Finding of pathological thrombomodulin gene variant in a patient with idiopathic nodular glomerulosclerosis and chronic thrombotic microangiopathy-like changes

Idiopathic nodular glomerulosclerosis is an unusual histopathological finding that has commonly been observed in male smokers with hypertension. It has remained an enigmatic condition and is best described as a diabetic pattern of glomerular injury seen in non-diabetic patients. It is also one of the few nicotine (smoking)-associated/smoking-associated patterns of renal injury. We present an even more unusual manifestation of this pathological finding in a 59-year-old Hispanic female who presented with chronic kidney disease approaching need for renal replacement therapy. The patient had idiopathic nodular glomerulosclerosis on kidney biopsy, despite no prior history of diabetes, nor smoking history, including no secondhand smoking exposure. The patient did have hypertension. The renal biopsy also showed evidence of chronic thrombotic-microangiopathic changes within arteries and arterioles. Genetic testing of the alternative pathway revealed an unusual and likely pathological variant of thrombomodulin supporting complement dysfunction as having a role in the presentation.

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Factor Associated with Abnormal Ankle-Brachial Index Among Diabetic Patients in Songklanagarind Hospital: A Retrospective Cohort Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201828 ◽

2018 ◽

Vol 36 (4) ◽

pp. 299 ◽

Cited By ~ 1

Author(s):

Supakorn Sripaew ◽

Thanittha Sirirak

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Coronary Revascularization ◽

Ankle Brachial Index ◽

Smoking History ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Previous Stroke ◽

History Of

Objective: To find the correlation between type 2 diabetic patients who had abnormal ankle-brachial index (ABI) among factors affected diabetes and cardiovascular outcomes including acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization stroke, renal replacement therapy, leg revascularization and limb amputation Material and Methods: Retrospective cohort study collecting the data of 548 diabetic patients examined ABI at Outpatient Departments from 1st January 2009 to 31st December 2015. Results: From 548 medical records including only normal-ABI group and low-ABI group, we found that hypertension, chronic kidney disease (CKD), smoking, history of previous MI, history of previous stroke and age were the significant associated factor of low-ABI. The survival analyses revealed the significantly higher rate of ACS, MI, and coronary revascularization in low-ABI group (p-value=0.04, <0.01, <0.01 respectively) after exposed to low-ABI around 4 years. However, the study found no significant difference of other outcomes between the 2 groups. Conclusion: Songklanagarind’s diabetic patients with low-ABI were associated with the significantly higher rate of multiple cardiovascular risk factors including hypertension, CKD, smoking, history of previous MI, history of previous stroke and age and they tend to significantly experience more ACS, MI and coronary revascularization after 4 years exposed to low-ABI.

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Associations of hypertension Diabetes Smoking History and SNPs with Responses to Aflibercept Treatment for tAMD and PCV

Current Trends in Ophthalmology ◽

10.18314/ctoy.v2i1.1666 ◽

2019 ◽

pp. 170-177

Author(s):

Tanaka K ◽

Furuya K ◽

Mori R ◽

Kawamura A ◽

Yuzawa M ◽

...

Keyword(s):

Diabetes Mellitus ◽

Initial Treatment ◽

Smoking History ◽

Diabetic Patients ◽

Therapeutic Effects ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

History Of ◽

One Year ◽

The One

Purpose: To determine the correlation between therapeutic effects of IVA treatment on typical AMD (tAMD), and polypoidal choroidal vasculopathy (PCV) and the history of hypertension, diabetes mellitus, smoking history and single nucleotide polymorphisms (SNPs).Methods: Prospective, interventional study. Subjects were assigned to 125 untreated patients with exudative AMD (tAMD: 58 patients, PCV: 67 patients, male: 91:34, mean age 73.4 years). Among the tAMD patients, there were 28 bimonthly injections 30 who received pro re nata (PRN) injections after three monthly injections. Among the PCV patients, 33 were treated with bimonthly injections and 34 received PRN injections after three monthly injections. Therapeutic effects were evaluated by best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (CCT), and exudative change after 3 months and 1 year from initial treatment, and also the history of hypertension, diabetes mellitus, smoking and five SNPs (rs10490924, rs800292, rs699947, rs1061170, rs13278062).Results: Improvements of BCVA, CRT were observed in all groups at 1 year after initial treatment. The one-yearchange in CRT showed significant improvement in nonsmokers than smokers in tAMD. The one-year change in CRT indicated a significant improvement in non-diabetic patients in PCV. There was more exudation at both 3 months and 1 year who had smoking history in tAMD. With respect to the rs1061170 mutation of tAMD, in the case with TT type, significant residual exudation was noted at both 3 and 12 months.Conclusions: The history of smoking and diabetes could be influence to IVA treatment for AMD.

