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Evaluation Of Etiological Causes of Hematuria in Children

Year 2020, Volume 14, Issue 6, 480 - 487, 30.11.2020
https://doi.org/10.12956/tchd.597567

Abstract

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.

References

  • 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.

Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi

Year 2020, Volume 14, Issue 6, 480 - 487, 30.11.2020
https://doi.org/10.12956/tchd.597567

Abstract

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.

References

  • 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.

Details

Primary Language English
Subjects Medicine
Journal Section ORIGINAL ARTICLES
Authors

Mehmet Emre ARI
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA DR. SAMİ ULUS KADIN DOĞUM ÇOCUK SAĞLIĞI VE HASTALIKLARI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, ÇOCUK SAĞLIĞI VE HASTALIKLARI ANABİLİM DALI
0000-0001-7932-1074
Türkiye


Sare Gülfem ÖZLÜ (Primary Author)
ANKARA YILDIRIM BEYAZIT UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY
0000-0002-9609-1511


Gülay DEMİRCİN
TOBB ETU UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY
0000-0003-2433-6644


Aysun ÇALTIK YILMAZ
UNIVERSITY OF HEALTH SCIENCES, ANKARA KEÇİÖREN TRAININING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
0000-0003-0774-4419


Özlem AYDOĞ
ONDOKUZ MAYIS UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY
0000-0002-3117-5968


Mehmet BÜLBÜL This is me
UNIVERSITY OF HEALTH SCIENCES, DR SAMI ULUS CHILDRENS AND MATERNITY HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
0000-0001-9007-9653

Publication Date November 30, 2020
Application Date July 27, 2019
Acceptance Date November 11, 2019
Published in Issue Year 2020, Volume 14, Issue 6

Cite

Bibtex @research article { tchd597567, journal = {Türkiye Çocuk Hastalıkları Dergisi}, issn = {1307-4490}, eissn = {2148-3566}, address = {Şehit Ömer Halisdemir Cad. Kurtdereli Sok. No:10 ANKARA}, publisher = {T.C. Sağlık Bakanlığı Ankara Şehir Hastanesi}, year = {2020}, volume = {14}, pages = {480 - 487}, doi = {10.12956/tchd.597567}, title = {Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi}, key = {cite}, author = {Arı, Mehmet Emre and Özlü, Sare Gülfem and Demircin, Gülay and Çaltık Yılmaz, Aysun and Aydoğ, Özlem and Bülbül, Mehmet} }
APA Arı, M. E. , Özlü, S. G. , Demircin, G. , Çaltık Yılmaz, A. , Aydoğ, Ö. & Bülbül, M. (2020). Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi . Türkiye Çocuk Hastalıkları Dergisi , 14 (6) , 480-487 . DOI: 10.12956/tchd.597567
MLA Arı, M. E. , Özlü, S. G. , Demircin, G. , Çaltık Yılmaz, A. , Aydoğ, Ö. , Bülbül, M. "Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi" . Türkiye Çocuk Hastalıkları Dergisi 14 (2020 ): 480-487 <https://dergipark.org.tr/en/pub/tchd/issue/57924/597567>
Chicago Arı, M. E. , Özlü, S. G. , Demircin, G. , Çaltık Yılmaz, A. , Aydoğ, Ö. , Bülbül, M. "Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi". Türkiye Çocuk Hastalıkları Dergisi 14 (2020 ): 480-487
RIS TY - JOUR T1 - Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi AU - Mehmet Emre Arı , Sare Gülfem Özlü , Gülay Demircin , Aysun Çaltık Yılmaz , Özlem Aydoğ , Mehmet Bülbül Y1 - 2020 PY - 2020 N1 - doi: 10.12956/tchd.597567 DO - 10.12956/tchd.597567 T2 - Türkiye Çocuk Hastalıkları Dergisi JF - Journal JO - JOR SP - 480 EP - 487 VL - 14 IS - 6 SN - 1307-4490-2148-3566 M3 - doi: 10.12956/tchd.597567 UR - https://doi.org/10.12956/tchd.597567 Y2 - 2019 ER -
EndNote %0 Turkish Journal of Pediatric Disease Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi %A Mehmet Emre Arı , Sare Gülfem Özlü , Gülay Demircin , Aysun Çaltık Yılmaz , Özlem Aydoğ , Mehmet Bülbül %T Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi %D 2020 %J Türkiye Çocuk Hastalıkları Dergisi %P 1307-4490-2148-3566 %V 14 %N 6 %R doi: 10.12956/tchd.597567 %U 10.12956/tchd.597567
ISNAD Arı, Mehmet Emre , Özlü, Sare Gülfem , Demircin, Gülay , Çaltık Yılmaz, Aysun , Aydoğ, Özlem , Bülbül, Mehmet . "Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi". Türkiye Çocuk Hastalıkları Dergisi 14 / 6 (November 2020): 480-487 . https://doi.org/10.12956/tchd.597567
AMA Arı M. E. , Özlü S. G. , Demircin G. , Çaltık Yılmaz A. , Aydoğ Ö. , Bülbül M. Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi. Türkiye Çocuk Hast Derg. 2020; 14(6): 480-487.
Vancouver Arı M. E. , Özlü S. G. , Demircin G. , Çaltık Yılmaz A. , Aydoğ Ö. , Bülbül M. Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi. Türkiye Çocuk Hastalıkları Dergisi. 2020; 14(6): 480-487.
IEEE M. E. Arı , S. G. Özlü , G. Demircin , A. Çaltık Yılmaz , Ö. Aydoğ and M. Bülbül , "Çocukluk Çağı Hematüri Olgularında Etiyolojik Nedenlerin İncelenmesi", Türkiye Çocuk Hastalıkları Dergisi, vol. 14, no. 6, pp. 480-487, Nov. 2020, doi:10.12956/tchd.597567


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