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[Renal biopsy in children with isolated microhematuria]
Danica Batinić1, Mira Sćukanec-Spoljar, Danko Milosević
1Referentni centar za djecju nefrologiju Republike Hrvatske, Zagreb, Hrvatska.
Unlabelled:
Isolated microscopic hematuria (IMH) in children always raises the question whether, besides other examinations, there is a need of performing a renal biopsy. Many authors consider IMH to be a minor abnormality where pathologic glomerular changes are not likely to be found, however, general agreement has not yet been achieved. The aim of the study was to evaluate the contribution of renal biopsy to the diagnosis of the disease in IMH.
Patients And Methods:
Renal biopsy was performed in 54 children with IMH (22 boys and 32 girls, mean age 8.2 and 8.5 years, respectively) in whom urologic abnormalities, hypercalciuria, systemic diseases, coagulopathy or overt family history of renal disease were excluded. The mean duration of IMH prior to biopsy was 2.8 years. Biopsy specimens were examined by light (LM), immunofluorescent (IF) and electron microscopy (EM).
Results:
Glomerular abnormalities were found in 43 (79.6%) patients. On LM 18 patients had normal glomeruli (NG), 22 mesangial proliferative glomerulonephritis (MEPGN), 9 focal glomerulosclerosis (FGS), 3 focal glomerulonephritis (FGN) and 2 membranoproliferative glomerulonephritis (MPGN). IF revealed 2 cases of NG, 5 cases of MEPGN, and all 3 cases of FGN as IgA nephropathy. EM detected GBM changes consistent with Alport syndrome in 21 patients, 7 of them with NG, 9 with MEPGN and 5 with FGS on LM. Diffuse thinning of GBM was found in 10 children, 7 with NG and 3 with MEPGN on LM. In 5 cases subepithelial hump-like deposits, which were considered to be the sign of acute postinfectious glomerulonephritis in resolution, were found. One of 2 cases of MPGN showed to be type II (DDD). On follow-up, 6 of 21 children with changes consistent with Alport syndrome developed clinical signs of the syndrome. Further surveillance is needed to confirm the significance of EM findings in others.
Conclusion:
The authors concluded that in children with IMH renal biopsy is justified and should always be analyzed by light, immunofluorescent and electron microscopy.
Insights
Renal biopsy is crucial for diagnosing kidney disease in children with isolated microscopic hematuria (IMH). This study found significant glomerular abnormalities in nearly 80% of patients, justifying biopsy for accurate diagnosis.
Area of Science:
- Pediatric Nephrology
- Diagnostic Pathology
- Glomerular Diseases
Context:
- Isolated microscopic hematuria (IMH) in children presents a diagnostic challenge, with ongoing debate regarding the necessity of renal biopsy.
- Exclusion criteria included urologic abnormalities, hypercalciuria, systemic diseases, coagulopathy, and family history of renal disease.
Purpose:
- To evaluate the diagnostic contribution of renal biopsy in children with isolated microscopic hematuria (IMH).
Summary:
- Renal biopsy was performed on 54 children with IMH. Glomerular abnormalities were detected in 79.6% of patients via light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM).
- Specific findings included mesangial proliferative glomerulonephritis, focal glomerulosclerosis, IgA nephropathy, and GBM changes consistent with Alport syndrome.
- EM revealed diffuse GBM thinning in 10 children and subepithelial deposits in 5, suggesting resolving postinfectious glomerulonephritis.
Impact:
- The findings support the routine use of renal biopsy in pediatric IMH cases.
- Comprehensive analysis using LM, IF, and EM is recommended for accurate diagnosis and management of glomerular abnormalities.