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Cardiovascular outcomes of type 2 diabetic patients treated with DPP‑4 inhibitors versus sulphonylureas as add-on to metformin in clinical practice

Scientific Reports ◽

10.1038/s41598-021-02670-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juan Carlos Bazo-Alvarez ◽

Kingshuk Pal ◽

Tra My Pham ◽

Irwin Nazareth ◽

Irene Petersen ◽

...

Keyword(s):

Clinical Practice ◽

Social Deprivation ◽

Smoking Status ◽

Cardiovascular Outcomes ◽

Major Adverse Cardiovascular Events ◽

Prior History ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

History Of

AbstractDPP-4 inhibitors (DPP-4i) and sulphonylureas remain the most widely prescribed add-on treatments after metformin. However, there is limited evidence from clinical practice comparing major adverse cardiovascular events (MACE) in patients prescribed these treatments, particularly among those without prior history of MACE and from vulnerable population groups. Using electronic health records from UK primary care, we undertook a retrospective cohort study with people diagnosed type-2 diabetes mellitus, comparing incidence of MACE (myocardial infarction, stroke, major cardiovascular surgery, unstable angina) and all-cause mortality among those prescribed DPP-4i versus sulphonylureas as add-on to metformin. We stratified analysis by history of MACE, age, social deprivation and comorbidities and adjusted for HbA1c, weight, smoking-status, comorbidities and medications. We identified 17,570 patients prescribed sulphonylureas and 6,267 prescribed DPP-4i between 2008–2017. Of these, 16.3% had pre-existing MACE. Primary incidence of MACE was similar in patients prescribed DPP-4i and sulphonylureas (10.3 vs 8.5 events per 1000 person-years; adjusted Hazard Ratio (adjHR): 0.94; 95%CI 0.80–1.14). For those with pre-existing MACE, rates for recurrence were higher overall, but similar between the two groups (21.8 vs 17.2 events per 1000 person-years; adjHR: 0.93; 95%CI 0.69–1.24). For those aged over 75 and with BMI less than 25 kg/m2 there was a protective effect for DPP-I, warranting further investigation. Patients initiating a DPP-4i had similar risk of cardiovascular outcomes to those initiating a sulphonylurea. This indicates the choice should be based on safety and cost, not cardiovascular prognosis, when deciding between a DPP-4i or sulphonylurea as add-on to metformin.

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Cardiovascular Outcomes of Type 2 Diabetic Patients Treated With DPP‑4 Inhibitors Versus Sulphonylureas As Add-on to Metformin in Clinical Practice

10.21203/rs.3.rs-575651/v1 ◽

2021 ◽

Author(s):

Juan Carlos Bazo-Alvarez ◽

Kingshuk Pal ◽

Tra My Pham ◽

Irwin Nazareth ◽

Irene Petersen ◽

...

Keyword(s):

