Persistent Haematuria Is Associated With Reduced Kidney Survival in Primary Podocytopathies

Haematuria is frequently present in podocytopathies, but its significance and prognostic value are not well described. This study aimed to determine the prevalence and association between persistent haematuria and kidney survival in patients with membranous nephropathy (MN), minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS).

We conducted a retrospective cohort study of 236 adults with biopsy-proven primary podocytopathies. Persistent haematuria was defined as ≥ 5 red blood cells per high-power field in ≥ 3 consecutive urine specimens within 3 months post-biopsy. The primary outcome was end-stage kidney disease (ESKD) requiring chronic renal replacement therapy. Kaplan-Meier analysis and Cox proportional hazards regression were performed.

Among 236 participants (114 MN, 76 MCD, 46 FSGS), 73 (31%) had persistent haematuria. Participants with haematuria had higher proteinuria (5.3 vs. 3.2 g/g, p = 0.01) and were more likely to have hypertension (55% vs. 36%, p = 0.007). During a median follow-up of 96 months, 38 patients (16%) reached ESKD. ESKD incidence was significantly higher in patients with persistent haematuria (32% vs. 9%, p < 0.001). After adjusting for diagnosis, eGFR, proteinuria, Charlson comorbidity score and histological chronicity score, persistent haematuria remained independently associated with ESKD (hazard ratio: 3.55; 95% CI: 1.78-7.05; p < 0.001).

Persistent haematuria is prevalent among patients with podocytopathies and is significantly and independently associated with ESKD. Urinalysis, including microscopic haematuria assessment, is widely available and inexpensive, providing a valuable data point to help formulate patient prognosis.