Hematuria Post Kidney Transplant Prasanth Krish, MD Hofstra North Shore LIJ School of Medicine
Post-Transplant Hematuria <ul><li>Data is limited to a few retrospective studies </li></ul><ul><li>First studied by Previt...
 
Findings <ul><li>0 cases of malignancy </li></ul><ul><li>12% incidence of hematuria is higher than general population, but...
<ul><li>Retrospective analysis of 640 pts, on different immunosuppression (AZA/MMF or CSA/TAC </li></ul><ul><li>13% had pe...
 
 
<ul><li>No difference between living or cadaveric </li></ul><ul><li>Pts with original diagnosis of IgA had higher rate of ...
<ul><li>Retrospective study of 189 pts; 23% had hematuria </li></ul><ul><li>Persistent hematuria defined as >3 RBC on 3 co...
 
<ul><li>All 19 tumors were identified in the native urinary tracts </li></ul><ul><li>Longer duration of hematuria associat...
<ul><li>Kim et al 2010: retrospective study of 539 patients at Henry Ford – Detroit </li></ul><ul><li>Persistent hematuria...
<ul><li>10% had persistent hematuria </li></ul><ul><li>18 urological malignancies identified (33% of hematuria group), all...
<ul><li>Risk factors to think about for future: </li></ul><ul><li>-type of immunosuppression </li></ul><ul><li>-oncogenic ...
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Hematuria post transplant

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Dr.Krish takes us to the evidence on what could be the potential causes of this entity.

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Hematuria post transplant

  1. 1. Hematuria Post Kidney Transplant Prasanth Krish, MD Hofstra North Shore LIJ School of Medicine
  2. 2. Post-Transplant Hematuria <ul><li>Data is limited to a few retrospective studies </li></ul><ul><li>First studied by Previte in 1978 – 127 male transplant recipients, 16 cases of hematuria (12.6%; 12 gross, 4 micro) </li></ul><ul><li>Immunosuppression with steroids and azathioprine </li></ul>
  3. 4. Findings <ul><li>0 cases of malignancy </li></ul><ul><li>12% incidence of hematuria is higher than general population, but site of origin and etiology is similar </li></ul><ul><li>Higher incidence attributed to anatomic differences (ex. trauma) and immunosuppression </li></ul>
  4. 5. <ul><li>Retrospective analysis of 640 pts, on different immunosuppression (AZA/MMF or CSA/TAC </li></ul><ul><li>13% had persistent hematuria (defined as dipstick 1+ on >75% of visits over min 4 weeks </li></ul>
  5. 8. <ul><li>No difference between living or cadaveric </li></ul><ul><li>Pts with original diagnosis of IgA had higher rate of hematuria (31% vs 12%) </li></ul><ul><li>Pts with persistent hematuria had higher creatinine </li></ul><ul><li>Persistent hematuria is associated with graft failure or death but not death alone </li></ul><ul><li>More than half of pts had unknown etiology </li></ul>
  6. 9. <ul><li>Retrospective study of 189 pts; 23% had hematuria </li></ul><ul><li>Persistent hematuria defined as >3 RBC on 3 consecutive visits </li></ul>
  7. 11. <ul><li>All 19 tumors were identified in the native urinary tracts </li></ul><ul><li>Longer duration of hematuria associated with malignancy and high creatinine </li></ul><ul><li>One case of microscopic hematuria had unknown etiology after endoscopy and radiology; underwent bilateral nephroureterectomy; pathology showed squamous metaplasia </li></ul><ul><li>No investigations into CMV or acute rejection </li></ul>
  8. 12. <ul><li>Kim et al 2010: retrospective study of 539 patients at Henry Ford – Detroit </li></ul><ul><li>Persistent hematuria defined as >3 specimens </li></ul><ul><li>Negative U/S or CT lead to cystoscopy </li></ul>
  9. 13. <ul><li>10% had persistent hematuria </li></ul><ul><li>18 urological malignancies identified (33% of hematuria group), all in native kidneys </li></ul><ul><li>Of 18 malignancies, 16 had hematuria </li></ul>
  10. 14. <ul><li>Risk factors to think about for future: </li></ul><ul><li>-type of immunosuppression </li></ul><ul><li>-oncogenic viral infections </li></ul><ul><li>-length of time on dialysis (more acquired cystic lesions while on HD) </li></ul>
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