Etiology of hematuria in childhood Original Article

Abstract

Summary Aim: The aim was evaluating the causes of hematuria showing the consequence of the prognosis and differential diagnosis and preventing unnecessary invasive tests Material and Method: A retrospective study was conducted in patients aged between 4 months and 16 years who referred to the nbsp; nephrology clinic with the complaint of hematuria between January 1999 and June 2004 The patients were grouped as fallows: macroscopic hematuria asymptomatic isolated microscopic hematuria microscopic hematuria with clinical findings and asymptomatic microscopic hematuria with proteinuria Results: Macroscopic and microscopic hematuria were detected in 136 and 164 patients respectively The cases were diagnosed as glomerular diseases 34 3 urinary stone disease and crystalluria 27 4 infections 12 and anatomic abnormalities 10 The most common cause of hematuria was crystalluria in isolated microscopic hematuria group and glomeruler diseases in the other groups Renal biopsy was performed to 33 patients Glomerulopathy was detected in 32 cases The duration of hematuria was 614 plusmn;681 and 135 plusmn;384 days in biopsy performed group or not respectively Conclusions: Glomerular diseases were stated as the most common causes of hematuria in childhood Urinary stone disease crystalluria and infections were other causes of hematuria in our study group In long term follow up renal biopsy should be considered in selected cases Turk Arch Ped 2010; 45: 246 51 Key words: Children etiology hematuria

Keywords

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Çocukluk çağında hematürinin etiolojik nedenleri Özgün Araştırma

Öz

Özet Amaç: Çalışmamızda hematürinin nedenleri seyirdeki önemi ve ayırıcı tanının gerekliliği gösterilerek gereksiz girişimsel incelemelerin önlenmesi amaçlanmıştır Gereç ve Yöntem: Ocak 1999 ile Haziran 2004 tarihleri arasında hastanemiz Nefroloji Polikliniği rsquo;nde hematüri nedeni ile izleme alınan 4 ay ile 16 yaş arasındaki 300 hasta 146 rsquo;sı 48 7 kız 154 rsquo;ü 51 3 erkek ortalama yaşları 90 plusmn;40 4 192 ay geriye dönük olarak değerlendirildi Hastalar makroskobik hematüri asemptomatik izole mikroskobik hematüri mikroskobik hematüri ve klinik bulgular asemptomatik mikroskobik hematüri ve proteinüri olarak dört grupta incelendi Bulgular: Olguların 136 rsquo;sında 45 3 makroskobik hematüri 164 rsquo;ünde 54 7 mikroskobik hematüri vardı Olguların 34 3 rsquo;ünde glomerüler nedenler 27 4 rsquo;ünde taş ve kristalüri 12 rsquo;sinde enfeksiyonlar 10 rsquo;unda anatomik bozukluklar saptandı İzole mikroskobik hematüride en sık neden olarak kristalüri saptanırken diğer gruplarda hematüri nedeni olarak en sık glomerüler hastalıklar saptandı Tanı amaçlı 33 hastaya böbrek biyopsisi yapıldı Bir hasta dışında tüm biyopsi örneklerinde glomerülopati saptandı Biyopsi yapılan hastaların ortalama hematüri süresi 614 plusmn;681 gün iken yapılmayanların 135 plusmn;384 gün olarak izlendi Çıkarımlar: Çocukluk yaş grubunda makroskobik ve mikroskobik hematüri ile başvuran hastalarda en sık olarak glomerüler hastalıklar saptanmıştır Glomerüler hastalıkları taş hastalığı kristalüri ve enfeksiyonlar izlemektedir Tanıda uzun süreli izlemde seçilmiş olgularda böbrek biyopsisi düşünülmelidir Türk Ped Arş 2010; 45: 246 51 Anahtar sözcükler: Çocuk etiolojik nedenler hematüri

Anahtar Kelimeler

• Çocuk, etiolojik nedenler, hematüri

Kaynakça

1. Kalia A, Travis LB. Hematuria, leucocyturia, and cylindyruria. In: Edelman CM Jr (ed). Pediatric Kidney Disease. Boston USA: Little, Brown and Company, 1992: 553-63.
2. Feld LG, Waz WR, Pérez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin North Am 1997; 44: 1191-210. (Abstract) / (Full Text) / (PDF)
3. Patel HP, Bissler JJ. Hematuria in children. Pediatric Clin North Am 2001; 48: 1519-37. (Full Text) / (PDF)
4. Shane R. Hematuria. Pediatr Rev 1998; 19: 209-13. (Abstract) / (Full Text) / (PDF)
5. Quigley R. Evaluation of hematuria and proteinuria: how should a pediatrician proceed? Curr Opin Pediatr 2008; 20: 140-4. (Abstract)
6. Davis ID, Avner ED. Conditions particularly associated with he- matüria. In: Behrman RE, Kliegman RM, Jenson HB, Stanton BF (eds). Nelson Textbook of Pediatrics. Philadelphia: W.B. Saunders Company, 2007; 2168-88.
7. Dodge WF, West EF, Smith EH, Harvey B. Proteinuria and he- maturia in school children: epidemiology and early natural his- tory. J Pediatr 1976; 88: 327-47.
8. Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr 1979; 95: 676-84. (Abstract)

