Persistent Haematuria Is Associated With Reduced Kidney Survival in Primary Podocytopathies

Area of Science:

• Nephrology
• Urology
• Internal Medicine

Background:

• Podocytopathies, including membranous nephropathy (MN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS), frequently present with haematuria.
• The prognostic significance of persistent haematuria in these conditions remains incompletely understood.

Purpose of the Study:

• To investigate the prevalence of persistent haematuria in primary podocytopathies.
• To determine the association between persistent haematuria and the risk of end-stage kidney disease (ESKD).

Main Methods:

• Retrospective cohort study of 236 adult patients with biopsy-proven primary podocytopathies.
• Persistent haematuria defined as ≥5 red blood cells/high-power field in ≥3 consecutive urine samples within 3 months post-biopsy.
• Kaplan-Meier analysis and Cox regression used to assess the association with ESKD, adjusting for covariates.

Main Results:

• 31% of patients exhibited persistent haematuria, which was associated with higher proteinuria and hypertension.
• Patients with persistent haematuria had a significantly higher incidence of ESKD (32% vs. 9%).
• Persistent haematuria independently predicted ESKD (HR: 3.55; 95% CI: 1.78-7.05) after multivariable adjustment.

Conclusions:

• Persistent haematuria is a prevalent finding in primary podocytopathies.
• Microscopic haematuria is a significant and independent predictor of poor kidney survival, including progression to ESKD.
• Simple urinalysis for haematuria offers a valuable, accessible tool for prognostication in podocytopathy patients.