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Abstract: TH-PO1020

The Association of Hematuria with MEST-C Score and Renal Outcomes in IgA Nephropathy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Bobart, Shane A., Mayo Clinic, Rochester, Minnesota, United States
  • Alexander, Mariam P., Mayo Clinic, Rochester, Minnesota, United States
  • Shawwa, Khaled, Mayo Clinic, Rochester, Minnesota, United States
  • Vaughan, Lisa E., Mayo Clinic, Rochester, Minnesota, United States
  • Ghamrawi, Ranine, Mayo Clinic, Rochester, Minnesota, United States
  • Cornell, Lynn D., Mayo Clinic, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Clinic, Rochester, Minnesota, United States
  • Glassock, Richard J., David Geffen School of Medicine at UCLA, Laguna Niguel, California, United States
  • Fervenza, Fernando C., Mayo Clinic, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic, Rochester, Minnesota, United States
Background

Hematuria is common in IgA Nephropathy. However, current prognostication is largely based on the degree of proteinuria and MEST-C scores found on renal biopsy. We asked: 1) Are MEST-C score components associated with the presence of hematuria at the time of biopsy? 2) Is hematuria an independent risk factor for change in GFR after adjusting for follow-up time, proteinuria, MEST-C score and treatment?

Methods

We identified 125 patients with IgA Nephropathy and MEST-C scoring who were not on immunosuppression at biopsy. We compared clinical and laboratory parameters by hematuria at baseline using equal variance t-test for continuous measures and Chi-square test for categorical measures. Generalized estimating equations were used to evaluate the association between the degree of hematuria and eGFR throughout follow-up, where degree of hematuria was considered as ordinal (<3, 3-10, 11-20, 21-30, 31-40, 41-50, 51-100, >100 RBC/hpf).

Results

Ninety seven of 125 patients had hematuria at baseline (>3 RBCs/hpf), and were more likely to have M1, E1 and C ≥1 lesions (P<0.05 for all) compared to patients without hematuria. Seventy two of the 125 patients had follow up data available (median [IQR] 3.7 years [2.1, 7.0]; of these, 60 (83%) had hematuria at baseline. Nine of the 72 patients progressed to ESKD, with 6 of these 9 having >1 gram proteinuria and hematuria at baseline.
An increase in degree of hematuria was significantly associated with an eGFR decline of -0.81 mL/min/1.73 m2, (95% CI -1.44 to -0.18, P=0.01). Results were similar after adjusting for follow-up time, proteinuria, MEST-C and treatment during follow-up (P<0.05 for all) and after restricting analysis to patients with hematuria and proteinuria >1 gram/d at baseline. T was the only score found to be significantly associated with a decline in eGFR (P<0.001 with and without adjustment).
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Conclusion

Hematuria at follow up is an independent predictor of eGFR decline after adjusting for follow-up time, proteinuria, MEST-C score and treatment. This suggests that monitoring the degree of hematuria as well as proteinuria is important for guiding treatment; however, RCTs using a decline in hematuria as a primary surrogate outcome measure are needed.

Funding

  • Private Foundation Support