Risk Of Hematuria Research Articles

JIM Reading List.

JIM Reading List.

Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis.

Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.

Genotype\u2013phenotype correlations for COL4A3\u2013COL4A5 variants resulting in Gly substitutions in Alport syndrome

Alport syndrome is the commonest inherited kidney disease and nearly half the pathogenic variants in the COL4A3–COL4A5 genes that cause Alport syndrome result in Gly substitutions. This study examined the molecular characteristics of Gly substitutions that determine the severity of clinical features. Pathogenic COL4A5 variants affecting Gly in the Leiden Open Variation Database in males with X-linked Alport syndrome were correlated with age at kidney failure (n = 157) and hearing loss diagnosis (n = 80). Heterozygous pathogenic COL4A3 and COL4A4 variants affecting Gly (n = 304) in autosomal dominant Alport syndrome were correlated with the risk of haematuria in the UK 100,000 Genomes Project. Gly substitutions were stratified by exon location (1 to 20 or 21 to carboxyl terminus), being adjacent to a non-collagenous region (interruption or terminus), and the degree of instability caused by the replacement residue. Pathogenic COL4A5 variants that resulted in a Gly substitution with a highly destabilising residue reduced the median age at kidney failure by 7 years (p = 0.002), and age at hearing loss diagnosis by 21 years (p = 0.004). Substitutions adjacent to a non-collagenous region delayed kidney failure by 19 years (p = 0.014). Heterozygous pathogenic COL4A3 and COL4A4 variants that resulted in a Gly substitution with a highly destabilising residue (Arg, Val, Glu, Asp, Trp) were associated with an increased risk of haematuria (p = 0.018), and those adjacent to a non-collagenous region were associated with a reduced risk (p = 0.046). Exon location had no effect. In addition, COL4A5 variants adjacent to non-collagenous regions were over-represented in the normal population in gnomAD (p < 0.001). The nature of the substitution and of nearby residues determine the risk of haematuria, early onset kidney failure and hearing loss for Gly substitutions in X-linked and autosomal dominant Alport syndrome.

Use of angiotensin converting enzyme inhibitors is associated with reduced risk of late bladder toxicity following radiotherapy for prostate cancer

Background and purposeGenome-wide association studies (GWAS) of late hematuria following prostate cancer radiotherapy identified single nucleotide polymorphisms (SNPs) near AGT, encoding angiotensinogen. We tested the hypothesis that patients taking angiotensin converting enzyme inhibitors (ACEi) have a reduced risk of late hematuria. We additionally tested genetically-defined hypertension. Materials and methodsProstate cancer patients undergoing potentially-curative radiotherapy were enrolled onto two multi-center observational studies, URWCI (N = 256) and REQUITE (N = 1,437). Patients were assessed pre-radiotherapy and followed prospectively for development of toxicity for up to four years. The cumulative probability of hematuria was estimated by the Kaplan-Meier method. Multivariable grouped relative risk models assessed the effect of ACEi on time to hematuria adjusting for clinical factors and stratified by enrollment site. A polygenic risk score (PRS) for blood pressure was tested for association with hematuria in REQUITE and our Radiogenomics Consortium GWAS. ResultsPatients taking ACEi during radiotherapy had a reduced risk of hematuria (HR 0.51, 95%CI 0.28 to 0.94, p = 0.030) after adjusting for prior transurethral prostate and/or bladder resection, heart disease, pelvic node radiotherapy, and bladder volume receiving 70 Gy, which are associated with hematuria. A blood pressure PRS was associated with hypertension (odds ratio per standard deviation 1.38, 95%CI 1.31 to 1.46, n = 5,288, p < 0.001) but not hematuria (HR per standard deviation 0.96, 95%CI 0.87 to 1.06, n = 5,126, p = 0.41). ConclusionsOur study is the first to show a radioprotective effect of ACEi on bladder in an international, multi-site study of patients receiving pelvic radiotherapy. Mechanistic studies are needed to understand how targeting the angiotensin pathway protects the bladder.

