Microhematuria is for risk assessment as a marker of disease activity in IgA nephropathy

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Microhematuria is for risk assessment as a marker of disease activity in IgA nephropathy

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Co-author 1

Toshiki Kano tkano@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan *

Co-author 2

Ryosuke Aoki r-aoki@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 3

Yusuke Fukao y-fukao@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 4

Yoshihito Nihei y-nihei@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 5

Masahiro Muto mmutou@juntendo.ac.jp Juntendo University Urayasu Hospital Department of Nephrology Chiba Japan -

Co-author 6

Yusuke Suzuki yusuke@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan -

Co-author 7

Hitoshi Suzuki shitoshi@juntendo.ac.jp Juntendo University Faculty of Medicine Department of Nephrology Tokyo Japan - Juntendo University Urayasu Hospital Department of Nephrology Chiba Japan

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Microscopic hematuria is one of the clinical features of IgA nephropathy (IgAN). Approximately 70% of patients present with hematuria as their first symptom. Recent international clinical trials showed that microscopic hematuria correlates with disease activity and has been used to evaluate treatment responses. However, the renal pathological findings and their activity in patients with IgAN presenting only with isolated hematuria remain unclear. Thus, e aimed to clarify the significance of isolated microscopic hematuria in the proportion and pathological activity of glomerulonephritis.

Methods

Among 513 patients who underwent renal biopsy in Juntendo University Urayasu Hospital, between January 2023 and December 2024, 42 patients showed hematuria without overt proteinuria. We analyzed the proportion of glomerulonephritis and pathological activities.

Results

IgAN was diagnosed with the largest number of 30 cases (71.4%), thin basement membrane disease (TBM) was in 9 (21.4%), minor glomerular abnormality in 2 (4.8%), and crescentic formed glomerulonephritis in 1 (2.4%). Among patients with IgAN, average age was 40.8 years old, endocapillary proliferation and crescentic formation were seen in 33.3% and 30%, respectively. Adhesion and segmental sclerosis were shown in 10% patients with IgAN. Global sclerosis and Oxford T lesions were rarely observed.

Conclusion

In cases of isolated hematuria, IgAN was the most dominant. In patients with IgAN, pathological findings of disease activity were observed even in cases of hematuria without overt proteinuria. Microscopic hematuria may be an early hallmark of pathological activity.

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