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Long-term microscopic haematuria prognosis

A Patients over 45 with asymptomatic microscopic haematuria (AMH) are investigated as 10-15 per cent have a cancer of the bladder, kidney or prostate, and another 10-15 per cent have other structural causes such as stones. If investigations are normal 1-2 per cent have an occult malignancy which will present within three years.

AMH patients under 45 and older ones with no urological abnormality are referred to nephrologists who measure serum creatinine, creatinine clearance, urinary protein excretion and look for dysmorphic (small and irregular) RBCs and casts that would indicate a tubulointerstitial or glomerulonephritis.

Nephrologists do not do routine renal biopsy on patients with AMH if creatinine clearance is normal and there is <1g proteinuria="" per="" day="" as="" the="" result="" seldom="" alters="" management.="" biopsy,="" if="" performed,="" reveals="" normal="" glomeruli="" in="" 20="" per="" cent="" of="" patients,="" mild="" glomerular="" abnormalities="" in="" 20="" per="" cent,="" thin="" basement="" membrane="" nephropathy(tbmn)="" in="" 40="" per="" cent="" and="" iga="" nephropathy="" (igan)="" in="" 20="" per="" cent.="" tbmn="" seldom="" progresses="" to="" end-stage="" renal="">

IgAN presenting with AMH, no proteinuria and normal creatinine clearance has a good medium-term prognosis, but no guarantees long-term.

The patient should report any renal, urinary or systemic symptoms and attend annually for tests. Blood pressure and lipids should be controlled to strictly normal levels. Patients should be referred for biopsy if creatinine clearance falls to <70ml in="" or="" proteinuria="" exceeds="">

Dr Clive Hall is consultant nephrologist at the Royal United Hospital, Bath

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