Asymptomatic Hematuria Research Articles

Comparison of asymptomatic and symptomatic childhood glomerulonephritis progressing to renal failure: a report of Kyushu Pediatric Nephrology Study Group

We evaluated the clinicopathological features and the outcome of 33 children with primary glomerulonephritis (GN) as the cause of renal failure; 17 had asymptomatic (ASP) haematuria and/or proteinuria and the remaining 16 had symptoms suggestive of GN. The renal histology in the ASP group indicated IgA GN in 6 children, focal segmental glomerular sclerosis (FSGS) in 4, diffuse proliferative GN (DPGN) in 3, membranous GN (MGN) in 1, membranoproliferative GN (MPGN) in 1 and diffuse sclerosing GN in 2. In the symptomatic (SYP) group, FSGS was evident in 9 children, DPGN in 3, MGN in 2, IgA GN in 1 and MPGN in 1. There was no difference in the histological severity between the two groups. Fourteen children in the SYP group had nephrotic syndrome (NS) and/or hypertension at their initial visits. Only 4 children in the ASP group showed NS or hypertension during the period of follow-up. Eleven children in the ASP group and all in the SYP group were treated with immunosuppressive and/or antihypertensive drugs, but these did not improve the prognosis of the ASP children compared with those in the SYP group. There was no significant difference in the mean duration between the onset of the disease and the start of dialysis in these two groups. In conclusion, it is questionable whether the urinary mass screening programme in Japan will alter the outcome of children with GN.

PERCUTANEOUS RENAL ALLOGRAFT BIOPSY

We retrospectively reviewed all (n = 369) percutaneous renal allograft biopsies performed at our institution between 1987 and 1992, comparing 14-gauge Franklin-Silverman (internal diameter = 2.0 mm, n = 169) and 18-gauge automated (internal diameter = 1.2 mm, n = 200) core biopsy needles. Visualization method, specimen adequacy, and complications were grouped by needle type. Five or more glomeruli were present in 88.9% of specimens obtained with Franklin-Silverman needles and in 82.7% with automated needles. A histologic diagnosis was obtained in 94.1% and 95.5% of Franklin-Silverman and automated biopsies, respectively. A complication was detected in 27 Franklin-Silverman biopsies (16.0%) and in 21 automated biopsies (10.5%) (not significant [NS], P > 0.05). Some procedures had more than one complication. Excluding asymptomatic gross hematuria, incidental hematomas, and incidental arteriovenous fistulas detected by routine ultrasonography, clinically significant complication rates were 6.5% for Franklin-Silverman biopsies and 2.5% for automated biopsies (NS). No allograft losses or patient deaths occurred as a result of allograft biopsy. Subgroup analysis of all biopsies performed with ultrasound marking alone (Franklin-Silverman, n = 119; automated, n = 148) revealed no significant (NS) difference in complication rates (15.1% vs. 10.8%). Additional subgroup analyses of palpation, ultrasound marking, and real-time ultrasonographic visualization techniques within each needle type also revealed no significant difference in the complication rate. Biopsy within 30 days of transplantation and no antihypertensive therapy were the only factors univariately associated (P < 0.05) with an increased complication rate. Multivariate analysis found biopsy within 30 days of transplantation (P = 0.007) was associated with the overall presence of one or more complications of any type. Type of needle (Franklin-Silverman vs. automated) achieved borderline significance (P = 0.047) when time to biopsy was statistically adjusted for; the Franklin-Silverman needle had a higher complication rate.

Inherited Diseases of the Glomerular Basement Membrane

The inherited diseases of the glomerular basement membrane include Alport's syndrome (AS), nail-patella syndrome, and thin basement membrane nephropathy. Classical AS is inherited in an X-linked manner and accounts for approximately 85% of the cases. Its manifestations include hematuria, sensorineural hearing loss, ocular defects, and a progression to renal failure. A defect(s) in the alpha 5 (IV) chain of type IV collagen is believed to be the etiology of classic AS, and alterations in its encoding gene localized to the X-chromosome have been elucidated. Although isolated cases of anti-glomerular basement membrane glomerulonephritis have been reported following renal transplantation in patients with AS, it is considered an effective form of renal replacement therapy. Less is known regarding the genetic basis of the autosomal-dominant form of AS, which apparently accounts for the remaining 15% of the cases. Nail-patella syndrome is characterized by nail dysplasia, patellar hypoplasia or aplasia, and nephropathy. It is inherited in an autosomal-dominant fashion with the gene locus assigned to the long arm of chromosome 9. Possible linkage between the COL5A1 gene and the gene for nail-patella syndrome has been suggested. Approximately 30% of the patients progress to end-stage renal failure. Renal transplantation has been successful in treating patients who progress to end-stage renal failure. Thin basement membrane nephropathy is an autosomal dominant trait that accounts for approximately 30% of the cases presenting as persistent, asymptomatic hematuria. The cause of thin basement membrane nephropathy is unknown at present. No decline in renal function is associated with thin basement membrane nephropathy.

