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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.

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

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