Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
Journal website http://www.jocmr.org |
Original Article
Volume 9, Number 7, July 2017, pages 560-566
Variables to Predict Nephrological Disease in General, and Glomerulonephritis in Particular, in Patients With Microhematuria
Figure
Tables
Mean ± SD (range) or n/N (%) | |
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Epidemiological data were taken from the whole cohort (N = 805), whereas the other data (N = 543) were taken only from patients with confirmed MH (≥ 3 erythrocytes per high power field of view in urine sediment analysis). BMI: body mass index; CV: cardiovascular; SBP: systolic blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate. | |
Epidemiology (N = 805) | |
Age (years) | 56.3 ± 18.1 (6 - 91) |
Patients ≥ 40 years | 665/805 (82.6%) |
Sex (male) | 389/805 (48.3%) |
BMI (kg/m2) | 27.8 ± 6.0 (12.6 - 64.7) |
CV risk factors (N = 543) | |
SBP (mm Hg) | 144.7 ± 23.5 (90 - 227) |
DBP (mm Hg) | 82.4 ± 14.4 (50 - 145) |
History of arterial hypertension | 359/543 (66.1%) |
Diabetes mellitus, type 1 or 2 | 86/543 (15.8%) |
Hyperlipidemia | 178/543 (32.8%) |
Current smoker | 132/543 (24.3%) |
Kidney function (N = 543) | |
eGFR (mL/min) | 62.1 ± 34.1 (2 - 186) |
eGFR < 90 mL/min | 375/502 (74.1%) |
eGFR < 60 mL/min | 236/502 (47.1%) |
Microalbuminuria > 20 mg/L | 255/372 (68.5%) |
Signs of urinary tract infection (N = 543) | |
Leukocytes in urine test strip ≥ 25/μL | 229/543 (42.2%) |
Nitrite in urine | 37/543 (6.8%) |
Chronic infection of the urinary tract | 53/543 (9.8%) |
n/N (%) | |
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Data from the urine test strip analysis were collected at the first visit to the nephrologist (N = 805). †Confirmed hematuria is defined as patients that had ≥ 3 erythrocytes per high power field of view in urine sediment analysis. | |
Erythrocytes in urine stick analysis (per μL) | |
< 10 | 78/805 (9.7%) |
≥ 10 - 49 | 371/805 (46.1%) |
≥ 50 - 249 | 188/805 (23.4%) |
≥ 250 | 167/805 (20.8%) |
Macroscopic hematuria | 37/805 (4.6%) |
Chronic hematuria | 20/805 (2.5%) |
Confirmed MH (urine sediment)† | 543/805 (67.5%) |
n/N (%) | |
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NOAC: non-vitamin-K oral anticoagulant; NSAID: non-steroidal anti-inflammatory drug. *Includes multiple myeloma and renal amyloidosis; multiple myeloma; scleroderma; and suspected or non-proven glomerulonephritis. #Thrombocytopenia, increased INR, or elevated prothrombin time. †Includes aspirin, clopidogrel, dipyridamol, ticlopidine. ‡CRP > 5 mg/L or ESR > 20 mm/h or leukocytes > 10/nL. | |
Nephrological disease (all) | 262/543 (48.3%) |
Glomerulonephritis (all) | 68/543 (12.4%) |
Rapid progressive glomerulonephritis | 16/543 (2.9%) |
Interstitial nephritis | 33/543 (6.1%) |
Congenital kidney disease | 15/543 (2.8%) |
Diabetic nephropathy | 51/543 (9.4%) |
Hypertensive nephropathy | 144/543 (26.5%) |
Other kidney diseases* | 16/543 (2.9%) |
Urological source | 113/543 (20.8%) |
Infection of the urinary tract | 55/543 (10.1%) |
Pyelonephritis | 10/543 (1.8%) |
Coagulation abnormality# | 64/541 (11.8%) |
Vitamin K antagonist/NOAC use | 44/543 (8.1%) |
Anti-platelet drug use† | 97/543 (17.9%) |
NSAID use | 66/543 (12.2%) |
Systemic inflammation‡ | 124/543 (22.8%) |
Number of potential sources of MH | |
1 | 147/543 (27.1%) |
2 | 127/543 (23.4%) |
3 | 76/543 (14.0%) |
4 | 19/543 (3.5%) |
Unclear diagnosis, benign MH | 174/543 (32.0%) |
