Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria

Iwasaki, Chihiro; Moriyama, Takahito; Tanaka, Kayu; Takei, Takashi; Nitta, Kosaku

doi:10.15171/jnp.2016.12

Cited by 19 publications

(18 citation statements)

References 24 publications

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“…Although some studies suggested a significant influence of hematuria on the risk of developing ESRD, 6,9,19,20 others could not confirm this finding. [21][22][23][24] However, the robustness of these studies was reduced by the way in which hematuria was evaluated (at the onset of the disease, at the time of renal biopsy, or by cross-sectional studies) without longitudinal data. 23,24 In other studies, urine dipsticks were used, and the magnitude of hematuria was not quantified.…”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24] However, the robustness of these studies was reduced by the way in which hematuria was evaluated (at the onset of the disease, at the time of renal biopsy, or by cross-sectional studies) without longitudinal data. 23,24 In other studies, urine dipsticks were used, and the magnitude of hematuria was not quantified. 20 At the end of follow-up, 17.2% of our patients had reached ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…In some of them, patients with hematuria had a worse prognosis, 6,9,19,20 but this result was not confirmed in others. [21][22][23][24] A common shortcoming in these studies was, however, that the analysis of hematuria was performed only at the onset of the disease or some isolated point in the evolution of patients. Likewise, in most studies, the magnitude of hematuria (i.e., the number of red blood cells [RBCs] per microscopic field) was not quantified.…”

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confidence: 99%

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Remission of Hematuria Improves Renal Survival in IgA Nephropathy

Sevillano¹,

Gutiérrez²,

Yuste³

et al. 2017

JASN

121

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Hematuria is a cardinal symptom in IgA nephropathy, but its influence on the risk of disease progression has been scarcely investigated. We followed a cohort of 112 patients with IgA nephropathy for a mean±SEM period of 14±10.2 years, during which clinical and analytic risk factors (including urine sediment examination) were regularly recorded. According to the magnitude of time-averaged hematuria, we classified patients as those with persistent hematuria and those with negative or minimal hematuria. We also classified patients according to the magnitude of time-averaged proteinuria (>0.75 or ≤0.75 g/d). The proportion of patients reaching ESRD or a 50% reduction of renal function was significantly greater among patients with persistent hematuria than patients with minimal or negative hematuria (30.4% and 37.0% versus 10.6% and 15.2%, respectively; =0.01). Multivariable analysis revealed time-averaged hematuria, time-averaged proteinuria, renal function at baseline, and the presence of tubulointerstitial fibrosis on renal biopsy as independent predictors of ESRD. After hematuria disappearance, which occurred in 46% of the patients, the rate of renal function decline changed from -6.45±14.66 to -0.18±2.56 ml/min per 1.73 m per year (=0.001). Patients with time-averaged proteinuria >0.75 g/d had significantly poorer renal survival than those with time-averaged proteinuria ≤0.75 g/d. However, on further classification by time-averaged hematuria, only those patients with time-averaged proteinuria >0.75 g/d and persistent hematuria had significantly worse renal survival than those in the other three groups. In conclusion, remission of hematuria may have a significant favorable effect on IgA nephropathy outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Remission of Hematuria Improves Renal Survival in IgA Nephropathy

Sevillano¹,

Gutiérrez²,

Yuste³

et al. 2017

JASN

121

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“…In the Cox proportional hazard model, the corresponding HR was 0.85 (95% CI, 0.64–1.14; p = .28). Of 2 studies from the same center in Japan [ 14 , 33 ], the magnitude of hematuria at biopsy (per 20 RBCs/HPF increase) was evaluated in IgAN patients with proteinuria (> 1 g/day) and mild proteinuria (< 0.5 g/day). The HRs were 0.75 (95% CI, 0.55–1.00; p = .053) and 1.16 (95% CI, 0.89–1.46; p = .247), respectively.…”

Section: Resultsmentioning

confidence: 99%

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Wang

Huang

et al. 2021

Renal Failure

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Background: The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN. Methods: Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models. Results: Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87-2.00; p ¼ .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40-2.50; p < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58-0.79; p < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR. Conclusions: Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.

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“…Conversely, proteinuria at onset was not associated with bad prognosis, probably because it represents the consequence of the acute inflammation, reversible with steroid therapy. Gross hematuria, per se, is not prognostic (119), but persistence of severe microscopic hematuria has recently been considered a risk factor (120). Glomerular filtration rate at biopsy is a predictor of the need for dialysis in adults (118,(121)(122)(123)(124).…”

Section: Natural History and Prognosismentioning

confidence: 99%

Clinical and Pathophysiological Insights Into Immunological Mediated Glomerular Diseases in Childhood

et al. 2020

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The kidney is often the target of immune system dysregulation in the context of primary or systemic disease. In particular, the glomerulus represents the anatomical entity most frequently involved, generally as the expression of inflammatory cell invasion or circulant or in situ immune-complex deposition. Glomerulonephritis is the most common clinical and pathological manifestation of this involvement. There are no universally accepted classifications for glomerulonephritis. However, recent advances in our understanding of the pathophysiological mechanisms suggest the assessment of immunological features, biomarkers, and genetic analysis. At the same time, more accurate and targeted therapies have been developed. Data on pediatric glomerulonephritis are scarce and often derived from adult studies. In this review, we update the current understanding of the etiologic events and genetic factors involved in the pathogenesis of pediatric immunologically mediated primitive forms of glomerulonephritis, together with the clinical spectrum and prognosis. Possible new therapeutic targets are also briefly discussed.

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Effect of hematuria on the outcome of immunoglobulin A nephropathy with proteinuria

Cited by 19 publications

References 24 publications

Remission of Hematuria Improves Renal Survival in IgA Nephropathy

Remission of Hematuria Improves Renal Survival in IgA Nephropathy

Hematuria was a high risk for renal progression and ESRD in immunoglobulin a nephropathy: a systematic review and meta-analysis

Clinical and Pathophysiological Insights Into Immunological Mediated Glomerular Diseases in Childhood

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