Dysmorphic RBCs Glomerular Haematuria — ESENeph MCQ

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EasyGlomerulonephritisDysmorphic RBCs Glomerular HaematuriaESENeph

A 40-year-old man with CKD G3a has microscopic haematuria with dysmorphic red cells and red cell casts on phase-contrast urine microscopy. What does this indicate about the source of haematuria?

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Correct answer: B — Glomerular origin – dysmorphic red cells and red cell casts are hallmarks of glomerular haematuria

Dysmorphic red blood cells (distorted morphology from passage through the GBM) and red blood cell casts (formed in renal tubules) are pathognomonic for glomerular haematuria. Phase-contrast microscopy is the most reliable method for detecting dysmorphic RBCs. Isomorphic (normal-shaped) red cells suggest non-glomerular origin (urological: stones, tumour, infection). Acanthocytes (ring-shaped with membrane protrusions) are the most specific dysmorphic RBC type for glomerular disease. This finding warrants nephrological evaluation and likely kidney biopsy.

Reference: KDIGO 2021 – GN Guideline (Chapter 1); Fairley and Birch 1982 – Dysmorphic RBCs