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[Long-term prognosis in monosymptomatic microscopic hematuria]
U Ruberto1, P D'Eufemia, O Giardini
1II Cattedra di Puericultura dell'Università degli Studi di Roma La Sapienza, Italia.
Insights
In children with microscopic hematuria, careful observation is key. Many cases resolve spontaneously over time, suggesting a conservative approach is often best for this common pediatric condition.
Area of Science:
- Pediatric Nephrology
- Urology
Context:
- Microscopic hematuria is a common finding in pediatric patients.
- Identifying the underlying cause is crucial for appropriate management.
- Previous studies have varied in their diagnostic approaches and follow-up durations.
Purpose:
- To evaluate the natural history and diagnostic yield of microscopic hematuria in children.
- To determine the most effective management strategy for monosymptomatic microscopic hematuria.
- To identify the prevalence of various underlying pathologies causing hematuria in pediatric cases.
Summary:
- A study followed 168 children diagnosed with microscopic hematuria.
- Causes were identified in 52 children, including urinary tract infections, nephropathies, and familial hematurias.
- Spontaneous resolution occurred in 39.9% of cases over nine years, supporting a 'watchful waiting' approach for monosymptomatic cases.
Impact:
- This study suggests that a conservative management strategy, or "careful waiting," is appropriate for children with monosymptomatic microscopic hematuria.
- Understanding the spontaneous resolution rates can help clinicians counsel families and avoid unnecessary interventions.
- The findings contribute to evidence-based guidelines for managing pediatric hematuria.
Abstract:
A group of 210 children, aged one to twelve years (86 males and 124 females) were sent to our Clinic with the diagnosis of microscopic hematuria. Twelve children in which microhematuria wasn't confirmed were immediately excluded; thirty children were excluded because they showed pathologic findings. The remaining 168 children were put under diagnostic examination (hematologic exams, urinoculture, abdomen radiographic, family screening). The cause of microhematuria was identified in 52 of them. The group was selected down to 116 who were then monitored for a period ranging from 1 to 9 years with periodical clinical and biohumoral controls and with diagnostic exams. Biopsies were performed only in 16 cases in which a nephropathy was suspected. Nine cases presented significant histological lesions. Seventy five children were subjected to observation for a period of over one year. After few years hematuria gradually disappeared in twenty six children. After nine years microhematuria had disappeared spontaneously in 39.9% of cases. It remained in core of 33.6% of case, for which no cause could be found. With reference to the full group of 168 children, the following pathologies have been found responsible of microhematuria: a) urinary way infections: 25 cases (14.8%) b) nephropathies: 16 cases (9.5%) c) familiar hematurias: 14 cases (8.3%) d) lithiasis: 9 cases (5.3%) e) alteration of the coagulation system: 3 cases (1.8%) f) renal hypercalciuria without lithiasis: 3 cases (1.8%) Based on these observation, we believe that careful waiting is the best tactic in the cases of monosymptomatic microhematuria.(ABSTRACT TRUNCATED AT 250 WORDS)