Microscopic Haematuria and Clinical Outcomes in Patients With Stage 3–5 Nondiabetic Chronic Kidney Disease

Abstract

Microscopic haematuria is proposed as a prognostic factor for renal outcomes in patients with glomerulonephritis. However, the role of haematuria in patients with advanced chronic kidney disease (CKD) or heavy proteinuria has not been investigated. We divided 1799 patients with stage 3–5 nondiabetic CKD into 3 groups according to the results from 3 urinalyses: no haematuria (0–2 red blood cells [RBCs]/hpf ≥2 times), mild haematuria (2–5 RBCs/hpf ≥2 times) and moderate haematuria (≥5–10 RBCs/hpf ≥2 times). The estimated glomerular filtration rate was 25.4 mL/min/1.73 m2, with a urine protein-to-creatinine ratio (UPCR) of 881 mg/g. The hazard ratios (HRs) of mild and moderate haematuria for end-stage renal disease (ESRD) were 1.28 (95% confidence interval [CI]: 1.05–1.56, P = 0.024) and 1.34 (95% CI: 1.03–1.74, P = 0.030), respectively. The HR of moderate haematuria for mortality was 1.56 (95% CI: 1.11–2.20, P = 0.011). According to subgroup analysis, the HR of moderate haematuria for ESRD in patients with a UPCR of <500 mg/g was more prominent than that in patients with a UPCR of ≥500 mg/g. Microscopic haematuria in patients with stage 3–5 nondiabetic CKD is associated with increased risks of ESRD and mortality.

Diabetic Retinopathy and Clinical Parameters Favoring the Presence of Diabetic Nephropathy could Predict Renal Outcome in Patients with Diabetic Kidney Disease

“…However, these studies exhibited heterogeneity, especially on the definition of hematuria. Our previous study has shown that hematuria according to ≥5–10 red blood cells per high power field (RBC/HPF), but not 2–5 RBC/HPF, was associated with NDRD 33 . This is supported by another report 11 .…”

“…Multivariate logistic regression analysis was used to evaluate the relationships between parameters and rapid renal progression. The model was adjusted for age, sex, the eGFR, the log-transformed UPCR, hypertension, CV disease, MBP, HbA1c, hemoglobin, albumin, BMI, log-transformed cholesterol, log-transformed CRP, and phosphorus, according to the literature and our previous publications 33 , 34 .…”

Risk factors for progression of chronic kidney disease in the EPPIC trials and the effect of AST-120

“…A large-scale cohort study in Israel of young adults with hematuria demonstrated that persistent asymptomatic microscopic hematuria was a risk factor for ESRD onset [ 11 ]. A study of patients with stage 3–5 nondiabetic CKD demonstrated that microscopic hematuria was significantly associated with increased risk of ESRD, rapid renal function progression, and all-cause mortality, particularly in those with mild proteinuria [ 12 ]. Another study demonstrated that patients with advanced CKD with hematuria progressed significantly faster to ESRD as compared with patients with proteinuria alone [ 13 ].…”

Sublytic C5b-9 Induces Glomerular Mesangial Cell Apoptosis through the Cascade Pathway of MEKK2–p38 MAPK–IRF-1–TRADD–Caspase 8 in Rat Thy-1 Nephritis

“…Collectively, these findings indicate that the cascade axis of MEKK2-p38 MAPK-IRF-1-TRADD-caspase 8 may play an important role in GMC apoptosis following exposure to sublytic C5b-9 in rat Thy-1N. The Journal of Immunology, 2017Immunology, , 198: 1104Immunology, -1118 M esangioproliferative glomerulonephritis (MsPGN), which is characterized by glomerular mesangial cell (GMC) apoptosis, proliferation, and extracellular matrix (ECM) secretion, is a representative nephritis that leads to chronic kidney disease (1)(2)(3)(4)(5), one of the most important risk factors for human end-stage renal disease and death (6)(7)(8). Although C5b-9, especially the sublytic C5b-9 complex, was found in the glomeruli of patients with MsPGN (9-12), it is not fully understood how it causes GMC damage.…”