Related Experiment Videos
Long-term follow-up of patients with persistent/recurrent, isolated haematuria: a Hungarian multicentre study
1Department of Paediatrics, Albert Szent-Györgyi Medical University, Szeged, Hungary.
Insights
Persistent microscopic haematuria in children can resolve, but a significant portion develop proteinuria and kidney disease over time. Long-term monitoring is crucial for early detection of complications like Alport nephropathy.
Area of Science:
- Pediatric Nephrology
- Clinical Urology
- Internal Medicine
Background:
- Persistent or recurrent isolated microscopic haematuria is a common finding in children.
- Long-term outcomes and potential complications require further investigation.
Purpose of the Study:
- To evaluate the long-term prognosis of children diagnosed with persistent/recurrent isolated haematuria.
- To identify risk factors and the natural history of this condition.
Main Methods:
- Retrospective multicentre study of 341 children with isolated haematuria for at least 6 months.
- Follow-up durations ranged from 2 to over 15 years.
- Analysis of symptom resolution, development of proteinuria, azotaemia, hypertension, and urolithiasis.
Main Results:
- 47.8% of children became symptom-free; 18.4% had persistent isolated haematuria.
- 13.8% developed proteinuria (>250 mg/day) within 2 years, increasing with time (37.0% after 5 years).
- 14 of 47 patients undergoing biopsy for glomerular disease had Alport nephropathy; severe azotaemia and hypertension were rare but associated with initial microscopic haematuria and chronic glomerulonephritis, respectively. Urolithiasis occurred in 14.3% of patients with hypercalciuria.
Conclusions:
- Isolated microscopic haematuria in children can have a benign course but carries a risk of developing significant renal complications, particularly proteinuria and potentially Alport nephropathy.
- Long-term follow-up is essential for early detection and management of these complications.
- Hypercalciuria is a significant risk factor for urolithiasis in this cohort.
Abstract:
A retrospective multicentre study of 341 children with persistent/recurrent, isolated haematuria is described. The haematuria was isolated for at least 6 months at the beginning of observation. The duration of follow-up was 2-5 years in 201, 5-10 years in 119, 10-15 years in 19, and over 15 years in 2 cases. Of these patients 47.8% became symptom-free. In 18.4% the haematuria remained isolated; in 13.8% it was combined with proteinuria over 250 mg/day more than 2 years later. The occurrence of associated proteinuria increased progressively with time. It was 8.6% between the 3rd and 5th years, and 37.0% after the 5th year. Renal biopsy was performed because of the symptoms of glomerular disease in 47 cases at an average time of 12 months following the appearance of proteinuria. Proteinuria appeared after a 2-5, 5-10, 10-15 and more than 15 years follow-up period in 16, 23, 6, and 2 patients respectively; 14 of them had Alport's nephropathy. The percentage of more serious azotaemia was 1.7 (creatinine clearance: 10-50 ml/min per 1.73 m2) and 0.3 (creatinine clearance: less than 10 ml/min per 1.73 m2). Mortality was 0.58%. Most of the patients who developed severe azotaemia had persistent microscopic haematuria at the beginning. The prevalence of hypertension was only 1.2%. The time of its appearance was above 5 years in 2 and below 5 years in 2 cases. All these patients had chronic glomerulonephritis. The haematuria was associated with hypercalciuria in 19.9%. In 14.3% of the overall group of patients urolithiasis developed 2-15 years after onset. All of these had hypercalciuria.(ABSTRACT TRUNCATED AT 250 WORDS)