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Kidney Week

Abstract: PO1571

Asymptomatic Pyuria as a Prognostic Factor in Autosomal Dominate Polycystic Kidney Disease

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Jones, Brian Edward, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
  • Mkhaimer, Yaman Ghassan, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
  • Neal, Reem M., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
  • Randhawa, Amarjyot Kaur, Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
  • Torres, Vicente E., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
  • Chebib, Fouad T., Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, United States
Background

Urinary tract infection (UTI) in patients with autosomal dominant polycystic kidney disease (ADPKD) is linked to faster disease progression. The effect of asymptomatic pyuria on ADPKD disease progression is not known.

Methods

Retrospective study of ADPKD patients seen at a tertiary academic center with available urinalysis (UA) and abdominal CT/MR imaging, and without infection or other cause of pyuria. Clinical characteristics of patients with asymptomatic pyuria (AP) (> 10 urinary WBC/hpf without UTI) were compared to the group with no pyuria (NP) (WBC 0-3/hpf). First and last available eGFR and height-adjusted total kidney volume (HtTKV) were obtained to calculate the rate of eGFR and HtTKV change with time.

Results

Female and male patients with AP had similar mean age at UA and baseline eGFR as compared to their counterpart with NP (Table 1). Median baseline HtTKV was similar in NP and AP females (596 vs 550 ml/m, respectively) but higher in AP males as compared to NP males (1132 vs 898 ml/m, respectively). There was no difference between females NP and AP in the median rate of eGFR decline (-2.2 vs -2.0 ml/min/1.73m2/yr) or HtTKV growth (4.4 vs 4.0 %/yr). Compared to males NP, males AP had a higher median rate of eGFR decline (-3.8 vs -2.6 ml/min/1.73m2/yr, p= 0.04) and a faster median rate of Ht-TKV growth (12.9 vs 6.7 %/yr, p= 0.03).

Conclusion

Asymptomatic pyuria is associated with a faster decline in kidney function and growth of kidney volume in male patients with ADPKD. This could be used as an additional negative prognostic marker.

Table 1: Kidney Function and Height-adjusted Total Kidney Volume by Subgroup
 Females
No pyuria
(N=317)
Females Asymptomatic pyuria
(N=180)
Males
No pyuria
(N=259)
Males
Asymptomatic pyuria
(N=67)
Age at UA, years,
mean + SD
46.5 ± 13.749.5 ± 16.150.1 ± 16.147.3 ± 16.3
eGFR1, ml/min/1.73m2,
mean + SD
66.5 ± 29.365.2 ± 29.759.9 ± 32.858.3 ± 35.5
Age at eGFR1, years,
mean + SD
44.3 ± 13.045.7 ± 15.446.8 ± 15.443.3 ± 16.6
eGFR2, ml/min/1.73m2,
mean + SD
51.7 ± 32.147.5 ± 32.742.3 ± 32.132.3 ± 25.8
Age at eGFR2, years,
mean + SD
51.0 ± 13.454.9 ± 15.354.4 ± 16.051.0 ± 15.7
Time between eGFR1 and eGFR2, years, mean + SD6.6 ± 6.99.2 ± 7.67.5 ± 7.37.6 ± 7.3
Ht-TKV1, ml/m,
median (IQR)
595.7
(343.1 – 1029.9)
550.2
(319.5 – 974.0)
898.0
(475.5 – 1621.2)
1132.2
(6509.4 — 2507.7)
Age at Ht-TKV1, years,
mean + SD
45.2 ± 13.247.3 ± 15.548.6 ± 15.944.0 ± 20.1
Ht-TKV2 , ml/m,
median (IQR)
692.4
(400.9 – 1295.0)
705.0
(349.8 – 1172.6)
1060.2
(572.2 – 2090.5)
1850.5
(819.6 – 2865.6)
Age at Ht-TKV2, years,
mean + SD
49.1 ± 13.051.9 ± 15.152.0 ± 15.549.4 ± 15.4
Time between HtTKV1 and HtTKV2, years, mean + SD3.8 ± 4.74.5 ± 5.23.4 ± 5.15.3 ± 12.6
eGFR rate of decline, ml/min/1.73m2 per year
median (IQR)
-2.2 (-4.1 — -0.7)-2.0 ( -3.3 – -0.8)-2.6 (-4.3 — -1.1)-3.8 (-5.7 — -2.2)
HtTKV rate of growth, % per year, median (IQR)4.4 (0.7 – 8.4)4.0 (1.2 – 8.0)6.7 (3.1 – 13.1)12.9 (1.7 – 15.4)