Clinical Practice ◽

Social Deprivation ◽

Smoking Status ◽

Cardiovascular Outcomes ◽

Major Adverse Cardiovascular Events ◽

Prior History ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

History Of

Abstract Background: DPP-4 inhibitors (DPP-4i) and sulphonylureas remain the most widely prescribed add-on treatments after metformin. However, there is limited evidence from clinical practice comparing major adverse cardiovascular events (MACE) in patients prescribed these treatments, particularly among those without prior history of MACE and from vulnerable population.Methods: Using electronic health records from the UK primary care, we undertook a retrospective cohort study with people diagnosed type-2 diabetes mellitus, comparing incidence of MACE (myocardial infarction, stroke, major cardiovascular surgery, unstable angina) and all-cause mortality among those prescribed DPP-4i versus sulphonylureas as add-on to metformin. We stratified analysis by history of MACE, age, social deprivation and comorbidities and adjusted for HbA1c, weight, smoking-status, comorbidities and medications.Results: We identified 17,570 patients prescribed sulphonylureas and 6,267 prescribed DPP-4i between 2008-2017. Of these, 16.3% had pre-existing MACE. Primary incidence of MACE was similar in patients prescribed DPP-4i and sulphonylureas (10.3 vs 8.5 events per 1000 person-years; adjusted Hazard Ratio (adjHR): 0.94; 95%CI 0.80–1.14). For those with pre-existing MACE, rates for recurrence were higher, but similar between the two groups (21.8 vs 17.2 events per 1000 person-years; adjHR: 0.93; 95%CI 0.69–1.24). For those aged over 75 and with BMI less than 25kg/m2 there was a protective effect for DPP-I, warranting further investigation.Conclusions: Patients initiating a DPP-4i had similar risk of cardiovascular outcomes to those initiating a sulphonylurea. This indicates the choice should be based on safety and cost, not cardiovascular prognosis, when deciding between a DPP-4i or sulphonylurea as add-on to metformin.

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Predictors of Post-Thrombotic Ulcer after Acute DVT: The RIETE Registry

Thrombosis and Haemostasis ◽

10.1160/th17-08-0598 ◽

2018 ◽

Vol 118 (02) ◽

pp. 320-328 ◽

Cited By ~ 10

Author(s):

Jean-Philippe Galanaud ◽

Laurent Bertoletti ◽

Maria Amitrano ◽

Carmen Fernández-Capitán ◽

José Pedrajas ◽

...

Keyword(s):

Venous Thromboembolism ◽

Statistical Significance ◽

Signs And Symptoms ◽

Venous Ulcer ◽

Lower Limbs ◽

Prior History ◽

Diabetic Patients ◽

Vein Thrombosis ◽

History Of ◽

End Stage

AbstractIn patients with deep-vein thrombosis (DVT) in the lower limbs, venous ulcer is the most debilitating and end-stage clinical expression of the post-thrombotic syndrome (PTS). To date, risk factors for PTS-related ulcer in DVT patients have not been identified.We used the international observational RIETE registry to assess the evolution of PTS signs and symptoms during a 3-year follow-up period and to identify independent predictors of PTS ulcer at 1 year in patients with acute DVT.Among 1,866 eligible patients, cumulative rates of PTS ulcer at 1, 2 and 3 years were 2.7% (n = 50), 4.3% (n = 54) and 7.1% (n = 60), respectively. The proportion of patients with PTS symptoms at 1, 2 or 3 years remained stable (≈40%), while the proportion of patients with PTS signs increased slightly over time (from 49 to 53%). Prior history of venous thromboembolism (VTE) (odds ratio [OR] = 5.5 [2.8–10.9]), diabetes (OR = 2.3 [1.1–4.7]), pre-existing leg varicosities (OR = 3.2 [1.7–6.1]) and male sex (OR = 2.5 [1.3–5.1]) independently increased the risk of PTS ulcer at 1 year. Obesity also increased the risk but failed to reach statistical significance (OR = 1.8 [0.9–3.3]). DVT treatment characteristics (duration or drug) did not influence the risk.Our results evidence that after acute DVT, pre-existing leg varicosities, prior venous thromboembolism, diabetes and male gender independently increased the risk for PTS ulcer. This suggests that clinicians should consider strategies aimed to prevent ulcers in high-risk DVT patients, such as preventing VTE recurrence, use of stockings in those with pre-existing venous insufficiency, careful monitoring of diabetic patients and encouraging weight loss in obese patients.

