Hematuria In Children Research Articles

Detection of Alport gene variants in children and young people with persistent haematuria.

Genetic kidney disease is an important cause of persistent microscopic haematuria in children and young people. We aimed to determine the frequency of variants in the Alport syndrome genes (COL4A3, COL4A4 or COL4A5) in individuals under 18 years of age presenting with persistent microscopic haematuria to a single specialist centre in the UK over a 10-year period. We conducted a retrospective longitudinal study of individuals referred to a tertiary paediatric nephrology service with persistent microscopic haematuria between April 2012 to 2022. A total of 224 individuals (female 51.8%) were evaluated with persistent microscopic haematuria of greater than 6 months duration. The age at presentation was 7.5 ± 4.3 years (mean ± SD) with a duration of follow-up of 6.8 ± 4.6 years (mean ± SD). Targeted exome sequencing was performed in 134 individuals and 91 (68%) had a pathogenic or likely pathogenic variant in COL4A3, COL4A4 or COL4A5. Only 49.5% of individuals with identified variants had a family history of microscopic haematuria documented and 37.4% (34/91) had additional proteinuria at presentation. COL4A5 was the most common gene affected and missense variants affecting glycine residues were the most common variant type. Over two-thirds of children and young people who underwent genetic testing had an identifiable genetic basis for their microscopic haematuria and over half did not have a documented family history. Genetic testing should be part of the evaluation of persistent microscopic haematuria despite a negative family history.

Evaluation and Management of Hematuria in Children

Evaluation and Management of Hematuria in Children

Investigating hematuria among young Indian adults using MDCT urography.

Hematuria may suggest bladder cancer, renal cell carcinoma, UUT-UCC, or urinary tract stones. Therefore, it is of interest to use Multi-Detector Computed Tomography (MDCT) to determine the cause of hematuria in children and connect MDCT results with cystoscopic and histological findings. The study included 110 young people under 40 with microscopic or macroscopic hematuria. A clinical exam and complete history were recorded. MDCT data from non-contrast and contrast-enhanced scans were properly documented. Histopathological and cystoscopic findings were noted alongside MDCT data when appropriate. The study's typical patient was 26 years old, 66% male. Eighty of the cases had hematuria as the cause. In 66 of 80 individuals, renal or ureteric calculi were the most common clinically relevant outcomes. There were four renal and four UB masses. Two cases of renal papillary necrosis and four of pyelonephritis/renal abscess were identified. MDCT diagnosed renal and vesical masses 100% accurately. MDCT can diagnose and treat hematuria, especially in young men, according to one study. The findings emphasize clinical awareness and targeted diagnosis. Further research is needed to determine hematuria causes and prevention across demographics.

Hematuria in children: causes and evaluation

Hematuria is the presence of blood in the urine and is classified as either gross hematuria or microscopic hematuria. There are many causes of hematuria, and the differential diagnosis depends on the presence or absence of comorbidities and whether it is glomerular or non-glomerular. When hematuria in children is symptomatic or persistent, an evaluation of the cause is essential. The causes of hematuria and basic approaches to its diagnosis are discussed in this review.

Asymptomatic hematuria in children: Korean Society of Pediatric Nephrology recommendations for diagnosis and management.

Hematuria is a relatively common condition among school-aged children. Because international guidelines for asymptomatic hematuria in children are unavailable, developing practical guidelines for the diagnosis and management of asymptomatic hematuria based on scientific evidence while considering real-world practice settings, values, and patient and physician preferences is essential. The Korean Society of Pediatric Nephrology developed clinical guidelines to address key questions regarding the diagnosis and management of asymptomatic hematuria in children.

Clinical pattern and outcome of hematuria in children – A prospective follow-up study from South India

