Macroscopic hematuria in childhood IgA nephropathy

The clinical presentation, initial laboratory and renal biopsy findings, and subsequent clinical course in 205 children with IgA nephropathy were studied retrospectively. The findings in the 119 patients with macroscopic hematuria and those in the 86 without macroscopic hematuria were compared. There were no differences with regard to sex distribution, age at onset, initial renal function, incidence of hypertension, degree of proteinuria and degree of mesangial proliferation. At the latest follow-up, 3% of the patients with macroscopic hematuria and 8% without macroscopic hematuria had developed chronic renal failure; 8% of the patients with macroscopic hematuria and 20% without had heavy proteinuria with or without hypertension (p less than 0.01); 41% of the patients with macroscopic hematuria and 24% without macroscopic hematuria had normal urine, blood pressure and GFR (p less than 0.05). The disease appears to follow a significantly more benign course in children with macroscopic hematuria than in those without macroscopic hematuria. These observations suggest some macroscopic hematuria-related differences in the natural history of childhood IgA nephropathy.