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Malignancy incidences by glycemic control among diabetic patients

Endocrine Connections ◽

10.1530/ec-18-0355 ◽

2018 ◽

Vol 7 (12) ◽

pp. 1457-1463 ◽

Cited By ~ 3

Author(s):

Daiki Kobayashi ◽

Nagato Kuriyama ◽

Keita Hirano ◽

Osamu Takahashi ◽

Hiroshi Noto

Keyword(s):

Longitudinal Study ◽

Glycemic Control ◽

Time Dependent ◽

Prior History ◽

Diabetic Patients ◽

Mixed Effect ◽

History Of ◽

The Mean ◽

The Difference ◽

Hba1c Levels

Background The aim of this study was to evaluate the difference in malignancy incidence by evaluating time-dependent HbA1c levels among diabetic patients in a longitudinal study. Methods We conducted a retrospective longitudinal study at large academic hospital, Tokyo, Japan, from 2006 to 2016. We included all diabetic patients who were 50 years or older and who underwent health check-ups at the Center for Preventive Medicine. Those patients with a prior history of malignancies were excluded. We categorized patients into five groups on the basis of HbA1c measurements: <5.4, 5.5–6.4, 6.5–7.4, 7.5–8.5, >8.5%. Our primary outcome was the development of any types of malignancy. Longitudinal analyses by a mixed effect model with time-dependent HbA1c levels were applied in order to take into account fluctuations in HbA1c levels within the same patient. Results In total, 2729 participants were included in this study, where the mean age was 62.6 (standard deviation (s.d.): 7.8) and 2031 (74.4%) were male. The mean disease duration of diabetes was 7.6 (s.d.: 7.6) years, and 1688 (61.8%) were prescribed medications. Median follow-up was 1443.5 (interquartile range (IQR): 2508) days and 376 (13.8%) developed malignancies. Compared to the reference range of HbA1c (5.5–6.4%), the odds ratios for developing malignancies among the other HbA1c level groups were similar and not statistically different (OR: 0.98, 95% CI:0.31–3.15 (for HbA1c <5.4%); OR: 0.88, 95% CI: 0.69–1.12 (for HbA1c 6.5–7.4%); OR: 0.88, 95% CI: 0.64–1.22 (for HbA1c 7.5–8.4%); OR 1.07, 95% CI: 0.70–1.66 (for HbA1c >8.5%)). Conclusion In our study, there was no association between glycemic control and the development of future malignancies. Compared to very strictly controlled HbA1c levels, both excessive control and good or bad control had a statistically similar risk of developing malignancies.

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Fatty Acid Binding Protein 4—A Circulating Protein Associated with Peripheral Arterial Disease in Diabetic Patients

Journal of Clinical Medicine ◽

10.3390/jcm9092843 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2843 ◽

Cited By ~ 1

Author(s):

Abdelrahman Zamzam ◽

Muzammil H. Syed ◽

Elisa Greco ◽

Mark Wheatcroft ◽

Shubha Jain ◽

...

Keyword(s):

Fatty Acid Binding Protein ◽

Arterial Disease ◽

Prior History ◽

P Value ◽

Diabetic Patients ◽

Fatty Acid Binding ◽

Coronary Arterial Disease ◽

Acid Binding Protein ◽

History Of ◽

Peripheral Arterial

Diabetic patients with peripheral arterial disease (PAD) often suffer from poor clinical outcomes such as limb-loss. Fatty acid binding protein 4 (FABP4) is mainly expressed by adipocytes and is known to play a significant role in the development of atherosclerosis. In this study, we sought to investigate whether FABP4 is associated with PAD in patients with type 2 diabetes mellitus (DM). FABP4 plasma levels were studied in 119 diabetic patients with PAD (DM-PAD) and 49 diabetic patients without PAD (DM-noPAD) presenting to St. Michael’s Hospital between October 2017 and September 2018. Levels of FABP4 in DM-PAD patients (23.34 ± 15.27 ng/mL) were found to be over two-fold higher than the levels in DM-noPAD patients (10.3 ± 7.59 ng/mL). Regression analysis demonstrated a significant association between FABP4 levels and DM-PAD after adjusting for age, sex, prior history of coronary arterial disease and white blood cells count (OR, 2.77; 95% CI, 1.81–4.31; p-value = 0.001). Relative to DM-noPAD controls, plasma FABP4 levels in DM-PAD patients were noted to be inversely correlated with the ankle brachial index (ABI; r= −0.374, p-value < 0.001). The diagnostic ability of FABP4 was investigated using receiver operator curves (ROC) and area under the curve (AUC) analysis. FABP4 had an AUC of 0.79, which improved to 0.86 after adjusting for age, sex and prior history of coronary arterial disease. This raises a possibility of utilizing FABP4 as a biomarker for diagnosing PAD in diabetic patients.