Background: Hematuria is defined by the presence of an increased number of red blood cells (RBCs) in the urine. It can be visible or apparent only on microscopic analysis of urine which many times is an incidental finding. The prevalence of microscopic hematuria is 4–5% in routine clinical practice in children of 6–12 years of age. The pediatrician is the first person who comes in contact with children having microscopic or gross hematuria. Updated knowledge of clinical patterns and their outcomes will help improve the management of children with hematuria. Aim and Objective: The aim and objectives are to study the outcome of hematuria in children attending SAT Hospital, Government Medical College, Thiruvananthapuram. Materials and Methods: This is a prospective follow-up study of 100 children admitted with hematuria in our hospital whose ages were between 1 month and 12 years. A preformed and piloted questionnaire was used. Clinical history and examinations were done. Relevant investigations and follow-up assessments were done for 1 year. Biopsy was done for 35 patients by an experienced pediatric nephrologist. Results: Among the 100 children presented with hematuria, 24 had prior renal disease whereas 76 children did not have any pre-existing renal disease. Both were followed up for 1 year. 80% (45) of those without prior renal involvement cleared of hematuria by 1 year and 20% had persistent renal impairment. In the other group with prior renal problems, 75% (15) showed persistent renal problems. School-going children (57%) were mostly affected with female preponderance (30%). The most common etiology was acute post-infectious glomerulonephritis (60%), and the next most common seems to be IgA nephropathy (23%) followed by SLE (17%) Conclusion: Eighty percent of hematuria was found to be resolved completely after 1 year. The remaining 20% has to be carefully evaluated including renal biopsy when indicated. This will help the clinician to provide better care for sick babies with hematuria.

HAEMATURIA DETECTABLE IN OUTPATIENT CHILDREN AND TEENAGERS: THE FREQUENCY AND POSSIBLE REASONS

Determining the cause of haematuria in children often causes significant difficulties, especially for outpatients, due to the large number of diseases with increased quantity of red blood cells in urine and complexity of such patients examination.
 The frequency and features of haematuria have been defined in outpatient children and teenagers. The frequency of haematuria in 2018-2021 was on average 4,5 %, increasing significantly from 2,4 % in 2018 to 8,3 % in 2021. The most cases of haematuria after a hot summer can relate to increased concentration of salt components in urine due to insufficient drinking intake. Haematuria identified in outpatient children was not a manifestation of severe diseases with poor prognosis (tumors, tuberculosis). It was small, transient, and disappeared in most patients after increased fluid intake, nutrition and physical activity correction, antibacterial medicines and phytotherapy appointment in urinary tract infection

Bladder Rhabdomyosarcoma: A Case Report

Tumors of the urogenital sinus in children are very rare. Rhabdomyosarcoma is the most common tumor. In girls, it includes tumors of the uterus, vagina, cervix, vulva and bladder. Rhabdomyosarcomas account for 8℅ of all pediatric malignancies. Rhabdomyosarcoma of the bladder is a rare condition. We report an observation of a bladder rhabdomyosarcoma in a one-year-old girl, who consulted for hematuria with impaired renal function. The aim of this paper is to review the clinical symptomatology and radiological appearance of this condition in children, following a literature review of the condition, and to discuss therapeutic options. Rabdomyosarcoma should be considered in the presence of dysuria associated with hematuria in children. Its diagnosis is suspected by imaging and confirmed by anatomopathology.

PD34-12 THE ROLE OF MICROSCOPIC HEMATURIA IN SYMPTOMATIC CHILDREN WITH SUSPECTED URINARY STONES

You have accessJournal of UrologyCME1 Apr 2023PD34-12 THE ROLE OF MICROSCOPIC HEMATURIA IN SYMPTOMATIC CHILDREN WITH SUSPECTED URINARY STONES Yossi Ventura, Roi Babaoff, Dimitry Hunovich, Tal May, David Ben meir, David A lifshitz, and Roy Morag Yossi VenturaYossi Ventura More articles by this author , Roi BabaoffRoi Babaoff More articles by this author , Dimitry HunovichDimitry Hunovich More articles by this author , Tal MayTal May More articles by this author , David Ben meirDavid Ben meir More articles by this author , David A lifshitzDavid A lifshitz More articles by this author , and Roy MoragRoy Morag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prevalence of pediatric stone disease has increased over the last few decades. In children, the clinical attributes are not typical and require a high index of suspicion for correct diagnosis. We aimed to evaluate the role of microscopic hematuria as a diagnostic tool in children presenting with symptomatic urinary stones compared to the adult population. METHODS: A retrospective review of consecutive cases of suspected symptomatic urinary stones between 2016-2021 at a pediatric referral center's emergency department. Collected data included: medical history, clinical symptoms, laboratory, and radiological findings. We compared the prevalence of microscopic hematuria in children with radiologically confirmed urinary stones to a similar adult cohort and examined the associations between microscopic hematuria and the clinical, laboratory, and radiological findings in children. RESULTS: Of 184 patients reviewed, ninety-four children were diagnosed with symptomatic urinary stones confirmed by ultrasound (55%) or computed tomography (45%). Median age was 10 years (IQR 6-15) and 55% were males. Compared to an adult cohort [n=90, median age 52 years (IQR 41-65)], microscopic hematuria prevalence was significantly lower in children (62.8 vs. 82%, p=0.005). Reported clinical symptoms included flank/abdominal pain (47%), hematuria (27.7%), fever (21.3), and LUTS (12.8%). Children who presented with flank/abdominal pain and concurrent fever were associated with lower rates of microscopic hematuria on multivariate analysis [OR=0.24 (CI 0.06-0.089), p=0.03]. CONCLUSIONS: Microscopic hematuria prevalence is significantly lower in the pediatric population compared to the adult population and should not be used as a single guide to further evaluation when urinary stones are suspected. Source of Funding: no sources © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e925 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yossi Ventura More articles by this author Roi Babaoff More articles by this author Dimitry Hunovich More articles by this author Tal May More articles by this author David Ben meir More articles by this author David A lifshitz More articles by this author Roy Morag More articles by this author Expand All Advertisement PDF downloadLoading ...

