Aysun CALTIK YILMAZ, Sare Gülfem ÖZLÜ, Mehmet BÜLBÜL, Mehmet Emre ARI, Gülay DEMİRCİN, Özlem AYDOG

Evaluation Of Etiological Causes of Hematuria in Children

Background: Hematuria is an important and common sign of urinary system diseases in children. Careful assessment is needed for definitive diagnosis and appropriate management. In this study we aimed to investigate the demographic and clinical characteristics of patients who were admitted to our pediatric nephrology clinic with hematuria and to determine the features that will guide the diagnosis. Methods: Medical charts of 370 patients who were referred to our clinic in a period of four years with gross or microscopic hematuria were evaluated retrospectively. Demographical data, clinical and laboratory findings, imaging modalities and diagnosis of the patients were investigated. Findings: Of the patients 195 (52.7 %) were boys and 175 (47.3%) were girls and the majority of the patients were in the age group of 6-10 years. Major presenting feature was red colored urine (64.1 %). Non-glomerular causes were found to be significantly higher among patients with macroscopic hematuria (p=0.002). Acute poststreptococcal glomerulonephritis formed the majority of glomerular hematuria and urinary system infections formed the majority of non-glomerular hematuria causes respectively. Conclusions: This study suggests that a careful history, detailed physical examination and clinical evaluation may elucidate the etiology in the majority of the patients with hematuria. Advanced imaging modalities and renal biopsy are indicated only in selected cases.

Anahtar Kelimeler:

children, hematuria, etiology

Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi

Amaç: Hematüri çocuklarda üriner sistem hastalıklarının önemli bir bulgusudur. Altta yatan ciddi hastalıkların belirtisi olabileceğinden ayırıcı tanı için dikkatli bir değerlendirme ve iyi bir klinik yaklaşım gerektirmektedir. Bu çalışmada pediatrik nefroloji kliniğimize hematüri nedeni ile başvuran hastaların demografik ve klinik özelliklerinin incelenmesi ve tanıya yol gösterecek özelliklerin belirlenmesi amaçlandı.Hastalar ve Yöntem: Bu çalışma, kliniğimizde makroskopik ve/veya mikroskopik hematüri nedeniyle izlenmiş olan 370 hastanın dosyası retrospektif olarak değerlendirilerek gerçekleştirildi. Hastaların demografik verileri,l aboratuar sonuçları ve klinik bulguları, görüntüleme tetkikleri ve nihai tanıları araştırıldı.Bulgular: Hastaların 195’i (%52.7) erkek, 175 (%47.7)’si kızdı ve çoğunluğu 6-10 yaş grubunda yer almaktaydı. Hastaların 234 ‘ü (%63.2) makroskopik hematüri ile başvururken , 44’ünde (%15.3) glomerüler hematüri saptandı. Makroskopik hematüri grubunda non-glomerular nedenler anlamlı olarak yüksek bulundu. Glomerüler hematüri nedenleri arasında ülkemizde halen yaygın olarak saptanan akut poststreptokokkal glomerülonefrit (APSGN), non glomerüler nedenlerden de üriner sistem enfeksiyonu en yüksek oranda görülen hastalıkları oluşturmaktaydı. Tartışma: Bu çalışma dikkatli bir öykü, ayrıntılı fizik muayene ve klinik değerlendirme ile hematüri ile başvuran hastaların büyük çoğunluğunda etiyolojinin aydınlatılabileceğini göstermektedir. İleri görüntüleme tetkikleri ve renal biyopsi sadece seçilmiş vakalarda endikedir.

Keywords:

