Applying the European Urinalysis Guideline

Letters to the Editor regarding the article Microhematuria in Children and Young Adults Evaluation for the Early Detection of Kidney Disease by Kay Latta, Jan Boeckhaus, Ina Weinreich, Angela Borisch, Dominik Müller, and Oliver Gross in issue 14/2024

The authors deserve thanks for presenting a structured approach to the investigation of microhematuria in children and young adults (1).

Medical laboratories have an important role in this setting, since urine samples are now seldom analyzed at the point of care.

Laboratories are often guided by the current European Urinalysis Guideline (2). This advises against microscopy in the case of erythrocyturia <20×10⁶/L (<20/µL), so as to avoid examination of “physiological hematuria”.

The urinalysis guideline defines dysmorphic hematuria as presence of dysmorphic erythrocytes or acanthocytes (a subset of the dysmorphic erythrocytes) or red blood cell casts in urine.

The phase-contrast microscopy image in the publication (1) shows—in addition to massive numbers of acanthocytes—numerous dysmorphic erythrocytes. Glomerular disease is probable with ≥80% of dysmorphic erythrocytes or ≥5% acanthocytes or confirmation of red blood cell casts (2).

Do the authors find this diagnostic pathway for evaluating microhematuria equally appropriate for diagnosis in children and young adults?

DOI: 10.3238/arztebl.m2024.0186

Prof. Dr. med. Nicolas von Ahsen

Zentrallaboratorien der Kliniken Bremen-Nord, Bremen-Ost und Links der Weser

Gesundheit Nord Klinikverbund Bremen gGmbH

Klinikum Links der Weser, Bremen

References

1. Latta K, Boeckhaus J, Weinreich I, Borisch A, Müller D, Gross O: Clinical practice guideline: Microhematuria in children and young adults—evaluation for the early detection of kidney disease. Dtsch Arztebl Int 2024; 121: 461–6

2. Kouri TT, Hofmann W, Falbo R, et al.: The EFLM European Urinalysis Guideline 2023. Clin Chem Lab Med 2024; 62: 1653–786