Haematuria increases progression of advanced proteinuric kidney disease.

Claudia Yuste,Juan Antonio Moreno,Ignacio Mahillo,Alba Santos,Soraya Abad,Manuel Praga,Juan Manuel López-Gómez,Alfonso Rubio-Navarro,Jesús Egido,Daniel Barraca,Inés Aragoncillo,Nicolás Macias,Eduardo Gutiérrez,Almudena Vega,Shree Ram Singh

doi:10.1371/journal.pone.0128575

Abstract

BackgroundHaematuria has been traditionally considered as a benign hallmark of some glomerular diseases; however new studies show that haematuria may decrease renal function.ObjectiveTo determine the influence of haematuria on the rate of chronic kidney disease (CKD) progression in 71 proteinuric patients with advanced CKD (baseline eGFR <30 mL/min) during 12 months of follow-up.ResultsThe mean rate of decline in eGFR was higher in patients with both haematuria and proteinuria (haemoproteinuria, HP, n=31) than in patients with proteinuria alone (P patients, n=40) (-3.8±8.9 vs 0.9±9.5 mL/min/1.73m2/year, p<0.05, respectively). The deleterious effect of haematuria on rate of decline in eGFR was observed in patients <65 years (-6.8±9.9 (HP) vs. 0.1±11.7 (P) mL/min/1.73m2/year, p<0.05), but not in patients >65 years (-1.2±6.8 (HP) vs. 1.5±7.7 (P) mL/min/1.73m2/year). Furthermore, the harmful effect of haematuria on eGFR slope was found patients with proteinuria >0.5 g/24 h (-5.8±6.4 (HP) vs. -1.37± 7.9 (P) mL/min/1.73m2/year, p<0.05), whereas no significant differences were found in patients with proteinuria < 0.5 g/24 h (-0.62±7.4 (HP) vs. 3.4±11.1 (P) mL/min/1.73m2/year). Multivariate analysis reported that presence of haematuria was significantly and independently associated with eGFR deterioration after adjusting for traditional risk factors, including age, serum phosphate, mean proteinuria and mean serum PTH (β=-4.316, p=0.025).ConclusionsThe presence of haematuria is closely associated with a faster decrease in renal function in advanced proteinuric CKD patients, especially in younger CKD patients with high proteinuria levels; therefore this high risk subgroup of patients would benefit of intensive medical surveillance and treatment.

Highlights

Chronic kidney disease (CKD) is a global public health problem, as result of its growing prevalence and costs, and the higher risk to progress to end-stage renal disease (ESRD), cardiovascular disease and death [1, 2]
Haematuria has been traditionally considered as a benign hallmark of some glomerular diseases; new studies show that haematuria may decrease renal function
Multivariate analysis reported that presence of haematuria was significantly and independently associated with estimated glomerular filtration rate (eGFR) deterioration after adjusting for traditional risk factors, including age, serum phosphate, mean proteinuria and mean serum PTH (β=-4.316, p=0.025)

Summary

Introduction

Chronic kidney disease (CKD) is a global public health problem, as result of its growing prevalence and costs, and the higher risk to progress to end-stage renal disease (ESRD), cardiovascular disease and death [1, 2]. Recent evidences show that up to 25% of IgAN patients and 66% WRN patients did not recover baseline renal function after macroscopic haematuria-associated AKI, leading to adverse long-term outcomes [9, 16]. The KDOQI (Kidney Disease Outcomes Quality Initiative) and KDIGO (Kidney Disease: Improving Global Outcome) guidelines recommend to assess every CKD patient with dipstick [17], they not recommend further monitoring or treatment in patients with glomerulonephritis and isolated microscopic haematuria. These guidelines acknowledge that IgAN with haematuria and minimal proteinuria is a progressive disease [18]. Haematuria has been traditionally considered as a benign hallmark of some glomerular diseases; new studies show that haematuria may decrease renal function.

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