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Vivante A, Afek A, Frenkel-Nir Y, et al. Persistent Asymptomatic Isolated Microscopic Hematuria in Israeli Adolescents and Young Adults and Risk for End-Stage Renal Disease. JAMA. 2011;306(7):729–736. doi:10.1001/jama.2011.1141
Author Affiliations: Israeli Defense Forces Medical Corps (Drs Vivante, Frenkel-Nir, Farfel, and Chaiter and Ms Tzur); Department of Pediatrics, Talpiot Medical Leadership Program, Edmond and Lily Safra Children's Hospital, Tel Hashomer (Dr Vivante); Sheba Medical Center, Tel Hashomer (Drs Vivante and Afek); Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv (Drs Vivante, Afek, Golan, and Shohat); Department of Nephrology; Rambam Health Care Campus, Rappaport Faculty of Medicine and Research Institute, The Technion–Israel Institute of Technology, Haifa (Dr Skorecki); Israel Renal Registry and Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba (Dr Golan); Israel Center for Disease Control, Ministry of Health, Jerusalem (Drs Shohat and Calderon-Margalit); and Hadassah-Hebrew University Braun School of Public Health, Jerusalem (Dr Calderon-Margalit), Israel.
Context Few data are available on long-term outcomes among adolescents and young adults with persistent asymptomatic isolated microscopic hematuria.
Objective To evaluate the risk of end-stage renal disease (ESRD) in adolescents and young adults with persistent asymptomatic isolated microscopic hematuria.
Design, Setting, and Participants Nationwide, population-based, retrospective cohort study using medical data from 1 203 626 persons aged 16 through 25 years (60% male) examined for fitness for military service between 1975 and 1997 were linked to the Israeli treated ESRD registry. Incident cases of treated ESRD from January 1, 1980, to May 31, 2010, were included. Cox proportional hazards models were used to estimate the hazard ratio (HR) of treated ESRD among those diagnosed as having persistent asymptomatic isolated microscopic hematuria.
Main Outcome Measures Treated ESRD onset, defined as the date of initiation of dialysis treatment or the date of renal transplantation, whichever came first.
Results Persistent asymptomatic isolated microscopic hematuria was diagnosed in 3690 of 1 203 626 eligible individuals (0.3%). During 21.88 (SD, 6.74) years of follow-up, treated ESRD developed in 26 individuals (0.70%) with and 539 (0.045%) without persistent asymptomatic isolated microscopic hematuria, yielding incidence rates of 34.0 and 2.05 per 100 000 person-years, respectively, and a crude HR of 19.5 (95% confidence interval [CI], 13.1-28.9). A multivariate model adjusted for age, sex, paternal country of origin, year of enrollment, body mass index, and blood pressure at baseline did not substantially alter the risk associated with persistent asymptomatic isolated microscopic hematuria (HR, 18.5 [95% CI, 12.4-27.6]). A substantially increased risk for treated ESRD attributed to primary glomerular disease was found for individuals with persistent asymptomatic isolated microscopic hematuria compared with those without the condition (incidence rates, 19.6 vs 0.55 per 100 000 person-years, respectively; HR, 32.4 [95% CI, 18.9-55.7]). The fraction of treated ESRD attributed to microscopic hematuria was 4.3% (95% CI, 2.9%-6.4%).
Conclusion Presence of persistent asymptomatic isolated microscopic hematuria in persons aged 16 through 25 years was associated with significantly increased risk of treated ESRD for a period of 22 years, although the incidence and absolute risk remain quite low.
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