Prevalence of haematuria positively associated with urine albumin excretion in Type2 diabetes

Abstract

Aims Some guidelines or studies consider haematuria an indication for renal biopsy or a potential cause of albuminuria that precludes accurate assessment of urinary albumin excretion. This study examined the justification of excluding haematuria in interpreting urinary albumin excretion in patients with Type2 diabetes and its associations with other diabetes-related variables. Methods Between May and November 2008, patients with Type2 diabetes at a single centre with data on urinary albumin excretion and urinalysis in the same urine sample were recruited. Urinary albumin excretion was determined by urine albumin/creatinine ratio in spot urine. Diagnosis of haematuria was made by positive urine occult blood from 1+ to 4+ and/or presence of more than nine red blood cells/ml in urinalysis. Demographic, anthropometric, clinical and laboratory variables and diabetes-associated complications were analysed. Results In total, 743 patients were enrolled. Prevalence of haematuria among patients with normoalbuminuria, microalbuminuria, or macroalbuminuria was 8.7% (n=13), 16.1% (n=67) and 35.8% (n=64), respectively. Urine albumin/creatinine ratio was significantly higher, while macroalbuminuria was more common in patients with haematuria (n=144) than in those without (n=599). Multiple regression analysis identified urine albumin/creatinine ratio (odds ratio1.33, P=0.01) and macroalbuminuria (odds ratio2.66, P=0.01) as the only independent predictors of haematuria. Moreover, urine albumin/creatinine ratio was an independent predictor of haematuria in the macroalbuminuria subgroup (odds ratio1.30, P=0.04). Conclusions Increased urine albumin/creatinine ratio and macroalbuminuria were the only independent predictors of haematuria in patients with Type2 diabetes, raising questions on the justifications of excluding haematuria in interpreting urinary albumin excretion in patients with Type2 diabetes and including haematuria as an indication for renal biopsy in those with macroalbuminuria. © 2012 Diabetes UK.