Persistent dipstick haematuria following renal transplantation

• Published in: Clinical transplantation Vol. 18; no. 3; pp. 321 - 326
• Main Authors: McDonald, Kenneth J, McMillan, Margaret A, Rodger, R Stuart C, Junor, Brian JR, Geddes, Colin C, Douglas Briggs, J, Jardine, Alan G
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01-06-2004; Blackwell
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; chronic allograft nephropathy; Cross-Sectional Studies; Female; General aspects; Graft Survival; Hematuria - diagnosis; Hematuria - epidemiology; Hematuria - etiology; Humans; IgA nephropathy; Indicators and Reagents; kidney transplantation; Kidney Transplantation - adverse effects; Male; Medical sciences; microhaematuria; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prevalence; recurrentglomerulonephritis; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; transplant survival; Urinalysis - methods; Glomerulonephritis; Graft(material); Relapse; Prognosis; chronic allograft nephropathy; kidney transplantation; Homograft; Transplantation; recurrent glomerulonephritis; Homotransplantation; Surgery; Graft; Anesthesia; microhaematuria; Cardiology; Kidney disease; Urinary system disease; IgA Nephropathy; Recurrent; transplant survival; Survival; Rejection; Chronic; Treatment; Urinary system; Renal failure; Circulatory system
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2004.00169.x

:  Despite widespread testing for dipstick haematuria following renal transplantation, there are no published series describing the prevalence and possible causes of this complication in an adult population. A cross‐sectional study of 640 renal transplant recipients under review at our follow‐up clinic was performed. Persistent haematuria was defined as a minimum of 1+ of blood on urinalysis stick testing detected at not fewer than 75% of clinic visits since its onset, or since the start of routine testing, present over a period of at least 4 weeks. The prevalence of persistent dipstick haematuria was 13.3%. Median serum creatinine was higher in patients with persistent haematuria but age, gender and length of time since transplantation were not significantly different. Potential explanations for persistent haematuria in 21 of 85 affected patients were chronic infection, ureteric stent without chronic infection, regular or intermittent self‐catheterization, persistent menstrual bleeding, anticoagulant therapy, graft calculus, and allograft renal cell carcinoma. Recurrent or de novo glomerular disease was confirmed by graft biopsy in 10 of 85 patients. Among the 41 recipients whose original cause of renal failure was IgA nephropathy (IgAN), the prevalence of persistent haematuria was 31.7% compared with 12% in the remaining patients (relative risk 2.6, 95% CI: 1.6–4.3). Persistent haematuria in IgAN patients was not associated with gender, age or time since transplantation. After 29 months of follow‐up, 20% of patients with haematuria had progressed to graft failure or death compared with 11.6% of the unaffected group (p = 0.029). However, despite the association with earlier graft failure, haematuria did not predict this endpoint independently of renal function.