A rare case of idiopathic vascular renal tumor renal hemangioma: A case report

@#Renal hemangioma is a rare benign vascular tumor which can present with painful or painless gross hematuria. Its preoperative diagnosis is extremely difficult due to non-specific imaging findings and can also mimic other disease entity.This is a case of a 31-year-old female who presented with recurrent gross hematuria with no antecedent cause. KUB ultrasound and CT stonogram showed insignificant findings of the cause of hematuria. Renal Angiogram revealed multiple vascular channels with arterial and venous connections at the upper pole of the right kidney with the impression of gross hematuria secondary to AV malformation. Simple Nephrectomy was done to address the hematuria wherein histopathologic findings were indicative of renal hemangioma. Patient did not report any episode of gross hematuria since the operation.

Indications for percutaneous renal biopsy in children with asymptomatic hematuria / 临床儿科杂志

Objective To explore the indications for percutaneous renal biopsy of asymptomatic hematuria in children. Methods The renal pathological types of 485 children with asymptomatic hematuria were analyzed retrospectively. According to the degree of hematuria and whether or not combined with proteinuria, the children were divided into microscopic hematuria group, gross hematuria group and hematuria with proteinuria group. The microscopic hematuria group was further divided into urine red blood cell30/HPF group according to hematuria degree. Results In 227 males and 258 females with the average age of 7.23±2.93 years, there were 318 cases in microscopic hematuria group, in which the most common pathological types were minor lesions (64.8%), followed by focal glomerular lesions (16.7%) and focal segmental glomerulosclerosis (8.2%). There were 119 cases in gross hematuria group, in which the most common pathological types were also minor lesions (26.1%), followed by IgA nephropathy (24.4%) and mesangial proliferative glomerulopathy (20.2%). There were 48 cases in hematuria with proteinuria group, in which the most common pathological types were IgA nephropathy (29.2%) and minor lesions (29.2%). The distribution of the pathological types among microscopic hematuria group, gross hematuria group and hematuria with proteinuria group were statistically different (χ2=152.03, P30/HPF. There was no difference in pathological types among three sub-groups (χ2=15.18, P=0.51), and mild lesions were the most common pathological types in each group. Conclusion Renal biopsy should be performed at earliest possible time to make pathological diagnosis in asymptomatic hematuria children with gross hematuria or proteinuria.

Effects of gross hematuria on the results in laboratory urine examination / 临床儿科杂志

Objectives To explore the effects of gross hematuria on the results of several parmeters in laboratory urine examination. Methods Eighty (80) children with IgA nephropathy and 40 cases with acute post-streptococcal glomerulonephritis hospitalized in our hospital from January 2014 to December 2015 were recruited. The ratio of urinary calcium and protein to creatinine, quantitative test of 24 h urinary calcium and protein, quantitative test of 24 h urinary albumin,α1-microglobulinuria, microalbuminuria and urine protein electrophoresis were tested during and after the gross hematuria, respectively. Results The ratio of urinary calcium and protein to creatinine, quantitative test of 24 h urinary calcium and protein were much higher in the duration of gross hematuria as compared to those after the duration of gross hematuria, while α1-microglobulinuria, microalbuminuria and quantitative test of 24 h urinary albumin showed no difference between the two periods. Conclusions Gross hematuria could increase the level of urinary calcium and protein, while quantitative test of 24 h urinary albremin is not affected.

A retrospective study on management of gross hematuria in autosomal dominant polycystic kidney disease patients / 中华肾脏病杂志

Objective To seauch the ideal management for gross hematuria in autosomal dominant polycystic kidney disease (ADPKD).Methods ADPKD patients who were ever hospitalized and followed up in our department since 1993 were enrolled in the study.Demographic and clinical data were colloected,such as gender,age of gross hematuria,level of renal function,causative factors,management strategies,duration of gross hematuria,blood platelet count,activated partial thromboplastin time,prothrombin time,international normalized ratio,size of kidney cyst and so on.ADPKD patients were divided into different groups according to causative factors or management.The clinical data were compared among groups.Results A total of 905 ADPKD patients were screened,among whom 279 patients ever had gross hematuria (male/female:150/129),One hundred and forty-six patients had integrated therapeutic process records,while only 101patients could provide relevant laboratory examination results.In these 101 patients,gross hematuria was found in any stage of chronic kidney disease (CKD); the average eGFR was (56.4±44.1) mml·min-1 ·(1.73 m2)-1; the duration of gross hematuria was (8.8±8.0) d; no significant difference between male and female in duration of gross hematuria existed [(8.2±7.3) d vs (9.5±8.8) d,P=0.426]; coagulation parameters were all normal.The platelet count was also normal in 91 patients.Duration of gross hematuria among groups divided according to different causative factors was significantly different (P＜0.05).The patients in bed rest group had significantly shorter duration of gross hematuria compared with other groups (P＜0.05).The platelet count,prothromhin time and international normalized ratio were all at similar level in different groups.Conclusions The causative factors in ADPKD patients with gross hematuria should be confirmed as the first step of management strategies.Bed rest is the key point in management.Antifibrinolytic agent is a proper choice in the cases receiving bemostatic drugs.It is unnecessary to use antibiotic agent for prevention.

