Purpose

To investigate the relationships between hematuria, clinicopathological features and renal outcomes in patients with biopsy-proven diabetic nephropathy (DN).

Methods

This cohort study included 261 patients with DN. Participants were divided into two groups according to number of red blood cells per high-power field (RBC/hpf) in urine sediment: the hematuria (−) group (≤ 3 RBC/hpf) and the hematuria (+) group (> 3 RBC/hpf). Basic clinical parameters were measured at the time of renal biopsy; relationships between hematuria and clinicopathological features and renal outcomes were analyzed.

Results

Patients in the hematuria (+) group often had overt proteinuria. Interstitial inflammation was more severe in the hematuria (+) group than in the hematuria (−) group. Glomerular arteriolar hyalinosis, interstitial fibrosis and tubular atrophy were comparable between groups. For patients with early DN (eGFR ≥ 60 ml/min/1.73 m²), urinary RBC/hpf at baseline was positively correlated with glomerular classification, interstitial fibrosis/tubular atrophy scores and interstitial inflammation scores. In prognostic analysis, hematuria was associated with a higher risk of progression to end-stage renal disease. Hematuria remained an independent predictor after adjustment for confounding factors such as sex, age, duration of diabetes, serum glucose level, hypertension, cholesterol, eGFR and urine protein excretion, especially in patients with early DN and in male patients.

Conclusion

In this study, hematuria was associated with more severe renal pathologic lesions in patients with DN. The presence of hematuria could be an independent predictor of renal outcome in patients with early DN.

中文翻译：

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血尿与糖尿病肾病患者肾脏临床病理特征和肾脏预后的关系：一项基于活检的研究。

目的

目的：探讨活检证实的糖尿病肾病（DN）患者的血尿，临床病理特征与肾脏预后之间的关系。

方法

该队列研究纳入了261例DN患者。根据尿沉渣中每个高倍视野的红细胞数量（RBC / hpf）将参与者分为两组：血尿（-）组（≤3 RBC / hpf）和血尿（+）组（> 3 RBC / hpf）。在肾活检时测量基本临床参数；分析了血尿与临床病理特征和肾预后之间的关系。

结果

血尿（+）组的患者经常有明显的蛋白尿。血尿（+）组的间质性炎症比血尿（-）组的严重。两组之间的肾小球小动脉透明质化，间质纤维化和肾小管萎缩可比。对于早期DN（eGFR≥60 ml / min / 1.73 m ²），基线时的尿RBC / hpf与肾小球分类，间质纤维化/肾小管萎缩评分和间质炎症评分呈正相关。在预后分析中，血尿与进展为终末期肾脏疾病的风险较高。在调整了诸如性别，年龄，糖尿病持续时间，血糖水平，高血压，胆固醇，eGFR和尿蛋白排泄等混杂因素后，血尿仍然是一个独立的预测因素，尤其是对于早期DN患者和男性患者。

结论

在这项研究中，血尿与DN患者的更严重的肾脏病理病变有关。血尿的存在可能是早期DN患者肾预后的独立预测指标。