Isolated Hematuria in SLE Patients and its Association with Proteinuria, Uri-nary Cast and SLE Disease Activity

  • Mahmood Akbarian Mail Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Hosein Soleymani Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Gharibdoost Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Abdolhadi Nadji Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Ahmad Reza Jamshidi Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Farhad Shahram Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Masoumeh Akhlaghi Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Shahrzad Khosravi Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Simin Almasi Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Fereydoun Davatchi Department of Rheumatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Isolated hematuria, systemic lupus erythematosus, SLE disease activity

Abstract

Isolated hematuria and its association with proteinuria, and urinary cast and systemic lupus erythematosus (SLE) disease activity, and decision for renal biopsy is a dilemma for physician in SLE patients. The aim of this study was to investigate 1. whether isolated hematuria is associated with active SLE, 2. to determine duration between hematuria and proteinuria and urinary cast, and 3. to determine renal histological type in SLE patients with isolated hematuria. All episodes of isolated hematuria between 1981 and 1997 were identified from Lupus Unit, Rheumatology Research Center database. Isolated hematuria was defined as >5 RBC/hpf in the absence of urinary infection and other renal manifestations. Relation of hematuria was assessed with proteinuria and urinary cast and SLE disease activity. Needle renal biopsy was done in 19 SLE patents with isolated hematuria. 4.42% (31/700) of our cohort had at least one episode of isolated hematuria. Out of 31 patients in whom the isolated hematuria was the first documented renal manifestation, 11 patients (35.48%) developed another renal manifestation (25.8% proteinuria and 9.67% casts). 54.54% (6/11) of patients developed proteinuria and urinary cast within 3 months. The mean time for development of a second renal manifestation for the patients with isolated hematuria was 19.9 months. Renal needle biopsy was performed for 19 patients (5.78% type IV, 63.15% type III and 21.50% type II). The results of the present study indicate that isolated hematuria is not rare in SLE patients. Also, there was no significant relationship between isolated hematuria and anti ds-DNA, C3, C4 and major organ involvement in patients with SLE. Our study suggests that SLE patients who have isolated hematuria should undergo renal biopsy and that isolated hematuria should be considered a manifestation of active renal SLE.

References

Wallace DJ, Hahn BH, Klippel JH. Lupus nephritis. In: Wallace DJ, Hahn BH, editors. Dubois’ Lupus Erythematosus, 5th ed. Philadelphia, PA: Lea & Febiger; 1997. p. 1053-65.

Gonzalez-Crespo MR, Lopez-Fernandez JI, Usera G, Poveda MJ, Gomez-Reino JJ. Outcome of silent lupus nephritis. Semin Arthritis Rheum 1996; 26(1): 468-76.

Hebert LA, Dillon JJ, Middendorf DF, Lewis EJ, Peter JB. Relationship between appearance of urinary red blood cell/white blood cell casts and the onset of renal relapse in systemic lupus erythematosus. Am J Kidney Dis 1995; 26(3): 432-8.

Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality. J Rheumatol 1995; 22: 1265-70.

Urowitz MB, Gladman DD, Tozman EC, Goldsmith CH. The lupus activity criteria count (LACC). J Rheumatol 1984; 11(6): 783-7.

Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992; 35(6): 630-40.

Rahman P, Gladman DD, Ibanez D, Urowitz MB. Significance of isolated hematuria and isolated pyuria in systemic lupus erythematosus. Lupus 2001; 10(6): 418-23.

Sayer J, McCarthy MP, Schmidt JD. Identification and significance of dysmorphic versus isomorphic hematuria. J Urol 1990; 143(3): 545-8.

Esdaile JM, Federgreen W, Quintal H, Suissa S, Hayslett JP, Kashgarian M. Predictors of one year outcome in lupus nephritis: the importance of renal biopsy. Q J Med 1991; 81(295): 907-18.

Mitjavila F, Pac V, Moga I, Poveda R, Vidaller A, Carrera M, et al. Clinicopathological correlations and prognostic factors in lupus nephritis. Clin Exp Rheumatol 1997; 15(6): 625-31.

How to Cite
1.
Akbarian M, Soleymani H, Gharibdoost F, Nadji A, Jamshidi AR, Shahram F, Akhlaghi M, Khosravi S, Almasi S, Davatchi F. Isolated Hematuria in SLE Patients and its Association with Proteinuria, Uri-nary Cast and SLE Disease Activity. Acta Med Iran. 47(1):5-8.
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