Significant Microscopic Hematuria Research Articles

Prognostic value of preoperative microscopic hematuria in patients with non-metastatic renal cell carcinoma who underwent nephrectomy.

Microscopic hematuria is associated with various urinary system diseases and is commonly used for the diagnosis of these conditions. Its prognostic role in non-metastatic renal cell carcinoma (RCC) patients who underwent nephrectomy remains unclear. A retrospective analysis of non-metastatic RCC patients who underwent nephrectomy in West China Hospital of Sichuan University from 2011 to 2013 was performed. Significant microscopic hematuria (SMH), defined as a threshold with a significant impact on disease-free survival (DFS) and overall survival (OS), was determined by Kaplan-Meier curves and the Maximally Selected Log-Rank Statistic. Kaplan-Meier curves were then used to estimate patients' DFS and OS, and the log-rank test was used to examine statistical significance. Logistic regression was utilized to identify clinical-pathological factors associated with SMH, while Cox regression was employed to determine independent factors of survival. A total of 773 patients were included, and 20 red blood cells per high-power field was identified as the cutoff of SMH, of which 90 patients had preoperative SMH (11.6%) and 683 patients (88.4%) did not. Larger tumor size (OR = 1.10 [per cm], 95% CI 1.01-1.19, p = 0.036) and higher Fuhrman grade (grade 3 vs. grade 1-2, OR = 1.76, 95% CI 1.09-2.83, p = 0.02; grade 4 vs. grade 1-2, OR = 2.15, 95% CI 0.73-6.31, p = 0.164) were predictors of SMH. Compared to non-SMH patients, SMH patients had poorer DFS (HR = 3.16, 95% CI 2.07-4.83, p < 0.001) and OS (HR = 2.11, 95% CI 1.34-3.32, p = 0.001). In summary, preoperative SMH is associated with larger tumor size and higher Fuhrman grade, and it is also independently correlated with poorer DFS and OS in non-metastatic RCC patients who underwent nephrectomy.

Urinary tract infection in nephrotic syndrome in pediatric age group: a hospital based cross-sectional study

Background: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population. Aim of this study were to find out the prevalence of Urinary Tract Infection (UTI) in nephrotic syndrome, bacterial etiologies and antibiotic sensitivity pattern.Methods: After matching the criteria, 82 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution based cross-sectional descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on inclusion exclusion criteria was included in this study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23).Results: Among 82 participants evaluated with nephrotic syndrome 29.3% participants had UTI, majority 66.7% were asymptomatic and 33.3% were symptomatic. Significant microscopic hematuria were found in 20.7% study subjects and significant pyuria were found in 58.54% study subjects. Majority of UTI caused by E.coli 33.3% followed by Klebsiella 25%, Proteus 16.7%, Staphylococcus aureus 12.5%, Citrobacter, Acinetobacter and mixed growth were found in 4.2% each. Mean serum cholesterol of group with UTI was 422.13±34.65 and group without UTI was 307.43±26.13. The variation amongst the two groups were found to be significant (p=0.0001).Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic, often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.

COL4A2 mutation causing adult onset recurrent intracerebral hemorrhage and leukoencephalopathy

Type IV collagen α1 and α2 chains form heterotrimers that constitute an essential component of basement membranes. Mutations in COL4A1, encoding the α1 chain, cause a multisystem disease with prominent cerebrovascular manifestations, including porencephaly, bleeding-prone cerebral small vessel disease, and intracranial aneurysms. Mutations in COL4A2 have only been reported in a few porencephaly families so far. Herein, we report on a young adult patient with recurrent intracerebral hemorrhage, leukoencephalopathy, intracranial aneurysms, nephropathy, and myopathy associated with a novel COL4A2 mutation. We extensively investigated a 29-year-old male patient with recurrent deep intracerebral hemorrhages causing mild motor and sensory hemisyndromes. Brain MRI showed deep intracerebral hemorrhages of different age, diffuse leukoencephalopathy, multiple cerebral microbleeds and small aneurysms of the carotid siphon bilaterally. Laboratory work-up revealed significant microscopic hematuria and elevation of creatine-kinase. Genetic testing found a de novo glycine mutation within the COL4A2 triple helical domain. The presented case completes the spectrum of cerebral and systemic manifestations of COL4A2 mutations that appears to be very similar to that in COL4A1 mutations. Therefore, we emphasize the importance of screening both COL4A1 and COL4A2 in patients showing recurrent intracerebral hemorrhage of unknown etiology, particularly if associated with leukoencephalopathy.

Canadian guidelines for the management of asymptomatic microscopic hematuria in adults

Microscopic hematuria is a frequent reason for referral to urology. It is often found incidentally as a result of routine examination in patients without urinary tract symptoms. Although there is generally no debate about the need to fully investigate patients with gross hematuria, there is often controversy regarding the approach to the patient with asymptomatic microscopic hematuria. The main issues disputed are related to the detection and definition of significant microscopic hematuria, which patients should be investigated, and how should they be evaluated. In 1998, the Canadian Urological Association published patient guidelines for asymptomatic hematuria.1 A decade has passed since the initial development of these principles. Thus, the CUA Patient Guidelines Committee has been given the mandate from the CUA to update the asymptomatic microscopic hematuria patient guidelines.

Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system.

Hematuria is one of the most common findings on urinalysis in patients encountered by primary care physicians. In many instances it can also be the first presentation of a serious urological problem. As such, we sought to evaluate current practices adopted by primary care physicians in the workup and screening of hematuria. Questionnaires were mailed to all registered primary care physicians across Quebec. Questions covered each physician's personal approach to men and postmenopausal women with painless gross hematuria or with asymptomatic microscopic hematuria, as well as screening techniques, general knowledge with regards to urine collection and sampling, and referral patterns. Of the surveys mailed, 599 were returned. Annual routine screening urinalysis on all adult male and female patients was performed by 47% of respondents, regardless of age or risk factors. Of all the respondents, 95% stated microscopic hematuria was associated with bladder cancer. However, in an older male with painless gross hematuria, only 64% of respondents recommended further evaluation by urology. On the other hand, in a postmenopausal woman with 2 consecutive events of significant microscopic hematuria, only 48.6% recommended referral to urology. Findings were not associated with the gender of the respondent, experience or geographic location of practice (urban vs. rural). There seems to be reluctance amongst primary care physicians to refer patients with gross or significant microscopic hematuria to urology for further investigation. A higher level of suspicion and further education should be implemented to detect serious conditions and to offer earlier intervention when possible.

Renal trauma: a practical guide to evaluation and management.

1. Blunt trauma and gross hematuria. Gross hematuria is the most reliable indicator for serious urological injury. The degree of hematuria, however, does not correlate with the degree of injury. In fact, renal pedicle avulsion or acute thrombosis of segmental renal arteries can occur in the absence of hematuria while renal contusions can present with gross hematuria. 2. Blunt trauma, microscopic hematuria and shock. Significant microscopic hematuria is >5 RBC/HPF in the first voided or catheterized specimen. Shock is any presence of systolic blood pressure <90 during transport or upon arrival in the emergency room. Blunt trauma patients with microhematuria and no shock have minor renal injuries in nearly all cases. Miller and McAninch, based on findings in over 2000 blunt renal trauma injuries determined that in <0.2% of cases will a grade 2 or more severe renal injury be missed. These patients are the victims of multiple trauma and thus during the evaluation of other intra-abdominal injuries, most of the missed major renal injuries will be detected. When patients who were imaged for associated intra-abdominal injuries are included only 0.03% of significant renal injuries were not identified. 3-5 3. Major deceleration injury. The kidney primarily floats free in a bed of fat contained within the envelope of Gerota's fascia. The kidney is fixed at only two points, the ureter and the vascular pedicle. Because of poor fixation, the kidney can be easily dislocated by sudden acceleration or deceleration. Kidney dislocation can result in tearing of the collecting system at the ureteropelvic junction (UPJ) or tearing of renal artery intima, resulting in partial to complete vessel occlusion. Such injuries can occur with major deceleration, as in head-on motor vehicle accidents (MVA) or

Microscopic hematuria and calculus-related ureteral obstruction

The evaluation of patients with ureteral calculi in the emergency department has historically included urinalysis (UA) and intravenous pyelograms (IVP). This retrospective study was done to determine if a statistically significant relationship existed between the degree of calculus-related ureteral obstruction, proven by IVP, and the presence or absence of microscopic hematuria. Urine red blood cells were recorded as less than 3 rbc/hpf (negative) or greater than or equal to 3 rbc/hpf (positive). IVPs were recorded as nonsevere or severe. IVP criteria were based on the presence or absence of extravasation, greater than 2-hour ureteral filling times, and a numerical scoring system of 1 to 4 for ureteral or calyceal dilatation and nephrogenic effect. Eighty-nine men (72%) had non-severe obstructions and 34 (28%) had severe obstructions. Twenty-five women (68%) had nonsevere obstructions and 12 (32%) had severe obstructions. Of the 28 patients with normal UAs, 11 had severe ureteral obstructions and 17 had nonsevere ureteral obstructions. There were no statistically significant differences between the presence or absence of significant microscopic hematuria and the presence or absence of severe ureteral obstruction. Microscopic hematuria is neither sensitive nor specific in determining the degree of calculus-related ureteral obstruction.

Hematuria and Cholethiasis With β-Thalassemia

To the Editor.— Since the report of Goodwin et al 1 in 1950 of painless hematuria associated with sickle cell hemoglobinopathy, numerous reports have confirmed the phenomenon in both sickle cell (SS) trait and SS disease. Gunnels and Grim 2 have reported painless hematuria in A/D hemoglobinopathy. We have previously reported a case of recurrent painless hematuria in a patient with hemoglobin C trait. 3 The present report concerns a child with painless hematuria who had β-thalassemia trait associated with silent gall stones. A 5-year-old black American child was found on routine preschool examination to have significant microscopic hematuria. Complete urological evaluation revealed no abnormality but x-ray films showed radiopaque gall stones. Results of hematological evaluation included a hemoglobin level of 10.8 gm/100 ml, normal bilirubin level, and normal reticulocyte count. Hemoglobin electrophoresis however revealed an A 2 hemoglobin value of 4.3%. Analysis of the parents revealed normal hematograms for both