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Is hyperglycemia a prognostic factor in pancreatic cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14078 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14078-14078 ◽

Cited By ~ 1

Author(s):

S. F. Mekan ◽

M. M. Safa ◽

R. S. Komrokji ◽

Z. A. Nahleh ◽

A. R. Jazieh

Keyword(s):

Diabetes Mellitus ◽

Pancreatic Cancer ◽

Median Survival ◽

Tumor Biology ◽

Stage Iv ◽

Smoking History ◽

Prior History ◽

P Value ◽

History Of ◽

The Impact

14078 Background: Pancreatic hyperglycemia is one of the manifestations of pancreatic cancer.The purpose of this study is to explore the prevalence and significance of hyperglycemia at the time of diagnosis of pancreatic cancer. Methods: We reviewed retrospectively cases presenting to our institution with diagnosis of pancreatic carcinoma between 1999–2003. Hyperglycemia was defined as a blood sugar of greater than 140mg/dL. Results: There were 155 cases diagnosed with pancreatic cancer. Out of these, 67 (43.2%) were males and 71(45.8%) were females. The mean age was 63 years. Staging was reported in 134 patients: 19 patients (14%) were stage I, 23 (17%) stage II, 40 (30%) stage III and 52 (39%) stage IV. Median survival time was 8 months. Thirty-four (22%) patients had prior history of diabetes mellitus and were excluded from subsequent analysis. Sixty-four patients out of 121 patients (53%) were found to be hyperglycemic. These patients had no prior history of diabetes mellitus or were diagnosed with diabetes within six months. There was no difference between hyperglycemic patients and normoglycemic patients regarding age, sex, race, tumor location, smoking history, history of pancreatitis and hypertension. Hyperglycemic patients were more likely to have history of alcohol use compared to normoglycemic patients (p value = 0.005, OR = 4.07). Hyperglycemic patients were less likely to present with stage IV disease as compared to normoglycemic patients (25% vs. 55%) (p-value 0.002). The median survival in hyperglycemic patients was significantly longer than in normoglycemic patients (12 vs. 6 months, p-value = 0.02).There was a trend towards better survival among stage IV hyperglycemic patients as compared to normoglycemic patients (13 months vs 3 months) (p-value 0.38). Conclusions: In this retrospective analysis, 53% of pancreatic cancer patients without diabetes had hyperglycemia at presentation. These patients presented at an earlier stage compared to normoglycemic patients and had significantly longer survival. The impact of hyperglycemia on survival could be related to earlier presentation or difference in the tumor biology. The clinical significance of hyperglycemia in pancreatic cancer should be further studied in prospective fashion. No significant financial relationships to disclose.

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Randomized phase II study of nivolumab (N) alone versus with pegilodecakin (PEG) in combination with N in patients (pts) with post-platinum immunotherapy-naive stage IV non-small cell lung cancer (NSCLC) and no or low PD-L1 expression (CYPRESS 2).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21744 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21744-e21744

Author(s):

Robert M. Jotte ◽

Jerome H. Goldschmidt ◽

Jeffrey Gary Schneider ◽

Merrill Kingman Shum ◽

David Berz ◽

...

Keyword(s):

