Persistent dipstick haematuria following renal transplantation

Abstract

Despite widespread testing for dipstick haematuria following renal transplantation, there are no published series describing the prevalence and possible causes of this complication in an adult population. A cross-sectional study of 640 renal transplant recipients under review at our follow-up clinic was performed. Persistent haematuria was defined as a minimum of 1+ of blood on urinalysis stick testing detected at not fewer than 75% of clinic visits since its onset, or since the start of routine testing, present over a period of at least 4 weeks. The prevalence of persistent dipstick haematuria was 13.3%. Median serum creatinine was higher in patients with persistent haematuria but age, gender and length of time since transplantation were not significantly different. Potential explanations for persistent haematuria in 21 of 85 affected patients were chronic infection, ureteric stent without chronic infection, regular or intermittent self-catheterization, persistent menstrual bleeding, anticoagulant therapy, graft calculus, and allograft renal cell carcinoma. Recurrent or de novo glomerular disease was confirmed by graft biopsy in 10 of 85 patients. Among the 41 recipients whose original cause of renal failure was IgA nephropathy (IgAN), the prevalence of persistent haematuria was 31.7% compared with 12% in the remaining patients (relative risk 2.6, 95% CI: 1.6-4.3). Persistent haematuria in IgAN patients was not associated with gender, age or time since transplantation. After 29 months of follow-up, 20% of patients with haematuria had progressed to graft failure or death compared with 11.6% of the unaffected group (p = 0.029). However, despite the association with earlier graft failure, haematuria did not predict this endpoint independently of renal function.

Two decades outcomes of posttransplant immunoglobulin a nephropathy in live donor renal transplantation

“…Persistent microscopic hematuria, on the other hand, is often the earliest marker of recurrent IgAN, but it does not predict a poor outcome. [ 38 39 ] In evaluating the predictors of early graft failure in the posttransplant IgAN group, we found contrasting findings to that of the previous studies. The only significant predictor of early graft failure in our study was serum creatinine at 5 years.…”

High incidence of urinary tract malignancy among patients with haematuria following kidney transplantation in Taiwan

“…Only few reports describing the frequency and possible causes of haematuria following kidney transplantation have been published in the literature [1][2][3]. In contrast to the previous reports, in which a majority of causes identified were associated with nonmalignant conditions, the most prevalent cause contributing to persistent haematuria in our series was urological malignancy (42.2%) including one superficial bladder UC, one invasive bladder UC, 16 patients with upper urinary tract UC (ureter/renal pelvis) and one adenocarcinoma of urachus.…”

“…Allograft renal cell carcinoma was diagnosed in one patient and was managed with partial graft nephrectomy. In addition, they concluded that patients with haematuria had poorer graft function and higher risk to progress to graft failure [3].…”

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“…3 One of the most common causes of the posttransplant gross hematuria is related to the native kidneys and usually presents as the late onset posttransplant gross hematuria. Early onset posttransplant gross hematuria is usually caused by bleeding from the site of ureteroneocystostomy that is managed by conservative therapy and continues bladder irrigation.…”