Harika ALPAY, Nurdan YILDIZ, Neslihan Çiçek DENİZ, İbrahim GÖKÇE, Ülger ALTUNTAŞ, Serçin GÜVEN

Clinical and histopathological features of asymptomatic persistent microscopic hematuria in children

Background/aim: We analyzed the clinical and pathological features and prognosis of 106 children with persistent asymptomatic microscopic hematuria (PAMH) with or without mild proteinuria. Materials and methods: This was a retrospective study of 106 children who were referred to our clinics from 2000 to 2013 for evaluation of PAMH. Results: Among the 106 patients, 69 (65%) were female and 37 (35%) were male. The patients were divided into two groups: 101 patients with isolated microscopic hematuria (IMH) and 5 patients with asymptomatic microscopic hematuria and mild proteinuria (AMHP). Renal biopsy was performed in all 5 children with AHMP: 2 patients had hereditary nephropathy and 2 patients had focal segmental glomerulosclerosis (FSGS). One biopsy specimen revealed nonspecific findings. Renal biopsy was performed in 9 children with IMH: 4 patients had hereditary nephropathy and 5 patients had nonspecific findings. None of the patients received any specific treatment prior to renal biopsy. During the follow-up period, none of the patients developed impaired renal function. Among all the children, only one patient with AMHP developed hypertension and 2 patients with IMH developed proteinuria. Conclusion: Long-term follow-up must be done carefully for isolated microscopic hematuria and renal biopsy should be performed in selected cases.

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1. Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria: an integrated medical and surgical approach. Pediatr Clin North Am 1997; 44: 1191-1210.
2. Feld LG, Meyers KE, Kaplan BS, Stapleton FB. Limited evaluation of microscopic hematuria in pediatrics. Pediatrics 1998; 102: E42.
3. Meyers KE. Evaluation of hematuria in children. Urol Clin North Am 2004; 31: 559-573.
4. Bergstein J. Hematuria, proteinuria and urinary tract infections. Pediatr Clin North Am 1982; 29: 55-66.
5. Feld LG, Stapleton FB, Duffy L. Renal biopsy in children with asymptomatic hematuria or proteinuria: survey of pediatric nephrologists. Pediatr Nephrol 1993; 7: 441-443.
6. Patel HP, Bissler JJ. Hematuria in children. Pediatric Clin North Am 2001; 48: 1519-1537.
7. Strivastava RN. Asymptomatic hematuria in children. J Indian Med Assoc 2002; 100: 88-92.
8. Shen P, He L, Jiang Y, Wang C, Chen M. Useful indicators for performing renal biopsy in adult patients with isolated microscopic haematuria. Int J Clin Pract 2007; 61: 789-794.
9. Qigley R. Evaluation of hematuria and proteinuria: how should a pediatrician proceed. Curr Opin Pediatr 2008; 20: 140-144.
10. Shen X. Diagnostic algorithm for the evaluation of hematuria. J Am Acad Nurse Pract 2010; 22: 186-191.
11. Cho BS, Hahn WH, Cheong HI, Lim I, Ko CW, Kim SY, Lee DY, Ha TS, Suh JS. A nationwide study of mass urine screening tests on Korean school children and implications for chronic kidney disease management. Clin Exp Nephrol 2013; 17: 205- 210.
12. Lin CY, Hsieh CC, Chen WP, Yang LY, Wang HH. The underlying diseases and follow-up in Taiwanese children screened by urinalysis. Pediatr Nephrol 2001; 16: 232-237.
13. Lee YM, Baek SY, Kim JH, Kim DS, Lee JS, Kim PK. Analysis of renal biopsies performed in children with abnormal findings in urinary mass screening. Acta Paediatr 2006; 95: 849-853.
14. Vivante A, Afek A, Frenkel-Nir Y, Tzur D, Farfel A, Golan E, Chaiter Y, Shohat T, Skorecki K, Calderon-Margalit R. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA 2011; 306: 729-736.