A Case of Exercise-Induced Hematuria Presenting as Gross Hematuria Lasting One Week / 대한내과학회지

Exercise-induced hematuria is a phenomenon occurring in subjects who participate in strenuous exercise. Rapid resolution is an important feature of exercise-induced hematuria. We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. Three months ago, recurrent gross hematuria was lasting 1 week, regardless of exercise intensity. Compression of the left renal vein between the aorta and superior mesenteric artery, without prominent venous collaterals, was detected by computed tomography. However, no abnormalities were detected by renal venography, arteriography or kidney biopsy. Exercise-induced hematuria occurs with a high incidence, but is self-limiting. In contrast, recurrent and gross hematuria can be associated with bladder carcinoma or vascular abnormality. This should be kept in mind, and urological evaluations such as cystoscopy and angiography are necessary in gross and recurrent hematuria.

A Case of Exercise-Induced Hematuria Presenting as Gross Hematuria Lasting One Week / 대한내과학회지

Exercise-induced hematuria is a phenomenon occurring in subjects who participate in strenuous exercise. Rapid resolution is an important feature of exercise-induced hematuria. We report here a case of exercise-induced hematuria presenting as gross hematuria lasting 1 week in a 19-year-old male patient. Gross hematuria developed after strenuous exercise about 3 years ago. Three months ago, recurrent gross hematuria was lasting 1 week, regardless of exercise intensity. Compression of the left renal vein between the aorta and superior mesenteric artery, without prominent venous collaterals, was detected by computed tomography. However, no abnormalities were detected by renal venography, arteriography or kidney biopsy. Exercise-induced hematuria occurs with a high incidence, but is self-limiting. In contrast, recurrent and gross hematuria can be associated with bladder carcinoma or vascular abnormality. This should be kept in mind, and urological evaluations such as cystoscopy and angiography are necessary in gross and recurrent hematuria.

Factors Concerning Fragmentation of Urinary Stones in Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: Majority of the urinary stones are primarily treated by extracorporeal shock wave lithotripsy(SWL). The factors effecting on fragmentation of stones are characteristics of stones, mechanism of fragmentation, and technique of operator. There were many reports concerning stone size, location, composition, and lithotriptor itself, but no report concerning technical aspect in fragmentation of stones. We know the therapeutic results of SWL using same machine and under similar in conditions of stones were different. So, we investigated fragmentation rate of the stones according to gross hematuria and pain as one of parameters on behalf of technical aspects in addition to other characteristics of the stones. MATERIALS AND METHODS: We analysed the results of urinary stone fragmentations in 61 patients for whom SWL had been undergone from March, 1998 to August, 1998. Success rates and their correlations according to the size, location, shape, and radiopacity of the stones, degree of the flank pain and severity of gross hematuria during and after operation. RESULTS: The rates of stone fragmentations according to size, location, shape, and radiopacity of the stones did not show significant differences, wherease severity of gross hematuria and flank pain during and after SWL showed significant correlations to success rates(p<0.01). CONCLUTIONS: In practicing SWL, we think it is helpful to rasing success rate to consider of the severity of gross hematuria and flank pain following SWL.

A Case of Nutcracker Syndrome in a Patient with Gross Hermaturia / 대한신장학회잡지

Nutcracker syndrome(renal vein entrapment syndrome) is probably more common than previously suspected. The nutcracker phenomenon refers to compression of left renal vein between aorta and superior mesenteric artery that results in elevation of pressure in left renal vein and develoment of collateral veins. This syndrome occurs in relatively young and previously healthy patients and is characterized by intermittent gross hematuria due to left renal vein hypertension, at times associated with flank pain, abdominal pain or varicocele. We report a 17 years-old male patient with this syndrome presented with flank pain, abdominal pain, and intermittent gross hematuria for 3 months. Urinalysis revealed protein(-), blood(+++), many RBC with only 1% of dysmorphic RBC. IVP and cystoscopy showed no remarkable finding but doppler ultrasonography and abdominal spiral CT revealed compression of left renal vein between aorta and superior mesenteric artery. Renal venography showed compression of left renal vein and collateral circulation to left gonadal vein and the pressure gradient between left renal vein and inferior vena cava was 11mmHg. The nutcracker syndrome should be considered as one of the causes of nonglomerular hematuria. All patients with unexplained severe left flank or abdominal pain, or unilateral hematuria from the left on cystoscopy, should be studied by selective renal venography and pressure measurement in inferior vena cava and renal veins. The patient with this typical syndrome could be treated surgically, by transposition of left renal vein and resection of collateral veins as the procedure of choice to correct the underlying pathologic process and eliminate these troublesome symptoms.

