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)