Hydroxychloroquine Ameliorates Hematuria in Children with X-Linked Alport Syndrome: Retrospective Case Series Study.

As a rare collagen type IV hereditary kidney disease, X-linked Alport syndrome (XLAS) is the most common form of Alport syndrome, the prevalence of which is estimated at 1:10,000 of the population, four times higher than the prevalence rate of autosomal recessive Alport syndrome. To describe a series of eight XLAS children with persistent hematuria and proteinuria and the clinical outcomes after hydroxychloroquine (HCQ) treatment to assess its efficacy as early intervention. The study retrospectively analysed 8 patients with persistent hematuria and proteinuria at different onset ages who were diagnosed with XLAS and been treated with HCQ. The urinary erythrocyte count, urinary albuminn were measured. Descriptive statistics were used to estimate the patients' responses to HCQ treatment after one month, three months, and six months. After the first month, the three months, and the six months of HCQ treatment, the urinary erythrocyte counts of four, seven, and eight children were significantly reduced; the decreasing proteinuria was found in two, four, and five children. Only one child with increasing proteinuria was found after 1-month HCQ treatment. This proteinuria was maintained after 3-month HCQ treatment but decreased to minor after 6-month HCQ treatment. We present the first potential efficacy of HCQ treatment in XLAS with hematuria and persistent proteinuria. It suggested that HCQ could be an effective treatment to ameliorate hematuria and proteinuria.

Clinical and diagnostic utility of genomic sequencing for children referred to a Kidney Genomics Clinic with microscopic haematuria.

Microscopic haematuria in children is associated with the risk of progression to chronic kidney disease. Genetic disease is an important potential aetiology. Genomic sequencing presents the most effective diagnostic route for these conditions, but access remains inequitable internationally. We conducted a retrospective review of the electronic medical records of a Kidney Genomics Clinic (KGC) from January 2016 to December 2021. Sixty patients were referred to the KGC with haematuria over this period. Forty-three percent of patients had analysis of a limited haematuria panel (COL4A1, COL4A3, COL4A4, COL4A5, MYH9) with 58% receiving a genetic diagnosis. Forty-two percent of referred patients had further analysis of genes implicated in the development of kidney disease, and 36% received a diagnosis. Eight percent of patients underwent cascade testing for a known familial variant, and all received a diagnosis. Children with the highest levels of haematuria (> 500 × 106/L red blood cells) had the highest diagnostic yield (67%). Proteinuria, defined as a urinary protein to creatinine ratio > 20, increased the diagnostic yield from 31 to 65%. Importantly, negative genetic analysis can still have significant clinical utility for patients by altering surveillance and further management; the genetic result had clinical utility in 60% of patients. Our KGC review highlights the substantial clinical utility and diagnostic yield of genomic analysis for microscopic haematuria in paediatric patients. Whilst the management of variants of uncertain significance can be challenging, a multidisciplinary team including genetic counselling can help ensure these patients are followed up meaningfully. A higher resolution version of the Graphical abstract is available as Supplementary information.

