Clinicopathological analysis of 155 patients with persistent isolated hematuria
Rong-rong Li1, Hang Li2, Yu-bin Wen2
1Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Objectives:
To reveal etiologies of persistent isolated hematuria (PIH) through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH.
Methods:
we retrospectively studied 155 PIH patients receiving renal biopsy between January, 2003 and December, 2008 in Peking Union Medical College Hospital. All the clinical data and follow-up result were analyzed.
Results:
All subjects included 38 children and 117 adults, with mean age of 11.38±3.25 years for children and 35.17±8.44 years for adults. Thin basement membrane nephropathy (TBMN) was the most common pathology (55.3% of children and 49.6% of adults), followed by IgA nephropathy (18.4% of children and 32.5% of adults, mainly grade 2-3) and mesangial proliferative glomerulonephritis (MsPGN) without IgA deposition (13.2% of children and 12.8% of adults). Besides, Alport syndrome (2.6% of children) and membrane nephropathy (2.6% of children and 0.9% of adults) were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological types of PIH. Totally, 86 patients were followed up and 37 cases therein stayed on track for long term (mean duration 41.11?28.92 months, range 8-113 months). Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN (without IgA deposition), and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention.
Conclusions:
Close follow-up should be required as the primary management for PIH. Equally important is careful monitoring for early identification of undesirable predictors; while renal biopsy and other timely intervention are warranted if there is hypertension, significant proteinuria or renal impairment.
Insights
Persistent isolated hematuria (PIH) is most commonly caused by Thin Basement Membrane Nephropathy (TBMN), with IgA nephropathy also frequent. Close follow-up is key, with renal biopsy recommended for concerning symptoms.
Area of Science:
- Nephrology
- Pathology
- Internal Medicine
Background:
- Persistent isolated hematuria (PIH) necessitates understanding its underlying causes.
- Ultrastructural pathology and clinicopathological correlations are crucial for managing PIH.
Purpose of the Study:
- To identify the etiologies of PIH using ultrastructural pathological examination.
- To establish clinicopathological correlations in PIH cases.
- To outline appropriate management strategies for PIH patients.
Main Methods:
- Retrospective study of 155 PIH patients who underwent renal biopsy.
- Analysis of clinical data and follow-up results from January 2003 to December 2008.
- Inclusion of both pediatric and adult patient cohorts.
Main Results:
- Thin Basement Membrane Nephropathy (TBMN) was the most prevalent diagnosis (49.6-55.3%).
- IgA nephropathy and mesangial proliferative glomerulonephritis (MsPGN) were other significant findings.
- Elevated blood pressure or proteinuria indicated higher risk for MsPGN; microhematuria severity was not predictive of pathology type.
Conclusions:
- Close patient follow-up is the primary management for PIH.
- Monitoring for predictors of adverse outcomes is essential.
- Renal biopsy and timely interventions are indicated for patients with hypertension, significant proteinuria, or renal impairment.
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