What kind of RBC finding is highly suggestive of glomerular disease?

Dysmorphic red blood cells, particularly acanthocytes, are highly suggestive of glomerular disease due to their association with the presence of hematuria that occurs in the context of renal pathology. In glomerular diseases such as nephritic syndrome or glomerulonephritis, the glomerular filtration barrier is damaged, allowing red blood cells to escape into the urine. The passage through the abnormal glomerular environment and the resulting shear stress can deform the RBCs, leading to their dysmorphic appearance.

Acanthocytes, characterized by their irregular shape and projections, are indicative of the mechanical damage and turbulent flow they experience when traversing a diseased glomerulus. The presence of these dysmorphic RBCs in the urine is a key finding that clinicians use to suggest underlying glomerular involvement, guiding further diagnostic evaluation and management of potential renal diseases.

While the other options represent different types of red blood cell abnormalities, they are not specifically linked to glomerular diseases in the same way dysmorphic RBCs are. Normocytic RBCs may suggest a number of conditions, macrocytic RBCs are usually associated with deficiencies (like vitamin B12 or folate), and spherocytes are typically seen