Avaliação comparativa da sedimentoscopia urinária realizada pelo nefrologista e pelo profissional de análises clínicas em pacientes com glomerulopatias

Introducao: A sedimentoscopia urinaria com microscopio munido com contraste de fase (MCF) deveria ser a primeira etapa na determinacao da origemdas hematurias. Objetivo: Avaliar discrepâncias nas descricoes dos parâmetros urinarios relacionados a origem das hematurias, comparando as descricoes do nefrologista (Nef) e do profissional de analises clinicas (PAC). Metodos: Urinas de pacientes com glomerulopatias (GP) confirmadas por biopsia renal foram analisadas sob MCF, por um Nef e um PAC, ambos sem conhecimento previo da origem das amostras. Cilindros hematicos, acantocituria ou celulas G1 >5% e dismorfismo eritrocitario foram utilizados na localizacao glomerular das hematurias. Resultados: Dos 28 pacientes, 13 pacientes (46,4%) apresentavam glomerulonefrites nao proliferativas e 15 (53,6%) glomerulonefrites proliferativas. Comparativamente ao PAC, o Nef identificou maior numero de hemacias (mediana/mL de urina, 80.000 vs 4.800, p=0,001), maior numero de cilindros hematicos (39,3% vs 0%, p=0,001), maior frequencia de acantocituria ou celulas G1 >5% (35,7% vs. 7,14%, p=0,021) e de dismorfismo eritrocitario (96,2% vs 7,14%, p Introduction: In the assessment of hematuria, the first step should be the identification of the origin of the bleeding, which can be done easily by analyzing the urine under phase-contrast microscopy. Obective: To assess the discrepancy of reports of the urinary parameters utilized in the localization of the glomerular origin of hematuria, comparing reports by the nephrologists and by the clinical laboratory technologist. Methods: Urines of patients with biopsy proven glomerulonephritis were assessed under phase-contrast microscopy by a nephrologist and a clinical laboratory technologist, both without previous knowledge of the origin of the samples. Red blood cell (RBC) casts, urinary acanthocytes or G1 cells >5%, and erithrocyte dysmorphism were used tolocalize the glomerular bleeding. Results: Among 28 patients, 13 (46.4%) had non proliferative glomerulonephritis and 15 (53.6%) had proliferative glomerulonephritis. Relatively to the clinical laboratory technologist, the nephrologist identified more RBC (median of 80.000 vs 4.800, p= 0.001), more RBC casts (39.3% vs 0%, p=0.001), more urinary acanthocytes or G1 cells >5% (35.7% vs 7.14%, p=0.021) and more dysmorphic RBC (96.2% vs 7.14%,p