Hematuria in anticoagulated patients with atrial fibrillation and urologic cancer

BackgroundBased on their renal excretion, direct oral anticoagulants (DOACs) may increase the risk of hematuria in patients with atrial fibrillation (AF) and urologic cancer compared with vitamin K antagonists. ObjectivesTo examine the risk of bleeding associated with DOAC versus warfarin in patients with AF and urologic cancer. MethodsWe conducted a Danish nationwide cohort study with individually linked registry data on patients with AF and active or a history of urologic cancer. We calculated crude rates per 100 person‐years of hospital episodes of major bleeding and hematuria. We then compared rates of hematuria during the year after initial oral anticoagulation filled prescription by treatment regimen using inverse probability of treatment weighting and Cox regression. ResultsThe study population included 2615 patients with AF and urologic cancer (6.1% women; median age, 76 years) initiating a DOAC or warfarin. One‐year risk of hematuria was 4.8% in the DOAC group and 4.7% in the warfarin group with a corresponding weighted hazard ratio (HR) of 1.21 (95% confidence interval [CI], 0.81‐1.81). HRs for hematuria were generally similar in analyses restricted to patients treated with standard‐dose DOAC and patients with active cancer. For those with cancer of the kidney, renal pelvis, ureter, and bladder, the HR was 0.82 (95% CI, 0.44‐1.54). Results were mirrored for other bleeding events, whereas the risk for intracranial bleeding was lower with DOACs. ConclusionIn patients with AF and urologic cancer, there was a similar risk of hematuria associated with DOAC and warfarin treatment.

Incidence and Severity of Hematuria After Post-Prostatectomy Radiotherapy in a Cohort With Long-Term Follow-up

Incidence and Severity of Hematuria After Post-Prostatectomy Radiotherapy in a Cohort With Long-Term Follow-up

Association of Rosuvastatin Use with Risk of Hematuria and Proteinuria

Association of Rosuvastatin Use with Risk of Hematuria and Proteinuria

MP01-02 UNDERSTANDING HOLEP RECOVERY: ASSESSING PATIENT EXPECTATIONS &amp; UNDERSTANDING

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-02 UNDERSTANDING HOLEP RECOVERY: ASSESSING PATIENT EXPECTATIONS & UNDERSTANDING Mark Assmus, Matthew Lee, Deepak Agarwal, Tim Large, and Amy Krambeck Mark AssmusMark Assmus More articles by this author , Matthew LeeMatthew Lee More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Tim LargeTim Large More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although holmium laser enucleation of the prostate (HoLEP) is a highly effective surgery for BPH; there is a variable period of recovery where patients may experience hematuria, dysuria or urinary incontinence (UI). Despite preoperative consultation, there is a paucity of literature examining physician-patient communication of the postoperative recovery from the patients’ perspective. We sought to examine patient expectation and understanding as a patient reported outcome (PRO) quality metric for HoLEP. METHODS: With IRB approval we queried our EMR and retrospective clinical registry to identify 50 consecutive patients that underwent HoLEP Nov 2019 – Mar 2020 by two endourologists at our center. Patients were provided a PRO questionnaire via Twistle ≥6 months postoperatively. Patient demographics and perioperative course was examined in the context of their responses. Our primary objectives were to assess whether patients felt they had a reasonable understanding of the recovery period and identify areas requiring improvement. RESULTS: We observed a 92% (46/50) response rate with average age 72.2 years (range 41.6-88.5). Overall, 91.3% (42/46) felt they had a reasonable understanding of the healing process. 97.8% (45/56) were aware there may be temporary UI with 87% having ≥1 episodes of UI after catheter removal. 47.8% (22/46) of patients expected their UI to resolve within 30 days while 8.6% expected >90 days of UI. Patients unaware of the risk of UI reported the degree of not knowing to be 1/10 on a 10-point Likert scale (1=no bother). All patients were aware of the risk of hematuria with 93.5% (43/46) expecting resolution within 30 days (<7 d 47.8%, 7-14 d 28.3%, 15-30 d 17.4%). Despite preoperative counseling, 10.9% (5/46) were not aware ejaculate volume may change postoperatively with 80% of these patients reporting that is important information. After catheter removal 69.6% experienced any dysuria, with 65.6% reporting - ″as expected″, 28.1% - ″Less painful″, 3.1% - ″More painful.″ The three most common patient reported ways to improve communication were: 27.3% - handout, 18.2% - spend more time, 18.2% - explain to family member/friend. Only 9.1% felt communication could improve with a HoLEP website. CONCLUSIONS: Although surgical technique and technologies continue to improve the outcomes and postoperative recovery following HoLEP, ensuring adequate physician-patient communication to optimize expectations is also crucial. We report patient understanding of HoLEP recovery and areas for future improvement. Source of Funding: None to disclose © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1-e1 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Matthew Lee More articles by this author Deepak Agarwal More articles by this author Tim Large More articles by this author Amy Krambeck More articles by this author Expand All Advertisement Loading ...

