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Macroscopic hematuria in mesangial IgA nephropathy: correlation with glomerular crescents and renal dysfunction
Insights
Macroscopic hematuria in IgA nephropathy patients is linked to more crescents on kidney biopsies and poorer kidney function. Urine analysis can help assess disease activity.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- IgA nephropathy is a common cause of glomerulonephritis.
- Macroscopic hematuria can indicate active kidney disease.
Purpose of the Study:
- To investigate the association between macroscopic hematuria and renal biopsy findings in IgA nephropathy.
- To correlate macroscopic hematuria with renal function in IgA nephropathy patients.
Main Methods:
- Retrospective analysis of 186 renal biopsy specimens from 79 adult patients with IgA nephropathy.
- Comparison of patients with and without a history of macroscopic hematuria.
- Correlation of biopsy findings (crescent formation) with clinical data (serum creatinine, creatinine clearance).
Main Results:
- Patients with macroscopic hematuria showed significantly higher serum creatinine and lower creatinine clearance.
- 100% of biopsies during macroscopic hematuria episodes revealed crescents.
- 79-91% of biopsies in patients with microscopic hematuria also showed crescents.
Conclusions:
- Macroscopic hematuria in IgA nephropathy is associated with a high prevalence of crescents and impaired renal function.
- Quantitative urine analysis for renal bleeding may aid in disease activity assessment.
Abstract:
One hundred and eighty-six renal biopsy specimens from 79 adult patients with mesangial IgA nephropathy were examined and correlated with clinical data at the time of biopsy. Forty patients (group 1) with a history of macroscopic hematuria were compared with 39 patients (group 2) without such a history. Group 1 patients had a higher serum creatinine, 240 +/- 20 mumoles/liter vs. 140 +/- 10 mumoles/liter (P less than 0.01), lower creatinine clearance 69 +/- 36 ml/min vs. 87 +/- 30 ml/min (P less than 0.05), and a higher percentage of patients presenting with serum creatinine greater than 300 mumoles/liter, 22.5% vs. 5.1% (P less than 0.05). Fourteen biopsies were performed in 11 patients during an episode of macroscopic hematuria (group 1A). One hundred percent of these biopsy specimens showed crescents. Ninety-one percent of 11 biopsy specimens from ten patients (group 1B), taken 3 to 27 days following an episode but at a time when urinary red cells were less than 1,000,000/ml, also showed crescent formation. Of 14 biopsy specimens from 13 patients without macroscopic hematuria, but with greater than 1,000,000 red cells/ml in the urine just prior to biopsy (group 2A), 79% had crescents. In conclusion, macroscopic hematuria in adult patients with mesangial IgA nephropathy is associated with a high likelihood of crescents on renal biopsy specimens and worse renal function. Careful quantitative assessment of the urine for renal bleeding may help to better define the activity of disease in these patients.