Es mas fcil vivir con los ojos cerrados

interpretando mal...
todo lo que se ve.

Jhon Lenon.
 Hematuria
(nmero de clulas por campo y %)
 Examen General de Orina
Examen Macroscpico Examen Microscpico de Sedimento
Color Amarillo Celularidad
Aspecto Ligero turbio De origen
Sedimento Escaso Uretral no se observaron
(uretra)
Examen Fsico-qumico Urotelial no se observaron
Densidad 1.017 (vejiga, urteres, pelvis renal)
pH 5.5 Renal no se observaron
Glucosa <20 mg/dL. (tbulos renales)
Protenas <20 mg/dL Citolisis no se observaron
Hemoglobina Negativa Leucocitos no se observaron
Cetonas Negativos Piocitos no se observaron
Bilirrubinas Negativas Bacterias no se observaron
Urobilingeno Normal Eritrocitos no se observaron
Nitritos Negativos % normorficos no se observaron
% dismorficos no se observaron
Cristalaluria Espermas no se observaron
Uratos amorfos no se observaron Levaduras no se observaron
cido rico no se observaron Parsitos no se observaron
Oxalatos clcicos no se observaron F. mucoides no se observaron
Fosfatos amorfos no se observaron Cilindros no se observaron
Fosfatos triples no se observaron
Riesgo litognico no se observo Observaciones: Primer orina de la maana
Tincin: Sternheimer Malbin
 Hematuria
La hematuria puede manifestar diferentes disfunciones
del sistema urinario y hematolgicas.

a) Hematolgicas:
- Anticoagulantes.
- Coagulopatias.
- Anemia falciforme.
- Hemofilias.
- Trombocitopenias.
b) Del sistema urinario:
1) Renales
- Glomerulares:
Glomerulonefritis aguda; glomerulonefritis proliferativa
focal, glomerulonefritis rapidamente progresiva,
glomerulonefritis membranosa; nefritis lpica; hematuria
familiar benigna, etc
- No glomerulares:
Nefroesclerosis secundaria a hipertensin, infarto renal,
trombosis de la vena renal, tuberculosis, pielonefritis,
enfermedad poliqustica, nefritis intersticial, necrosis
papilar, necrosis cortical, trauma, etc.
2) Post-renales:
Clculos, pieloureteritis secundarias a patologas extra-
renales, tumores el sistema urinario inferior, cistitis,
prostatitis, epididimitis, hiperplasia prosttica. Etc.

3) Falsas hemorragias:
Ingestin de alimentos que den color a la orina,
medicamentos, betabel, etc.
 Hematuria*
a)Normrficos
No glomerular

b) Dismrficos
Glomerular

* Birch DF, Fairley KF. Hematuria: glomerular or non-glomerular. Lancet 1979; 2(8147):845-846
Normorficos Dismorficos

Vaco Anular

Monodiverticular Polidiverticular
Normales

Septado Pinzado

Espiculado Fantasmas
 Normorficos Dismorficos

Normales Vaco Anular

Espiculado

Monodiverticular Polidiverticular

Fantasmas

Pinzado
Septado

Nguyen GK. Urine cytology in renal glomerular disease and value of G1 cell in the diagnosis of glomerular bleeding. Diagn Cytopathol 2003; 29: 67-73
Normorficos o Isomorficos

(No glomerular)
Isomrficos

Normales

Espiculado

Fantasmas

Septado
 Glomrulo

Microcirculacin

Tbulos renales
 Mesangio intraglomerular
(efector).

Clulas de Goormaghtigh
o Lacis (comunicador)

Clulas granulares
(yuxtaglomerulares) (productor) Macula densa
(sensor)
Plasma y molculas
< a 65,000 Daltons
 Normrficos

Isomrficos

(No glomerular)
Normrfico
No glomerular (normrficos)
a) Pertenecen al grupo de Isomrfia los hemates
- Normales.

b) Las alteraciones inespecficas tales como los

hemates.

