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Microhematuria Enhances the Risks of Relapse and Renal Progression in Primary Membranous Nephropathy

Peng He1, Xiaoyong Yu2, Yang Zha1

  • 1Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.

Frontiers in Medicine
|December 27, 2021
PubMed

Insights

Microscopic blood in urine (microhematuria) predicts relapse and kidney disease progression in primary membranous nephropathy (PMN). Higher initial hematuria increases relapse risk, while persistent microhematuria worsens kidney outcomes.

Area of Science:

  • Nephrology
  • Internal Medicine
  • Urology

Background:

  • Primary membranous nephropathy (PMN) is a leading cause of nephrotic syndrome in adults.
  • Microhematuria is a common finding in PMN, but its prognostic significance is not fully established.
  • Understanding predictors of relapse and progression is crucial for patient management.

Purpose of the Study:

  • To investigate the association between microhematuria and clinical outcomes in patients with PMN.
  • To determine if initial, time-averaged, or cumulative microhematuria predicts relapse or kidney disease progression.
  • To evaluate the impact of hematuria remission on renal outcomes.

Main Methods:

  • A cohort of 639 patients with biopsy-proven PMN was followed for a median of 40 months.
  • Exposures included initial, time-averaged, and cumulative duration of microhematuria.
  • Outcomes were relapse and renal progression (40% GFR decline or ESRD), analyzed using Cox regression and competing risk models.

Main Results:

  • Higher initial microhematuria independently predicted a greater hazard of relapse (HR 1.43).
  • Worsening hematuria significantly increased short-term relapse risk (HR 4.64).
  • Time-averaged (sHR 1.35) and cumulative hematuria (sHR 1.17) were independent predictors of renal progression. Hematuria remission reduced progression risk (sHR 0.63).

Conclusions:

  • Initial microhematuria is a significant predictor of relapse in PMN patients.
  • The magnitude and persistence of microhematuria are independently associated with kidney disease progression.
  • Microhematuria status and its changes provide valuable prognostic information in PMN.
Keywords:
kidney disease progressionmicroscopic hematuriaprimary membranous nephropathyrelapseremission

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