Clinicopathological Characteristics and Outcome of Adult Patients with Hematuria and/or Proteinuria Found during Routine Examination

Shen, Peicheng; Ding, Xiaoqiang; Ten, Jie; Ji, Jun; Zou, Jianzhou; Fang, Yi

doi:10.1159/000092912

Cited by 12 publications

(7 citation statements)

References 48 publications

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“…The rising level of urinary erythrocytes might indicate a high degree of glomerular inflammation in the early course of renal disease and were found associated with renal function deterioration (21). Recently, several authors demonstrated that patients with persistent microscopic haematuria had a poor prognosis, particularly those with development of proteinuria and hypertension (22,23). Hence, more attention should be paid to adult patients with IMH, because their prognosis may not be optimistic.…”

Section: Discussionmentioning

confidence: 99%

Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria

Shen

Jiang

et al. 2007

International Journal of Clinical Practice

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Among adult patients with isolated microscopic haematuria (IMH) which is defined as persistent microscopic haematuria but without proteinura, hypertension, renal insufficiency, urinary tract infection or structural abnormality of the urinary tract, some patients have chronic glomerulonephritis (CGN), in whom early diagnosis by renal biopsy is beneficial to timely intervention. Nevertheless, a considerable number of patients with optimistic prognosis [e.g. thin basement membrane nephropathy (TBMN)] undergo invasive and needless renal biopsy. Indicators for weighing the necessity of renal biopsy would be clinically significant. To investigate the value of urinary albumin/creatinine ratio (UACR), serum IgA level, serum C3 level and serum IgA to C3 ratio in predicting the necessity of renal biopsy for adult patients with IMH, 216 patients were studied retrospectively. Patients were divided into: (CGN group, n=137), (TBMN group, n=56) and normal biopsy (normal group, n=23). Of all patients, 131 (61%) evidenced microalbuminuria (UACR=30-299 mg/g) and 85 (39%) had normoalbuminuria (UACR<30 mg/g). The mean value of UACR in CGN group was higher (96+/-17 mg/g) compared with that in TBMN (20+/-4 mg/g, p<0.01) or normal (18+/-3 mg/g, p<0.01) group. The mean values of serum IgA and serum IgA/C3 ratio in patients with IgA nephropathy (IgAN) were significantly higher than those with non-IgAN (380+/-103:217+/-99 mg/dl, p<0.01; 4.5+/-1.2 : 2.4+/-0.9, p<0.01). The odds ratio for distinguishing IgAN from non-IgAN was significantly correlated with serum IgA level and serum IgA to C3 ratio. For adult patients with IMH, UACR, serum IgA level and serum IgA to C3 ratio are non-invasive markers for predicting the necessity of renal biopsy.

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Section: Discussionmentioning

confidence: 99%

Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria

Shen

Jiang

et al. 2007

International Journal of Clinical Practice

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“…In fact, patients with persistent hematuria and/ or mild proteinuria found during routine examination in children and adults are commonly encountered. 4,5 Hence, late referral for this disease to a physician or a nephrologist when there is a reduction in the renal function is often common. Currently, renal biopsy remains the standard invasive approach for diagnosing IgAN.…”

mentioning

confidence: 99%

In a retrospective international study, circulating miR-148b and let-7b were found to be serum markers for detecting primary IgA nephropathy

Serino

Pesce

Sallustio

et al. 2016

Kidney International

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Immunoglobulin A nephropathy (IgAN) is a worldwide disease characterized by the presence of galactose-deficient IgA1 deposits in the glomerular mesangium. A kidney biopsy for diagnosis is required. Here, we measured two miRNAs (let-7b and miR-148b), previously identified as regulators of the O-glycosylation process of IgA1, in serum samples from patients with IgAN and healthy blood donors (controls) recruited in an international multicenter study. Two predictive models, based on these miRNAs, were developed and the diagnostic accuracy of the combined biomarkers was assessed by the area under the receiver operating characteristic (ROC) curve (AUC) carried out in three steps. In a training study, the combined miRNAs were able to discriminate between 100 patients with IgAN and 119 controls (AUC, 0.82). A validation study confirmed the model in an independent cohort of 145 patients with IgAN and 64 controls (AUC, 0.78). Finally, in a test study, the combined biomarkers were able to discriminate patients with IgAN from 105 patients affected by other forms of primary glomerulonephritis, supporting the specificity (AUC, 0.76). Using the same study design, we also performed two subgroup analyses (one for Caucasians and one for East Asians) and found that race-specific models were the best fit to distinguish IgAN patients from controls. Thus, serum levels of the combined miRNA biomarker, let-7b and miR-148b, appears to be a novel, reliable, and noninvasive test to predict the probability of having IgAN.

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“…Some studies use urinalysis alone to screen for early stage CKD; this simplifies analysis in a variety of different populations [18,19,20,21,22]. In particular, proteinuria has been associated with renal outcome [23]. Those studies found that urinalysis was valuable for renal function analysis.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Study on the Use of Urinalysis for Screening Early-Stage Renal Insufficiency

Xue

Zhang

Teng

et al. 2016

Nephron

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Background/Aims: Proteinuria and hematuria detected by routine urinalysis can indicate impaired renal function. This study evaluated the effect of routine urinalysis in screening out patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² at an early stage and investigated its associated factors. Methods: Healthy adults who underwent physical examination between September 2008 and September 2013 were enrolled in the study (n = 43,516). Urine was analyzed for protein, and red and white blood cells. Ten milliliter blood samples were collected for serum creatinine, urea, albumin and other parameters for the estimation of eGFR and renal function. Results: Abnormal routine urinalysis was found in 7.1% and eGFR <60 ml/min/1.73 m² was found in 0.9% of subjects. Age and gender were similar in the overall and abnormal urinalysis populations (43 vs. 43 years and 36.7 vs. 38.2% females, respectively), but the eGFR <60 ml/min/1.73 m² group were older (64 years, p < 0.001) with increased females (46.4%, p = 0.002). Sensitivity for predicting eGFR <60 ml/min/1.73 m² was 0.110 and specificity was 0.928. Univariate and multivariate analyses in 6,318 subjects with more detailed clinical data suggested significant associations of sex (OR 0.058, 95% CI 0.030-0.113), age (OR 1.045, 95% CI 1.027-1.064), and high density lipoprotein (HDL) (OR 0.158, 95% CI 0.043-0.587) with eGFR <60 ml/min/1.73 m². Conclusion: Routine urinalysis showed a poor performance in the screening for early-stage renal insufficiency. In future, other screening methods should be considered. Age, gender and HDL were associated with eGFR <60 ml/min/1.73 m².

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Clinicopathological Characteristics and Outcome of Adult Patients with Hematuria and/or Proteinuria Found during Routine Examination

Cited by 12 publications

References 48 publications

Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria

Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria

In a retrospective international study, circulating miR-148b and let-7b were found to be serum markers for detecting primary IgA nephropathy

A Cross-Sectional Study on the Use of Urinalysis for Screening Early-Stage Renal Insufficiency

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