- Equinocitos.

- Gigantes.

- Fantasmas.

- Septados
Se encuentran en patologas como:

- Tumores u quistes
- Infarto renal
- Trombosis de vena renal
- Fistula arteriovenosa
- Tuberculosis
- Diabetes mellitus (no IRC)
- Traumatismos
- Hipercalciuria
- Hiperuricosuria
- Nefritis por medicamentos
- Nefropatia poliquistica
- Litiasis renal
Tomita M, Kitamoto Y, Nakayama M, Sato T. A new morphological classification of urinary erythrocytes for differential diagnosis
of glomerular hematuria. Clin Nephrol 1992; 37:84-89
Espiculado

Eritrocitos en orina hipertnica

Video
 Dismrficos
(Glomerular)

* Birch DF, Fairley KF. Hematuria: glomerular or non-glomerular. Lancet 1979; 2(8147):845-846
 Dismorficos

Vaco Anular

Monodiverticular Polidiverticular

Pinzado

Nguyen GK. Urine cytology in renal glomerular disease and value of G1 cell in the diagnosis of glomerular bleeding. Diagn Cytopathol 2003; 29: 67-73
 Glomrulo

Microcirculacin

Tbulos renales
 Dismrficos
(Glomerular)
Son alteraciones especficas (Dismorfia) los hemates:
- Anulares
- Poli y monodiverticulares.
- Vacos
- Espiculares (acantocitos).
- Mixtos (combinaciones de los anteriores).
La sensibilidad del mtodo con microscopio de contraste de
fases es:
- 96,0% y la especificidad usando la nueva clasificacin de
las alteraciones alcanza el 98,1% si se observa solo un tipo
de alteracin especfica.
- 98,4% si se observan dos.
- 99,95% si se observan tres*.
* Mireau JR, Smith R, Rayner D, Nguyen GK. Value of G1 cell in the diagnosis of renal
glomerular microhematuria. Viet Med J 2002;2:15-20
 "URINE CYTOLOGY IN RENAL GLOMERULAR
DISEASE AND VALUE OF G1 CELL IN THE DIAGNOSIS
OF GLOMERULAR BLEEDING

Gia-Khanh Nguyen, M.D., F.I.A.C.

Head of Cytopathology, University of Alberta Hospitals,

Edmonton, Alberta, Canada. 2003
Urine cytology in renal glomerular diseases is best studied
by semiquantitative cytologic urinalysis, as the specimen
preparation method used in this diagnostic procedure
concentrates urinary cellular elements and makes them
more easily to be evaluated.

For semiquantitative cytologic urinalysis, an aliquot of 10

mL of freshy voided urine without ethanol fixatives is
centrifuged at 1800 rpm for 10 min. Nine mL of the
supernatant is discarded, and 4 cytospin smears are
prepared from the remaining 1 mL of the sediment. The
smears obtained are immediately fixed in 95% ethanol for
five minutes and then stained by the Papanicolaou method.
The smears are first screened with a x 10 objective and
then selected cellular areas are carefully evaluated in high-
power-fields (HPF), using a 40x objective.
Urine sediments were divided into 4 cytomorphologic
groups :

1). Abundant G1 cells and non-G1 erythrocytes, and no

erythrocytic casts.

(2). Abundant G1 cells and non-G1 erythrocytes, and rare

erythrocytic casts.

(3). Abundant non-G1 erythrocytes and erythrocytic casts,

and no G1 cells and.

(4). Abundant normal erythrocytes only.

Nguyen GK. Urine cytology in renal glomerular disease and value of G1 cell in the
diagnosis of glomerular bleeding. Diagn Cytopathol 2003; 29: 67-73
CONCLUSION:

Urinary G1 cells and ECs are important makers for renal

glomerular bleeding/disease.

Microscopic hematuria is a common clinical finding, and

investigation of microhematuria is costly, time-consuming
and inconvenient to the patient.

