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Introdução: Vaginose bacteriana é definida como uma síndrome clínica polimicrobiana envolvendo a substituição de Lactobacillus spp. por microrganismos de vários gêneros, incluindo bactérias anaeróbias como Prevotella sp., Mobiluncus sp., Atopobium vaginae; Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma urealyticum entre outras bactérias. O diagnóstico laboratorial de escolha para pesquisa de VB é a bacterioscopia pelo Gram, método simplificado por Nugent. No entanto, a VB e outras alterações relacionadas às infecções do trato genital feminino podem ser determinadas método de Papanicolaou, pela evidência de base nebulosa de pequenos cocobacilos, presença de clue cells e ausência notável de lactobacilos. Método: estudo transversal, com 102 mulheres, das quais foram examinados esfregaços da região ecto e endocervical do colo do útero pelo método de Papanicolaou, e de fundo de saco vaginal pelo método de Gram interpretados pelo escore de Nugent. Resultados: parâmetros indicadores de vaginose pelo PapaClue e Bethesda pelo Papanicolaou, comparado com o método de Gram segundo os critérios de Nugent mostrou que a maior parte dos resultados dos dois testes (Gram e Pap) é discordante na população estudada, concordância ruim (Kappa = 0,349) e concordância boa (Kappa = 0,489), respectivamente (p < 0,001). Quando os parâmetros do Papanicolaou são comparados entre si, a combinação PapaClue/Bethesda apresentou concordância boa (Kappa < 0,539), também com significância estatística (p < 0,001). Conclusão: Esta pesquisa demonstrou baixa detecção de VB pelo Pap (5 %) em relação ao Gram (19%), em maioria (75%) de mulheres na fase reprodutiva.

Introduction: Usage of ceftriaxone-based therapy to treat Methicillin-Susceptible Staphylococcus aureus (MSSA) infections is a controversial issue, from in vitro to clinical studies.Area covered: We conducted a literature review using PubMed of articles with ceftriaxone pharmacokinetics parameters and built a probability of target attainment (PTA) based on PK values from stable conditions (non-critically-ill patients) with goals of fT>55%, fT>75%, and fT>100%. Ceftriaxone's minimal inhibitory concentration from 31 MSSA strains (0.25-64 mg/L) was used to build the cumulative fraction response (CFR). The isolates were clinically relevant from blood, bronchoalveolar lavage, and soft tissue biopsy.Expert opinion: The results from controversies about using ceftriaxone for MSSA infections have been commonly addressed in the literature. However, variables such as (i) pharmacokinetic profile, (ii) pharmacodynamic target, (iii) site of infection, and (iv) MIC distributions may influence divergences. From this pharmacokinetics-pharmacodynamics perspective, ceftriaxone may be a reasonable option for MSSA infections when the MIC50 and MIC90 were 4 mg/L and 8 mg/L. CFR analysis demonstrated that ceftriaxone 1 g q24 h could be used if bacteriostasis is the aim (fT>55%), while 1 g q12h should be used for bactericidal effects (fT>75% or fT>100%). These dosing regimens should be considered in other clinical trials.

To the Editor, In this journal attempts to circumvent carbapenem resistance of Pseudomonas aeruginosa were recently reported [1]. Among 28 clinical carbapenem-resistant isolates of P. aeruginosa, 1...

