QJM vol. 97 no. 11 © Association of Physicians 2004; all rights reserved.
Asymptomatic isolated microscopic haematuria: long-term follow-up
From the Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China
Received 12 May 2004 and in revised form 12 July 2004
Background: Evidence to support current diagnostic and management approaches to asymptomatic haematuria is lacking and based on short-term clinical observation.
Aim: To ascertain the natural history and long-term outcome of asymptomatic and isolated haematuria, and to determine the clinical correlates of adverse renal events.
Design: Prospective observational referral-based study.
Methods: We evaluated 90 consecutive patients with isolated microscopic haematuria, first seen between 1985 and 1996 at an out-patient nephrology clinic. We defined adverse renal events as the development of proteinuria (> 0.5 g/24 h) on two consecutive occasions, development of hypertension, or impaired renal function characterized by glomerular filtration rate (GFR) of <60 ml/min/1.73 m2 for 3 months or more.
Results: There were 24 males and 66 females, median follow-up 5.2 years (total 442 patient-years). Mean age at presentation was 39 ± 13 years. Fifteen (17%) had complete resolution of microscopic haematuria. One (1%) had transitional cell carcinoma of urinary bladder 20 months after initial presentation. Twelve (13%) developed hypertension, and 10 (11%) proteinuria. Only one developed chronic renal failure, 2.3 years after initial presentation. Altogether, 16 (19%) developed at least one adverse event, after a mean 42 months. Neither history of renal biopsy nor histological diagnosis of glomerular disease was predictive of renal events. Three independent variables were predictive of adverse renal events: baseline proteinuria (RR per 0.1 g/day 2.04; 95%CI 1.13–3.68; p = 0.018); MDRD-estimated GFR at presentation (RR per 10 ml/min/1.73 m2 decrement 2.01; 95%CI 1.09–3.71; p = 0.025); and baseline serum urate (RR per 100 µmol/l 1.02; 95%CI 1.01–1.03; p = 0.009).
Discussion: Asymptomatic microscopic haematuria can lead to adverse renal events, and warrants nephrologist evaluation and regular follow-up. Its isolated microscopic haematuria is closely related to early hints of chronic kidney disease, such as low-grade proteinuria and renal insufficiency, as well as hyperuricaemia.
Address correspondence to Dr C.C. Szeto, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. e-mail: ccszeto{at}cuhk.edu.hk
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