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Arch Intern Med. 1987 Mar;147(3):434-7.

'Idiopathic' hematuria. A prospective evaluation.


Evaluation of the patient with isolated hematuria is often problematic. Sixty-five patients with this entity were studied prospectively with renal biopsy; serum IgA levels, skin biopsy for IgA immunofluorescence, and HLA typing were also studied in most patients. Previously, all patients had had a non-contributory history and physical examination, normal results of structural evaluation, serologic and clotting studies, and proteinuria of less than 1000 mg/d (less than 1 g/d). Seventy-eight percent were found to have abnormal renal biopsy results and were divisible into two patient groups: those with IgA nephropathy (49%, 32/65) and those with multiple nonspecific abnormalities (29%, 19/65). Ancillary testing, demographic data, and clinical data, other than abnormal amounts of proteinuria, were not distinguishable between these groups and patients with normal renal biopsy results (22%, 14/65). Etiologic differentiation of the hematuria was possible only by renal biopsy. At present, renal biopsy in this group of patients makes no difference therapeutically or, probably, prognostically. It should not, therefore, be considered necessary for routine management of asymptomatic hematuria.

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