Safety of transrectal ultrasound-guided prostate biopsy in patients receiving aspirin: An update meta-analysis including 3373 patients.

Background:The management of aspirin before transrectal prostate puncture-guided biopsy continues to be controversial. The conclusions in newly published studies differ from the published guideline. Therefore, an updated meta-analysis was performed to assess the safety of continuing to take aspirin when undergoing a transrectal ultrasound-guided prostate biopsy (TRUS-PB).Methods:We searched the following databases for relevant literature from their inception to October 30, 2020: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Medline, Web of Science, Sinomed, Chinese National Knowledge Internet, and WANGFANG. Studies that compared the bleeding rates between aspirin that took aspirin and non-aspirin groups were included. The quality of all included studies was evaluated using the Newcastle-Ottawa Scale. Revman Manger version 5.2 software was employed to complete the meta-analysis to assess the risk of hematuria, hematospermia, and rectal bleeding.Results:Six articles involving 3373 patients were included in this meta-analysis. Our study revealed that compared with the non-aspirin group, those taking aspirin exhibited a higher risk of rectal bleeding after TRUS-PB (risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.09–1.49], P = .002). Also, the meta-analysis results did not reveal any significant difference between the 2 groups for the risk of hematuria (RR = 1.02, 95%CI [0.91–1.16], P = .71) and hematospermia (RR = 0.93, 95%CI [0.82–1.06], P = .29).Conclusion:Taking aspirin does not increase the risk of hematuria and hematospermia after TRUS-PB. However, the risk of rectal bleeding, which was slight and self-limiting, did increase. We concluded that it was not necessary to stop taking aspirin before undergoing TRUS-PB.

Understanding holmium laser enucleation of the prostate (HoLEP) recovery: Assessing patient expectations and understanding.

Although holmium laser enucleation of the prostate (HoLEP) is a highly effective surgery, there is a variable recovery period where patients may experience hematuria, dysuria, or urinary incontinence (UI). Despite preoperative consultation, there is a paucity of literature examining the effectiveness of physician-patient communication in preparing the patient for the postoperative recovery period. We sought to examine recovery expectations as a patient-reported outcome (PRO) metric for HoLEP. With institutional review board approval, we queried our electronic medical record and retrospective clinical registry to identify 50 consecutive patients that underwent HoLEP from November 2019 to March 2020 by two endourologists. Patients were provided questionnaires via Twistle© ≥6 months postoperatively. Patient demographics and perioperative course was examined in the context of responses. Our primary objective was determining whether patients felt they had a reasonable understanding of the recovery process. We observed a 92% (46/50) response rate, with an average patient age of 69.4 years (range 55-88). Overall, 91.3% (42/46) felt they had a reasonable understanding of the recovery. Additionally, 97.8% (45/46) were aware of temporary UI, with 87% having ≥1 episodes of UI after catheter removal. We found 47.8% (22/46) of patients expected UI to resolve within 30 days, while 8.6% expected >90 days of UI. All patients were aware of the risk of hematuria, with 93.5% (43/46) expecting resolution within 30 days (<7 days: 47.8%; 7-14 days: 28.3%; 15-30 days: 17.4%). Although surgical technique continues to improve HoLEP, ensuring adequate physician-patient communication to optimize expectations is crucial. We report patient understanding of HoLEP recovery and areas for future improvement.

Association of the STAT4, CDKN1A, and IRF5 variants with risk of lupus nephritis and renal biopsy classification in patients in Vietnam.

