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Asymptomatic hematuria in childhood: a practical approach to evaluation
1Division of Pediatric Nephrology, Saint Louis University Health Sciences Centre, Cardinal Glennon Children's Hospital, MO 63104, USA. Woodeg@slu.edu
Insights
Hematuria in children requires careful diagnosis. Isolated microscopic hematuria may be monitored, but combined hematuria and proteinuria necessitate prompt evaluation, often including a renal biopsy.
Area of Science:
- Pediatric Nephrology
- Clinical Diagnosis
- Urology
Background:
- Hematuria with or without proteinuria presents a broad differential diagnosis in pediatric patients.
- Isolated hematuria is a frequent concern in children and adolescents.
Purpose of the Study:
- To outline diagnostic approaches for hematuria in children.
- To differentiate management strategies based on the presence and type of hematuria and proteinuria.
Main Methods:
- Review of differential diagnoses for hematuria and proteinuria in pediatric populations.
- Discussion of evaluation pathways for isolated microscopic hematuria versus macroscopic and microscopic hematuria.
- Emphasis on the diagnostic workup for combined hematuria and proteinuria, including indications for renal biopsy.
Main Results:
- Isolated microscopic hematuria may be managed with baseline evaluation and observation.
- Macroscopic and microscopic hematuria requires extensive investigation for glomerular and non-glomerular causes.
- Children with hematuria and proteinuria typically need rapid, systematic evaluation, often with renal biopsy, unless post-streptococcal glomerulonephritis (GN) is evident.
Conclusions:
- Post-streptococcal GN is a common cause of glomerulonephritis in children, characterized by specific C3 level changes and a generally favorable prognosis over 6-12 months.
- The diagnostic approach to pediatric hematuria varies significantly based on clinical presentation, guiding timely and appropriate management.
Abstract:
The differential diagnosis of hematuria with or without proteinuria is extensive, and isolated hematuria is a common problem in children and adolescents. Extensive evaluation is often necessary for the child presenting with macroscopic plus microscopic hematuria including nonglomerular and glomerular etiologies, while children with only isolated microscopic hematuria can generally be followed after baseline evaluation to rule out infection, hypercalciuria, familial hematuria, sickle cell disease, post-streptococcal glomerulonephritis (GN), and structural abnormalities (cysts, stones, obstruction, Wilms tumor). Children with the combination of hematuria and proteinuria require rapid systematic evaluation, generally including renal biopsy, except in cases where post-streptococcal GN can be clearly documented. Post-streptococcal GN occurs 7-21 days after a streptococcal infection, is associated with an acute fall in C3 levels with return to normal by approximately 8 weeks, rarely causes acute renal failure, and in children has a pattern of gradual resolution of hypertension, hematuria, and proteinuria over a course of 6-12 months.