Microscopic hematuria is a risk factor of incident chronic kidney disease in the Korean general population: a community-based prospective cohort study

Kim, Hyeon Chang; Lee, Myoungkyu; U, M; Nam, Ki Heon; An, Seokyung; Park, S; Jhee, Jong Hyun; Yun, Hae‐Ryong; Kee, Youn Kyung; Park, J T; Yoo, Tae‐Hyun; Kang, Shin Wook; Han, Seung Hyeok

doi:10.1093/qjmed/hcy054

Cited by 11 publications

(21 citation statements)

References 37 publications

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“…Our finding that decreased renal function at diagnosis is associated with poor outcome in patients diagnosed with IgAN is consistent with the results of previous studies [26,31]. CHP has also been identified as a risk factor for CKD progression in the general population [32,33]. In a long-term longitudinal study that targeted the general population of Korea (n = 8719), Kim et al [32] reported that subjects with microscopic hematuria with proteinuria (n = 19) had a higher risk of CKD stage 3-5 than those who did not present with these clinical signs (Hazard Ratio 5.4, 95% CI 2.54-11.49, p < 0.001) during a median follow-up of 11.7 years.…”

Section: Discussionsupporting

confidence: 92%

“…CHP has also been identified as a risk factor for CKD progression in the general population [32,33]. In a long-term longitudinal study that targeted the general population of Korea (n = 8719), Kim et al [32] reported that subjects with microscopic hematuria with proteinuria (n = 19) had a higher risk of CKD stage 3-5 than those who did not present with these clinical signs (Hazard Ratio 5.4, 95% CI 2.54-11.49, p < 0.001) during a median follow-up of 11.7 years. Moreover, in a Japanese study of adult patients with AUA initially identified as a result of mass urine screening (n = 772), a high proportion (23%) of individuals with CHP (n = 155) also presented with deterioration of renal function (serum creatinine > 2.0 mg/dL) during a median follow-up period of 6.3 years [33].Very recently, Shima et al [34] reported that, among 25 children diagnosed with crescentic IgAN, 16 children (64%) were initially diagnosed with IgAN by SUS and most of them (14 of 16) presented with CHP.…”

Section: Discussionmentioning

confidence: 99%

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Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy

Suh

Jang

Hyun

et al. 2020

JCM

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Immunoglobulin A nephropathy (IgAN) is one of the most common primary glomerulopathies diagnosed in children and adolescents. This study aimed to evaluate the clinical features in and outcomes of pediatric IgAN over the last 30 years. Patients who were diagnosed before age of 18 at 20 centers in Korea were evaluated retrospectively. Of the 1154 patients (768 males, 386 females) with a median follow-up of 5 years, 5.6% (n = 65) progressed to stage 3–5 chronic kidney disease (CKD). The 10- and 20-year CKD-free survival rates were 91.2% and 75.6%, respectively. Outcomes did not differ when comparing those in Korea who were diagnosed prior to versus after the year 2000. On multivariate analysis, combined asymptomatic hematuria and proteinuria as presenting symptoms and decreased renal function at the time of biopsy were associated with progression to CKD, while remission of proteinuria was negatively associated with this outcome. Patients who presented with gross hematuria or nephrotic syndrome tended toward positive outcomes, especially if they ultimately achieved remission. While remission of proteinuria might imply that the disease is inherently less aggressive, it also can be achieved by management. Therefore, more aggressive management might be required for pediatric-onset IgAN.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy

Suh

Jang

Hyun

et al. 2020

JCM

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“…A large nationwide population-based study examined the long-term risk of end-stage kidney disease (ESKDearlier denoted ESRD) among Israeli adolescents and persistent asymptomatic isolated microscopic hematuria was associated with an 18-fold increased ESKD risk [5]. Similar results, though less evident, have been reported by three smaller cohort studies conducted on East Asian populations evaluating long-term risk of chronic kidney disease (CKD), ESKD or kidney function deterioration among patients with microscopic hematuria [6][7][8]. All previous studies however, investigated selected subpopulations using volunteer recruitment and most of them were limited by small sample sizes and loss to follow-up.…”

Section: Introductionmentioning

confidence: 73%

“…Yet, hematuria has been associated with increased risk of kidney disease in individuals where initial work-up revealed no apparent underlying cause of an abnormal dipstick finding [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study

Fogh

Vestergaard

Christiansen

et al. 2022

European Journal of Internal Medicine

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Background: Hematuria is a frequent incidental clinical finding and may be a symptom of pre-existing underlying benign or malignant urinary tract or kidney disease. However, in patients with no apparent underlying cause of hematuria, long-term prognosis of hematuria remains unknown. Objectives: To assess the long-term risk of end-stage-kidney disease (ESKD) in patients with a hospital-based hematuria diagnosis and no apparent underlying cause. Methods: Patients with a hospital diagnosis of hematuria were included and matched in a 1:5 ratio with comparison persons from the background population by age, sex and residency. We calculated the cumulative risk of ESKD considering death as a competing risk. Furthermore, we computed unadjusted and adjusted hazard ratios with 95% confidence intervals using Cox hazard regression with adjustment for age, sex, and comorbidities. Results: We included 170,189 hematuria-diagnosed patients. The absolute 10-year risk of ESKD was 0.7% (95% CI: 0.7-0.8) in patients with hematuria and 0.4% (95%CI: 0.3-0.4) in comparison persons, hence yielding an overall adjusted hazard ratio of 1.6 (95%CI: 1.4-1.7). Hematuria also increased the risk of EKSD in patients with pre-existing comorbidities like diabetes (adjusted HR: 1.3 [95%CI: 1.1-1.5]) and urogenital cancer (adjusted HR: 1.4 ([95%CI: 1.1-1.9]), whereas no association was observed in patients with previous kidney disease (adjusted HR: 0.9 (95%CI: 0.8-1.0). Conclusion: A hospital-based hematuria diagnosis in patients with no apparent underlying cause of hematuria is a marker of an increased risk of future ESKD.

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“…However, regardless of its origin, hematuria has been reported to influence patient outcomes and renal function in the general population. Hematuria is associated with the incidence of acute kidney injury (AKI) [ 2 ] and chronic kidney disease (CKD) [ 3 ]. Moreover, a long-term follow-up study revealed that persistent asymptomatic hematuria correlated with increased risk of renal progression [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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

Chang

Hsieh

Chao

et al. 2021

JCM

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Background: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. Methods: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. Results: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. Conclusion: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival.

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Microscopic hematuria is a risk factor of incident chronic kidney disease in the Korean general population: a community-based prospective cohort study

Abstract: The presence of MH is associated with an increased risk of incident CKD in the general population. Therefore, attentive follow-up is warranted in persons with MH for early detection of CKD.

Cited by 11 publications

References 37 publications

Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy

Remission of Proteinuria May Protect against Progression to Chronic Kidney Disease in Pediatric-Onset IgA Nephropathy

Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study

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

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