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Isolated and persistent glomerular hematuria: IgA; Alport; thin basement membrane nephropathy

Clifford E Kashtan, MD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD


Hematuria is a common finding in glomerular diseases. In the patient with persistent hematuria, dysmorphic red cells and red cell casts suggest the presence of a glomerular disease, as does the presence of albuminuria. (See "Etiology and evaluation of hematuria in adults", section on 'Glomerular versus nonglomerular bleeding' and "Assessment of urinary protein excretion and evaluation of isolated non-nephrotic proteinuria in adults", section on 'Types of proteinuria'.)

Patients with glomerular hematuria often have other abnormalities, including proteinuria, edema, hypertension, and impaired glomerular filtration rate. However, in some patients the only manifestation of glomerular disease is persistent hematuria, similar to that seen with extraglomerular causes of bleeding such as prostatic disease and stones.

The definition and evaluation of isolated and persistent glomerular hematuria are discussed in this topic. The overall etiology and evaluation of hematuria in adults and the differential diagnosis of glomerular disease in adults are presented separately. (See "Etiology and evaluation of hematuria in adults" and "Differential diagnosis and evaluation of glomerular disease".)


The patient should initially be reexamined over a period of weeks to months to ascertain that the hematuria is persistent. Transient hematuria is a relatively common finding over time in adults and may be induced by factors such as exercise or infection. (See "Etiology and evaluation of hematuria in adults" and "Exercise-induced hematuria".)

Signs of glomerular bleeding (best identified by a nephrologist or other experienced examiner) include a dysmorphic appearance of some red cells, red cell casts and, in patients with gross hematuria, a brown, cola-colored urine (table 1 and picture 1A-C). (See "Etiology and evaluation of hematuria in adults", section on 'Glomerular versus nonglomerular bleeding'.)


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Literature review current through: Sep 2016. | This topic last updated: Oct 6, 2015.
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  1. Topham PS, Harper SJ, Furness PN, et al. Glomerular disease as a cause of isolated microscopic haematuria. Q J Med 1994; 87:329.
  2. Tiebosch AT, Wolters J, Frederik PF, et al. Epidemiology of idiopathic glomerular disease: a prospective study. Kidney Int 1987; 32:112.
  3. Tiebosch AT, Frederik PM, van Breda Vriesman PJ, et al. Thin-basement-membrane nephropathy in adults with persistent hematuria. N Engl J Med 1989; 320:14.
  4. Trachtman H, Weiss RA, Bennett B, Greifer I. Isolated hematuria in children: indications for a renal biopsy. Kidney Int 1984; 25:94.
  5. Auwardt R, Savige J, Wilson D. A comparison of the clinical and laboratory features of thin basement membrane disease (TBMD) and IgA glomerulonephritis (IgA GN). Clin Nephrol 1999; 52:1.
  6. Hudson BG, Tryggvason K, Sundaramoorthy M, Neilson EG. Alport's syndrome, Goodpasture's syndrome, and type IV collagen. N Engl J Med 2003; 348:2543.
  7. Plaisier E, Alamowitch S, Gribouval O, et al. Autosomal-dominant familial hematuria with retinal arteriolar tortuosity and contractures: a novel syndrome. Kidney Int 2005; 67:2354.
  8. Blumenthal SS, Fritsche C, Lemann J Jr. Establishing the diagnosis of benign familial hematuria. The importance of examining the urine sediment of family members. JAMA 1988; 259:2263.
  9. Aarons I, Smith PS, Davies RA, et al. Thin membrane nephropathy: a clinico-pathological study. Clin Nephrol 1989; 32:151.
  10. Flinter FA, Cameron JS, Chantler C, et al. Genetics of classic Alport's syndrome. Lancet 1988; 2:1005.
  11. Kashtan CE. Alport syndrome and thin glomerular basement membrane disease. J Am Soc Nephrol 1998; 9:1736.
  12. Julian BA, Quiggins PA, Thompson JS, et al. Familial IgA nephropathy. Evidence of an inherited mechanism of disease. N Engl J Med 1985; 312:202.
  13. Yamagata K, Yamagata Y, Kobayashi M, Koyama A. A long-term follow-up study of asymptomatic hematuria and/or proteinuria in adults. Clin Nephrol 1996; 45:281.
  14. Tanaka H, Kim ST, Takasugi M, Kuroiwa A. Isolated hematuria in adults: IgA nephropathy is a predominant cause of hematuria compared with thin glomerular basement membrane nephropathy. Am J Nephrol 1996; 16:412.
  15. van Paassen P, van Breda Vriesman PJ, van Rie H, Tervaert JW. Signs and symptoms of thin basement membrane nephropathy: a prospective regional study on primary glomerular disease-The Limburg Renal Registry. Kidney Int 2004; 66:909.
  16. Iseki K, Miyasato F, Uehara H, et al. Outcome study of renal biopsy patients in Okinawa, Japan. Kidney Int 2004; 66:914.
  17. Savige J, Gregory M, Gross O, et al. Expert guidelines for the management of Alport syndrome and thin basement membrane nephropathy. J Am Soc Nephrol 2013; 24:364.
  18. Richards NT, Darby S, Howie AJ, et al. Knowledge of renal histology alters patient management in over 40% of cases. Nephrol Dial Transplant 1994; 9:1255.
  19. Szeto CC, Lai FM, To KF, et al. The natural history of immunoglobulin a nephropathy among patients with hematuria and minimal proteinuria. Am J Med 2001; 110:434.
  20. Eardley KS, Ferreira MA, Howie AJ, et al. Urinary albumin excretion: a predictor of glomerular findings in adults with microscopic haematuria. QJM 2004; 97:297.
  21. Voskarides K, Damianou L, Neocleous V, et al. COL4A3/COL4A4 mutations producing focal segmental glomerulosclerosis and renal failure in thin basement membrane nephropathy. J Am Soc Nephrol 2007; 18:3004.
  22. Yoshioka K, Hino S, Takemura T, et al. Type IV collagen alpha 5 chain. Normal distribution and abnormalities in X-linked Alport syndrome revealed by monoclonal antibody. Am J Pathol 1994; 144:986.