to count particles and compared the results with UF-100 flow cytometry as an alternative to traditional sediment analysis. Results: We compared 252 randomly selected urine samples and obtained a review rate of 33%. Microscopic verification was necessary because of the presence of casts, yeast, sperm, dysmorphic erythrocytes, and some misclassified erythrocytes or leukocytes that were detected by incongruent dipstick results and abnormal scattergrams. We obtained correlation coefficients of 0.966 for erythrocytes and 0.935 for leukocytes. Criteria for an algorithm to identify samples that needed microscopic review were derived from comparisons between the number of particles from UF-100, dipstick results, cell chamber counting, and sediment analysis. Conclusions: Automated cell counting combined with microscopic counting with a standardized cell chamber system is useful. An objective algorithm for review criteria can be developed via systematic comparison of UF-100 flow cytometry and microscopy. Only urine samples that meet these criteria need to be confirmed microscopically.