URINARY MACROPHAGE COUNTS AND RATIO TO T-LYMPHOCYTES - POSSIBLE USE IN DIFFERENTIAL-DIAGNOSIS AND MANAGEMENT OF GLOMERULAR-DISEASE

The noninvasive method that can differentiate hematuria-positive patie nts has not yet been developed. We evaluated the clinical value, of th e analysis of mononuclear cells in urine in combination with urinary e rythrocytes as a noninvasive differential diagnostic tool of glomerula r disease. The number of macrophages (CD14(+) cells/ml . urine) and T- lymphocytes (CD3(+) cells/ml . urine) were measured by flow cytometry using samples of freshly voided urine from 203 patients with hematuria . They had various types of proliferative glomerular disease, includin g rapidly progressive glomerulonephritis (RPGN), IgA nephropathy (IgAN ), and membranoproliferative glomerulonephritis (MPGN), or nonprolifer ative glomerulopathy including idiopathic renal hematuria and heredita ry nephropathy. Urinary macrophage counts Increased significantly with the severity of glomerulonephritis; their number consistently exceede d that of T-lymphocyte counts in patients with active proliferative gl omerulonephritis. Urinary macrophage counts in patients with prolifera tive GN were consistently higher than those of hematuria-matched nonpr oliferative GN. Moreover, urinary macrophage counts in patients with R PGN were significantly higher than those of MPGN and IgAN. Most of the patients with inactive proliferative glomerulonephritis or with nonpr oliferative glomerulopathy showed no marked increase in urinary macrop hages. Although some patients with nonproliferative glomerulopathy who exhibited gross hematuria showed a slight increase in urinary macroph age counts, such counts were consistently lower than those of T lympho cytes. These observations suggests that urinary macrophage count and i ts ratio to T-lymphocyte count may provide useful information for clin icians in managing patients with proliferative glomerular disease as w ell as deciding whether to conduct renal biopsy in patients with hemat uria. (C) 1996 Wiley-Liss, Inc.