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Identification of the Source of hematuria by the Ratio of the Urinary Erythrocyte MCV to That in Blood

Journal of the Korean Pediatric Society 1994;37(8):1097-1103.
Published online August 15, 1994.
Identification of the Source of hematuria by the Ratio of the Urinary Erythrocyte MCV to That in Blood
Young Guk Kim, Gi Chan Lee, Keun Haeng Cho, Kee Hwan Yoo, Soon Kyum Kim
Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
소변과 혈액내 평균 적혈구용적 비율(Urine MCV/Blood MCV)을 이용한 혈뇨의 감별
김영국, 이기찬, 조근행, 유기환, 김순겸
고려대학교 의과대학 소아과학교실
Abstract
The frequent occurrence of hematuria in children necessitates diagnostic evaluation. Hematuria may occur with either renal or lower urinary tract disease. Clarification of the etiology of hematuria, whether microscopic or gross, is facilited by localizing the site of bleeding to the kidney(glomerular) or the lower urinary tract (non-glomerular). The mean cellular volume (MCV) of urinary red blood cells (RBCs) of pediatric patients with glomerular (group I; n=77) and non-glomerular (group II; n=34) hematuria was determined using coulter Counter Model S plus IV. We found that red blood cells of glomerular origin had a smaller volume than non-glomerular cells (73.79¡¾9.75um3 vs 83.55¡¾3.77 um3, p<0.001). If an urinary MCV equal to 80.56um3 was taken as the cut-off value between glomerular and non-glomerular hematuria, a correct assessment of the site of bleeding was made in 89 (80%) of the 111 patients studied (sensitivity 76%, specificity 88%). The ratio of the urinary erythrocyte MCV to that in blood (Umcv/Bmcv) was compared with the diagnosis. If an Umcv/Bmcv ratio equal to 0.95 was taken as the cut-off value between glomerular and non-glomerular hematuria, a correct assessment of the site of bleeding was made in 93 (83%) of the 111 patients studied (sensitivity 79.6%, specificity 94%). Coulter counter analysis of urine provides a simple nonivasive and objective aid to the diagnosis of hematuria. This test, when used early in the management of pediatric patients with hematuria, may help to avoid invasive investigations.
Key Words: Hematuria, Urinary red blood cell volume


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