Postpartum infections are a significant cause of prolonged hospitalization and maternal morbidity and mortality, with cesarean delivery being one of the main risk factors. This is a retrospective cross-sectional study, in which the medical records of patients affected with postpartum infection in the years 2019 to 2021 at the Hospital Universitário Regional Wallace Thadeu de Mello e Silva / Hospital Universitário Materno Infantil in Ponta Grossa were evaluated. During this period, 9097 obstetric procedures were performed, and 58 cases of obstetric infections were recorded, resulting in a rate of 0.63%, going from a rate of 1.5% (45 notifications) in 2019 to 0.27% (8) in 2020 and 0.15% (5) in 2021. The rate of healthcare-associated infections in cesarean sections was 1.78%, and showed a decrease, being 5.26% in 2019 and falling to 0.63% in 2020 and 0.27% in 2021, while the rate in vaginal delivery remained similar in the three years studied (0.11% in 2019 and 0.12% in 2020 and 2021). Among these, 79.31% were wound infections, while 12.06% were endometritis infections. It is concluded that performing cesarean sections predisposes to a higher risk of postpartum infection, especially if performed after the onset of labor. Moreover, there was a progressive increase in the cesarean rate over the years studied, reaching 40.85% in 2021, considerably higher than that recommended by the World Health Organization. Las infecciones posparto son una causa importante de hospitalización prolongada y de morbilidad y mortalidad materna, siendo el parto por cesárea uno de los principales factores de riesgo. Se trata de un estudio transversal retrospectivo, en el que se evaluaron las historias clínicas de las pacientes afectadas con infección posparto en los años 2019 a 2021 en el Hospital Universitário Regional Wallace Thadeu de Mello e Silva / Hospital Universitario Materno Infantil en Ponta Grossa. En este periodo se han realizado 9097 procedimientos obstétricos y se han registrado 58 casos de infecciones obstétricas, lo que supone una tasa del 0,63%, pasando de una tasa del 1,5% (45 notificaciones) en 2019 al 0,27% (8) en 2020 y al 0,15% (5) en 2021. La tasa de infecciones relacionadas con la asistencia sanitaria en las cesáreas fue del 1,78%, y mostró un descenso, siendo del 5,26% en 2019 bajando al 0,63% en 2020 y al 0,27% en 2021, mientras que la tasa en el parto vaginal se mantuvo similar en los tres años estudiados (0,11% en 2019 y 0,12% en 2020 y en 2021). Entre ellas, el 79,31% fueron infecciones del sitio quirúrgico, mientras que el 12,06% se debieron a endometritis. Se concluye que la realización de cesáreas predispone a un mayor riesgo de infección posparto, especialmente si se realiza tras el inicio del parto. Además, se produjo un aumento progresivo de la tasa de cesáreas a lo largo de los años estudiados, hasta alcanzar el 40,85% en 2021, muy por encima de lo recomendado por la Organización Mundial de la Salud. As infecções pós-parto são importantes causa de hospitalização prolongada e de morbimortalidade materna, sendo o parto cesáreo um dos principais fatores de risco. Esse é um estudo transversal retrospectivo, em que foram avaliados os prontuários das pacientes acometidas com infecção pós-parto nos anos de 2019 a 2021 no Hospital Universitário Regional Wallace Thadeu de Mello e Silva / Hospital Universitário Materno Infantil em Ponta Grossa. Nesse período, foram realizados 9097 procedimentos obstétricos e registrados 58 casos de infecções obstétricas, resultando em uma taxa de 0,63%, indo de uma taxa de 1,5% (45 notificações) em 2019 para 0,27% (8) em 2020 e de 0,15% (5) em 2021. A taxa de infecções relacionadas à assistência à saúde em cesáreas foi de 1,78%, e apresentou queda, sendo de 5,26% em 2019 caindo para 0,63% em 2020 e 0,27% em 2021, enquanto a taxa em parto vaginal se manteve semelhante nos três anos estudados (0,11% em 2019 e de 0,12% em 2020 e em 2021). Dentre essas, 79,31% foram infecções de sítio cirúrgico, enquanto 12,06% por endometrite. Conclui-se que a realização de cesáreas predispõe maior risco de infecção pós-parto, especialmente se realizadas após o início do trabalho de parto. Além disso, houve aumento progressivo na taxa de cesáreas ao longo dos anos estudados, chegando a 40,85% em 2021, consideravelmente acima do preconizado pela Organização Mundial da Saúde.

