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      Prevalence and Implications of Isolated Microscopic Hematuria in Asymptomatic Chinese Pregnant Women

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          Abstract

          Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. However, the actual prevalence of microscopic hematuria and IgAN is unknown in the Chinese population. Methods: We screened 7,828 consecutive pregnant women for microscopic hematuria in the antenatal clinic of a tertiary referral center. Persistent microscopic hematuria was defined as urine Hemastix® (Bayer Diagnostics, Hong Kong) of 1+ for red cells in two clinic visits. Subjects were referred to the renal clinic for specialist evaluation, including measurement of blood pressure, serum creatinine, urine bacterial culture, and quantification of proteinuria. Result: There were 207 women (2.64%) with microscopic hematuria. Mean age was 31.8 ± 5.0 years. In 101 patients (48.8%), there was proteinuria >0.1 g/day by quanti- tative assay. Hematuria was found to resolve before or shortly after delivery in 126 (60.9%) and 68 women (32.9%), respectively. Five patients (2.4%) had urinary tract infection proved by repeated urine culture, 1 had papillary necrosis, and 1 had duplex collecting system. Three patients were confirmed to have IgAN by renal biopsy; all had normal blood pressure and serum creatinine, but dysmorphic red cells in urine microscopy, and proteinuria of over 0.5 g/day that persisted after delivery. Renal biopsy on another woman showed no specific pathology. Two women were lost to follow-up, both with normal renal function and no detectable proteinuria. The overall prevalence of IgAN was 38 cases per 100,000 population (95% confidence interval: 8–112 cases). Conclusion: Microscopic hematuria is not uncommon in pregnant women, and IgAN is present in a small proportion of these patients. Further study is needed to determine whether screening for microscopic hematuria would allow early diagnosis and improve the prognosis of these patients.

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          Most cited references 20

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          IgA nephropathy.

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            Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy.

            We conducted a retrospective investigation of renal outcome in 329 patients with immunoglobulin A (IgA) nephropathy with an observation period longer than 36 months (82.3 +/- 38.2 months) in our renal unit between 1977 and 1995. Clinical remission, renal progression, and the impact of covariates were estimated by Kaplan-Meier analysis and a Cox regression model. In 157 of 329 patients (48%), disappearance of urinary abnormalities (clinical remission) was obtained. None of these 157 patients showed progressive deterioration, defined as a 50% increase in serum creatinine (Scr) level from baseline, during the observation period. Conversely, in patients without clinical remission, the Kaplan-Meier estimate of probability of progressive deterioration was 21% +/- 5% at 10 years. In the multivariate Cox regression model with 13 independent covariates, initial Scr level, histological score, tonsillectomy, and high-dose methylprednisolone therapy had a significant impact on clinical remission, whereas proteinuria, age, sex, levels of hematuria, blood pressure, conventional steroid therapy, angiotensin-converting enzyme inhibitor therapy, and cyclophosphamide therapy had no significant effect. These findings indicate that interventions aimed at achieving clinical remission have provided encouraging results applicable to managing patients with IgA nephropathy.
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              A retrospective analysis of the natural history of primary IgA nephropathy worldwide.

              The worldwide medical literature was reviewed to determine whether the prevalence, clinical presentation, and immunohistologic findings of primary IgA nephropathy were related to geographic areas. A total of 68 reports containing detailed clinical histories and laboratory findings were analyzed. The selected articles were grouped according to their geographic origin: Asia, Australia, Europe, and North America (Canada and the United States). Analysis of the data showed that IgA nephropathy is more frequent in the Asian area than in Australia, Europe, and North America. The male/female ratio indicates that males are more likely to be affected by the disease, particularly in the second and third decade of life. The appearance of the disease is characterized by microscopic hematuria and mild proteinuria in Asians, whereas gross hematuria is more frequent in American and European patients. At the time of renal biopsy, fixed microscopic hematuria is detected in a high percentage of patients in Asia and Europe, whereas macroscopic hematuria is more frequent in American patients. Mild renal lesions occur more frequently in Asian patients, while severe renal lesions and a high frequency of immunoglobulin and complement deposits are present in American and European patients. Differences encountered in this retrospective analysis may be influenced by two important factors: (1) the absence of urinalysis screening programs in the schools of Europe and North America, and (2) the different approaches to renal biopsy in the eastern and western parts of the world. Due to the high rate of renal insufficiency and end-stage kidney disease in European and North American patients with IgA nephropathy, it is recommended that a program of urinalysis screening in schools and an appropriate renal biopsy policy be adopted in the western areas of the world.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2007
                March 2007
                25 January 2007
                : 105
                : 4
                : c147-c152
                Affiliations
                Departments of aMedicine and Therapeutics, bAnatomical and Cellular Pathology, and cObstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
                Article
                99004 Nephron Clin Pract 2007;105:c147–c152
                10.1159/000099004
                17259739
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 2, References: 35, Pages: 1
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/99004
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                IgA nephropathy, Proteinuria, Hematuria

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