Weekly issue 2026-W38 ·
Baseline hematuria in autosomal dominant polycystic kidney disease
Plain language
Blood in the urine is common in ADPKD. One clinic followed 173 people for up to 20 years and found that those who had blood in their urine early on — visible, or only seen under the microscope — lost kidney function faster and reached kidney failure sooner. It was not linked to bigger kidneys, so it may add information that kidney-size scans miss. Tell your team about any episode of red or dark urine.
Clinical note
Single-centre ADPKD cohort (n=173 with standardised sediment 2006–11; registry linkage to 20 years). Hematuria in 26% (microscopic 15%, macroscopic 17%). Any hematuria: adjusted eGFR slope −1.46 mL/min/1.73 m²/yr (95% CI −2.12 to −0.80); composite ESKD/eGFR halving 15-yr event-free 33% vs 58%; macroscopic aHR 1.97 (1.08–3.58). No association with TKV growth; robust to baseline TKV, albuminuria, untreated subset; dose-dependent for macroscopic episodes. Cheap functional risk marker complementing Mayo class — needs external validation.
Question for your next visit
Have my urine tests ever shown blood, and does that change how you judge my risk of faster kidney decline?