Çocukluk Çağı, Etiyoloji, Hematüri,

PDF

___

1) Hiren, P.Patel, John J.Bissler. Hematuria in children. Pediatric Clinics of North America 2001; 48: 6.
2) Davis ID, Avner ED. Clinical evaluation of the child with hematuria. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF (eds). Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007. p: 2170.
3) Yap HK, Weng Lau PY. Hematuria and Proteinuria. In: Geary D, Schaefer F (eds). Comprehensive Pediatric Nephrology. 1st ed. Philadelphia: Saunders Elsevier; 2008.p: 179-184.
4) Tu WH, Shortliffe LD. Evaluation of asymptomatic, atraumatic hematuria in children and adults. Nat Rev Urol. 2010; 7(4):189-94. doi:10.1038/nrurol.2010.27.
5) Shenay M, Webb NJA. Clinical Evaluation of the Child With Suspected Renal Disease. In: Avner E, Harmon W, Niaudet P, Norishige Y, Emma F, Goldstein S (eds). Pediatric Nephrology; 7th ed. 2016; p.608.
6) Cho BS, Kim SD. School urinalysis screening in Korea. Nephrology (Carlton). 2007; 12 Suppl 3:S3-7. Review.10.1111/j.1440-1797.2007.00873.x
7) Sönmez F, Yenisey Ç, Cüce D, Ülgen H. Asymptomatic hematuria, proteinuria and pyuria in school children. Med J Ege University. 1997; 7:23-25.
8) Greenfield SP, Williot P, Kaplan D. Gross hematuria in children: a ten-year review. Urology. 2007; 69(1): 166-9.10.1016/j.urology.2006.10.018
9) Youn T, Trachtman H, Gauthier B. Clinical spectrum of gross hematuria in pediatric patients. Clin Pediatr (Phila). 2006; 45(2): 135-41.10.1177/000992280604500204
10) Pan CG. Evaluation of gross hematuria. Pediatr Clin North Am. 2006;53(3):401-12, vi. Review.10.1016/j.pcl.2006.03.002
11) Feld LG, Meyers KE, Kaplan BS, Stapleton FB. Limited evaluation of microscopic hematuria in pediatrics. Pediatrics. 1998;102(4):E42. 10.1542/peds.102.4.e42
12) Stapleton FB, Roy S 3rd, Noe HN, Jerkins G. Hypercalciuria in children withhematuria. N Engl J Med. 1984 24;310(21):1345-8. 13. Rheault M.N, Kashtan CE. Inherited Glomerular Diseases. In: Avner E, Harmon W, Niaudet P, Norishige Y, Emma F, Goldstein S. Pediatric Nephrology; 7th ed. 2016; p:779-795.
14. Martinez MG, dos S Silva V, do Valle AP, Amaro CR, Corrente JE, Martin LC. Comparison of different methods of erythrocyte dysmorphism analysis to determine the origin of hematuria. Nephron Clin Pract. 2014; 128(1-2):88-94. doi:10.1159/000367848.
15. Wenderfer SE, Gaut JP. Glomerular Diseases in Children. Adv Chronic Kidney Dis. 2017;24(6):364-371. doi: 10.1053/j.ackd.2017.09.005. Review. 16. Dagan R, Cleper R, Davidovits M, Sinai-Trieman L, Krause I. Post-Infectious Glomerulonephritis in Pediatric Patients over Two Decades: Severity-Associated Features. Isr Med Assoc J. 2016;18(6):336-40.
17. Lee JH, Choi HW, Lee YJ, Park YS. Causes and outcomes of asymptomatic gross haematuria in children. Nephrology (Carlton). 2014;19(2):101-6. doi:10.1111/nep.12181.
18. Moloney F, Murphy KP, Twomey M, O'Connor OJ, Maher MM. Haematuria: an imaging guide. Adv Urol. 2014;2014:414125. doi: 10.1155/2014/414125. Epub 2014 Jul 17. Review.
19. Datta SN, Allen GM, Evans R, Vaughton KC, Lucas MG. Urinary tractultrasonography in the evaluation of haematuria--a report of over 1,000 cases. Ann R Coll Surg Engl. 2002;84(3):203-5.
20. Park SJ, Oh JY, Shin JI. Diagnostic value of renal Doppler ultrasonography for detecting nutcracker syndrome in children with recurrent gross hematuria. Clin Pediatr (Phila). 2012 Oct;51(10):1001. doi: 10.1177/0009922812459071.
21. O'Connor OJ, McSweeney SE, Maher MM. Imaging of hematuria. Radiol Clin North Am. 2008 Jan; 46(1):113-32, vii. doi: 10.1016/j.rcl.2008.01.007. Review.
22. Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on thedetection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 2007;166(5):399-404. Epub 2006 Oct 19.
23. Park SJ, Shin JI. Renal Doppler ultrasonography in the diagnosis of nutcrackersyndrome. Eur J Pediatr. 2013;172(1):135-6. doi: 10.1007/s00431-012-1859-5.Epub 2012 Nov 20.
24. Esteghamati M, Ghasemi K, Nami M. Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014. Electron Physician. 2017; 25(9):5261-5264. doi:10.19082/5261. eCollection 2017 Sep.
25. Spivacow FR, Del Valle EE, Rey PG. Metabolic risk factors in children withasymptomatic hematuria. Pediatr Nephrol. 2016;31(7):1101-6. doi:10.1007/s00467-015-3282-4.