Bladder hemangiomas: A rare cause of persistent gross hematuria in children

Bladder hemangiomas: A rare cause of persistent gross hematuria in children

CLINICAL AND BIOLOGICAL ASPECTS OF HEMATURIA IN CHILDREN

  Introduction: Hematuria is very common in childhood but if it persists in multiple urine examinations it deserves further detailed evaluation. Hematuria is an increased excretion of erythrocytes in the urine. It can be macroscopic or microscopic. It is a finding of more than 5 erythrocytes/ hpf in the urine sediment.This study aims to analyze demographic and etiological characteristics of hematuria in children, to determine the diagnostic value of urine calcium, proteinuria and ultrasound findings in both forms of hematuria, microscopic and macroscopic. Material and methods: The study includes 150 children aged 1-16 years, with confirmed hematuria in the period January 2020 - February 2022 at the University Children’s Hospital - Skopje. Patients are divided into two groups: the group with macroscopic and the group with microscopic hematuria. The two groups are compared in terms of ultrasound findings, urine calcium and proteinuria. Familial urinary screening for hematuria was also performed. Results: From 150 children 59.33% had microscopic and 40.67% macroscopic hematuria. The most common proven etiology in microscopic hematuria is familial hematuria (34.83%) while in macroscopic hematuria the most common cause is glomerulonephritis (39.34%). Hypercalciuria was found in 5 (6%) of the examined children. Proteinuria is significantly higher in the gross hematuria group. Of the 80 screened families, 35 found a familial form of hematuria. Conclusion: This study indicates the frequency of familial hematuria and the importance of familial screening. The values of urine calcium and ultrasound finding do not have a statistically significant difference between the two groups while proteinuria is higher in macroscopic hematuria (p <0.05). Key words: hematuria, macroscopic, microscopic, children.       &nbsp

Клиническая оценка детей с гематурией на уровне первичной медицинской помощи

Гематурия — это наличие пяти или более эритроцитов в трех последовательных анализах мочи, полученных с интервалом в одну неделю. На уровне первичной медицинской помощи врач должен уметь распо­знать и подтвердить наличие гематурии, предположить ее возможные причины, провести отбор пациентов, которые потенциально могут иметь тяжелое заболевание мочевой системы. Алгоритм оказания первичной медицинской помощи при гематурии у детей зависит от ее клинического варианта: макрогематурия, симптоматическая микрогематурия, асимптоматическая микрогематурия с протеинурией, асимптоматическая изолированная микрогематурия. Детям с макрогематурией показано следующее обследование: общий анализ мочи, общий анализ крови, креатинин сыворотки, соотношение кальций/креатинин в разовой моче, УЗИ почек и мочевого пузыря. Если в результате уточнения жалоб, анамнеза, объективного и дополнительного обследования причина макрогематурии не установлена, ребенка следует направить к детскому нефрологу. Оценка детей с симптоматической микрогематурией направлена на выявление общих (лихорадка, недомогание, боль в животе и др.), неспецифических (сыпь, артрит, желтуха, респираторные, желудочно-кишечные симптомы и др.) и специфических для мочевой системы (дизурия, поллакиурия, недержание мочи, энурез, отеки, артериальная гипертензия) симптомов. Наличие гематурии в сочетании с протеинурией у детей чаще всего предполагает гломерулярное происхождение гематурии. Бессимптомные пациенты, у которых сохраняются гематурия и протеинурия в течение 2–3 недель, должны быть направлены к детскому нефрологу для дальнейшего обследования. Бессимптомная изолированная микрогематурия является наиболее распространенным вариантом гематурии у детей, обычно кратковременным и, как правило, не связанным с тяжелым почечным заболеванием. Наиболее распространенными причинами персистирующей более шести месяцев асимптоматической микрогематурии являются IgA-нефропатия, болезнь тонких базальных мембран, менее частыми — наследственный нефрит (синдром Альпорта), гиперкальциурия, инфекция мочевых путей. На этапе дообследования и дальнейшего наблюдения детей с асимптоматической изолированной микрогематурией оптимальным лекарственным средством является фитониринговый препарат Канефрон® Н.

Determination of prevalence of asymptomatic proteinuria and haematuria in 5-15 year aged school children in southern India

Background: Chronic renal diseases remain major cause of morbidity and mortality in young children. Although idiopathic nephrotic syndrome takes on chronic course other histopathological variants can lead to rapid progression of disease. Proteinuria in children can be physiological. Hematuria in children is always should be investigated. Persistent proteinuria in children should be investigated for any significant progressive renal disease after excluding orthostatic proteinuria. Although many countries adopt high risk screening in pediatric age group many eastern countries advocate school screening for asymptomatic proteinuria and hematuria using dipstick urine screening.Methods: A 6 month cross sectional study of asymptomatic children aged 5-15 years in metropolitan school for dipstick urine analysis for proteinuria and hematuria.Results: The ratio of male and female children in the study is 1.2:1 (total-1999, male-1056, and female-934). Age group ranged from 5 to 15 with mean 12.13 and standard deviation (SD)-2.46. Maximum number of students in the study are above 10 years of age. Children with isolated asymptomatic proteinuria have significant differences due to their sex (p value-0.005) and hematuria (p value-0.007). Prevalence of asymptomatic proteinuria is 9.8% and hematuria is 1.05%. Prevalence of persistent proteinuria is 1.35%.Conclusions: Prevalence of asymptomatic proteinuria and hematuria can be determined using dipstick urine analysis in school children. Mass screening is cost effective and feasible only if persistent cases of proteinuria are followed up, ruling out orthostatic proteinuria. Although study is feasible, it is cumbersome. High risk screening is the best cost effective method.

