{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:57:33Z","timestamp":1791917853338,"version":"4.3.4"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009155","name":"Otsuka America Pharmaceutical, Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009155","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hematuria\u2014either macroscopic hematuria or asymptomatic microscopic hematuria\u2014is a clinical feature typical but not specific for immunoglobulin A nephropathy (IgAN). The only biomarker supported by the Kidney Disease: Improving Global Outcomes group as a predictor of progression, identifying patients needing treatment, is proteinuria &amp;gt;1\u00a0g\/day persistent despite maximized supportive care. However, proteinuria can occur in the setting of active glomerulonephritis or secondary to sclerotic renal lesions. Microscopic hematuria is observed in experimental models of IgAN after IgA\u2013IgG immunocomplex deposition, activation of inflammation and complement pathways. Oxidative damage, triggered by hemoglobin release, is thought to contribute to the development of proteinuria and progression. Despite being a clinical hallmark of IgAN and having a rational relationship with its pathophysiology, the value of microscopic hematuria in assessing activity and predicting outcomes in patients with IgAN is still debated. This was partly due to a lack of standardization and day-to-day variability of microhematuria, which discouraged the inclusion of microhematuria in large multicenter studies. More recently, several studies from Asia, Europe and the USA have highlighted the importance of microhematuria assessment over longitudinal follow-up, using a systematic approach with either experienced personnel or automated techniques.<\/jats:p>\n                  <jats:p>We report lights and shadows of microhematuria evaluation in IgAN, looking for evidence for a more consistent consensus on its value as a marker of clinical and histological activity, risk assessment and prediction of treatment response. We propose that hematuria should be included as part of the clinical decision-making process when considering when to use immunosuppressive therapy and as part of criteria for enrollment into clinical trials to test drugs targeting the inflammatory reaction elicited by immune pathway activation in IgAN.<\/jats:p>","DOI":"10.1093\/ckj\/sfad232","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T16:08:59Z","timestamp":1696608539000},"page":"ii19-ii27","source":"Crossref","is-referenced-by-count":54,"title":["Microscopic hematuria as a risk factor for IgAN progression: considering this biomarker in selecting and monitoring patients"],"prefix":"10.1093","volume":"16","author":[{"given":"Ladan","family":"Zand","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension. Mayo Clinic. Rochester , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9952-209X","authenticated-orcid":false,"given":"Fernando C","family":"Fervenza","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension. Mayo Clinic. Rochester , MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosanna","family":"Coppo","sequence":"additional","affiliation":[{"name":"Fondazione Ricerca Molinette, Regina Margherita Hospital , Turin , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"2023120420071078200_bib1","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1056\/NEJMra1206793","article-title":"IgA nephropathy","volume":"368","author":"Wyatt","year":"2013","journal-title":"N Engl J Med"},{"key":"2023120420071078200_bib2","first-page":"8296","article-title":"A noninvasive artificial neural network model to predict IgA nephropathy risk in Chinese population","volume-title":"Sci Rep","author":"Hou","year":"2022"},{"key":"2023120420071078200_bib3","first-page":"S1","article-title":"KDIGO 2021 clinical practice guideline for the management of glomerular diseases","volume-title":"Kidney Int","author":"Kidney Disease: Improving Global Outcomes Glomerular Diseases Work Group","year":"2021"},{"key":"2023120420071078200_bib4","first-page":"251","article-title":"IgA-mesangial nephropathy (Berger's disease) with rapid decline in renal function","volume":"16","author":"D'Amico","year":"1981","journal-title":"Clin Nephrol"},{"key":"2023120420071078200_bib5","first-page":"393","article-title":"Macroscopic hematuria in mesangial IgA nephropathy: correlation with glomerular crescents and renal dysfunction","volume-title":"Kidney Int","author":"Bennett","year":"1983"},{"key":"2023120420071078200_bib6","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.2215\/CJN.13251118","article-title":"IgA nephropathy in elderly patients","volume":"14","author":"Sevillano","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"2023120420071078200_bib7","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1007\/s00467-005-1915-8","article-title":"Hematuria and proteinuria in a mass school urine screening test","volume":"20","author":"Park","year":"2005","journal-title":"Pediatr Nephrol"},{"key":"2023120420071078200_bib8","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/ndt\/12.3.418","article-title":"Survey of the Italian Registry of Renal Biopsies. 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