We evaluated the performance of ceftazidime-avibactam and ceftolozane-tazobactam MicroScan Neg multidrug-resistant MIC 1 (NMR1) panel for clinical carbapenem-nonsusceptible Gram-negative bacilli isolates. We evaluated 212 clinically significant carbapenem-nonsusceptible Gram-negative bacilli (139 Pseudomonas aeruginosa and 73 KPC-producing Enterobacterales) from 71 Brazilian hospitals (2013 to 2020). Ceftazidime-avibactam and ceftolozane-tazobactam MICs from the panel were compared with a broth microdilution (BMD) test as the reference method. Essential agreement (EA) and categorical agreement (CA) were assessed. For P. aeruginosa, antimicrobial susceptibility testing error rates were calculated using the error-rate bound method. Discrepancies were initially observed with 11 isolates; 4 resolved after retesting, 2 in favor of the NMR1 and 2 in favor of the BMD method. The ceftazidime-avibactam EA (overall and evaluable) was 100% for P. aeruginosa and Enterobacterales. The CA was 100% for Enterobacterales and 98.6% for P. aeruginosa. The ceftolozane-tazobactam EA was 98.6% and 100% (overall and evaluable, respectively), and the CA was 96.4% for P. aeruginosa. For ceftazidime/avibactam, no very major error (VME) was found, and the major error (ME) rate was 4.2% (2/48). For ceftolozane-tazobactam and P. aeruginosa, using the CLSI breakpoints, the minor error (mE) was 11.4%, and no VME or ME was found. While using EUCAST breakpoints, the VME was 11.4% with no ME. The mE becomes ME or VME in the absence of the intermediate category. All categorical errors were also within 1 log of MIC variation, and the adjusted error rate for CLSI/EUCAST was 0% (0/212). The NMR1 panel is an option to test ceftazidime-avibactam for KPC-producing Enterobacterales and carbapenem-nonsusceptible P. aeruginosa. When a MIC of 4 mg/liter for ceftolozane-tazobactam is obtained using this method, an alert could be created, and the results could be confirmed by an alternative method.

Plazomicin is a next-generation aminoglycoside with activity against Enterobacteriaceae, including carbapenemase-producing Enterobacteriaceae (CPE). The aim of this study was to evaluate the activity of plazomicin against CPE (Klebsiella spp., Escherichia coli, Serratia spp., Enterobacter spp., Citrobacter spp., Morganella spp., Proteus spp., Providencia spp.) from different Brazilian hospitals. A total of 4000 carbapenem-resistant Enterobacteriaceae isolates were collected from clinical samples in 50 Brazilian hospitals during 2013-2015. Of these, 499 carbapenem-resistant isolates (CLSI criteria) were selected for further evaluation via broth microdilution to assess for the activity of plazomicin, colistin, tigecycline, meropenem, amikacin, and gentamicin. Additionally, the isolates were assessed for the presence of carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaIMP, blaBKC, blaGES, and blaVIM) by polymerase chain reaction (PCR). When PCR was positive to blaOXA-48-like, blaIMP, blaGES, and blaVIM, the carbapenemase genes were sequenced. blaKPC was the most prevalent carbapenemase gene found (n=397), followed by blaNDM (n=81), blaOXA-48 (n=12), and blaIMP-1 (n=3). Other genes were identified in only 1 isolate each: blaBKC-1, blaGES-16, blaGES-1, blaOXA-370, and blaVIM-1. One isolate had 2 carbapenemase genes (blaKPC and blaNDM). Thirty-three percent of the isolates were nonsusceptible to colistin, 24% to tigecycline, 97% to meropenem, 51% to amikacin, and 81% to gentamicin (via EUCAST criteria). The plazomicin MIC50/90 was 0.5/64mg/L, with 85% of MICs ≤2mg/L and 87% of MICs ≤4mg/L. Elevated MICs to plazomicin were not associated with a specific carbapenemase or bacterial species. The MICs of plazomicin against CPE were lower than those of other aminoglycosides. Plazomicin is a promising drug for the treatment of CPE infections.

