无症状孤立性镜下血尿：长期随访

Asymptomatic isolated microscopic haematuria: long-term follow-up.

作者信息

Chow K M, Kwan B C, Li P K, Szeto C C

机构信息

Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China.

出版信息

QJM. 2004 Nov;97(11):739-45. doi: 10.1093/qjmed/hch125.

DOI:10.1093/qjmed/hch125

PMID:15496530

Abstract

BACKGROUND

Evidence to support current diagnostic and management approaches to asymptomatic haematuria is lacking and based on short-term clinical observation.

AIM

To ascertain the natural history and long-term outcome of asymptomatic and isolated haematuria, and to determine the clinical correlates of adverse renal events.

DESIGN

Prospective observational referral-based study.

METHODS

We evaluated 90 consecutive patients with isolated microscopic haematuria, first seen between 1985 and 1996 at an out-patient nephrology clinic. We defined adverse renal events as the development of proteinuria (> 0.5 g/24 h) on two consecutive occasions, development of hypertension, or impaired renal function characterized by glomerular filtration rate (GFR) of <60 ml/min/1.73 m(2) for 3 months or more.

RESULTS

There were 24 males and 66 females, median follow-up 5.2 years (total 442 patient-years). Mean age at presentation was 39 +/- 13 years. Fifteen (17%) had complete resolution of microscopic haematuria. One (1%) had transitional cell carcinoma of urinary bladder 20 months after initial presentation. Twelve (13%) developed hypertension, and 10 (11%) proteinuria. Only one developed chronic renal failure, 2.3 years after initial presentation. Altogether, 16 (19%) developed at least one adverse event, after a mean 42 months. Neither history of renal biopsy nor histological diagnosis of glomerular disease was predictive of renal events. Three independent variables were predictive of adverse renal events: baseline proteinuria (RR per 0.1 g/day 2.04; 95%CI 1.13-3.68; p = 0.018); MDRD-estimated GFR at presentation (RR per 10 ml/min/1.73 m(2) decrement 2.01; 95%CI 1.09-3.71; p = 0.025); and baseline serum urate (RR per 100 micromol/l 1.02; 95%CI 1.01-1.03; p = 0.009).

DISCUSSION

Asymptomatic microscopic haematuria can lead to adverse renal events, and warrants nephrologist evaluation and regular follow-up. Its isolated microscopic haematuria is closely related to early hints of chronic kidney disease, such as low-grade proteinuria and renal insufficiency, as well as hyperuricaemia.

摘要

背景

支持目前无症状血尿诊断和管理方法的证据不足，且基于短期临床观察。

目的

确定无症状孤立性血尿的自然病史和长期预后，并确定不良肾脏事件的临床相关因素。

设计

基于前瞻性观察转诊的研究。

方法

我们评估了90例连续的孤立性镜下血尿患者，他们于1985年至1996年首次在门诊肾病诊所就诊。我们将不良肾脏事件定义为连续两次出现蛋白尿（>0.5 g/24 h）、出现高血压或肾功能损害，其特征为肾小球滤过率（GFR）<60 ml/min/1.73 m²持续3个月或更长时间。

结果

男性24例，女性66例，中位随访时间5.2年（共442患者年）。就诊时的平均年龄为39±13岁。15例（17%）镜下血尿完全缓解。1例（1%）在初次就诊20个月后发生膀胱移行细胞癌。12例（13%）出现高血压，10例（11%）出现蛋白尿。仅1例在初次就诊2.3年后发生慢性肾衰竭。总共16例（19%）在平均42个月后发生至少一项不良事件。肾活检病史和肾小球疾病的组织学诊断均不能预测肾脏事件。三个独立变量可预测不良肾脏事件：基线蛋白尿（每0.1 g/天的相对危险度2.04；95%可信区间1.13 - 3.68；p = 0.018）；就诊时MDRD估算的GFR（每降低10 ml/min/1.73 m²的相对危险度2.01；95%可信区间1.09 - 3.71；p = 0.025）；以及基线血尿酸（每100 μmol/l的相对危险度1.02；95%可信区间1.01 - 1.03；p = 0.009）。