Kidney Week

Abstract: PO0986

Microscopic Hematuria Is a Risk Factor for ESKD in Patients with Biopsy-Proven Diabetic Nephropathy

Session Information

• Diabetic Kidney Disease: Clinical - 1
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Furuyama, Riri, Nara Medical University, Kashihara, Nara, Japan

Riri Furuyama,

• Eriguchi, Masahiro, Nara Medical University, Kashihara, Nara, Japan

Masahiro Eriguchi,

• Tasaki, Hikari, Nara Medical University, Kashihara, Nara, Japan

Hikari Tasaki,

• Fukata, Fumihiro, Nara Medical University, Kashihara, Nara, Japan

Fumihiro Fukata,

• Nishimoto, Masatoshi, Nara Medical University, Kashihara, Nara, Japan

Masatoshi Nishimoto,

• Kosugi, Takaaki, Nara Medical University, Kashihara, Nara, Japan

Takaaki Kosugi,

• Tanabe, Kaori, Nara Medical University, Kashihara, Nara, Japan

Kaori Tanabe,

• Morimoto, Katsuhiko, Nara Prefecture Western Medical Center, Ikoma, Japan

Katsuhiko Morimoto,

• Okada, Sadanori, Nara Medical University, Kashihara, Nara, Japan

Sadanori Okada,

• Matsui, Masaru, Nara Prefecture General Medical Center, Nara, Japan

Masaru Matsui,

• Samejima, Ken-ichi, Nara Medical University, Kashihara, Nara, Japan

Ken-ichi Samejima,

• Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Nara, Japan

Kazuhiko Tsuruya,

Background

Microscopic hematuria is rarely observed in patients with diabetic nephropathy (DN). Some studies have reported that hematuria is a risk factor for end-stage kidney disease (ESKD) in glomerulonephritis, but association of hematuria with renal prognosis in DN is unknown.

Methods

The present study is a retrospective cohort study of patients with DN confirmed by renal biopsy between June 1981 and December 2014. The participants were followed until October 2018 or death. Exposure of interest is the presence of hematuria (U-RBC >5) and main outcome was the occurrence of ESKD. The association of hematuria with ESKD was evaluated using Cox hazard model with adjustment for clinically relevant factors [age, sex, eGFR, proteinuria, body mass index, systolic blood pressure (SBP) and pathological evaluations].

Results

Patients who had microscopic hematuria at the time of renal biopsy were defined as the hematuria group (N = 91), and the remainder as the non-hematuria group (N = 306). Hematuria group had more proportion of male, higher SBP, more proteinuria, and lower eGFR compared with non-hematuria group. Pathological findings revealed that glomerular, tubulointerstitial, and vascular lesions in the hematuria group were significantly more severe than those in non-hematuria group. During a median follow-up period of 80 months, 44 and 52 patients developed ESKD in the hematuria group and non-hematuria groups, respectively. Survival analyses showed that incidence of ESKD was significantly higher in the hematuria group (P <0.0001). The significance remained robust even after adjustment for confounding factors (adjusted HR 1.64, 95% CI; 1.03-2.60). In the subgroup analyses, the associations of hematuria with ESKD among male and overt proteinuria (≥0.5 g/day) were stronger than those among female and micro proteinuria (<0.5 g/day), respectively (P values for interaction <0.1 and <0.03, respectively).

Conclusion

The presence of microscopic hematuria is an independent risk factor for ESKD in diabetic nephropathy.