Imipenem-relebactam and ceftolozane-tazobactam are new antimicrobial options for the treatment of multidrug-resistant gram-negative bacteria, including carbapenem-resistant bacilli. In this study, we aimed to evaluate the activity of imipenem-relebactam and ceftolozane-tazobactam against carbapenem-resistant Pseudomonas aeruginosa and KPC-producing Enterobacterales. Imipenem-relebactam was effective against 96% and 63% of KPC-producing Enterobacterales and carbapenemase-resistant Pseudomonas aeruginosa isolates, respectively. However, ceftolozane-tazobactam inhibited 77% of carbapenem-resistant Pseudomonas aeruginosa. Therefore, when comparing the in vitro activities of ceftolozane-tazobactam and imipenem-relebactam, ceftolozane-tazobactam was more active against carbapenemase-nonproducing P. aeruginosa, whereas imipenem-relebactam was more active against KPC-producing Enterobacterales.

The species of the Lamiaceae family produce essential oils in the glandular trichomes, leaf surfaces, and in inflorescences, and can also produce many secondary compounds, which indicates great potential for study. The aim of this paper was to describe the chemical composition and the biological, antioxidant, antimicrobial, and antitumor activities of the essential oil of Cantinoa althaeifolia for the first time. The essential oil was obtained from the leaves by hydrodistillation and analyzed by gas chromatography mass spectrometry (GC/MS). The antioxidant activity was established by the phosphomolybdenum method. The minimum inhibitory concentration against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans was determined. The lethality test of Artemia salina was performed. The cytotoxicity against murine fibroblasts (3T3), non-tumor cells (McCoy), murine melanoma (B16F10), and human breast carcinoma (MCF-7) cells was assessed. Five major compounds were isolated: himachalene (11.62%), spathulenol (10.08%), caryophylline oxide (9.93%), (E)-caryophylene (9.21%), and pogostol (6.31%). The phosphomolybdenum complex method showed positive results. The minimum inhibitory concentration was greater than 1000 μg/mL for the tested microorganisms. The mortality rate of Artemia salina was low. The tested cancer cell lines showed an IC50 of 12.5 and 25 μg/mL. These findings indicate that the essential oil of Cantinoa althaeifolia has antioxidant, antimicrobial, and antitumor activities. Las especies de la familia Lamiaceae producen aceites esenciales en los tricomas glandulares, la superficie de las hojas y las inflorescencias, y también pueden producir muchos compuestos secundarios, lo que indica un gran potencial de estudio. El objetivo de este trabajo fue describir la composición química y las actividades biológicas, antioxidantes, antimicrobianas y antitumorales del aceite esencial de Cantinoa althaeifolia por primera vez. El aceite esencial se obtuvo de las hojas por hidrodestilación y se analizó mediante cromatografía de gases y espectrometría de masas (CG/EM). La actividad antioxidante se estableció mediante el método del fosfomolibdeno. Se determinó la concentración mínima inhibitoria contra Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa y Candida albicans. Se realizó la prueba de letalidad de Artemia salina. Se evaluó la citotoxicidad contra fibroblastos murinos (3T3), células no tumorales (McCoy), melanoma murino (B16F10) y carcinoma de mama humano (MCF-7). Se aislaron cinco compuestos principales: himachaleno (11,62%), espatulenol (10,08%), óxido de cariofileno (9,93%), (E)-cariofileno (9,21%) y pogostol (6,31%). El método del complejo de fosfomolibdeno mostró resultados positivos. La concentración inhibitoria mínima fue superior a 1000 μg/mL para los microorganismos probados. La tasa de mortalidad de Artemia salina fue baja. Las líneas celulares de cáncer probadas mostraron una CI50 de 12,5 y 25 μg/mL. Estos hallazgos indican que el aceite esencial de Cantinoa althaeifolia tiene actividades antioxidantes, antimicrobianas y antitumorales. As espécies da família Lamiaceae produzem óleos essenciais nos tricomas glandulares, superfícies foliares e em inflorescências, podendo também produzir diversos compostos secundários, o que indica grande potencial de estudo. O objetivo deste trabalho foi descrever a composição química e as atividades biológica, antioxidante, antimicrobiana e antitumoral do óleo essencial de Cantinoa althaeifolia pela primeira vez. O óleo essencial foi obtido das folhas por hidrodestilação e analisado por cromatografia gasosa e espectrometria de massas (CG/EM). A atividade antioxidante foi determinada pelo método do fosfomolibdênio. A concentração inibitória mínima contra Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa e Candida albicans foi determinada. Foi realizado o teste de letalidade de Artemia salina. A citotoxicidade contra fibroblastos murinos (3T3), células não tumorais (McCoy), melanoma murino (B16F10) e células de carcinoma de mama humano (MCF-7) também foi avaliada. Cinco compostos principais foram isolados: himachaleno (11,62%), espatulenol (10,08%), óxido de cariofileno (9,93%), (E)-cariofileno (9,21%) e pogostol (6,31%). O método do complexo de fosfomolibdênio apresentou resultados positivos. A concentração inibitória mínima foi superior a 1000 μg/mL para os microrganismos testados. A taxa de mortalidade de Artemia salina foi baixa. As linhas de células cancerosas testadas mostraram uma CI50 de 12,5 e 25 μg/mL. Esses achados indicam que o óleo essencial de Cantinoa althaeifolia possui atividades antioxidante, antimicrobiana e antitumoral.

