Microscopic hematuria is a risk factor for end-stage kidney disease in patients with biopsy-proven diabetic nephropathy

Abstract

IntroductionThere are fewer reports about whether the presence of hematuria affects the progression of chronic kidney disease in patients with diabetic nephropathy. We analyzed whether microscopic hematuria in diabetic nephropathy is a risk factor for end-stage kidney disease (ESKD).Research design and methodsThe present study was a retrospective cohort study of patients with biopsy-proven diabetic nephropathy. We recruited 397 patients with diabetic nephropathy, which was confirmed by renal biopsy between June 1981 and December 2014 and followed them until October 2018 or death. Patients with microscopic hematuria before renal biopsy were defined as the hematuria group (n=91), and the remainder as the no-hematuria group (n=306). The main outcome was the occurrence of ESKD, which was defined by the requirement of permanent renal replacement therapies.ResultsThe systolic and diastolic blood pressure, serum creatinine and proteinuria were significantly higher, and the estimated glomerular filtration rate was significantly lower in the hematuria group compared with the no-hematuria group. Pathological evaluations revealed that glomerular, tubulointerstitial and vascular lesions in the hematuria group were significantly more severe. During a median of 10.1 years, 44 and 52 patients developed ESKD in the hematuria group and the no-hematuria group, respectively. Survival analyses showed that the incidence of ESKD was significantly higher in the hematuria group compared with the no-hematuria group (log-rank, p<0.0001). The multivariable Cox proportional hazards models revealed a significant association between hematuria and the incidence of ESKD after adjusting for clinically relevant factors, including proteinuria and renal pathology (adjusted HR 1.64, 95% CI 1.03 to 2.60). The subgroups of men, proteinuria ≥0.5 g/day, and systolic blood pressure ≥132 mm Hg showed a stronger association between hematuria and ESKD than their opposing subgroups.ConclusionsMicroscopic hematuria is a risk factor for ESKD in diabetic nephropathy, independent of proteinuria and renal pathology.

Presence of Non-Diabetic Kidney Diseases in Biopsy Specimens of Diabetic Patients’ Single Center Experience

“…Also, a recent report of biopsy-proven diabetic nephropathy showed that patients with advanced diabetic nephropathy were accompanied by a high prevalence of hematuria [27]. Another study confirmed that patients with biopsy-proven diabetic nephropathy and hematuria had more advanced pathological findings than those without hematuria, and the presence of hematuria is a significant risk factor for ESKD in patients with diabetic nephropathy [28]. Despite the above mentioned controversies, hematuria was an important criterion for kidney biopsy in our study population.…”

Risk of CKD Following Detection of Microscopic Hematuria: A Retrospective Cohort Study

“…10 Several studies also reported that microscopic hematuria is a risk factor of end-stage kidney disease in patients with diabetic nephropathy. 18,19 However, these studies were conducted in populations with existing renal conditions and did not directly assess the role of hematuria as early signs of asymptomatic chronic kidney disease. Another community-based cohort study of 8,719 Korean participants showed that microscopic hematuria was associated with increased risk of incident CKD in the general population setting.…”

“…12,13 There were few studies reporting that microscopic hematuria was a risk factor for end-stage kidney disease in diabetic nephropathy, and was associated with worse renal outcomes more strongly in men. 18,19 However, no previous studies have evaluated sex-related differences in the association between microscopic hematuria and CKD. .…”

Association of Hematuria with Renal Progression and Survival in Patients Who Underwent Living Donor Liver Transplant

“…In addition, persistent hematuria was reported to be associated with an increased risk of ESRD in IgA nephropathy [ 13 ]. The degree of proteinuria definitely correlates with the risk of diabetic kidney; however, microscopic hematuria is also a dependent risk factor for ESRD in diabetic nephropathy [ 14 ]. These suggest that the presence of nondiabetic renal disease in patients with diabetic CKD carries a relatively high risk of renal progression [ 15 ].…”