Differentiation of glomerular and non-glomerular hematuria

显微镜下无症状血尿是一种比较常见的发现，发生在大约15%的成年人中。56岁以上男性无症状镜下血尿患者发生严重泌尿系统疾病的比例为6.7%。这一发现提示，不建议对所有有任何程度无症状微血尿的患者进行完整的泌尿学调查。为了建立一种新的简单的方法来区分泌尿系统疾病引起的显微血尿和肾小球疾病引起的显微血尿，我们使用扫描电子显微镜和用ACAS-570上的氩离子激光（488nm）激发的磷- a荧光光谱测量从新鲜尿液样本中获得的血细胞。肾小球性血尿很容易与非肾小球性血尿区分，主要表现为肾小球性血尿的典型血细胞膜畸形。然而，该电镜研究需要较长的准备时间，可能不适合临床情况。phophbide - a是一种光敏剂，用于光动力治疗，易溶于水，在正常血细胞内蓄积，并以4mug/ml的浓度应用于培养基中1小时后均匀分布，非肾小球性微血尿亦是如此。肾小球血尿时，嗜磷素a被血细胞吸收更快（30分钟内），分布形态更不规则。这种染色技术简单，可用于鉴别肾小球性和非肾小球性微血尿，但还需要进一步的研究，如细胞内积聚的定量分析。

Asymptomatic microscopic hematuria is a relatively common finding, occuring in about 15% of adult population. The frequency of serious urologic disease in patients with asymptomatic microscopic hematuria was 6.7% in men who were older than 56 years old. This finding suggests that complete urologic investigation of all patients with any degree of asymptomatic microhematuria can not be recommended. In order to develop a new simple test to differentiate microscopic hematuria due to urologic disorders from that of glomerular diseases, we examined blood cells obtained from fresh urine samples, using scanning electron microscopy and spectroscopic measurement of fluorescence using pheophorbide-A,which was excited with Argon ion laser (488nm) on ACAS-570. The glomerular hematuria was easily differentiated from non-glomerular hematuria by the typical deformity of the blood cell membrane which was predominantly observed in the former. This electron microscopic study, however, necessitates a long preparation time which may be inappropriate for clinical situation.Pheophorbide-A,which is a photosensitizer and have been used for photodynamic therapy is easily disolved in the water and is accumulated within the normal blood cell and eaqually distributed one hour after it's application in the culture medium at the concentration of 4mug/ml, which is also the case for non-glomerular microhematuria. In glomerular hematuria, pheophorbide-A was more rapidly absorbed by the blood cell (within 30 minutes), and the distribution pattern seemed more irregular in shape. This staining technique is simple and can be applied for the differential diagnosis of glomerular and non-glomerular microhematuria, although further studies such as quantative analysis of intracellular accumulation are needed.