ABSTRACT
Aims/Introduction: 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.
Materials and Methods: 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.
Results: 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).
Conclusions: 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.