J Korean Med Sci.  2016 Jun;31(6):909-914. 10.3346/jkms.2016.31.6.909.

The Natural Course of Biopsy-Proven Isolated Microscopic Hematuria: a Single Center Experience of 350 Patients

• Lee HM
• Hyun JI
• Min JW
• Lee K
• Kim YK
• Choi EJ
• Song HC

• KMID: 2373700
• DOI: http://doi.org/10.3346/jkms.2016.31.6.909

Abstract

The increasing interest in healthcare and health screening events is revealing additional cases of asymptomatic isolated microscopic hematuria (IMH). However, a consensus of the evaluation and explanation of the IMH prognosis is controversial among physicians. Here, we present the natural course of IMH together with the pathological diagnosis and features to provide supportive data when approaching patients with IMH. We retrospectively evaluated 350 patients with IMH who underwent a renal biopsy between 2002 and 2011, and the pathological diagnosis and chronic histopathological features (glomerulosclerosis, interstitial fibrosis, and tubular atrophy) were reviewed. Deterioration of renal function was examined during follow up. The patients with IMH were evaluated for a mean of 86 months. IgA nephropathy was the most common diagnosis in 164 patients (46.9%). Chronic histopathological changes were observed in 166 (47.4%) but was not correlated with proteinuria or a decline in renal function. Ten patients developed proteinuria, and all of them had IgA nephropathy. Three patients progressed to chronic kidney disease with an estimated glomerular filtration rate < 60 mL/min/1.73 m2 but none progressed to end stage renal disease. In conclusion, IMH had a generally benign course during 7-years of observation, although IgA nephropathy should be monitored if it progresses to proteinuria. Future prospective randomized studies may help conclude the long-term prognosis and lead to a consensus for managing IMH.

Keyword

Hematuria; Kidney; Biopsy; Proteinuria; Glomerulonephritis, IGA; Kidney Failure, Chronic

MeSH Terms

Adolescent
Adult
Biopsy
Female
Glomerular Filtration Rate
Glomerulonephritis, IGA/diagnosis
Hematuria/*diagnosis/pathology
Humans
Kidney/*pathology/physiology
Kidney Failure, Chronic/diagnosis
Male
Middle Aged
Prognosis
Proteinuria/diagnosis
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Process of evaluation and results of isolated microscopic hematuria patients.

Reference

1. Fuiano G, Mazza G, Comi N, Caglioti A, De Nicola L, Iodice C, Andreucci M, Andreucci VE. Current indications for renal biopsy: a questionnaire-based survey. Am J Kidney Dis. 2000; 35:448–457.

2. Michael J, Jones NF, Davies DR, Tighe JR. Recurrent haematuria: role of renal biopsy and investigative morbidity. BMJ. 1976; 1:686–688.

3. Paone DB, Meyer LE. The effect of biopsy on therapy in renal disease. Arch Intern Med. 1981; 141:1039–1041.

4. Cohen RA, Brown RS. Clinical practice. Microscopic hematuria. N Engl J Med. 2003; 348:2330–2338.

5. Sutton JM. Evaluation of hematuria in adults. JAMA. 1990; 263:2475–2480.

6. Vivante A, Afek A, Frenkel-Nir Y, Tzur D, Farfel A, Golan E, Chaiter Y, Shohat T, Skorecki K, Calderon-Margalit R. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA. 2011; 306:729–736.

7. Chow KM, Kwan BC, Li PK, Szeto CC. Asymptomatic isolated microscopic haematuria: long-term follow-up. QJM. 2004; 97:739–745.

8. Shen P, He L, Jiang Y, Wang C, Chen M. Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria. Int J Clin Pract. 2007; 61:789–794.

9. Yamagata K, Yamagata Y, Kobayashi M, Koyama A. A long-term follow-up study of asymptomatic hematuria and/or proteinuria in adults. Clin Nephrol. 1996; 45:281–288.

10. Richards NT, Darby S, Howie AJ, Adu D, Michael J. Knowledge of renal histology alters patient management in over 40% of cases. Nephrol Dial Transplant. 1994; 9:1255–1259.

11. To KF, Choi PC, Szeto CC, Li PK, Tang NL, Leung CB, Wang AY, Ho KK, Wong TY, Lui SF, et al. Outcome of IgA nephropathy in adults graded by chronic histological lesions. Am J Kidney Dis. 2000; 35:392–400.

12. Walsh M, Sar A, Lee D, Yilmaz S, Benediktsson H, Manns B, Hemmelgarn B. Histopathologic features aid in predicting risk for progression of IgA nephropathy. Clin J Am Soc Nephrol. 2010; 5:425–430.

13. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D; Modification of Diet in Renal Disease Study Group. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999; 130:461–470.

14. Lee CS, Cha RH, Lim YH, Kim H, Song KH, Gu N, Yu KS, Lim CS, Han JS, Kim S, et al. Ethnic coefficients for glomerular filtration rate estimation by the Modification of Diet in Renal Disease study equations in the Korean population. J Korean Med Sci. 2010; 25:1616–1625.

15. Kim BS, Kim YK, Shin YS, Kim YO, Song HC, Kim YS, Choi EJ. Natural history and renal pathology in patients with isolated microscopic hematuria. Korean J Intern Med. 2009; 24:356–361.

16. Hall CL, Bradley R, Kerr A, Attoti R, Peat D. Clinical value of renal biopsy in patients with asymptomatic microscopic hematuria with and without low-grade proteinuria. Clin Nephrol. 2004; 62:267–272.

17. Working Group of the International IgA Nephropathy Network and the Renal Pathology Society. The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility. Kidney Int. 2009; 76:546–556.

18. Daniel L, Saingra Y, Giorgi R, Bouvier C, Pellissier JF, Berland Y. Tubular lesions determine prognosis of IgA nephropathy. Am J Kidney Dis. 2000; 35:13–20.

19. D'Amico G. Tubulointerstitium as predictor of progression of glomerular diseases. Nephron. 1999; 83:289–295.