9. Stapleton FB. Asymptomatic microscopic hematuria: time to look the other way? Arch Pediatr Adolesc Med 2005; 159: 398-9. (Abstract) / (Full Text)
10. Tşri S, Visy M, Vissy A, et al. Long-term follow-up of patients with persistent/recurrent, isolated haematuria: a Hungarian multicentre study. Pediatr Nephrol 1989; 3: 235-9. (Abstract)
11. Ingelfinger JR, Davis AE, Grupe WE. Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics 1977; 59: 557-61. (Abstract) / (PDF)
12. Sönmez F, Yenisey Ç, Cüce D, Ülgen H. Asymptomatic hematuria proteinuria and pyuria in school children. Med J Ege University 1997; 7: 23-5.
13. Park YH, Choi JY, Chung HS, et al. Hematuria and proteinuri- a in a mass school urine screening test. Pediatr Nephrol 2005; 20: 1126-30. (Abstract) / (PDF)
14. Fairley KF, Birch DF. Hematuria: a simple method for identifying glomerular bleeding. Kidney Int 1982; 21: 105-8. (Abstract) / (PDF)
15. Wood EG. Asymptomatic hematuria in childhood: a practical ap- proach to evaluation. Indian J Pediatr 1999; 66: 207-14. (Abstract)
16. Trachtman H, Weiss RA, Bennett B, Greifer I. Isolated hematuria in children: indications for a renal biopsy. Kidney Int 1984; 25: 94-9. (Abstract) / (PDF)
17. 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: 849-53. (Abstract) / (PDF)
18. Piqueras AI, White RH, Raafat F, Moghal N, Milford DV. Renal biopsy diagnosis in children presenting with hematuria. Pedi- atr Nephrol 1998: 12: 386-91. (Abstract) / (PDF)
19. Diven SC, Travis LB. A practical primary care approach to hema- turia in children. Pediatr Nephrol 2000; 14: 65-72. (Abstract) / (PDF)
20. Greenfield SP, Williot P, Kaplan D. Gross hematuria in children: a ten-year review. Urology 2007; 69: 166–9. (Abstract) / (Full Text) / (PDF)
21. Youn T, Trachtman H, Gauthier B. Clinical spectrum of gross hematuria in pediatric patients. Clin Pediatr (Phila) 2006; 45: 135-41. (Abstract) / (PDF)
22. Feld LG, Meyers KE, Kaplan BS, Stapleton FB. Limited evaluation of microscopic hematuria in pediatrics. Pediatrics 1998; 102: E42. (Abstract) / (Full Text) / (PDF)
23. Bergstein J, Leiser J, Andreoli S. The clinical significance of asymptomatic gross and microscopic hematuria in children. Arch Pediatr Adolesc Med 2005; 159: 353-5. (Abstract) / (Full Text) / (PDF)
24. Chandar J, Gómez-Marín O, del Pozo R, et al. Role of routine urinalysis in asymptomatic pediatric patients. Clin Pediatr (Phi- la) 2005; 44: 43-8. (Abstract) / (PDF)
25. Stapleton FB, Roy S, Noe HN, Jerkins G. Hypercalciuria in children with hematuria. N Engl J Med 1984; 310: 1345-8. (Abstract)
26. Stapleton FB. Hematuria associated with hypercalciuria and hyperuricosuria: a practial approach. Pediatr Nephrol 1994; 8: 756-61.
27. Neiberger RE. The ABC’s of evaluating children with hematuria. Am Fam Physician 1994; 49: 623-8. (Abstract)
28. Lieu TA, Grasmeder HM 3rd, Kaplan BS. An approach to the evaluation and treatment of microscopic hematuria. Pediatr Clin Nort Am 1991; 38: 579-92.
29. Strivastava RN. Asymptomatic hematuria in children. J Indian Med Assoc 2002; 100: 88-92.
30. Haycock G. The child with idiopathic nephrotic syndrome. In: Webb N, Postlethwaite R, (eds). Clinical Paediatric Nephro- logy. New York: Oxford University Press, 2003: 341-66.
31. Feld LG, Stapleton FB, Duffy L. Renal biopsy in children with symptomatic hematuria or proteinuria. A survey of pediatric nephrologists. Pediatr Nephrol 1993; 7: 441-3. (Abstract) / (PDF)