Kidney Week

Abstract: TH-PO0490

Hemoglobinuria as a Biomarker of Inflammation in IgAN: Concordance with the Oxford Mesangial Hypercellularity, Endocapillary Hypercellularity, Segmental Sclerosis, Tubular Atrophy, and Crescent Formation (MEST-C) Score: A Multicenter Cohort Study

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

• Vargas-Brochero, Maria J., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Maria J. Vargas-Brochero, MD, MS

• Cara, Anila, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Anila Cara, MD

• Angioi, Andrea, Nephrology, Dialysis and Transplantation Unit, ARNAS "G. Brotzu", Cagliari, Italy

Andrea Angioi, MD, FASN

• Lepori, Nicola, Nephrology, Dialysis and Transplantation Unit, ARNAS "G. Brotzu", Cagliari, Italy

Nicola Lepori, MD

• Fenoglio, Roberta, Center of Research of Immunopathology and Rare Diseases-CMID, Turin, Italy

Roberta Fenoglio, PhD

• Juanet, Cristián, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Cristián Juanet, MD

• Acuña, Pilar A., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Pilar A. Acuña, MD, RD

• Laxamana, Trisha D., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Trisha D. Laxamana, MD

• Zand, Ladan, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Ladan Zand, MD

• Herrera Hernandez, Loren Paola, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Loren Paola Herrera Hernandez, MD

• Sethi, Sanjeev, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Sanjeev Sethi, MD, PhD

• Sciascia, Savino, Center of Research of Immunopathology and Rare Diseases-CMID, Turin, Italy

Savino Sciascia, MD

• Gutierrez-Martinez, Eduardo, Hospital Universitario 12 de Octubre, Madrid, Spain

Eduardo Gutierrez-Martinez

• Sevillano, Angel M., Hospital Universitario 12 de Octubre, Madrid, Spain

Angel M. Sevillano, MD

• Coppo, Rosanna, Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy

Rosanna Coppo, DrMed

• Glassock, Richard J., The David Geffen School of Medicine at UCLA, Los Angeles, California, United States

Richard J. Glassock, MD, FASN

• Pani, Antonello, Nephrology, Dialysis and Transplantation Unit, ARNAS "G. Brotzu", Cagliari, Italy

Antonello Pani, MD, DrMed

• Roccatello, Dario, Center of Research of Immunopathology and Rare Diseases-CMID, Turin, Italy

Dario Roccatello, MD

• Caravaca-Fontan, Fernando, Hospital Universitario 12 de Octubre, Madrid, Spain

Fernando Caravaca-Fontan, MD, PhD

• Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Fernando C. Fervenza, MD, PhD, FASN

Background

Hematuria is a hallmark manifestation of IgA nephropathy (IgAN).Despite this,current guidelines prioritize proteinuria and eGFR for risk assessment, leaving the evaluation of hematuria underutilized as a biomarker of disease activity.We evaluated the diagnostic performance of dipstick hemoglobinuria and hematuria and their association with Oxford MEST-C scores.

Methods

We conducted a multicenter retrospective cohort study of patients with biopsy-proven IgAN(2015–2025). All patients underwent urinalysis witin 14 days prior of kidney biopsy. Renal biopsies were scored by MEST-C. We assessed the diagnostic performance of hematuria and hemoglobinuria and their association with histologic lesions.Active glomerular inflammation was defined as the presence of a score of ≥1 or greater for inflammatory lesion: M1, E1, or C1–2.

Results

We included 441 patients (215 from the Italian cohort, 159 from the USA cohort, and 67 from the Spanish cohort).Hemoglobinuria consistently demonstrated higher discriminative performance than hematuria and proteinuria for predicting active glomerular inflammation across all cohorts. However, statistical significance was observed only in the USA cohort (AUC 0.802 vs 0.716, p<0.001). Similar directional trends were seen in the Spanish and Italian cohorts.The addition of proteinuria to hemoglobinuria modestly improved discrimination with no statistically significant difference. In pooled analyses, hemoglobinuria remained the strongest single predictor (AUC 0.751, 95% CI 0.698–0.805).

Conclusion

Dipstick urinalysis (for hemoglobinuria) offers a practical, cost-effective marker of renal inflammation in IgAN. Its integration into routine monitoring may enhance assessment of disease activity and risk stratification