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Long term prognosis of recurrent haematuria
Insights
Recurrent haematuria in children can lead to significant kidney problems, including end-stage renal failure and hypertension. Long-term monitoring is crucial for identifying adverse prognostic features and managing potential complications in pediatric nephrology patients.
Area of Science:
- Pediatric Nephrology
- Clinical Urology
- Renal Pathology
Background:
- Recurrent haematuria is a common referral reason in pediatric nephrology.
- Long-term outcomes and prognostic factors for pediatric recurrent haematuria are not fully elucidated.
Purpose of the Study:
- To assess the long-term outcomes of children with recurrent haematuria.
- To identify prognostic indicators for adverse renal events in this cohort.
Main Methods:
- A long-term follow-up study of 100 children with recurrent haematuria.
- Renal biopsies analyzed by electron microscopy and immunofluorescence.
- Assessment of renal function, blood pressure, and family history.
Main Results:
- Alport's syndrome (20%) and IgA nephropathy (26%) were diagnosed via biopsy.
- 5% developed end-stage renal failure and 6% required hypertension treatment over 8.2 years mean follow-up.
- Persistence of microscopic haematuria, proteinuria, and biopsy changes were adverse prognostic features.
Conclusions:
- Recurrent haematuria in children is associated with significant long-term morbidity, including renal failure and hypertension.
- Early identification of prognostic factors is essential for timely intervention.
- Family screening revealed a 30% incidence of affected relatives, suggesting a genetic component in some cases.
Abstract:
A long term follow up study of 100 children referred with recurrent haematuria for at least one year to two regional paediatric nephrology units is described. The mean duration of follow up was 8.2 years. An adequate renal biopsy was obtained in 96 and eight cases of Alport's syndrome and 10 of IgA nephropathy were diagnosed (20% and 26% respectively of the biopsies examined by electron microscopy and immunofluorescence). Five patients developed end stage renal failure and six hypertension requiring treatment, with the occurrence of these complications increasing progressively with increasing duration of follow up (1% at five years compared with 12% at 10 years). Adverse prognostic features were persistence of microscopic haematuria, proteinuria at presentation, and appreciable changes on renal biopsy. Eighty four patients had first degree relatives tested for haematuria; 30% of these families had another affected member. With long term follow up recurrent haematuria is associated with considerable morbidity and potential mortality.