Macroscopic Hematuria is associated with later Hypertension in Children with Autosomal Dominant Polycystic Kidney Disease – Report from four European Tertiary Centres

Background In adults with autosomal dominant polycystic kidney disease (ADPKD) episodes of gross hematuria are relatively common and are predictors of hypertension. We hypothesized that a history of gross hematuria will be associated also in children with ADPKD. Methods Altogether 289 children (median age 10.2 years) with ADPKD were followed in four European tertiary nephrology centres, in which we retrospectively investigated. A presence of ≥ 1 episode of macroscopic hematuria defines a group of MaHu + patients and an absence defines a group of MaHu- patients. Hypertension was defined as the use of antihypertensive drugs upon our last investigation. Results Macrohematuria occurred in 7.2% of children (n = 21). It was the first symptom of ADPKD leading to the diagnosis in 11 children (3.8%) and was the second most frequent presenting symptom of ADPKD (11 out of 51 children). The etiology of gross hematuria included ruptured cyst, urinary tract infection, urolithiasis and unknown. The prevalence of hypertension at the last follow-up in MaHu + children was significantly higher than in MaHu- children (14.3% vs. 3.1%, p = 0.017). Children from the MaHu + group had a significantly higher number of cysts when compared to the MaHu- group (20 vs. 10 cysts, p = 0.038). There were no significant differences between MaHu + vs. MaHu- groups in other variables. Multivariate analysis revealed gross hematuria as a significant independent predictor of later hypertension (OR 2.16, p = 0.03). Conclusions In children, ADPKD patients with a history of macroscopic hematuria are at an increased risk of developing later hypertension and require closer blood pressure follow-up.