Asymptomatic hematuria and/or proteinuria in children under 3 years of age: clinicopathological evaluation

Six boys and six girls aged under 3 years with asymptomatic hematuria and/or proteinuria were found and renal biopsies were performed from 1 month to 10 years after the discovery. Light microscopy uncovered 4 cases of focal segmental glomerulosclerosis (FSGS), 3 cases of diffuse mild mesangial proliferation, and 5 cases of minor glomerular abnormalities. Immunofluorescent studies did not show any significant depositions. Electron microscopy revealed diffuse thinning of the glomerular basement membrane (GBM) in 2 cases, and segmental thinning of the GBM in 8 cases, including 2 cases of FSGS found in the light microscopy. Four cases, including 2 cases of FSGS, had irregular thickening of the GBM and splitting of the lamina densa. Two cases of FSGS did not have GBM abnormalities. The significance of GBM abnormalities in children with asymptomatic hematuria and/or proteinuria under 3 years of age needs to further evaluated.

Insurability for Asymptomatic Hematuria or Proteinuria During Childhood

The objective of this survey was to describe life insurance underwriting practices concerning children with asymptomatic hematuria and proteinuria. A questionnaire was sent to 200 companies licensed to issue life insurance policies in the state of New York. The medical director of each company was asked to respond to the insurability of children with asymptomatic hematuria and proteinuria. Two case summaries were provided with the questionnaire. Of 97 companies, 66 would offer insurance to the patient with hematuria, although 38 (58%) would charge additional premiums. In response to the problem of proteinuria, 61 companies would offer life insurance, although 50 (82%) would require higher premium charges (P < 0.002 compared with hematuria). We conclude that children with asymptomatic hematuria and proteinuria can usually obtain life insurance, although often at higher cost. Invasive diagnostic tests are not necessary for insurers to offer insurance.

Asymptomatic Proteinuria and Hematuria in School Children

A preliminary baseline survey was conducted estimate the prevalance of asymptomatic proteinuria and hematuria in a group of 1770 schoolchildren (778 girls and 992 boys). Urine specimens were collected in the moming and evaluated one hour using Ames Multistick-10 dispticks. Blood reaction positive urine samples with dipsticks were also evaluated microscopically. Hematuria and proteinuria were defined as a condition with more than four red blood cells per high powered field in the sediment of centrifuged urine and greater than 30 mg/d1 values in dipsticks, respectively. The prevalances of hematuria and proteinuria were found as 3.61 % (42 girls and 22 boys) and 5.59 % (51 girls and 48 boys) in a11 children. in six-eleven age population studied (551 girls and boys) the prevalances of hematuria was 2.71 % (20 girls and 10 boys) and proteinuria was 4.53 % (30 girls and 20 boys). in the other group aged twelve-eighteen (227 girls and boys) the prevalances of hematuria and proteinuria were 5.09 % (22 girls and.12 boys) and 7.34 % (21 girls and 28 boys).In the comparision of two groups prevalance of hematuria and proteinuria in the 12-18 age group were significantly higher than the other group.

Nephrotic syndrome.