BackgroundLupus nephritis is a common complication of systemic lupus erythematosus (SLE, OMIM #15200) in the Asian population and a main contributor to mortality and morbidity. In this study, we evaluate the variants on three genes STAT4, CDKN1A, and IRF5 and their association with lupus nephritis.MethodOne hundred fifty‐two SLE patients with confirmed lupus nephritis (through biopsy) and 76 healthy controls were recruited. Genotyping of SNPs on three gene STAT4, CDKN1A, and IRF5, phenotypic, and laboratory assessment were performed; renal biopsy and classification were carried out for the patient group.ResultsCarriers of rs7582694 C alleles on STAT4 have higher risk of lupus nephritis (OR 2.0; 95% CI [1.14, 3.19]; p = 0.015), at higher risk of hematuria and higher serum level of dsDNA antibodies compared to controls (p < 0.05) and were more likely to have nephrotic histopathology grading of class III or higher. No association was observed for CDKN1A; and no variation was observed for the IRF5 gene in both the study and control group.ConclusionThis study investigates the relationship between STAT4, CDKN1A, and IRF5 gene and SLE in a Vietnamese patient population. Patients with the C allele (STAT4) in rs7582694 were associated with a more severe disease phenotype.

Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study.

Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan.Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined.Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students.Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.

Quantification of 3-Hydroxypropyl Mercapturic Acid in the Urine of Patients with Breast Cancer to Monitor Cyclophosphamide Toxicity

The alkylating agent cyclophosphamide is used in chemotherapy regimens for various type of cancer. However, cyclophosphamide may lead to toxic side effects on the bladder, namely hemorrhagic cystitis, which can cause hematuria, and, potentially, bladder cancer. These effects are caused by acrolein, a byproduct of cyclophosphamide metabolism. In this study, a method to quantify 3-hydroxypropyl mercapturic acid (3-HPMA) in urine was developed. 3-HPMA is a stable metabolite of acrolein that serves as biomarker of acrolein. Urine samples were collected 4 hours after cyclophosphamide administration and analyzed to determine the risk of hematuria. 3-HPMA was analyzed by reverse-phase LC-MS/MS using a triple quadrupole electrospray ionization mass spectrometer in the positive-ion mode. The mobile phase was a 90:10 (vol/vol) mixture of 0.1% formic acid in water and 0.1% formic acid in acetonitrile. Multiple reaction monitoring mode was used, with m/z 222.10 → 90.97 for 3-HPMA and 164.10 → 122.02 for the internal standard N-acetyl cysteine (NAC). Samples were prepared by acidification and dilution. The analytical method produced a linear response within the concentration range of 40-10,000 ng/mL. The method was validated in accordance with 2018 FDA guidelines and applied to quantify 3-HPMA in the urine of 40 patients with breast cancer. The measured concentrations ranged from 820.3 to 5596.1 ng/mg creatinine. Seven patients identified with hematuria had low 3-HPMA concentrations of 4445.824 ± 411.17 ng/mg creatinine, and 33 patients without hematuria had low 3-HPMA concentrations of 2419.4 ± 1171.8 ng/mg creatinine. The method was applicable for the quantification of 3-HPMA in human urine. Large variations in 3-HPMA concentrations were found in 40 patients with breast cancer treated with cyclophosphamide, with a significant difference (P < 0.05) observed between patients with hematuria and those without hematuria.

Asymptomatic Microscopic Hematuria: Validation of a Risk Index

Several years ago, urologists developed a “Hematuria Risk Index” to predict risk for urologic malignancy in patients with hematuria (Mayo Clin Proc

