Paulo B Franco

Evaluation of erythrocyte morphology in the urinary sediment for the differential diagnosis of haematurias using standard light microscopy

Summary: The glomerular or non‐glomerular origin of haematuria can be identified by the morphologic study of red blood cells in the urine. In the present study, we report the results obtained by the morphologic study of red blood cells in the urine of 39 patients: 22 with glomerular diseases and 17 with extra‐glomerular diseases. In a blind study, we used conventional light microscopy, lowering the condenser lens to obtain a picture similar to that provided by phase contrast microscopy, an original strategy not previously reported in the literature. the highest specificity (100%) while maintaining good sensitivity (90%) was obtained when 70% or more dysmorphic erythrocytes were adopted as a criterion of dysmorphism.

Cutaneous vesicostomy in children

OBJECTIVE In this report we assessed the results obtained with cutaneous vesicostomy for the temporary diversion of urine in small children. PATIENTS AND METHODS We analyzed the medical records of 20 patients (17 boys and 3 girls) that underwent this type of diversion at our institution. Cutaneous vesicostomy was done due to severe hydronephrosis with low renal function and/or urinary tract infection with metabolic acidosis. RESULTS The urinary tract anomalies were posterior urethral valves in 12 children, vesicoureteral reflux in 7 and anterior urethral valve in one. Elevated levels of serum urea and creatinine were found in 16 patients during pre-operative evaluation. During the follow-up there was a reduction of hydronephrosis in all patients, and 5 progressed to chronic renal failure. These patients had worse development of weight and body lenght when compared to those with normal renal function. The post-operative complications were prolapse in 2 patients and stenosis of the stoma in 2. CONCLUSION cutaneous vesicostomy has proved to be an useful form of urinary diversion. In our experience it is an effective and easily reversible temporary treatment for infants and children with severe hydronephrosis associated with urinary tract infection due to infravesical obstruction or vesicoureteral reflux.

Anterior urethral valves

Objective: to discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. Description: signs of urinary tract obstruction were identified on pre-natal ultrasound in two male fetuses and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in both patients. Later, the valves were fulgurated using an endoscopic procedure. During the follow-up period both patients presented normal renal function. Comments: anterior urethral valves are a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra.

[Protein/creatinine ratio in single urine samples for the semiquantitation of proteinuria in children with nephrosis]

OBJECTIVE: To estimate, semiquantitatively, the proteinuria of nephrotic patients by the use of the value of protein/creatinine ratio in single urine samples and determine its correlation with 24-hour proteinuria.METHODS: Analysis of 30 single urine samples and thirty 24-hour urine samples from 20 children with nephrosis followed up at the Division of Pediatric Nephrology of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Proteinuria in single urine samples and 24-hour urine samples was measured by the turbidimetric method with 3% sulfosalicylic acid. Urinary creatinine concentration was measured by the method of Hare, modified by Haugen and Blegen, adapted to the microtechnique.RESULTS: An excellent correlation was observed between 24-hour proteinuria and the protein/creatinine ratio in single urine samples, by linear regression analysis before (r = 0.82; p < 0.001) and after logarithmic transformation (r = 0.93; p < 0.001). All patients with 24-hour proteinuria at physiological levels (less than 0.1 g/m(2)/day) had a protein/creatinine ratio of less than 0.1 (mg/mg) in single urine samples. All patients with nephrotic 24-hour proteinuria (more than 1.0 g/m(2)/day) had a protein/creatinine ratio of more than 1.0 (mg/mg). The patients with intermediate proteinuria (between 0.1 and 1.0 g/m(2)/day) had a protein/creatinine ratio distributed on the three levels.CONCLUSIONS: The protein/creatinine ratio in a single urine sample is a simple and reliable method for the evaluation of proteinuria and eliminates the errors due to inadequate 24-hour urine collection.