CLINICAL AUDIT OF THE USE OF RENAL BIOPSY IN THE MANAGEMENT OF ISOLATED MICROSCOPIC HEMATURIA

Whether renal biopsies are indicated for the investigation of microsco pic hematuria is a subject of debate. In this retrospective study we e valuated our use of renal biopsy in patients who presented between 198 5 and 1995 with microscopic hematuria but without proteinuria, hyperte nsion or renal insufficiency. Of 111 patients, 75 had a renal biopsy. Histological diagnoses included thin membrane nephropathy (TMN) (36%), IgA nephropathy (IgAN) (23%), non-IgA mesangioproliferative glomerulo nephritis (MPGN) (9%), mild glomerular abnormalities (11%), focal glob al glomerulosclerosis (FGS) (4%) and normal (17%). After 85 patients h ad been followed for a mean of 43 months these were no deaths, 3 patie nts had proteinuria (IgAN 2, no biopsy 1), 1 had proteinuria and renal insufficiency (immune negative MPGN) and ii were hypertensive (TMN 3, IgAN 2, normal 2, FGS 1, no biopsy 3). Hematuria resolved in 23 patie nts. Only 1 1 patients were still attending the nephrology clinic and 27% of the patients who were advised to continue annual follow-up with family doctors had not done so. In summary, the information obtained from renal biopsy rarely altered clinical management. Hypertension dev eloped in 13% of the patients followed but it was not predicted by the biopsy result. Although a renal biopsy will usually be diagnostic it is difficult to justify in patients who have isolated microscopic hema turia.