SAT0218 SINGLE NUCLEOTIDE POLYMORPHISMS LOCATED IN REGULATORY REGIONS OF GENES INVOLVED IN SYSTEMIC INFLAMMATION (MAMDC1, ITGAM, AND CRP) CORRELATION WITH THE CLINICAL PICTURE OF DISEASE AND ACTIVITY PARAMETERS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:The exact pathogenesis of systemic lupus erythematosus (SLE) is poorly understood. It is an autoimmune disease that leads to a chronic inflammatory process involving numerous tissues and organs (skin, kidneys, joints, central nervous system, cardiovascular, respiratory, digestive and hematopoietic systems). However, despite the advancement of SLE molecular biology and the wide availability of tests and diagnostic tools, the knowledge about factors predicting the clinical disease activity as well as related changes in the laboratory results is insufficient.Objectives:The goal of the study was to assess the relationship between selected single nucleotide polymorphisms (SNPs) and the clinical picture of diseaseand some activity parametersin patients with SLE.Methods:We conducted a study of adult patients with SLE diagnosed and treated in the Rheumatology Department of Medical University of Lublin between 2016-2019. We enrolled 80 patients with SLE (71 women, 9 men), with the median (range) age 36 (19-72) and disease duration 6 (1-37) years. To objectively assess disease activity, standardized SLE activity scale - SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) was used. Using the Real-Time PCR method and specific TaqMan probes SNPs of 3 genes:MAMDC1(rs910875; c.-1687G&gt; C),CRP(rs3091244; c.-390C&gt; A), andITGAM(rs7193943; c.-323G&gt; A) were analyzed and then their relationship with specific clinical picture of disease, activity and laboratory results were assessed.Results:Carriers of the CC genotype compared to the remaining polymorphic variants (CG and GG) of theMAMDC1gene had an approximately 4-fold higher risk of skin disease compared to other clinical pictures of disease (renal, articular, neuro-psychiatric, hematological) (OR = 4.04; p = 0.0110)). Carriers of this genotype also had a higher risk of hematuria (OR = 4.57; p = 0.0082), sterile leukocyturia (OR = 53.91; p = 0.0071), the presence of anti-Sm / RNP antinuclear antibodies (OR = 4.15, p = 0.0074), reduced values of the C3 complement component (OR = 6.11; p = 0.0071) and the need for oral glucocorticosteroids (OR = 7.01; p = 0.0028). In addition, significantly higher values of SLEDAI disease activity scale were observed in carriers of the CC genotype of theMAMDC1gene (medians: 6 vs 4; p = 0.0220). Moreover, we observed a trend towards a higher risk of hepatomegaly in GG genotype carriers of theITGAMgene (OR=18.50; p=0.0525). In addition, the AA genotype of theCRPgene was associated with a higher risk of proteinuria (OR = 84; p &lt;0.0001), Anti-SSA / Ro autoantibodies (OR = 3.29; p = 0.0484), and aCL IgM (OR = 3.42; p = 0.0332) occurrence. Carriers of AA genotype of the above gene were also at higher risk of earlier occurrence of first disease symptoms as well as disease diagnosis at a younger age (respectively: 24 vs 31 years; p=0.0225, 23 vs 29 years; 0.0442).Conclusion:The results suggest the relationship between SNPs in genes involved in systemic inflammation (MAMDC1, ITGAM, CRP) and disease activity as well as the occurrence of some specific clinical pictures of disease in patients with SLE.The genetic dispositions described above may serve as attractive markers in SLE, potentially useful in clinical practice.Disclosure of Interests:Aleksandra Majdan: None declared, Radosław Mlak: None declared, Marcin Mazurek: None declared, Dominika Pigon: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Teresa Malecka Massalska: None declared

Use of a Risk Stratification Tool to Guide Evaluation of Patients With Asymptomatic Microscopic Hematuria

OBJECTIVETo determine if use of the hematuria risk index can reduce testing and cost, while maintaining equivalent lesion detection in patients with asymptomatic microscopic hematuria. MATERIALS AND METHODSRetrospective cohort study of 1049 patients at single institution. Hematuria risk index score was calculated based on clinical factors including age, sex, smoking history, and degree of hematuria for each patient along with evaluation studies performed and total number of tumors discovered. Cost benefit analysis was performed based on published Medicare averages. RESULTSTumor detection rate in overall, low-risk, and moderate-risk groups were 1.2%, 0%, and 2.96% at a total cost of $408,376. When low-risk group is not screened cost decreases to $166,252 with no lesions missed. The cost to discover one lesion/cancer in the overall group was $34,031.3, the cost to find one high-grade clinically significant lesion/cancer was $136,125.3 for the overall group. When the low-risk group was removed, the cost to find a high-grade clinically significant lesion/cancer decreased to $55,417.3 without missing any significant lesions. Ultrasound may be utilized instead of computed tomography with minimal loss of lesion detection in select moderate risk patients. CONCLUSIONNone of the low-risk hematuria risk patients were diagnosed with any lesions, as such these patients may not need an evaluation. Furthermore, by utilizing a risk-stratified approach to the assessment of asymptomatic microscopic hematuria health care costs can be significantly decreased with limited negative consequences in terms of lesion detection.

