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November 9, 2011

Microscopic Hematuria in Adolescents and Young Adults and Risk for End-stage Renal Disease—Reply

Author Affiliations

Author Affiliations: Israeli Defense Forces Medical Corps, Tel Hashomer, Israel (Dr Vivante) (asafvivante@gmail.com); Department of Nephrology, Rambam Health Care Campus, Haifa, Israel (Dr Skorecki); and Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (Dr Calderon-Margalit).

JAMA. 2011;306(18):1980-1981. doi:10.1001/jama.2011.1619

In Reply: Dr Sarafidis notes the current lack of follow-up of those with microscopic hematuria and a negative nephrologic work-up. Our study suggests that persistent isolated microscopic hematuria, which previously had been considered benign, does incur a risk for detrimental outcomes.

Sarafidis also raises the issue of population-based dipstick screening. Our study was not designed to evaluate the cost-effectiveness or utility of such screening programs. Nevertheless, in the United States, about 10.8% of adults younger than 65 years have early-stage chronic kidney disease,1 and chronic kidney disease has been associated with disability even before the onset of ESRD,1 thus rendering undetected chronic kidney disease a public health concern. This, together with the fact that screening programs detect proteinuria in addition to hematuria, should be taken in account when considering the need for population-based screening. Even without population-based screening programs, urinary dipstick tests are commonly performed in young adults in different settings; the results of our study suggest that in such cases, the incidental finding of microscopic hematuria has diagnostic, follow-up, and management implications that should be further studied.