Hematuria in Children with Spinal Injury

The presence of red blood cells (RBCs) in urine is hematuria, even in microscopic amounts alarms the patient and parents of the patient, and often prompts physician for many laboratory investigations. Hematuria can be red, dark or cola-colored, or brown known as macroscopic hematuria, and when it is not visible to the unaided eye, it is known as microscopic hematuria. RBCs in urine is one of the most important signs of genitourinary tract disease; however, it is almost never a cause of anemia, since few drops (1 mL) of blood can turn 1 L of urine into red-colored urine. Overall the physician should be alert enough not to overlook serious conditions like neoplasms and underlying bleeding disorder, to avoid unnecessary and often expensive laboratory studies. This article provides an approach to the evaluation and management of hematuria in children, and the detection of preventable and treatable conditions at the earliest to limit the disease progression, and an overall reduction in cost, energy, and anxiety. The patients are spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of postvoid residual urine, uroflowmetry, and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy, and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life. Keywords: Children; Kidneys, bladder, neurogenic, injuries, spinal cord, spinal cord disorders, ; RBC cast; Red blood cells; Urine, ASIA (American Spinal Injury Association)

Haematuria in children.

Haematuria is a common finding in children and can be macroscopic or microscopic. In contrast to adults, haematuria in children very rarely indicates an underlying malignant pathology. The differential diagnosis is broad, with the most common underlying causes being infection, glomerulonephritis and hypercalciuria. It is useful to distinguish between nephrological or upper urinary tract and lower urinary tract pathologies, as this will guide investigations and referral. This review discusses the causes of haematuria in the paediatric population.

Therapeutic Efficacy of Vitamin A in the Treatment of Idiopathic Microscopic Hematuria in Children

Background: Hematuria is a symptom with a prevalence of 0.5% to 2% in those aged 5 - 12 years. Different factors can influence the severity of hematuria, including vitamin A (as a micronutrient). Objectives: The current study aimed to evaluate the therapeutic effect of vitamin A on hematuria in children. Methods: In this clinical trial study, 156 children aged 5 - 12 years with Idiopathic Microscopic Hematuria are studied. Participants were divided into two groups of treatment and control (each with 76 subjects). Those in the treatment group received vitamin A as a pearl of 25000 in 14 days, in addition to the routine treatment. The control group only received routine handling. The basic information of patients were recorded using an author-develop form by the supervisor and intern. Urine samples were collected on 14, 28, and 42 days. Data were analyzed using SPSS. Statistical significance was considered when P-value < 0.05. Results: There was no significant difference between the two groups concerning gender (P = 0.202), age (P = 0.330), father's education (P = 0.152), mother's education (P = 0.392), father's occupation (P = 0.125), mother's occupation (P = 0.265), and numbers of children in the family (P = 0.209) variables. Hematuria status on days 14 (P = 0.014), 28 (P = 0.001), and 42 after treatment (P = 0.001) was statistically more positive in the vitamin A group. Hence, there was a significant difference between the two groups. Conclusions: Vitamin A can reduce idiopathic microscopic hematuria. Hence, vitamin can be used as an alternative treatment to treat idiopathic hematuria in children.

Clinico-Etiologic Profile of Macroscopic Hematuria in Children: A Single Center Experience

To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital. This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria. Of the 62 children (44 males) enrolled, (mean (SD) age of 7.3 (2.6) years), glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies. Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.

Haematuria in children

Haematuria in children can be associated with many illnesses, from the benign and self-limiting to the more complex and life-threatening. The most common form of haematuria in children is microscopic haematuria. Visible blood (also termed frank haematuria) is an uncommon, but often very distressing, finding for child and parent. Although the majority of cases are benign or less serious, it is important to identify those patients requiring referral to secondary care for further investigation and management. It is equally important to identify patients for diagnosis and appropriate management in primary care.