Macroscopic hematuria and impact on outcome

[Guest guest]

Hi Cy,

Here are a couple of references on gross hematuria for you.

IgA Glomerulnephritis - Synopsis of a paper by D. Gwyn ,

British Medical Journal

Jan 8, 1994

IgA nephropathy was first reported twenty-five years ago. It is fast

becoming recognized as the commonest form of glomerulonephritis.

Recent international meetings of kidney disease specialists have

acknowledged that nephrologists still do not know how to treat the

disease.

Two decades of observation have revealed that spontaneous remission

may occur but that 15-20% of patients suffer kidney failure within 10

years of diagnosis. The risk factors for progression are impaired

renal function at presentation, heavy proteinuria, hypertension, and

curiously, absence of the typical symptom - recurrent macroscopic

hematuria - blood in the urine. IgA nephropathy is shown convincingly

to be systemic by its recurrence in patients who receive kidney

transplants and, more remarkably, by the disappearance of IgA deposits

when a kidney from someone with IgA is transplanted into someone with

renal failure from another cause.

Factors associated with progression of IgA nephropathy are related to renal

function –

A model for estimating risk of progression in mild diseaseV. Rauta, P. Finne,

J. Fagerudd, K. Rosenlöf, T. Törnroth

and C. Grönhagen-RiskaHelsinki University Central Hospital, Department of

Medicine,

Division of Nephrology Helsinki, FinlandBackground: A number of factors are

linked to the outcome of IgA nephropathy (IgAN). However, it has been difficult

to compare results of studies since patient populations have varied greatly.

There were 3 aims in the study reported here, namely to compare factors

associated with renal outcome in IgAN patients with different levels of renal

function on diagnosis; to determine factors which were independently associated

with

progression of renal disease in initially mild IgAN; and to create a model

for the estimation of the risk of progression in individual IgAN patients with

normal renal function on diagnosis. Methods: Two hundred and fifty-nine IgAN

patients who had been followed on average for 9.1 (SD 4.5) after diagnosis were

divided into 2 groups on the basis of renal function on diagnosis. In group 1

(98 patients), Ccr (creatinine clearance, estimated by the Cockcroft-Gault

formula) was < 85 ml/min, in group 2 (161 patients) ³ 85 ml/min. Univariate

analyses were used to find significant differences between progressors and

non-progressors in both groups. Logistic regression analysis was used to

determine

factors independently associated with progression in group 2. Results: Several

factors were found to be associated with outcome in both groups, such as

hypertension, level of Ccr, serum cholesterol, proteinuria, and also

histopathological changes. Factors associated with progression in patients with

initially

decreased renal function (group 1), were predictable, such as male sex, absence

of

episodes of macroscopic hematuria, serum urate level and degree of tubular

atrophy. Surprisingly, in patients with initially normal renal function (group

2), numbers of urinary erythrocytes were associated with outcome. The factors

independently associated with progression in this group were number of urinary

erythrocytes, existence of hypertension and in histopathology

arteriolosclerosis and the level of glomerular score. A model for estimating

risk of

progression on the basis of various combinations of factors found to be

independently

associated with outcome is presented. Conclusions: We concluded that

association between variable and outcome in IgAN depends partly on renal

function at the

time of assessment of the factor. Since there are factors which are

independently associated with the outcome of early and apparently mild disease,

early

diagnosis of IgAN is desirable: outcome in mild IgAN can be predicted reliably

on the basis of factors found to be independently associated with outcome.

 

[Guest guest]

Hi Cy,

I was very struck by that too...first of all that they would transplant a

kidney with IgAN into someone else, and secondly that the deposits disappeared.

This would be a great avenue for research. Medical research is growing by

leaps and bounds, and I can't think of a more exciting and hopeful time for

medical research than now.

In a message dated 6/19/2004 10:46:09 PM Pacific Daylight Time,

cyashleywebb@... writes:

> " more remarkably, by the

> disappearance of IgA deposits

> when a kidney from someone with IgA is transplanted into someone with renal

> failure from another cause. "

[Guest guest]

Hi Cy,

I was very struck by that too...first of all that they would transplant a

kidney with IgAN into someone else, and secondly that the deposits disappeared.

This would be a great avenue for research. Medical research is growing by

leaps and bounds, and I can't think of a more exciting and hopeful time for

medical research than now.

In a message dated 6/19/2004 10:46:09 PM Pacific Daylight Time,

cyashleywebb@... writes:

> " more remarkably, by the

> disappearance of IgA deposits

> when a kidney from someone with IgA is transplanted into someone with renal

> failure from another cause. "

[Guest guest]

Hi Cy,

I was very struck by that too...first of all that they would transplant a

kidney with IgAN into someone else, and secondly that the deposits disappeared.

This would be a great avenue for research. Medical research is growing by

leaps and bounds, and I can't think of a more exciting and hopeful time for

medical research than now.

In a message dated 6/19/2004 10:46:09 PM Pacific Daylight Time,

cyashleywebb@... writes:

> " more remarkably, by the

> disappearance of IgA deposits

> when a kidney from someone with IgA is transplanted into someone with renal

> failure from another cause. "