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Adolescents and young adults with microscopic hematuria at increased risk of ESRD

Clinical Question:
Is asymptomatic isolated microscopic hematuria a risk factor for end-stage renal disease?

Bottom Line:
Adolescents and young adults with persistent asymptomatic isolated microscopic hematuria (AIMH) are at a significantly increased risk of end-stage renal disease (ESRD) compared with similar individuals without the condition. Primary glomerular disease was similarly significantly more common among those with the condition. (LOE = 1b)

Reference:
Vivante A, Afek A, Frenkel-Nir Y, et al. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA 2011;306(7):729-736.  [PMID:21846854]

Study Design:
Cohort (retrospective)

Funding:
Unknown/not stated

Setting:
Population-based

Synopsis:
These investigators analyzed data obtained from medical examinations of eligible Israeli adolescents and young adults, aged 16 years to 25 years, undergoing obligatory health assessment for military service. As part of the screening, a urinary dip stick test was performed followed by sediment examination when the result was positive. AIMH was defined as 5 or more red blood cells per high-power field obtained on 3 separate occasions on different days; normal serum creatinine levels; normal renal imaging study results; and confirmation of the diagnosis by a board-certified nephrologist. Information on ESRD was obtained from a separate national database. Between 1975 and 1997, 1,203,626 male and female adolescents and young adults underwent evaluation and 3690 (0.3%) were diagnosed with persistent AIMH. The condition was twice as prevalent among males than females. The mean age at recruitment was 17.6 years and the mean duration of follow-up was 20.7 years. ESRD developed in 565 individuals. Participants with AIMH who developed ESRD had an average lower body mass index than participants without AIMH who developed ESRD (20.6 vs 22.9). Individuals with AIMH who developed ESRD were also significantly younger at diagnosis compared with those without (mean age = 34.7 vs 38.6 years). The overall incidence rates of treated ESRD were 34.0 per 100,000 person years among participants with persistent AIMH and 2.05 per 100,000 person-years among those without the condition. Specific causes of ESRD occurred significantly more as a result of glomerular disease among participants with AIMH.

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