A Review on Hematuria in Children

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Abstract

Asymptomatic hematuria is very common in pediatric and adolescent patients. In contrast to painless hematuria in adults, the differential diagnosis and investigative modalities in the pediatric population is vastly different. This article presents the major diseases that may cause hematuria in children and suggests an evaluation algorithm for the pediatric urologist.

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Most cited references 20

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Renal abnormalities in sickle cell disease.

E Orringer, Kenneth I Ataga (2000)

Sickle cell anemia and the related hemoglobinopathies are associated with a large spectrum of renal abnormalities. The patients have impaired urinary concentrating ability, defects in urinary acidification and potassium excretion, and supranormal proximal tubular function. The latter is manifest by increased secretion of creatinine and by reabsorption of phosphorus and beta(2)-microglobulin. Young patients with sickle cell disease (SCD) have supranormal renal hemodynamics with elevations in both effective renal plasma flow (ERPF) and glomerular filtration rate (GFR). These parameters decrease with age as well as following the administration of prostaglandin inhibitors. Proteinuria, a common finding in adults with sickle cell disease, may progress to the nephrotic syndrome. Proteinuria, hypertension, and increasing anemia predict end-stage renal disease (ESRD). While ESRD can be managed by dialysis and/or renal transplantation, there may be an increased rate of complications in renal transplant recipients with SCD. Hematuria is seen in individuals with all of the SCDs as well as with sickle cell trait. In most cases the etiology of the hematuria turns out to be benign. However, there does appear to be an increased association between SCD and renal medullary carcinoma. Therefore, those SCD patients who present with hematuria should initially undergo a thorough evaluation in order to exclude this aggressive neoplasm. Papillary necrosis may occur due to medullary ischemia and infarction. Erythropoietin levels are usually lower than expected for their degree of anemia and decrease further as renal function deteriorates. An abnormal balance of renal prostaglandins may be responsible for some of the changes in sickle cell nephropathy. Acute renal failure is a component of the acute multiorgan failure syndrome (MOFS). Finally, progression of sickle cell nephropathy to ESRD may be slowed by adequate control of hypertension and proteinuria. However, the prevention of the renal complications of SCD will require a cure for this genetic disorder. Copyright 2000 Wiley-Liss, Inc.

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Familial hematuria due to type IV collagen mutations: Alport syndrome and thin basement membrane nephropathy.

Clifford E. Kashtan (2004)

Recent molecular genetic studies have shown that mutations in type IV collagen account for a significant proportion of patients with persistent glomerular hematuria. This review will discuss the implications of these findings for the diagnosis and management of persistent glomerular hematuria. Type IV collagen mutations are associated with a continuum of disease severity. Heterozygous mutations typically cause isolated, nonprogressive hematuria. Mutations in both alleles of the autosomal type IV collagen genes, or hemizygous mutations in the X-linked gene encoding the alpha 5 chain of type IV collagen, result in progressive renal disease that is often associated with sensorineural deafness (Alport syndrome). Animal models of Alport syndrome have begun to provide insights into the pathogenesis of end-stage renal disease in Alport syndrome, with potentially important implications for therapy. Recognition that glomerular hematuria frequently has a genetic basis is important for accurate genetic counseling, early identification of individuals at risk for end-stage renal disease development, and institution of therapies to delay the onset of ESRD.

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Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children.

E H Landau, O Gofrit, Joel Shapiro … (2001)

Treatment of ureteral calculi in the pediatric population represents a unique challenge. Extracorporeal shock wave lithotripsy (ESWL*) and ureteroscopy have been advocated for the treatment of such stones. We present our experience with ESWL monotherapy for ureteral stones in children in the last decade. Between 1989 and 1999 we treated 21 boys and 17 girls with a mean age of 8 years (range 8 months to 14 years) with ureteral stones at our institution. Records were reviewed and analyzed for presentation, metabolic and anatomical anomalies, stone size and location, outcome and complications. Average stone size was 9.5 x 6.5 mm. (range 3 to 32). Stones were in the upper ureter in 17 cases, mid ureter in 2 and lower ureter in 19. All patients underwent ESWL with a Dornier HM3 lithotriptor under general anesthesia. Nephrostomies were placed in an anuric infant with bilateral ureteral obstruction and in 2 patients with nonfunctioning kidneys (4 renal units). Ureteral catheters were used in 15 patients for better identification and localization of the stone during ESWL. The catheters were removed immediately postoperatively. Of the patients 31 (81.5%) were free of stones after 1 session of ESWL, 5 (13.1%) after 2 and 1 after 3. One patient underwent ureteroscopy for residual fragments after 2 ESWL sessions. The stone-free rate following 1 ESWL session was 100% for ureteral calculi 10 mm. or smaller regardless of location. Of the 12 patients with stones larger than 10 mm. 8 (67%) were free of stones following 1 ESWL session. The overall success rate of ESWL was 97.3%. No child had postoperative urinary infection or ureteral obstruction. ESWL is an efficient and safe modality for the treatment of pediatric ureteral stones.

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Author and article information

Journal

Journal ID (nlm-ta): ScientificWorldJournal

Journal ID (iso-abbrev): ScientificWorldJournal

Journal ID (publisher-id): TSWJ

Title: The Scientific World Journal

Publisher: TheScientificWorldJOURNAL

ISSN (Print): 2356-6140

ISSN (Electronic): 1537-744X

Publication date Collection: 2006

Publication date (Electronic): 8 March 2006

Volume: 6

Pages: 311-317

Affiliations

Department of Urology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, POB 9602, Haifa, Israel

Author notes

*Sarel Halachmi: s_halachmi@ 123456rambam.health.gov.il

Academic Editor: Joav Merrick

Article

Publisher ID: 903858

DOI: 10.1100/tsw.2006.59

PMC ID: 5917315

PubMed ID: 16532252

SO-VID: 568bdc47-42d0-4816-bca3-b4d504b324d6

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 1 February 2006

Date revision received : 24 February 2006

Date accepted : 24 February 2006

A Review on Hematuria in Children

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Most cited references 20

Renal abnormalities in sickle cell disease.

Familial hematuria due to type IV collagen mutations: Alport syndrome and thin basement membrane nephropathy.

Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children.

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