Abstract: TH-PO0484
Examining the Relationship Between Baseline Microscopic Hematuria and Immunosuppression Therapy in IgAN
Session Information
- Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - IgAN
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Bobart, Shane A., Mayo Clinic in Florida, Jacksonville, Florida, United States
- Fatfat, Adnan, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Batish, Ishaan, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Sharma, Abhinav, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Vaughan, Lisa E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Arevalo Salazar, Dory E., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Albadri, Sam, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Aslam, Nabeel, Mayo Clinic in Florida, Jacksonville, Florida, United States
- Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Hickson, LaTonya J., Mayo Clinic in Florida, Jacksonville, Florida, United States
Background
Microscopic hematuria in IgA nephropathy (IgAN) is associated with proliferative histologic lesions and worse kidney outcomes, suggesting that it may reflect active inflammatory disease. Nevertheless, hematuria has not yet been formally incorporated into treatment-guiding frameworks. We examined the relationship between microscopic hematuria and early immunosuppressive therapy at the time of biopsy with kidney outcomes in patients with IgAN.
Methods
We retrospectively identified adults with biopsy-proven IgAN with detectable proteinuria not on immunosuppression (IS) prior to biopsy. Patients were stratified into four groups based on microscopic hematuria levels and IS initiation within 3 months after biopsy. Characteristics at the time of biopsy were compared between groups. The primary kidney outcome was time to the composite event of ESKD or death. Cumulative incidence curves were estimated using the Kaplan-Meier method, and Cox regression models were used to evaluate the association between hematuria/IS status and risk of ESKD or death before and after individual adjustment for other clinical characteristics at biopsy.
Results
Among 278 patients, 61 had no hematuria/no IS, 139 had hematuria/no IS, 73 had hematuria/IS, and 5 had no hematuria/IS. Patients with hematuria, particularly those treated with IS, were more likely to have M1, E1, and C≥1 lesions compared to those without (p<0.05 for all). Overall, the cumulative incidence of ESKD or death at 5 years was 27%. In unadjusted models, compared with the hematuria-only group, risk of ESKD/death was lower in the hematuria/IS group (HR 0.66; 95% CI 0.30-1.49), and higher in the no hematuria/no IS group (HR 1.51; 95% CI 0.78-2.94), albeit results were not statistically significant. However, the hematuria/IS group was found to be significantly associated with a lower risk of ESKD/death compared with the hematuria-only group after independently adjusting for both T score (HR 0.41; 95% CI 0.17-0.96, P=0.040) and eGFR (HR 0.44; 95% CI 0.19-0.99, P=0.048).
Conclusion
These findings suggest that microscopic hematuria may identify a clinically relevant inflammatory phenotype in IgAN that may benefit from early immunosuppression. Given the retrospective design and potential confounding by indication, prospective studies are needed to determine whether hematuria should be incorporated into treatment-guiding risk stratification.
Funding
- Commercial Support – Otsuka Pharmaceuticals USA