diff --git a/clang-tools-extra/clangd/refactor/Rename.cpp b/clang-tools-extra/clangd/refactor/Rename.cpp
--- a/clang-tools-extra/clangd/refactor/Rename.cpp
+++ b/clang-tools-extra/clangd/refactor/Rename.cpp
@@ -306,6 +306,8 @@
   bool HasMore = Index.refs(RQuest, [&](const Ref &R) {
     if (AffectedFiles.size() > MaxLimitFiles)
       return;
+    if (!static_cast<uint8_t>(R.Kind & RefKind::Spelled))
+      return;
     if (auto RefFilePath = filePath(R.Location, /*HintFilePath=*/MainFile)) {
       if (*RefFilePath != MainFile)
         AffectedFiles[*RefFilePath].push_back(toRange(R.Location));
diff --git a/clang-tools-extra/clangd/unittests/RenameTests.cpp b/clang-tools-extra/clangd/unittests/RenameTests.cpp
--- a/clang-tools-extra/clangd/unittests/RenameTests.cpp
+++ b/clang-tools-extra/clangd/unittests/RenameTests.cpp
@@ -33,7 +33,7 @@
 // Convert a Range to a Ref.
 Ref refWithRange(const clangd::Range &Range, const std::string &URI) {
   Ref Result;
-  Result.Kind = RefKind::Reference;
+  Result.Kind = RefKind::Reference | RefKind::Spelled;
   Result.Location.Start.setLine(Range.start.line);
   Result.Location.Start.setColumn(Range.start.character);
   Result.Location.End.setLine(Range.end.line);
@@ -892,6 +892,22 @@
         }
       )cpp",
       },
+      {
+          // Rename only spelled references.
+          R"cpp(
+        class [[Fo^o]] {};
+        #define FooFoo Foo
+        #define FOO Foo
+      )cpp",
+          R"cpp(
+        #include "foo.h"
+        void bar() {
+          [[Foo]] x;
+          FOO y;
+          FooFoo z;
+        }
+      )cpp",
+      },
   };
 
   for (const auto& T : Cases) {