Hematuria Post Kidney Transplant Prasanth Krish, MD Hofstra North Shore LIJ School of Medicine
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
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
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
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
Retrospective study of 189 pts; 23% had hematuria
Persistent hematuria defined as >3 RBC on 3 consecutive visits
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
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
10% had persistent hematuria
18 urological malignancies identified (33% of hematuria group), all in native kidneys
Of 18 malignancies, 16 had hematuria
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)
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