- Design
- Multicentre retrospective cohort with random-effects pooling
- Population
- 441 patients with biopsy-proven IgA nephropathy
- Primary outcome
- Association of urinary findings with active Oxford MEST-C lesions
- Effect
- Composite active lesions: haemoglobinuria OR 2.28 (1.76 to 2.97); haematuria 1.36; proteinuria 1.20
A multicentre retrospective cohort of 441 patients with biopsy-proven IgA nephropathy compared urinalysis at biopsy with Oxford MEST-C scores.
Dipstick haemoglobinuria was associated with mesangial hypercellularity (OR 1.77), endocapillary hypercellularity (1.75) and crescents (1.57). For the composite of active lesions, the association was stronger for haemoglobinuria (OR 2.28) than for microscopic haematuria (1.36) or proteinuria (1.20). Neither haemoglobinuria nor haematuria was associated with chronic lesions, whereas proteinuria was associated with tubular atrophy and fibrosis.
Guidelines use proteinuria and eGFR to judge risk, but proteinuria mixes active and chronic injury. A simple dipstick may help flag ongoing inflammation that could respond to immunosuppression. This is an association study, not yet a validated treatment trigger.
- Record dipstick haemoglobinuria, not only proteinuria, in IgA nephropathy follow-up
- Consider persistent heavy haematuria as a possible sign of active disease
- Use biopsy findings, not urine alone, for immunosuppression decisions
- Track proteinuria as the marker of chronic damage and prognosis
Why it matters
A cheap bedside test may separate active from chronic injury, which proteinuria cannot do.
Don't overread it
The analyses were unadjusted and cross-sectional; haemoglobinuria has not been shown to guide treatment.
The statistics, in plain English
An odds ratio of 2.28 means the odds of active lesions were more than doubled when haemoglobinuria was present. These estimates were unadjusted, so other factors such as disease duration may account for part of the association. Pooling across centres with random effects allows for differences between sites.
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