Haematuria Increases Progression of Advanced Proteinuric Kidney Disease

Abstract

BackgroundHaematuria has been traditionally considered as a benign hallmark of some glomerular diseases; however new studies show that haematuria may decrease renal function.ObjectiveTo determine the influence of haematuria on the rate of chronic kidney disease (CKD) progression in 71 proteinuric patients with advanced CKD (baseline eGFR <30 mL/min) during 12 months of follow-up.ResultsThe mean rate of decline in eGFR was higher in patients with both haematuria and proteinuria (haemoproteinuria, HP, n=31) than in patients with proteinuria alone (P patients, n=40) (-3.8±8.9 vs 0.9±9.5 mL/min/1.73m2/year, p<0.05, respectively). The deleterious effect of haematuria on rate of decline in eGFR was observed in patients <65 years (-6.8±9.9 (HP) vs. 0.1±11.7 (P) mL/min/1.73m2/year, p<0.05), but not in patients >65 years (-1.2±6.8 (HP) vs. 1.5±7.7 (P) mL/min/1.73m2/year). Furthermore, the harmful effect of haematuria on eGFR slope was found patients with proteinuria >0.5 g/24 h (-5.8±6.4 (HP) vs. -1.37± 7.9 (P) mL/min/1.73m2/year, p<0.05), whereas no significant differences were found in patients with proteinuria < 0.5 g/24 h (-0.62±7.4 (HP) vs. 3.4±11.1 (P) mL/min/1.73m2/year). Multivariate analysis reported that presence of haematuria was significantly and independently associated with eGFR deterioration after adjusting for traditional risk factors, including age, serum phosphate, mean proteinuria and mean serum PTH (β=-4.316, p=0.025).ConclusionsThe presence of haematuria is closely associated with a faster decrease in renal function in advanced proteinuric CKD patients, especially in younger CKD patients with high proteinuria levels; therefore this high risk subgroup of patients would benefit of intensive medical surveillance and treatment.

Hematuria in aging men with hemophilia: Association with factor prophylaxis

“…In addition to being cytotoxic, heme can promote renal damage by inducing inflammation and fibrosis . Multiple episodes of macroscopic hematuria are associated with a decline in renal function and progression of chronic renal disease . Reducing macroscopic hematuria may thus improve renal function and limit future renal damage.…”

“…25,26 Multiple episodes of macroscopic hematuria are associated with a decline in renal function and progression of chronic renal disease. [27][28][29] Reducing macroscopic hematuria may thus improve renal function and limit future renal damage. Although management of macroscopic hematuria depends on etiology, the recommended initial treatment is increased fluid intake, either orally or by intravenous hydration.…”

Links between coagulation, inflammation, regeneration, and fibrosis in kidney pathology

“…Capillary wall injury in few glomeruli can produce hematuria. 56,57 It remains uncertain if persistent hematuria always originates from vascular lesions of the same glomeruli that do not heal or whether clots stop bleeding in some glomeruli, whereas others start to bleed with persistent hematuria as a net effect. IgA nephropathy as well as other renal disorders present with episodes of intermittent macrohematuria that can last several days, suggesting insufficient clotting.…”

Persistent Microscopic Hematuria as a Risk Factor for Progression of IgA Nephropathy: New Floodlight on a Nearly Forgotten Biomarker

“…The damage induced by hematuria does not appear to be unique to IgAN, as recently reported by the same investigators who found hematuria to be closely associated with more rapid decline in eGFR in a variety of proteinuria disorders other than IgAN, especially in younger patients. 21 Although persistent proteinuria can reflect active capillary and podocyte lesions, it can also be due to hyperfiltration in chronic, irreversible cases. In IgAN, proteinuria by itself cannot discriminate between active inflammation versus chronic damage.…”