Renal disease of glomerular origin has three major clinical presentations: asymptomatic hematuria and/or proteinuria; acute nephritic syndrome, characterized by the sudden onset of hematuria, edema, hypertension, and azotemia; and nephrotic syndrome (NS), characterized by the insidious onset of edema with massive proteinuria and hypoalbuminemia. Hypercholesterolemia is considered a traditional part of the nephrotic complex, but its presence is not of diagnostic value.NS may be primary or secondary. The term

Serum IgA-Fibronectin Aggregates in Patients With IgA Nephropathy and Henoch-Schiinlein Purpura: Diagnostic Value and Pathogenic Implications

IgA nephropathy is a common form of glomerulonephritis that has varied clinical expressions, ranging from asymptomatic hematuria to rapidly progressive nephritis. We report the strong association (P less than 0.0001) of circulating IgA-fibronectin aggregates with IgA nephropathy. Of 30 patients with IgA nephropathy, 93.3% had serum IgA-fibronectin aggregates detected with an enzyme immunoassay using collagen as a substrate to bind the aggregates. Among the patients with IgA-fibronectin aggregates were patients with Henoch-Schönlein purpura and recurrent crescentic IgA nephropathy in transplants. Only 11.7% of 103 patients with other types of glomerular disease and 6.7% of normal controls had positive IgA-fibronectin aggregate assay levels. IgA-fibronectin aggregates also were detected in serum using an antifibronectin antibody capture assay; and could be depleted from serum by heparin-agarose affinity chromatography. The circulating IgA-fibronectin aggregates had the same unusual predominance of lambda relative to kappa light chains that is observed in the glomerular deposits of IgA nephropathy. The data indicate that IgA-fibronectin aggregates are a useful serologic marker for IgA nephropathy, Henoch-Schönlein purpura, and recurrent IgA nephropathy in transplants. The presence of fibronectin in the circulating aggregates may play an important role in the preferential deposition of nephritogenic IgA-containing immune complexes in the mesangium of patients with IgA nephropathy.

Indications for Computed Tomography in Children with Blunt Abdominal Trauma

This investigation was undertaken to identify clinical variables, alone or in combination, that could be used to assign children to high- and low-risk categories for intra-abdominal injury following blunt trauma. Six hundred consecutive children who were examined with computed tomography (CT) following blunt trauma were enrolled. Complete data sets were available on 375 children. Stepwise logistic regression was used to identify predictor variables for the presence of abdominal injury. There were 174 children with abdominal injury detected by CT. Of these, 95 were classified as having significant injury. Indicators associated with significantly higher risk of abdominal injury included the following: more than three clinical indications given (odds likelihood ratio [OLR] = 4.60, 95% confidence interval [95% Cl] = 2.29, 9.21, p less than 0.001); gross hematuria (OLR = 5.80, 95% Cl = 2.51, 13.4, p less than 0.001); lap belt injury (OLR = 12.2, 95% Cl = 2.22, 66.8, p less than 0.01); assault or abuse as the mechanism of injury (OLR = 5.08, 95% Cl = 1.07, 24.2, p less than 0.05); abdominal tenderness (OLR = 2.73, 95% Cl = 1.296, 5.82, p less than 0.01); and Trauma Score less than or equal to 12 (OLR = 2.27, 95% Cl = 1.006, 5.13, p less than 0.01). No child with asymptomatic hematuria (n = 56), regardless of grade or neurologic impairment in the absence of abdominal findings (n = 15), had an abnormal CT examination. These data are useful as an adjunct to clinical judgment in triage when the availability of CT equipment is limited or there are competing extra-abdominal injuries.

Primary urinary cytodiagnosis of a bladder small‐cell carcinoma

A small-cell undifferentiated tumor of the bladder in a 69-yr-old man with asymptomatic hematuria is described. Urine cytology showed abundant, small, round-to-oval hyperchromatic cells with coarse chromatin, nuclear molding, and high nuclear/cytoplasmic ratios. A primary cytodiagnosis of small-cell undifferentiated cancer with associated severe urothelial atypia was made. Immunohistochemical stains were negative for neuron-specific enolase, leukocyte common antigen, chromogranin, epithelial membrane antigen, prostatic acid phosphatase, and prostate-specific phosphatase. The diagnosis was confirmed histologically by studies performed on cystoscopic bladder biopsy material.

泌尿器科における癌ウイルス

The advent of molecular biology has made a great progress for HPV research. It is now considered that more than 90% of cervical carcinomas are caused by HPV infection. However, it is the problem that penile lesions associated with cancer-related HPV types are subclinical, resulting in acceleration of HPV transmission by male reservoir. We urologists should make an effort to treat HPV infection and to prevent HPV prevalence. On the other hand, any pathological role of JCV has not been revealed in humans except for PML. Nowadays, it is considered unlikely that there is a pathogenetic relationship between JCV and human tumors. However, since archetypal JCV has been discovered, it has been thought that archetypal JCV receives DNA rearrangements during latency in the kidney by some immunological derangements of the host and is subsequently altered to PML-type JCV. Additionally, there is a possibility that archetypal JCV causes asymptomatic hematuria. More investigation will be necessary for elucidating pathological role of archetypal JCV in the field of urology.