Phase Ii ◽

Phase Ii Trial ◽

Stage Iv ◽

Smoking History ◽

Prior History ◽

Open Label ◽

Randomized Phase Ii ◽

Open Label Phase ◽

History Of ◽

Secondary Endpoints

e21744 Background: Nivolumab (N) is an immune checkpoint inhibitor (CPI) approved to treat post-platinum NSCLC as monotherapy. PEG in combination with N has demonstrated promising efficacy in NSCLC pts in a phase I trial (IVY; NCT02009449; Naing et al., 2019 Lancet Oncol), providing rationale for this randomized phase II trial (CYPRESS 2). Methods: CYPRESS 2 was an open label phase II trial, for ECOG 0-1, PD-L1 negative or low (TPS 0-49%), Stage IV NSCLC pts, without known EGFR/ALK mutations. Pts were randomized 1:1 to arm N (240 mg every 14-days or 480 mg every 28-days as decided by investigator) v. arm PEG+N (received N as above + PEG daily of 0.8 mg if weight ≤80kg and 1.6mg if weight > 80 kg). Pts were stratified by tumor histology and smoking history and must have no prior history of cancer or CPI therapy. Primary endpoint was ORR (per RECIST v 1.1 per investigator). Secondary endpoints included PFS, OS, and safety. Exploratory endpoints included immune activation biomarkers (baseline and change from baseline), assessed by immunoassay. Results: As of Aug 28, 2019, 52 pts were randomized to PEG+N (n=27) or N (n=25). Median follow-up time was 11.6 months. The following results were found for PEG+N versus N: ORR 14.8% v. 12.0%, mPFS 1.9 v. 1.9 months with HR = 1.01 (95% CI [0.52, 1.95]), mOS 6.7 v. 10.7 months with HR = 1.87 (95% CI [0.77, 4.53]). Gr ≥3 treatment related adverse events (TRAEs) for PEG+N versus N were 70.4% vs. 16.7%. Gr 3 TRAEs of ≥10% incidence included anemia (40.7% v. 0%), fatigue (18.5% v. 0%), and thrombocytopenia (14.8% v. 0%). In PEG+N arm, increased circulating IL-18, Granzyme B, FasL, and IFNg levels and decreased TGFb levels were observed on treatment. Conclusions: Exploratory pharmacodynamic results were consistent with immunostimulatory signals of the IL-10R pathway. Despite evidence of biological effect, adding PEG to N did not lead to improvement in ORR, PFS, or OS in post-platinum advanced NSCLC with no or low PD-L1 expression. PEG+N arm demonstrated expected safety profile but overall higher toxicity compared to nivolumab alone. Clinical trial information: NCT03382912.

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Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.223 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 223-223

Author(s):

Ronald Loo ◽

Violeta Rabrenovich ◽

Ann Michelle Aspera ◽

Steven Jacobsen ◽

Howard Landa ◽

...

Keyword(s):

Improve Patient Safety ◽

Risk Index ◽

Microscopic Hematuria ◽

Smoking History ◽

Considerable Proportion ◽

Prior History ◽

Evidence Based ◽

Gross Hematuria ◽

Asymptomatic Patients ◽

History Of

223 Background: AMH in the general population is common, occurring in up to 9-18%. Even low degrees of AMH have been considered a risk factor for UTMT. Although the prevalence of UTMT is low (.01-3%), many asymptomatic patients undergo unnecessary and hazardous evaluations. In 2007, the Kaiser Permanente (KP) Urologists started a multi-year QI effort to research and develop a risk stratified evidence-based approach in the evaluation of AMH. Methods: The group first conducted a retrospective analysis to determine the incidence of urinary cancer, and stratify risk according to age, gender, smoking history, and degree of hematuria. A multi-regional prospective, observational study was then conducted over a two year period. We used a data collection tool embedded within an EMR to determine patients with AMH who are at greatest risk for UTMT, and patients who might benefit from urologic evaluation or safely avoid unnecessary workup and radiation exposure. Results: 4,414 patients had full urologic work up. Overall, 100 bladder cancers were diagnosed among 4,414 patients (2.3%), and only 11 renal cancers (0.2%) were pathologically confirmed. Multivariable logistic regression was conducted for 5 common parameters: age, gender, smoking history, degree of microscopic hematuria, and history of gross hematuria within the past 6 months. The two most important risk factors were age > 50, and prior history of gross hematuria. A hematuria risk index (HRI) was developed, which significantly improved predictability (AUC = .809-HRI vs .532-AUA guideline). Overall, 32% of the population was identified as low risk with only 0.2% cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer diagnosed. Conclusions: These results suggest that a considerable proportion of patients may safely avoid hazardous evaluation using multivariate risk stratification. An evidence-based algorithm was developed for the management of asymptomatic microscopic hematuria and implemented within KP. We expect to significantly improve patient safety and improve reliability of patient evaluation.

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