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Kidney Week

Abstract: PO1569

The Significance of Hematuria in Primary Proteinuric Glomerular Disease Outcomes

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Marchel, Dorota, University of Michigan, Ann Arbor, Michigan, United States
  • Larkina, Maria, University of Michigan, Ann Arbor, Michigan, United States
  • Fermin, Damian, University of Michigan, Ann Arbor, Michigan, United States
  • Lai Yee, Jennifer, University of Michigan, Ann Arbor, Michigan, United States
  • Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States
  • Bomback, Andrew S., Columbia University, New York, New York, United States
  • Canetta, Pietro A., Columbia University, New York, New York, United States
  • Mottl, Amy K., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Parekh, Rulan S., The Hospital for Sick Children, Toronto, Ontario, Canada
  • Saha, Manish K., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Sampson, Matt G., Boston Children's Hospital, Boston, Massachusetts, United States
  • Trachtman, Howard, NYU Langone Health, New York, New York, United States
  • Lafayette, Richard A., Stanford University, Stanford, California, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
Background

Hematuria is associated with the incidence and progression of CKD. The study aims were to assess the prevalence of hematuria in a large cohort of proteinuric glomerular disease and assess the association between hematuria and kidney-related outcomes.

Methods

Hematuria was assessed at first reported study urinalysis in patients with MN, MCD, and FSGS in NEPTUNE and CureGN cohorts with >24 months of follow-up. Hematuria was defined as small, moderate, or large blood on urinary dipstick and no hematuria was negative or trace blood. Multivariable Cox proportional hazards models were fit for time to composite outcome (ESKD or 40% decline in GFR and eGFR <60) and proteinuria remission (UPCR <0.3 mg/mg).

Results

1,108 adults and children were included. 412 (37%) patients had FSGS, 389 (36%) had MCD, and 307 (28%) had MN. 745 (67%) participants were positive for hematuria at first urinalysis. Those who had hematuria vs. those without at first urinalysis were more likely to have an underlying diagnosis of MN (37% vs 23%), be older (34 vs 25 years), have shorter time since biopsy (128 vs 315 days) and higher UPCR (3.6 vs 0.8). Patients with hematuria had higher rates of the composite outcome and lower rates of complete remission (Figure 1). After adjusting for diagnosis, age, sex, UPCR, eGFR, time since biopsy, and cohort, hematuria was associated with a higher hazard of reaching the composite outcome (HR 1.39 [1.05, 1.84], p-value 0.02) and lower hazard of reaching proteinuria remission (HR 0.71 [0.55-0.91], p-value 0.006).

Conclusion

Hematuria is prevalent among patients with podocytopathic disease not classically considered nephritic. There was an independent association between hematuria and worse kidney related outcomes. The underlying mechanisms warrants further investigation and include genetic predisposition, structural alterations in the glomerular basement membrane, and tubular toxicity from heme pigment.

Funding

  • NIDDK Support