Differentiation of glomerular and non-glomerular hematuria

无症状的镜下血尿是一个相对常见的发现，发生在约15%的成年人。在56岁以上的男性中，无症状镜下血尿患者中严重泌尿系统疾病的发生率为6.7%。这一发现表明，不建议对所有无症状的显微血尿患者进行完整的泌尿系统检查。为了开发一种新的简单的试验，以区分显微镜下血尿，由于泌尿系统疾病的肾小球疾病，我们检查了血细胞从新鲜尿样，使用扫描电子显微镜和荧光光谱测量脱镁叶绿酸-A，这是激发氩离子激光（488 nm）ACAS-570。肾小球性血尿与非肾小球性血尿很容易通过血细胞膜的典型变形来区分，而血细胞膜的典型变形主要见于前者。用于光动力学治疗的光敏剂脱镁叶绿酸-A在4 μ g/ml浓度下加入培养液中1小时后，易溶于水，在正常血细胞中蓄积，分布均匀，这也是非肾小球性微血尿的情况。在肾小球性血尿中，脱镁叶绿酸-A被血细胞吸收更快（30分钟内），分布模式似乎更不规则。这种染色技术简单，可用于肾小球性和非肾小球性微量血尿的鉴别诊断，但需要进一步的研究，如细胞内积累的定量分析。

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.