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Glomerular isolated microscopic hematuria: urinary features and long term follow-up of a selected cohort of patients

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Abstract

Background

Isolated microscopic hematuria is a condition characterized by the presence in the urine of an “abnormal” number of erythrocytes in the absence of proteinuria. Several studies have been published on this condition, but with heterogeneous inclusion criteria and variable outcomes at follow-up. In this retrospective study, we describe a selected and homogenous cohort of patients who presented with isolated microscopic hematuria of glomerular origin.

Methods

We included in the study patients with isolated microscopic hematuria of glomerular origin (> 1 erythrocyte/high power field at 400× and ≥ 40% dysmorphic erythrocytes and/or ≥ 5% acanthocytes and proteinuria ≤ 150 mg/24 h) with a follow-up of > 60 months from the first documentation of microscopic hematuria.

Results

Forty-two patients (M 12, F 30, age at presentation 14–68 years, eGFR < 60 ml/min/1.73 m2: 1 patient) were included. During a medium term follow-up, microscopic hematuria was persistent in 25 patients (59.5%), transiently absent in 17 (40.5%), always glomerular in 16 patients (38.1%), and occasionally non-glomerular in 26 (61.9%); proteinuria, observed in 16 patients (38.1%), was always transient and < 500 mg/24 h. At the end of a follow-up of 181.8 ± 97.9 (median 168) months, only 2 patients (4.8%) had eGFR < 60 ml/min/1.73 m2, one of whom had reduced eGFR already at presentation.

Conclusions

This study on a small but selected and homogeneous cohort of patients with isolated microscopic hematuria of glomerular origin demonstrates that urinary features can transiently change over time and that the renal outcome is good.

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References

  1. Fogazzi GB, Ponticelli C (1996) Microscopic hematuria diagnosis and management. Nephron 72:125–134

    Article  CAS  PubMed  Google Scholar 

  2. Fairley K, Birch DF (1982) Hematuria: a simple method for identifying glomerular bleeding. Kidney Int 21:105–108

    Article  CAS  PubMed  Google Scholar 

  3. Cohen RA, Brown RS (2003) Clinical practice. Microscopic hematuria. New Engl J Med 348:2330–2338

    Article  PubMed  Google Scholar 

  4. Fogazzi GB (2010) The urinary sediment an integrated view, third edition. Elsevier, Milano

    Google Scholar 

  5. Haber MH, Blomberg D, Galagan K, Glassy EF, Ward PCJ (2010) Color atlas of the urinary sediment. An illustrated field guide based on proficiency testing. Cap Press, Northfield

    Google Scholar 

  6. Brunzel NA (2018) Fundamentals of urine and body fluid analysis fourth edition. Elsevier, St.Louis

    Google Scholar 

  7. Levey AS, Stevens LA, Schmid CH et al (2009) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). Ann Intern Med 150:604–612

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lamb EJ, MacKenzie F, Stevens PE (2009) How should proteinuria be detected and measured? Ann Clin Biochem 46:205–217

    Article  CAS  PubMed  Google Scholar 

  9. Fogazzi GB, Passerini P, Bazzi M et al (1989) Use of high power field in the evaluation of formed elements of urine. J Nephrol 2:107–112

    Google Scholar 

  10. Köhler H, Wandel E, Brunck B (1991) Acanthocyturia—a characteristic marker for glomerular bleeding. Kidney Int 40:115–120

    Article  PubMed  Google Scholar 

  11. Van der Snoek BE, Hoitsma AJ, van Weel C et al (1994) Dysmorphic erythrocytes in urinary sediment in differentiating urological from nephrological causes of hematuria. Ned Tijdschr Geneeskd 138:721–726

    PubMed  Google Scholar 

  12. Fogazzi GB, Edefonti A, Garigali G et al (2008) Urine erythrocyte morphology in patients with microscopic haematuria caused by a glomerulopathy. Pediatr Nephrol 23:1093–1100

    Article  PubMed  Google Scholar 

  13. Kitamoto Y, Tomita M, Akamine M et al (1993) Differentiation of hematuria using a uniquely shaped red cell. Nephron 64:32–36

    Article  CAS  PubMed  Google Scholar 

  14. Dinda AK, Saxena S, Guleria S et al (1997) Diagnosis of glomerular haematuria: role of dysmorfic red cells, G1 cell and bright field microscopy. Scand J Clin Lab Invest 57:203–208

