This multicenter retrospective cohort study (July 2015–July 2025) evaluated whether dipstick hemoglobinuria and microscopic hematuria are associated with active histologic lesions on Oxford Classification (MEST-C) in 441 adults with biopsy-proven IgA nephropathy (IgAN), compared to proteinuria as the current standard marker.
Hemoglobinuria showed the strongest association with composite active lesions (M1, E1, and/or C1/C2): pooled OR 2.28 (95% CI 1.76–2.97), outperforming hematuria (OR 1.36, 1.22–1.51) and proteinuria (OR 1.20, 1.04–1.38). Hemoglobinuria and hematuria were not associated with chronic lesions (T1/T2), while proteinuria was (OR 1.35, 1.20–1.52).
- Retrospective design with potential selection bias (only biopsied patients included). - Urinalysis was concurrent with biopsy but dipstick hemoglobinuria may not reflect sustained disease activity over time. - Individual center-level confounders may persist despite random-effects pooling.
Add dipstick hemoglobinuria to routine IgAN assessment — it flags active glomerular inflammation (endocapillary, mesangial, crescentic lesions) better than proteinuria alone. Persistent or worsening hemoglobinuria on dipstick may warrant closer monitoring or earlier biopsy review for active disease.
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