P4790Haematuria is not elevated in AF patients treated with NOACs versus VKAs: GARFIELD-AF study

Abstract Background Haematuria in atrial fibrillation (AF) patients taking oral anticoagulants (OACs) is usually viewed as less serious than intracranial and gastrointestinal bleeding. It is speculated that haematuria may result from renal excretion of active new oral anticoagulants (NOACs) causing a direct anticoagulating effect in the urinary tract. Vitamin K antagonists (VKAs) such as warfarin, on the other hand, undergo hepatic metabolism and may pose lower risk of haematuria. This large registry study investigated whether NOACs more likely cause haematuria compared with VKAs. Purpose To assess whether there is any difference in the incidence rate of haematuria in AF patients taking NOACs versus VKAs using data from the GARFIELD-AF registry. Methods GARFIELD-AF is an international prospective registry of nonvalvular AF patients with at least one additional risk factor for stroke, followed for at least 2 years. Macroscopic haematuria was identified by local investigators. Event rates were estimated by Poisson model. Adjusted hazard ratio (HR) for haematuria between treatment groups was calculated using overlap-weighted Cox model including a range of patient demographics and clinical parameters as variables. Only the first haematuria occurrence was considered. Patients who were not treated with either VKAs or NOACs were excluded. Results Among a registry population of 34,926 patients 24,079 were anticoagulated and 24,061 had available follow-up data. Baseline characteristics were evenly balanced between the VKAs and NOACs subgroups, except a somewhat higher proportion of VKA patients than NOAC patients received concomitant antiplatelet therapy. Rate of haematuria was similar between the two groups: VKAs, 115/12,307 cases (0.9% over study period; 0.55 [95% CI, 0.46–0.65] per 100 patient-years); NOACs, 119/11,754 cases (1.0% over study period; 0.49 [95% CI, 0.41–0.59] per 100 patient-years). Over 2 years cumulatively, adjusted HR for haematuria in NOAC group versus VKA was 0.85 (95% CI, 0.63–1.15; p=0.29). Most haematuria cases (approximately 94%) were minor or clinically relevant non-major bleeds, occurring at a similar rate in both subgroups. Major bleeds were very rare. No intervention was necessary in two thirds haematuria cases (65.2%); surgical procedures were performed in only 8.3%. No haematuria-related deaths were observed. Incidence of haematuria Conclusions The incidence and severity of haematuria were not increased in AF patients taking NOACs versus VKAs. Haematuria may occur in approximately one in 100 AF patients on long-term OACs therapy and is usually non-serious. Acknowledgement/Funding The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.

Comparison of the Harms, Advantages, and Costs Associated With Alternative Guidelines for the Evaluation of Hematuria

Existing recommendations for the diagnostic testing of hematuria range from uniform evaluation of varying intensity to patient-level risk stratification. Concerns have been raised about not only the costs and advantages of computed tomography (CT) scans but also the potential harms of CT radiation exposure. To compare the advantages, harms, and costs associated with 5 guidelines for hematuria evaluation. A microsimulation model was developed to assess each of the following guidelines (listed in order of increasing intensity) for initial evaluation of hematuria: Dutch, Canadian Urological Association (CUA), Kaiser Permanente (KP), Hematuria Risk Index (HRI), and American Urological Association (AUA). Participants comprised a hypothetical cohort of patients (n = 100 000) with hematuria aged 35 years or older. This study was conducted from August 2017 through November 2018. Under the Dutch and CUA guidelines, patients received cystoscopy and ultrasonography if they were 50 years or older (Dutch) or 40 years or older (CUA). Under the KP and HRI guidelines, patients received different combinations of cystoscopy, ultrasonography, and CT urography or no evaluation on the basis of risk factors. Under the AUA guidelines, all patients 35 years or older received cystoscopy and CT urography. Urinary tract cancer detection rates, radiation-induced secondary cancers (from CT radiation exposure), procedural complications, false-positive rates per 100 000 patients, and incremental cost per additional urinary tract cancer detected. The simulated cohort included 100 000 patients with hematuria, aged 35 years or older. A total of 3514 patients had urinary tract cancers (estimated prevalence, 3.5%; 95% CI, 3.0%-4.0%). The AUA guidelines missed detection for the fewest number of cancers (82 [2.3%]) compared with the detection rate of the HRI (116 [3.3%]) and KP (130 [3.7%]) guidelines. However, the simulation model projected 108 (95% CI, 34-201) radiation-induced cancers under the KP guidelines, 136 (95% CI, 62-229) under the HRI guidelines, and 575 (95% CI, 184-1069) under the AUA guidelines per 100 000 patients. The CUA and Dutch guidelines missed detection for a larger number of cancers (172 [4.9%] and 251 [7.1%]) but had 0 radiation-induced secondary cancers. The AUA guidelines cost approximately double the other 4 guidelines ($939/person vs $443/person for Dutch guidelines), with an incremental cost of $1 034 374 per urinary tract cancer detected compared with that of the HRI guidelines. In this simulation study, uniform CT imaging for patients with hematuria was associated with increased costs and harms of secondary cancers, procedural complications, and false positives, with only a marginal increase in cancer detection. Risk stratification may optimize the balance of advantages, harms, and costs of CT.

