Clinical Significance of Increased Degree of Hematuria in Patients affected by IgA Nephropathy

Vollständiger Abstract

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Abstract Background The clinical significance of increased degree of hematuria in patients affected by primary IgA Nephropathy (IgAN) remains unclear, highlighting the need for further investigation. Methods From January 2018 to December 2024, a total of 696 IgAN patients with persistent hematuria were enrolled to conduct a retrospective single-center study. Patients with a follow-up-to-baseline time-averaged hematuria ratio (Δ u-RBC count) ≥1 were assigned to the Increased-hematuria group. The remaining patients were 1:1 matched by age, gender, baseline estimated glomerular filtration rate (eGFR), and follow-up duration to form the Decreased-hematuria group. Survival was analyzed via the Kaplan–Meier (K-M) method and generalized linear mixed-effects model (GLMM), and risk factors for survival were identified using the Cox proportional hazards model. Results The Increased-hematuria and Decreased-hematuria groups each included 219 patients, with no significant difference in time-averaged hematuria degree between groups. Despite matched baseline demographic data and renal function, both K-M analysis (P = 0.03) and GLMM (P < 0.01) demonstrated that the Increased-hematuria group had significantly poorer prognosis than the Decreased-hematuria group. Increased hematuria degree was identified as an independent risk factor for reaching the composite endpoint (sustained ≥ 30% decline in eGFR from baseline or progression to end-stage renal disease [ESRD]). Notably, more substantial reduction in proteinuria levels was presented in Decreased-hematuria group but is not directly associated with prognosis among these patients. Conclusions Increased hematuria degree is associated with adverse outcomes in patients affected by IgAN, underscoring its potential as a prognostic indicator.