Homozygous C3 Deficiency Associated with IgA Nephropathy

A 23-year-old male patient with homozygous C3 deficiency who developed asymptomatic proteinuria and hematuria was reported. Renal biopsy disclosed typical IgA nephropathy with deposition of early- and late-complement components except for C3 deposition. C9 and membrane attack complex were detected in the glomeruli despite the absence of C3. It was suggested that there might be some unknown complement activation mechanism which does not require C3 component.

Screening for Proteinuria and Hematuria in School Children—Is It Possible to Reduce the Incidence of Chronic Renal Failure in Children and Adolescents?

In this study we evaluated the incidence of chronic renal failure in children with asymptomatic proteinuria and/or hematuria detected by a mass screening program in school and kindergarten. A total of four thousand and three children, aged from 2 to 18 years old was referred to our institute between 1977 and 1990. Of them, 4 cases were AGN, 8 cases Alports' syndrome, 7 cases FGN, 7 cases F(s)GS, 3 cases HSPN, 148 cases IgA nephropathy, 12 cases MN, 24 cases MPGN (including 7 cases of focal type MPGN), 1 case lupus nephritis, and others. Of these children 2 of 8 cases of Alports' syndrome, one of 7 cases of FGS, 6 of 148 cases of IgA nephropathy and none of 24 cases of MPGN developed chronic renal failure. It is true that the incidence of chronic renal failure in children with various kinds of renal disease detected by a mass screening program is lower than that of symptomatic children. However, since we do not have yet any specific treatment in most cases and also since the follow-up period is not long enough, the definite conclusion that a mass screening program can alter the prognosis of children with renal diseases cannot be drawn except for some particular lesions such as MPGN, especially the focal type. Further study including a much larger population of patients is necessary.

Asymptomatic Hematuria in Women-Reply

In Reply . — I appreciate Krane's interest in the subject of microscopic hematuria. My study was essentially stimulated by my lack of discovery of bladder neoplasms in female patients whom I evaluated for asymptomatic microscopic hematuria. I wish to make it clear that all of the subjects of the study were evaluated by their internists prior to being referred to me. None of these patients had any evidence of proteinuria, red blood cell casts, or abnormality in renal function. As a consequence, it was felt by the referring physician that the patient might harbor significant underlying urologic disease, ie, either a bladder or a renal neoplasm. The thrust of my study was to emphasize that I was unable to discover any urologic neoplasms either of the bladder or of the kidney. In essence, I was suggesting that an abbreviated urologic evaluation for female asymptomatic microhematuria might be considered that would

Asymptomatic hematuria in women

Asymptomatic hematuria in women

Asymptomatic Hematuria in Women

To the Editor .—In Bard's 1 recent review of the economic implications of urologic investigation of asymptomatic hematuria in women, he points out the low yield of urologic investigation. Unfortunately, I feel he has done a great disservice to patients with hematuria by suggesting that this problem is usually one of a urologic nature, and ignores the many other causes of hematuria, particularly those that are glomerular in origin. 2 The glomerular origin of hematuria is suggested from the urinalysis by the presence of proteinuria, red blood cell casts, or dysmorphic red blood cells. This study makes no mention of renal function, the degree of proteinuria, if any, and dismisses the ability to differentiate glomerular bleeding from other causes by phasecontrast microscopy of red blood cell morphology. Fairley and Birch 3 clearly described their technique for identifying glomerular bleeding in 1982, a practice commonly employed by nephrologists. This article suggests

Diagnosis of malignancy in the urinary tract and prostate gland from the aspect of hematuria