Renal disease (all) (N = 262) | Glomerulonephritis (N = 68) | |||||||
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OR (95% CI), univariate | P-value | OR (95% CI), multivariate* | P-value | OR (95% CI), univariate | P-value | OR (95% CI), multivariate# | P-value | |
OR: odds ratio; BMI: body mass index; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate. A P-value of < 0.05 was considered to be significant. *Variables entered in the multivariate analysis “Renal Disease (all)” were age > 40 years, male sex, BMI > 30 kg/m2, GFR < 90 mL/min, history of hypertension, diabetes mellitus type 1 and 2, microalbuminuria > 20 mg/L); other variables were not included owing to low numbers of patients. #Variables entered in the multivariate analysis “Glomerulonephritis” were erythrocytes in the urine test strip ≥ 250/µL, age > 40 years, male sex, microalbuminuria > 20 mg/L), and severe systemic inflammation; other variables were not included owing to low numbers of patients. †Systemic inflammation: CRP > 5 mg/L or ESR > 20 mm/h or leukocytes > 10/nL. Severe systemic inflammation: CRP > 50 mg/L or ESR > 75/h or leukocytes > 15/nL. | ||||||||
Erythrocytes in urine test strip analysis (per μL) | ||||||||
< 10 | 0.88 (0.54 - 1.42) | 0.61 | 0.97 (0.45 - 2.07) | 0.94 | 0.47 (0.15 - 1.06) | 0.10 | 0.47 (0.06 - 1.66) | 0.30 |
10 - 49 | 1.18 (0.82 - 1.71) | 0.37 | 1.28 (0.68 - 2.47) | 0.44 | 0.43 (0.20 - 0.80) | 0.012 | 1.15 (0.39 - 3.06) | 0.78 |
50 - 249 | 0.63 (0.42 - 0.92) | 0.017 | 0.71 (0.38 - 1.27) | 0.25 | 0.62 (0.31 - 1.14) | 0.14 | 1.46 (0.55 - 3.98) | 0.44 |
≥ 250 | 1.42 (0.98 - 2.07) | 0.067 | 1.18 (0.63 - 2.22) | 0.61 | 5.09 (2.44 - 7.00) | < 0.001 | 3.49 (1.75 - 7.32) | < 0.001 |
Epidemiological data | ||||||||
Age ≥ 40 years | 2.64 (1.69 - 4.27) | < 0.001 | 0.55 (0.25 - 1.17) | 0.13 | 0.74 (0.41 - 1.41) | 0.32 | 0.55 (0.24 - 1.33) | 0.16 |
Male sex | 1.94 (1.38 - 2.74) | < 0.001 | 1.22 (0.69 - 2.16) | 0.48 | 3.24 (1.87 - 6.05) | < 0.001 | 2.01 (0.94 - 4.91) | 0.082 |
BMI > 30 kg/m2 | 1.91 (1.29 - 2.86) | 0.001 | 1.81 (0.96 - 3.57) | 0.072 | 0.68 (0.33 - 1.24) | 0.23 | 0.88 (0.33 - 2.01) | 0.77 |
Blood pressure | ||||||||
History of hypertension | 6.03 (4.03 - 9.30) | < 0.001 | 4.10 (2.23 - 8.02) | < 0.001 | 1.25 (0.73 - 2.25) | 0.43 | 1.09 (0.50 - 2.59) | 0.84 |
Hypertension (> 140/90 mm Hg) | 2.73 (1.92 - 3.91) | < 0.001 | 1.43 (0.78 - 2.67) | 0.25 | 1.15 (0.69 - 1.94) | 0.59 | 1.10 (0.54 - 2.33) | 0.79 |
Kidney function | ||||||||
eGFR < 90 mL/min | 3.61 (2.34 - 5.66) | < 0.001 | 1.91 (1.01 - 3.64) | 0.047 | 1.25 (0.70 - 2.42) | 0.47 | 0.82 (0.37 - 1.93) | 0.62 |
eGFR < 60 mL/min | 7.50 (5.07 - 11.3) | < 0.001 | 5.38 (3.17 - 9.66) | < 0.001 | 1.50 (0.90 - 2.54) | 0.12 | 1.05 (0.52 - 2.15) | 0.88 |
Microalbuminuria > 20 mg/L (=A2) | 5.38 (3.45 - 8.63) | < 0.001 | 3.90 (2.27 - 7.03) | < 0.001 | 6.79 (2.93 - 21.8) | < 0.001 | 5.93 (2.42 - 20.3) | < 0.001 |
Further risk factors | ||||||||
Current smoker | 0.79 (0.53 - 1.17) | 0.25 | 1.55 (0.83 - 3.01) | 0.17 | 0.80 (0.41 - 1.45) | 0.48 | 0.46 (0.16 - 1.06) | 0.083 |
Diabetes mellitus | 5.43 (3.18 - 10.0) | < 0.001 | 2.76 (1.24 - 7.06) | 0.017 | 0.42 (0.13 - 1.04) | 0.061 | 0.47 (0.12 - 1.28) | 0.18 |
Systemic inflammation† | ||||||||
CRP > 5 mg/L | 2.32 (1.34 - 4.09) | 0.003 | 1.14 (0.48 - 2.59) | 0.76 | 1.84 (0.87 - 3.98) | 0.11 | 1.06 (0.39 - 2.77) | 0.90 |
Leukocytes > 10/nL | 1.46 (0.93 - 2.33) | 0.11 | 2.46 (1.18 - 5.56) | 0.019 | 2.31 (1.28 - 4.02) | 0.004 | 3.97 (1.77 - 9.19) | < 0.001 |