A separation of hematuria of glomerular origin from that of a

lower urinary tract origin will direct the patient to either a
nephrologic or urologic investigation.
 Nagahama D, Yoshiko K, Watanabe M, Morita Y,
Iwatani Y, Matsuo S. A useful new classification of
dysmorphic urinary erythrocytes.

Clin Exp Nephrol. 2005 Dec;9(4):304-9.

We classified D cells into three types (D1, D2, and D3 cells):

- D1 cells showed a ring-like shape and severe loss of cytoplasmic color

with protrusions or blebs;

- D2 cells showed a doughnut-like shape and moderate cytoplasmic

color loss with protrusions or blebs; and

- D3 cells showed a doughnut-like shape and mild cytoplasmic color

loss without protrusions or blebs.

We calculated the numbers of D cells of each type in 45 patients with

glomerular diseases and in 303 general outpatients. This was done by
bright-field microscopy modified for the analysis of urinary sediment,
and we also examined the significance of these cell types.
Results: In the 45 patients with glomerular diseases,
-The numbers of D1, D2, and D3 cells correlated with urine levels of
proteinuria and hematuria and numbers of cellular and fatty casts.

- Numbers of D1 and D2 cells correlated with urine concentrations of

albumin and N-acetyl--d-glucosaminidase, and the proportions of D1
and D2 cells in D cells increased with the activity of glomerular diseases
classified by urinalysis data.

- Only the number of D1 cells correlated with the urine concentration of

potassium, which may increase in hemolysis.

In the 303 outpatients, the sensitivity of D3 cells and D1 and/or D2 cells

(G1 cells) was 73% and 46%, respectively, for the detection of
glomerular diseases and the specificity was 93% and 99%, respectively.

Conclusions: These data indicate that the D3 cell is a sensitive

marker for glomerular diseases, and that D1 and/or D2 cells are
markers for severe glomerular diseases.
Se encuentran en patologas como:
- Glomerulonefritis
- Por Ig A
- Post-infecciosa
- Esclerosante focal
- Glomerulopatias secundarias
- LES
- Glomerulonefritis de las vasculitis
- Sndrome de Goodpasture
- Enfermedades glomerulares hereditarias
- Sndrome de Alport
- (Membana basal glomerular fina)
Plasma y molculas
< a 60,000 Daltons
 Eritrocitos
(dismorficos)

Plasma, molculas,
Eritrocitos
(dismorficos)
> a 50,000 Daltons
Rath B, Turner C, Hartley B, Chantler C. What makes red cells dysmorphic in glomerular hematuria ?. Pediatr Nephrol 1992; 6:424-427
Kitamoto Y, Yide C, Tomita M, Sato T. The mechanism of glomerular dysmorphic red cell formation in the kidney. Tohoku J Exp
Med 1992; 167:93-105
 Glucoforina C Glucoforina A Glucoforina A Glucoforina B

3 33 3 3 3 3 3 33 33 3 3

4.2 4.2
4.1
4 .1
4.1

Aducina Anquirina
Hb
F actina Espectrina
 Glucoforina C Glucoforina A
Glucoforina B

3 33 3 3 3 3 3 33 33

4. 1
4.2
4.2 Dematina

4 .1
Aducina Anquirina 4. 1
4.1
F actina
Espectrina
 3 3 3 3
3 3
4.
2

Dao
3 3 3 3
3 3
3 3
3 3
 3
3
3
3
 3
3
3
3
Monodiverticular
 pH
cido
Dao osmtico
Ye RG, Mao XL. Mechanism of urinary erythrocyte deformity in glomerular diseases. Zhonghua Nei Ke Za Zhi 1994; 33:77-79
 Monodiverticular

Vaco
Polidiverticular

Pinzado
Video 2 Video 3
Solo le pido a Dios
que lo desconocido no me sea indiferente
que la reseca ignorancia no me encuentre
vaco y solo sin hacer lo suficiente
Mercedes Sosa