Analysis of diagnostic concordance between urinary sediment and kidney biopsy

Q3 Health Professions

Revista Colombiana de Reumatologia Pub Date : 2026-04-01 Epub Date: 2026-02-05 DOI:10.1016/j.rcreu.2026.504863

José Lucas Daza , Andrés Cárdenas , Juan Sebastián Reyes Bello , Marcelo de Rosa , María Paola Joven Sierra , María Alejandra Muñoz

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引用次数: 0

Abstract

Introduction

The microscopic examination of urinary sediment, an integral part of urinalysis, is a valuable diagnostic tool in nephrology. Its correct execution and interpretation are crucial in the initial diagnostic approach and the clinical follow-up of various nephropathies, with particular relevance in the suspicion of glomerular diseases. The utility of this analysis in strongly suggesting the glomerular origin of hematuria provides significant diagnostic guidance, acting as a “liquid biopsy” whose formed elements can directly correlate with renal histology findings.

Objectives

To evaluate the correlation between renal histological findings and the presence of dysmorphic hematuria in the urinary sediment, stratifying the analysis based on the detection of acanthocytes and/or red blood cell casts.

Materials and methods

The cohort consisted of 200 women (66.7%) and 100 men (33.3%). The presence of acanthocytes and/or red blood cell casts (Group D1) was significantly associated with a higher probability of PG (OR 12; 95% CI: 9.6–20.5; p = 0.001). In contrast, dysmorphic hematuria without these specific elements (Group D2) was associated with a higher probability of NPG (OR 6; 95% CI: 2.4–8.3; p = 0.001).

Results

The urine samples corresponded to 200 women (66.6%) and 100 men (33.3%). The presence of acanthocytes (D1) in proliferative glomerular diseases (GP) was 12 times more frequent compared to non-proliferative diseases (NPG) (OR 12; 95% CI: 9.6–20.5; p = 0.01). The presence of red blood cells is 15 times more frequent in GP (OR 15; 95% CI: 9–40.9). Patients with non-acanthocyte hematuria (D2) are 6 times more frequent in an NPG (OR 6; 95% CI: 2.4–8.3; p = 0.01).

Conclusion

The presence of dysmorphic hematuria is a useful marker for detecting glomerular disease, although its moderate sensitivity highlights the need for complementary diagnostic tests. In this cohort, the combination of acanthocytic dysmorphic hematuria and the presence of at least one red blood cell cast demonstrated high specificity for diagnosing proliferative glomerulopathy. However, for an accurate diagnosis and prognosis, renal biopsy remains indispensable.

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尿沉渣与肾活检诊断一致性分析

尿沉渣的显微检查是尿液分析的重要组成部分，是肾脏病学中有价值的诊断工具。它的正确执行和解释对于各种肾病的初始诊断方法和临床随访至关重要，特别是与肾小球疾病的怀疑有关。该分析在强烈提示血尿的肾小球起源方面提供了重要的诊断指导，作为一种“液体活检”，其形成的元素可以直接与肾脏组织学结果相关。目的评价肾脏组织学表现与尿沉积物中畸形血尿的相关性，并根据棘细胞和/或红细胞铸型的检测进行分层分析。材料与方法该队列包括200名女性（66.7%）和100名男性（33.3%）。棘细胞和/或红细胞铸型（D1组）的存在与PG的高概率显著相关（or 12; 95% CI: 9.6-20.5; p = 0.001）。相比之下，没有这些特定元素的畸形血尿（D2组）与NPG的更高概率相关（OR 6; 95% CI: 2.4-8.3; p = 0.001）。结果女性200例（66.6%），男性100例（33.3%）。增生性肾小球疾病（GP）中棘细胞（D1）的出现是非增生性肾小球疾病（NPG）的12倍（OR 12; 95% CI: 9.6-20.5; p = 0.01）。GP患者出现红细胞的频率是前者的15倍（OR 15; 95% CI: 9-40.9）。非棘细胞血尿（D2）患者在NPG中的发生率是前者的6倍（OR 6; 95% CI: 2.4-8.3; p = 0.01）。结论畸形血尿是检测肾小球疾病的有效标志物，但其敏感性不高，需要补充诊断试验。在这个队列中，棘细胞畸形血尿和至少一个红细胞铸型的结合显示了诊断增生性肾小球病的高特异性。然而，为了准确的诊断和预后，肾活检仍然是必不可少的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista Colombiana de Reumatologia Medicine-Rheumatology

CiteScore

0.80

自引率

0.00%

发文量

期刊介绍： The Colombian Journal of Rheumatology (Revista Colombiana de Reumatología) is the official organ of the Colombian Association of Rheumatology (Asociación Colombiana de Reumatología) and the Central American, Caribbean and Andean Association of Rheumatology (Asociación Centroamericana Caribe Andina de Reumatología) - ACCA. It was created in December 1993 with the purpose of disseminating scientific information derived from primary and secondary research and presenting cases coming from the practice of Rheumatology in Latin America. Since its foundation, the Journal has been characterized by its plurality with subjects of all rheumatic and osteomuscular pathologies, in the form of original articles, historical articles, economic evaluations, and articles of reflection and education in Medicine. It covers an extensive area of topics ranging from the broad spectrum of the clinical aspects of rheumatology and related areas in autoimmunity (both in pediatric and adult pathologies), to aspects of basic sciences. It is an academic tool for the different members of the academic and scientific community at their different levels of training, from undergraduate to post-doctoral degrees, managing to integrate all actors inter and trans disciplinarily. It is intended for rheumatologists, general internists, specialists in related areas, and general practitioners in the country and abroad. It has become an important space in the work of all rheumatologists from Central and South America.