Association between vitamin D level and hematuria from a dipstick test in a large scale population based study: Korean National Health and nutrition examination survey

BackgroundVitamin D deficiency is an important health concern because it is related to several comorbidities and mortality. However, its relationship with the risk of hematuria remains undetermined in the general population. In this study, we analyzed the association between vitamin D deficiency and hematuria.MethodsWe conducted cross-sectional analysis using data of participants from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2014. A total of 20,240 participants, aged ≥18 years old, were analyzed. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured in a central laboratory and hematuria was defined as ≥1+ on a dipstick test. Multivariate logistic regression was conducted to calculate the odds ratio (OR) of hematuria risk according to serum 25(OH)D quartiles, after adjusting several covariates.ResultsA total 3144 (15.5%) participants had hematuria. The mean 25(OH)D level was 17.4 ± 6.2 ng/mL (median, 16.6 ng/mL (interquartile range, 13.1–20.8 ng/mL)). The 3rd and 4th quartiles had a higher risk of hematuria than the 1st quartile, with adjusted ORs 1.26 (1.114–1.415) and 1.40 (1.240–1.572) in the 3rd and 4th quartiles, respectively. However, this relationship was only significant in women, not in men. When stratified analyses were conducted according to menopausal status, there was a significant increase of hematuria risk according to quartiles in postmenopausal but not in premenopausal women.ConclusionWe found that vitamin D deficiency is correlated with hematuria in women, particularly after menopause. Further interventional studies are warranted to address whether correcting vitamin D deficiency can lower the risk of hematuria.

Risk Factors of Renal Involvement Based on Different Manifestations in Patients with Ankylosing Spondylitis

Background/Aims: Renal involvement is one of the most common extra-articular complications caused by ankylosing spondylitis (AS). Most studies have focused on the incidence rate, clinical manifestation and pathology, while risk factors have hardly been investigated. Therefore, the objective of this study was to assess the risk factors of renal involvement in patients with AS. Methods: Clinical and biochemical data of 926 AS patients were collected. Based on the manifestations of renal involvement, patients were divided into three groups and the differences in clinical and biochemical characteristics were compared. A group with non-renal involvement served as a control. Multivariable logistic regression was used for analyzing risk factors of renal involvement in AS. Results: Of the 926 AS patients, 201 patients suffered from renal involvement. Moreover, female AS patients faced a higher risk of hematuria compared to male patients. As indicated by the data obtained from multivariate logistic regression analysis, gender, uric acid (UA), immunoglobulin A (IgA), and serum albumin (ALB) were found to be risk factors of renal involvement in AS. An increase in UA or IgA levels, or a decrease in ALB level can increase the risk of renal involvement with multiple manifestations (more than one manifestation of renal damage). According to our findings, no definite variable was identified as a risk factor of proteinuria in AS patients. Conclusion: In AS patients, UA, IgA, and ALB levels can indicate the risk of renal involvement in AS patient and need to be paid special attention. Furthermore, women are subjected to a higher risk of hematuria.