血尿的评估和尿沉渣的显微镜检查是肾病学家评估肾小球疾病的常用工具。通过显微镜观察到的尿液红细胞（RBC）的某些形态方面可能有助于鉴定血尿的来源是否为肾小球。肾小球损伤的公认体征是红细胞铸型或畸形红细胞，特别是棘皮细胞（具有突出气泡的环形红细胞）。尽管是高度依赖操作员的测试，尿沉渣检查显示肾小球血尿的这些迹象已经证明了诊断肾小球疾病的特异性和阳性预测值在90%-100%之间。虽然灵敏度可以是相当可变的。血尿是诊断增生性肾小球肾炎如IgA肾病的常用工具,抗中性粒细胞胞浆抗体（ANCA）相关血管炎，和狼疮性肾炎,有时甚至作为肾脏受累的替代品。检查血尿在监测和预测这些疾病的不良结局中的作用的研究表明，结果不一致。可能是由于不一致的定义，通常无法考虑肾小球血尿的特定标记，如畸形红细胞，棘皮细胞,或RBC石膏。对肾小球性血尿构成的共识定义将有助于在未来研究中标准化使用，并可能提高血尿作为肾小球肾炎标志物的诊断和预后价值。
Evaluation of hematuria and microscopic examination of urine sediment are commonly used tools by nephrologists in their assessment of glomerular diseases. Certain morphological aspects of urine red blood cells (RBCs) seen by microscopy may help in identifying the source of hematuria as glomerular or not. Recognized signs of glomerular injury are RBC casts or dysmorphic RBCs, in particular acanthocytes (ring-shaped RBCs with protruding blebs). Despite being a highly operator-dependent test, urine sediment examination revealing these signs of glomerular hematuria has demonstrated specificities and positive predictive values ranging between 90%-100% for diagnosing glomerular disease, although sensitivity can be quite variable. Hematuria is a commonly used tool for diagnosing patients with proliferative glomerulonephritis such as IgA nephropathy, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, and lupus nephritis, sometimes even as a surrogate for kidney involvement. Studies examining the role for hematuria in monitoring and predicting adverse outcomes in these diseases have shown inconsistent results, possibly due to inconsistent definitions that often fail to consider specific markers of glomerular hematuria such as dysmorphic RBCs, acanthocytes, or RBC casts. A consensus definition of what constitutes glomerular hematuria would help standardize use in future studies and likely improve the diagnostic and prognostic value of hematuria as a marker of glomerulonephritis.
