Dysmorphic erythrocytes are superior to hematuria for indicating non-diabetic renal disease in type 2 diabetics.
Dysmorphic erythrocytes are superior to hematuria for indicating non-diabetic renal disease in type 2 diabetics.
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DOI：
10.1111/jdi.12371
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发表时间：
2016-01
影响因子：
3.2
通讯作者：
Chen XM
中科院分区：
文献类型：
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作者：
Dong ZY;Wang YD;Qiu Q;Hou K;Zhang L;Wu J;Zhu HY;Cai GY;Sun XF;Zhang XG;Liu MY;Kou J;Chen XM
在2型糖尿病肾病患者中，肾活检中红细胞形态学的研究很少且有限。本研究旨在阐明变形红细胞在2型糖尿病合并非糖尿病肾病患者中的预测价值以及对血尿的影响。我们检查了198例2型糖尿病患者，他们在2012年至2013年期间接受了肾活检。血尿定义为尿沉渣中每个高倍视野（RBC/hpf）红细胞>3或>10。如果>80%的红细胞变形，则诊断为肾小球性血尿。对19例血尿患者和61例无血尿患者的临床表现和红细胞变形预测值进行比较。同时筛选糖尿病肾病患者血尿的潜在危险因素。当血尿分界点为10 RBC/hpf时，糖尿病肾病组和非糖尿病肾病组之间存在统计学显著差异（6.6 vs 16.8%; P = 0.04）。以尿红细胞形态学检查为基础的血尿诊断率有显著性差异（3.3%对24.8%，P < 0.001）。肾小球血尿在非糖尿病肾病中显示出高特异性和阳性预测值（分别为0.97和0.94）。多因素分析显示肾病综合征与血尿显著相关（优势比3.636; P = 0.034）。在2型糖尿病患者中，异形红细胞在提示非糖尿病性肾脏疾病方面优于血尿上级。肾病综合征是血尿的独立危险因素。
There are sparse and limited studies on erythrocyte morphology in renal biopsy identifying nephropathic patients among type 2 diabetics. The present study sought to clarify the predictive value of dysmorphic erythrocytes in type 2 diabetics with non‐diabetic renal disease and influences on hematuria. We examined 198 patients with type 2 diabetes who underwent kidney biopsies between 2012 and 2013. Hematuria was defined as >3 or >10 red blood cells per high‐power field (RBCs/hpf) in urine sediment. If >80% of the erythrocytes were dysmorphic, glomerular hematuria was diagnosed. Clinical findings and predictive value of dysmorphic erythrocytes were compared between patients with hematuria (n = 19) and those without (n = 61). The potential risk factors for hematuria among diabetic nephropathy patients were also screened. There was a statistically significant difference between the diabetic nephropathy group and the non‐diabetic renal disease group (6.6 vs 16.8%; P = 0.04) when the demarcation point of hematuria was 10 RBCs/hpf. When the definition of hematuria was based on an examination of urinary erythrocyte morphology, a marked difference was seen (3.3 vs 24.8%; P < 0.001). Glomerular hematuria showed high specificity and a positive predictive value (0.97 and 0.94, respectively) in non‐diabetic renal disease. A multivariate analysis showed that nephrotic syndrome was significantly associated with hematuria (odds ratio 3.636; P = 0.034). Dysmorphic erythrocytes were superior to hematuria for indicating non‐diabetic renal disease in type 2 diabetics. Nephrotic syndrome was an independent risk factor for hematuria.