Download - Hematuria post transplant
HematuriaHematuriaPost Kidney Post Kidney TransplantTransplant
Prasanth Krish, MDPrasanth Krish, MD
Hofstra North Shore LIJ School of Hofstra North Shore LIJ School of MedicineMedicine
Post-Transplant Post-Transplant HematuriaHematuria
Data is limited to a few retrospective Data is limited to a few retrospective studiesstudies
First studied by Previte in 1978 – 127 First studied by Previte in 1978 – 127 male transplant recipients, 16 cases of male transplant recipients, 16 cases of hematuria (12.6%; 12 gross, 4 micro)hematuria (12.6%; 12 gross, 4 micro)
Immunosuppression with steroids and Immunosuppression with steroids and azathioprineazathioprine
FindingsFindings 0 cases of malignancy0 cases of malignancy
12% incidence of hematuria is higher 12% incidence of hematuria is higher than general population, but site of origin than general population, but site of origin and etiology is similarand etiology is similar
Higher incidence attributed to anatomic Higher incidence attributed to anatomic differences (ex. trauma) and differences (ex. trauma) and immunosuppressionimmunosuppression
Retrospective analysis of 640 pts, on Retrospective analysis of 640 pts, on different immunosuppression (AZA/MMF different immunosuppression (AZA/MMF or CSA/TACor CSA/TAC
13% had persistent hematuria (defined 13% had persistent hematuria (defined as dipstick 1+ on >75% of visits over min as dipstick 1+ on >75% of visits over min 4 weeks4 weeks
No difference between living or cadavericNo difference between living or cadaveric
Pts with original diagnosis of IgA had higher Pts with original diagnosis of IgA had higher rate of hematuria (31% vs 12%)rate of hematuria (31% vs 12%)
Pts with persistent hematuria had higher Pts with persistent hematuria had higher creatininecreatinine
Persistent hematuria is associated with graft Persistent hematuria is associated with graft failure or death but not death alonefailure or death but not death alone
More than half of pts had unknown etiologyMore than half of pts had unknown etiology
Retrospective study of 189 pts; 23% had Retrospective study of 189 pts; 23% had hematuriahematuria
Persistent hematuria defined as >3 RBC Persistent hematuria defined as >3 RBC on 3 consecutive visitson 3 consecutive visits
All 19 tumors were identified in the native All 19 tumors were identified in the native urinary tractsurinary tracts
Longer duration of hematuria associated with Longer duration of hematuria associated with malignancy and high creatininemalignancy and high creatinine
One case of microscopic hematuria had One case of microscopic hematuria had unknown etiology after endoscopy and unknown etiology after endoscopy and radiology; underwent bilateral radiology; underwent bilateral nephroureterectomy; pathology showed nephroureterectomy; pathology showed squamous metaplasiasquamous metaplasia
No investigations into CMV or acute rejectionNo investigations into CMV or acute rejection
Kim et al 2010: retrospective study of 539 Kim et al 2010: retrospective study of 539 patients at Henry Ford – Detroitpatients at Henry Ford – Detroit
Persistent hematuria defined as >3 Persistent hematuria defined as >3 specimensspecimens
Negative U/S or CT lead to cystoscopyNegative U/S or CT lead to cystoscopy
10% had persistent hematuria10% had persistent hematuria
18 urological malignancies identified 18 urological malignancies identified (33% of hematuria group), all in native (33% of hematuria group), all in native kidneyskidneys
Of 18 malignancies, 16 had hematuriaOf 18 malignancies, 16 had hematuria
Risk factors to think about for future:Risk factors to think about for future:
-type of immunosuppression-type of immunosuppression
-oncogenic viral infections-oncogenic viral infections
-length of time on dialysis (more acquired -length of time on dialysis (more acquired cystic lesions while on HD)cystic lesions while on HD)