During the 10 years from 1979 to 1988, 245 patients with urinary tract or prostate gland malignancy were diagnosed and treated at our Department. 245 malignancies were composed of 5 groups, i.e., 50 renal cell carcinomas (RCC), 17 renal pelvic and ureteral tumors (RPUT), 117 bladder tumors (BLT), 59 prostate carcinomas (PRC) and 2 urethral carcinomas (URC). On the basis of chief complaint or reason leading to diagnosis, and of grade of hematuria, evaluation was performed in 4 groups except for group URC. With regard to the chief complaint or reason leading to diagnosis, asymptomatic gross hematuria was most frequently seen at 40%, 59% and 74% in groups RCC, RPUT and BLT, respectively. In group PRC, asymptomatic gross hematuria was seen at 8%, although dysuria and urinary retention were the most popular. Regarding grade of hematuria at the first visit, urine without any RBC (55%) and microscopic hematuria (39%) were the commonest in group RCC, while moderate degree of microscopic hematuria (5-20/hpf) was most frequently seen in group RPUT (44%). On the contrary, gross hematuria (38%) was the commonest in group BLT. Patients in group PRC showed gross and microscopic hematuria at 25%, though it was not the commonest one. In conclusion, it should be noted that no RBC may be seen on the first visit even if the chief complaint was gross hematuria in patients with urinary tract malignancy.

多発性尿路上皮腫瘍を合併した後天性多嚢胞化腎の1例

A 41-year-old miller undergoing hemodialysis for 9 years presented with recurrent episodes of asymptomatic gross hematuria of a 7 years' duration and left flank pain with slight fever of a four months' duration. CT scans revealed bilateral acquired cystic disease of the kidney (ACDK) and a mass (phi 4 cm) in the medial portion of the left kidney, which was angiographically a hypovascular tumor. Cystoscopic examination revealed multiple papillary tumors arising from the entire bladder wall. These findings suggested that the renal mass was a renal pelvic tumor. Bilateral nephroureterectomy with left paraaortic lymph nodes dissection and radical cystectomy were carried out, followed by urethrectomy two weeks later. Histologically, multiple papillary transitional cell carcinomas with G2 greater than G3 anaplasia were found in the left renal pelvis, the lower portion of the left ureter and the bladder. The tumors were predominantly superficial, although the renal pelvic one focally invaded into the muscular layer. Lymph node metastasis and renal cell carcinoma were not recognized. Postoperative course was uneventful with normal blood pressure, though anemia was slightly progressive. He has been free of disease for six months.

Identification of the source of haematuria by automated measurement of red cell volume.

The mean corpuscular volume (MCV) of urinary erythrocytes was measured by a Coulter Counter in 42 patients with asymptomatic haematuria. All patients had the source of haematuria established by a renal biopsy, cystoscopy or radiology. The mean urine MCV was significantly less in those with glomerular disease (n = 21) than in those with non-glomerular haematuria (n = 21). In every patient with glomerulonephritis, urinary erythrocytes were smaller than those in their own venous blood. Conversely, urinary red cells larger than venous blood were confined to patients with a non-glomerular source. Coulter analysis of urine provides a simple and objective aid to the diagnosis of haematuria.

The Significance of Adult Hematuria: 1,000 Hematuria Evaluations Including a Risk-Benefit and Cost-Effectiveness Analysis

Between March 1976 and June 1985, 1,000 consecutive adults with asymptomatic gross or microscopic hematuria in the absence of proteinuria were evaluated urologically. Lesions that could account for the hematuria were detected in 88.3 per cent of the patients. Life-threatening lesions were diagnosed in 9.1 per cent of the patients, while lesions requiring at least observation were present in 22.8 per cent.The incidence of life-threatening lesions increased with age, with a sharp increase after age 50 years. Life-threatening lesions were more common in men (13.6 per cent) than in women (4.9 per cent). In general, as the degree of hematuria increased so did the yield of life-threatening lesions; however, there was no “safe” lower limit of hematuria. Of the patients with life-threatening lesions 18.6 per cent had at least 1 urinalysis with less than 3 red blood cells per high power field within 6 months of the diagnosis.The direct medical cost of a hematuria evaluation was $777. The difference in direct medical costs to diagnose and treat localized versus metastatic genitourinary cancer was $48,070 in 3 matched pairs of patients. In this study group 77 of 84 patients (92 per cent) diagnosed with genitourinary cancer had localized disease. A hematuria evaluation was cost-effective for all groups studied.A literature-based estimate of the life-threatening risks of diagnostic studies applied to the study data resulted in a 1.1 per cent life-threatening risk per hematuria evaluation. For all categories studied, except for women less than 40 years old with microscopic hematuria, the risk of a hematuria evaluation was less than the incidence of life-threatening lesions discovered as a result of the evaluation. Asymptomatic hematuria, whether gross or microscopic, is a significant finding and warrants evaluation from a risk-benefit and cost-effectiveness standpoint.