Background: The presence of 16S rRNA methyltranferases (16S-RMTases) in carbapenemase-producing Enterobacterales (CPE) is a major concern because it inactivates all clinical use of aminoglycosides, including plazomicin. The aim of this study is to investigate the prevalence of 16S-RMTases in CPE nonsusceptible to plazomicin collected in different Brazilian hospitals. Methods: All isolates with plazomicin MIC ≥ 4 µg/mL (n = 67) were screened for the presence of 16S-RMTases by sequencing. Results: 54 (80.6%) isolates encoded 16S-RMTase genes (41 rmtB1, 7 armA, 3 rmtD2, 1 rmtD1 and 2 rmtC). Among 41 samples rmtB1 positive, 40 co-harbored blaKPC-2 and 1 blaOXA-48 gene. Of the seven isolates harboring armA gene, 6 were New Delhi Metallo-beta-lactamase (NDM)-producer. rmtD was only found in isolates Klebsiella pneumoniae Carbapenemase (KPC)-producers, one in Serratia marcescens with rmtD2, not reported in Brazil. Conclusion: The co-existence of 16S-RMTase and CPE is worrisome because of limited treatment options and the endemic characteristic of (KPC) and NDM in Brazil.

Objective: HIV infection is exacerbated through additional pro-atherogenic mechanisms related to the processes of immune activation, inflammation, coagulation, and the modification of lipoproteins (e.g., particles of high density lipoprotein), contributing to increased cardiovascular risk. The aim of this study was to analyze the serum concentrations of myeloperoxidase (MPO) and other laboratory parameters in HIV-infected patients treated or not with antiretroviral drugs compared to non-infected individuals. Materials/Methods: The study included 154 volunteers: 47 non-infected individuals (control group - CON), 27 infected and untreated individuals (NTARV group) and 80 treated individuals (TARV group). We analyzed the counts of CD4+ lymphocytes and the viral load of the infected patients, along with the blood count, fasting glucose, total serum cholesterol (CHOL), HDL cholesterol, LDL cholesterol, triglycerides, MPO and high-sensitivity C-reactive protein (CRP) of all study participants. Results: There were significant increases in glucose, CHOL, LDL cholesterol, and triglycerides in the TARV group and significant reductions in the levels of HDL cholesterol for the TARV and NTARV groups. Significantly elevated levels of Hs-CRP were observed only in the TARV group, while levels of MPO were significantly higher in the TARV and NTARV groups compared to the control group. A correlation of MPO with Hs-CRP (r = 0.21, p = 0.032) was observed for HIV-infected patients, but MPO did not correlate significantly with the other analyzed parameters. Conclusions: The investigation of early biomarkers for cardiovascular risk evaluation, such as MPO, contributes to the clinical monitoring of HIV-infected individuals. The serum levels of MPO correlated with Hs-CRP and were high in HIV-infected individuals, indicating a possible predictor of cardiovascular events in these patients.

