Hematuria and risk for end-stage kidney disease

Hematuria is a common clinical finding requiring medical attention and poses several clinical challenges. The main challenge is to predict the future risk for chronic kidney disease and therefore to design a long-term follow-up evaluation and treatment plan. This review focuses on the risk for subsequent end-stage kidney disease among young persons with persistent isolated microscopic hematuria.

It has been recently recognized that young persons with persistent isolated microscopic hematuria have an increased risk for end-stage kidney disease, mainly secondary to primary glomerular diseases. These predominantly include IgA nephropathy, thin basement membrane disease, and Alport syndrome. Among these causes, the association with progression to chronic kidney disease is best established for IgA nephropathy and Alport syndrome. Thin basement membrane disease had been considered 'benign' by most authors, although recent findings suggest otherwise. In addition, novel diagnostic markers and therapeutic interventions for these conditions have recently been studied.

Persistent isolated microscopic hematuria confers a risk for future chronic kidney disease, which is dependent on disease context, underlying genetics, environment interactions, and treatment. 'Benign (familial) hematuria' is a misnomer, which we recommend abandoning as it prompts loss to follow-up. Instead, we favor annual/biennial follow-up assessment that should include measurement of blood pressure, urinalysis, and kidney function tests.