Ann Lab Med.  2019 May;39(3):271-277. 10.3343/alm.2019.39.3.271.

Small Red Blood Cell Fraction on the UF-1000i Urine Analyzer as a Screening Tool to Detect Dysmorphic Red Blood Cells for Diagnosing Glomerulonephritis

• Kim H
• Kim YO
• Kim Y
• Suh JS
• Cho EJ
• Lee HK

• KMID: 2431604
• DOI: http://doi.org/10.3343/alm.2019.39.3.271

Abstract

BACKGROUND
Dysmorphic red blood cells (dRBCs) are first-line biomarkers for detecting glomerulonephritis (GN) in patients with hematuria. The UF-1000i system (Sysmex, Kobe, Japan), based on flow cytometry, provides small red blood cell (RBC) values (UF-1000i [UF]-%sRBCs). We evaluated the clinical application of UF-%sRBCs for detecting %dRBCs and GN.
METHODS
Urine samples of 103 patients (47 with GN; 56 without GN [NGN]) were analyzed using UF-1000i urinalysis, phase-contrast microscopy (PCM), and urine chemistry. Serum creatinine (mg/dL), serum albumin (g/dL), serum protein (mg/dL), urine protein (mg/dL), and urea nitrogen (mg/dL) levels were measured using an automated chemical analyzer. To determine the cut-off level of predicting GN, ROC curve was analyzed.
RESULTS
UF-%sRBCs, %dRBCs, urine protein, serum creatinine, and estimated-glomerular filtration rate differed between the GN and NGN groups, with the greatest differences detected for UF-%sRBCs and %dRBCs (P < 0.0001). In ROC curve analysis, urine protein had the highest area under the curve (0.828), followed by %dRBCs (0.771) and UF-%sRBCs (0.745). To screen for GN, the best cut-off values of UF-%sRBCs and %dRBCs were >40.5% and >6.7%, respectively. %dRBCs (P=0.0001) and UF-%sRBCs (P=0.0006) differed between the GN and NGN groups in patients with isolated hematuria but without proteinuria.
CONCLUSIONS
UF-%sRBCs had similar diagnostic power to %dRBCs determined by PCM for identifying patients with GN. UF-%sRBCs may be more useful for diagnosing GN in patients with isolated hematuria. Predicting %dRBCs using UF-1000i will provide information on possible GN in patients presenting with asymptomatic hematuria.

Keyword

Small red blood cell; Dysmorphic red blood cell; Hematuria; Glomerulonephritis; UF-1000i; Screening

MeSH Terms

Biomarkers
Chemistry
Creatinine
Erythrocytes*
Filtration
Flow Cytometry
Glomerulonephritis*
Hematuria
Humans
Mass Screening*
Microscopy, Phase-Contrast
Nitrogen
Proteinuria
ROC Curve
Serum Albumin
Urea
Urinalysis
Biomarkers
Creatinine
Nitrogen
Serum Albumin
Urea

Figure

• 

  Fig. 1 Correlation between dysmorphic red blood cells (dRBCs) and UF-1000i small red blood cells (UF-%sRBCs) (r=0.685, P<0.0001). %dRBCs was counted by phase-contrast microscopy. %dRBCs <20% was used as the criterion to rule out non-glomerular nephritis.

• 

  Fig. 2 ROC curves for UF-1000i small red blood cells (RBCs)% (UF-%sRBCs) and dysmorphic RBCs (%dRBCs) to differentiate glomerulonephritis from non-glomerulonephritis patients. The cut-off was determined to be (A) >40.5% with area under the curve (AUC)=0.745 for UF-%sRBCs (B) >6.7% with AUC=0.771 for %dRBCs. Dotted lines are 95% confidence intervals of ROC cuves.

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