Introduction: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. Objectives: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. Methods: This is case–control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). Results: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13–5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24–2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12–0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. Conclusions: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. Keywords: Hospital infection, Morbimortality, Renal replacement therapy center, Hemodialysis, Bacteria, Sensitivity profiles

INTRODUÇÃO: A presença de hemácias dismórficas na urina é um forte indicativo da origem glomerular do sangramento, sendo uma ferramenta importante no diagnóstico de glomerulonefrites. Os cilindros hemáticos geralmente acompanham as hemácias dismórficas, sendo também fortes indicadores de hematúria glomerular, embora não sejam encontrados com frequência no exame parcial de urina. OBJETIVO: Comparar duas técnicas de concentração de amostras em uma série de exames de urina com hematúria dismórfica. MATERIAL E MÉTODOS: Foram selecionadas 249 amostras com hematúria dismórfica a partir de 4.277 amostras de urina de rotina. As amostras foram processadas utilizando-se duas técnicas: a convencional e a de concentração. O percentual de identificação dos cilindros hemáticos foi comparado de acordo com a metodologia utilizada. RESULTADOS: A presença de cilindros hemáticos pela técnica de concentração foi estatisticamente maior (52,6%) em comparação com a positividade pela metodologia convencional (8,4%) (p < 0,001). DISCUSSÃO E CONCLUSÃO: Sugere-se que a técnica convencional não concentrou suficientemente a amostra de urina e os cilindros hemáticos ficaram no sobrenadante, sendo descartados. A utilização da técnica de concentração aumentou a sensibilidade técnica para a pesquisa dos cilindros hemáticos. Portanto, a técnica de concentração, associada à presença de hemácias dismórficas, mostrou-se útil para aumentar a concordância dos dois parâmetros laboratoriais para a detecção da hematúria de origem glomerular como auxílio diagnóstico das glomerulopatias, importante causa de doença renal crônica. INTRODUCTION: Dysmorphic red blood cells (RBCs) in the urine are a strong indicator of a glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria. OBJECTIVE: This study tested the superiority of a urine concentration technique (CT) over the standard method (SM) for RBC cast identification in a group of patients suspected of glomerular hematuria. MATERIAL AND METHODS: Of a total of 4,227 routine urinary samples, 249 with dysmorphic hematuria were selected. The samples were processed according to two techniques: standard method (SM) and concentration technique (CT). The percentages of RBC cast identification according to each method were compared. RESULTS: The CT showed a higher rate of RBC casts (52.6%) compared to the SM (8.4%) (p < 0.001). DISCUSSION AND CONCLUSION: We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded. The CT increased the sensitivity of the RBC cast yield. The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification of glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.

Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella spp. is a problematic nosocomical pathogen around the world. In the present study, we aimed to evaluate the previous use of antibiotics as a risk factor for isolation of ESBL Klebsiella spp.

Dysmorphic red blood cells (RBCs) in the urine are a strong indicator of a glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria.This study tested the superiority of a urine concentration technique (CT) over the standard method (SM) for RBC cast identification in a group of patients suspected of glomerular hematuria.Of a total of 4,227 routine urinary samples, 249 with dysmorphic hematuria were selected. The samples were processed according to two techniques: standard method (SM) and concentration technique (CT). The percentages of RBC cast identification according to each method were compared.The CT showed a higher rate of RBC casts (52.6%) compared to the SM (8.4%) (p0.001).We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded. The CT increased the sensitivity of the RBC cast yield. The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification of glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.