    Article  CAS  PubMed  Google Scholar 

  15. Vehaskari VM, Rapola J, Koskimies O et al (1979) Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 956:76–84

    Google Scholar 

  16. Hisano S, Kwano M, Hatae K et al (1991) Asymptomatic isolated microhaematuria: natural history of 136 children. Pediatr Nephrol 5:578–581

    Article  CAS  PubMed  Google Scholar 

  17. Messing EM, Young TB, Hunt VB et al (1992) Home screening for hematuria: results of a multiclinic study. J Urol 148:289–292

    Article  CAS  PubMed  Google Scholar 

  18. Britton JP, Dowell AC, Whelan P et al (1992) A community study of bladder cancer screening by the detection of occult urinary bleeding. J Urol 148:788–790

    Article  CAS  PubMed  Google Scholar 

  19. Vivante A, Afek A, Frenkel-Nir Y et al (2011) Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. J Am Med Assoc 306:729–736

    Article  CAS  Google Scholar 

  20. Iseki K, Iseki C, Ikemiya Y et al (1996) Risk of developing end-stage renal disease in a cohort of mass screening. Kidney Int 49:800–805

    Article  CAS  PubMed  Google Scholar 

  21. Yamagata K, Takahashi H, Tomida C et al (2002) Prognosis of asymptomatic hematuria and/or proteinuria in men. High prevalence of IgA nephropathy among proteinuric patients found in mass screening. Nephron 91:34–42

    Article  PubMed  Google Scholar 

  22. Kovačević Z, Jovanović D, Rabrenović V et al (2008) Asymptomatic microscopic haematuria in young males. Int J Clin Pract 62:406–412

    Article  PubMed  Google Scholar 

  23. Kim BS, Kim YK, Shin YS et al (2009) Natural history and renal pathology in patients with isolated microscopic hematuria. Korean J Intern Med 24:356–361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Túri S, Visy M, Vissy A et al (1989) Long-term follow-up of patients with persistent/recurrent, isolated haematuria: a Hungarian multicentre study. Pediatr Nephrol 3:235–239

    Article  PubMed  Google Scholar 

  25. Feng CY, Xia YH, Wang WJ (2013) Persistent asymptomatic isolated hematuria in children: clinical and histopathological features and prognosis. World J Pediatr 9:163–168

    Article  CAS  PubMed  Google Scholar 

  26. McGregor DO, Lynn KL, Bailey RR et al (1998) Clinical audit of the use of renal biopsy in the menagement of isolated microscopic hematuria. Clin Nephrol 49:345–348

    CAS  PubMed  Google Scholar 

  27. Hall CL, Bradley R, Kerr A et al (2004) Clinical value of renal biopsy in patients with asymptomatic microscopic hematuria with and without low-grade proteinuria. Clin Nephrol 62:267–272

    Article  CAS  PubMed  Google Scholar 

  28. Chow KM, Kwam BC, Li PK et al (2004) Asymptomatic isolated microscopic haematuria: long-term follow-up. Q J Med 97:739–745

    Article  CAS  Google Scholar 

  29. Lee HM, Hyun JI, Min JW et al (2016) The natural course of biopsy-proven isolated microscopic hematuria: a single center experience of 350 patients. Korean Med Sci 31:909–914

    Article  CAS  Google Scholar 

  30. Schramek P, Schuster FX, Georgopoulos M et al (1989) Value of urinary erythrocyte morphology in assessment of symptomless microhaematuria. Lancet 2:1316–1319

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical and Research Laboratory on Urinary Sediment, U.O.C. di Nefrologia, Dialisi e Trapianto di Rene, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 15, Milan, Italy

    Cecilia Bellincioni, Giuseppe Garigali & Giovanni B. Fogazzi

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  1. Cecilia Bellincioni
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  2. Giuseppe Garigali
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  3. Giovanni B. Fogazzi
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Correspondence to Giovanni B. Fogazzi.

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All the patients were informed about the inclusion of their clinical data in the present paper and all of the have given their consent.

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Bellincioni, C., Garigali, G. & Fogazzi, G.B. Glomerular isolated microscopic hematuria: urinary features and long term follow-up of a selected cohort of patients. J Nephrol 32, 253–258 (2019). https://doi.org/10.1007/s40620-018-0560-9

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  • DOI: https://doi.org/10.1007/s40620-018-0560-9

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