A Case of IgA Nephropathy Associated with Anemia Induced by Persistent Gross Hematuria / 대한신장학회잡지

IgA nephropathy(IgAN) is the most frequent primary glomerular disease in many countries, including Korea. The typical clinical manifestation of IgAN is synpharygitic gross hematuria, which is usually innocuous for the renal function. Some patients who developed acute renal failure coinciding with episodes of gross hematuria are rarely observed in IgAN. We have observed a 29-year-old male patient with IgAN in whom the duration of gross hematuria(total 28 days) was clearly longer than usual, inducing anemia. We report a case of IgAN associated with anemia due to persistent gross hematuria and a brief review of the literature.

Acute Renal Failure Associated with Gross Hematuria in a Patient with Focal Glomerulonephritis

A 58-year-old female with an episode of gross hematuria two months before and fever and chill for the past three days presented oliguric acute renal failure. She has taken NSAID intermittently for 18 years due to rheumatoid arthritis, and herb medicine for one week two months ago when gross hematuria developed. Physical examination revealed mild tenderness on costovertebral angles. Her blood pressure was 170/100 mmHg, the urinalysis showed >300 mg protein with many RBCs and 10-20 WBCs and the serum creatinine was 5.8 mg/dl. A renal biopsy performed on the 4th hospital day showed that it was overwhelmed by severe tubular lesions which reveal intratubular obstruction by massive erythrocyte casts and tubular necrosis. The glomeruli showed focal minimal crescents with many red blood cells entrapped in the crescents and in the capillaries. Immune deposits were not present. A renal failure resolved spontaneously and the patient was discharged three weeks later with creatinine of 2.4 mg/dl. In this patient, acute renal failure was considered to be due to a tubular lesion related to the glomerular bleeding from focal glomerulonephritis revealing minimal crescents.

Upper Urinary Tract Gross Hematuria: Clinical Diagnosis and Disease Distribution / 대한비뇨기과학회지

A basic problem in evaluating upper urinary tract gross hematuria is the large number of diagnostic possibilities. The causation may be suspected after the initial history and physical examination, and can be confirmed with appropriate studies. We have retrospectively studied of 60 patients who confirmed upper urinary tract hematuria through the cystoscopy in period from Oct. 1971 to Dec. 1987. We have performed relatively precise clinical studies such as urinalysis, urine culture, urine cytology, blood clotting disorders, intravenous pyelography, renal arteriography and others and then we have obtained following results. 1. Disease distributions Calculous disease 12 cases (20.0%) Malignant disease 11 cases (18.3%) Vascular disease 7 cases (11.7%) Glomerulonephropathy 4 cases ( 6.6%) Unexplained hematuria 2l cases (35.0%) etc. 2. Cystoscopy, intravenous pyelography and renal arteriography are valuable essential procedures for diagnosis of upper urinary tract bleeding. 3. Cystoscopy, intravenous pyelography and angiography will bring the percentage of patients with a clear diagnosis up to about 70 per cent, especially excretory urography and cystoscopy must always be done.

Clinical analysis on 90 cases of Henoch-Schonlein purpura nephritis / 重庆医科大学学报

Objective: To analyze the clinical characteristics of Henoch-Schonlein purpura nephritis(HSPN).Methods: The clinical data of 90 HSPN patients were analyzed.Results: The patients with proteinuria over 1 gram per day and those with nephritic proteinuria accounted for 64.44% and 27.78%,respectively.Persistent gross hematuria often accompanied severe proteinuria even nephritic syndrome.Leucocyturia prevalence increased while the proteinuria became severe.Conclusion: Adolescent and adult HSPN have many clinical presentations with high index of gastral bleeding.The clinical presentations are getting worse with the increasing profile of proteinuria.Persistent gross hematuria and leucocyturia may reflect the severity and activity of HSPN.

A Clinical Observation on Gross Hematuria / 대한비뇨기과학회지

A clinical observation was made on 127 cases of gross hematuria who were admitted to the Department of Urology, Chosun University Hospital during the period from January, 1980 to October, 1982. The following results were obtained: 1. During the period, 127 cases (23. 1%) were found to be gross hematuria among 551 cases hospitalized. Of the 127 patients there were 95 males and 32 females, 3:1 in ratio. 2. The common diseases of gross hematuria were bladder tumor, renal injury, urethral injury tuberculosis of GUT, renal stone and ureteral stone. 3. Age distribution showed that 24 cases (18.9%) were 40-49 years, 21 cases (16.5%) were 20-29years and most frequent (67 %) ages were 20-59 years. 4. Etiology of the gross hematuria were highest in injury (34.6%), tumor (24.4 %) and calculus (18.9%). 5. The sites of the bleeding with gross hematuria were in the kidney (38.6%), bladder (30.0%), urethra (13.3 %), ureter (7.9 %), and prostate (4.7 %). 6. Incidence of painless and painful gross hematuria were 55.1% and 44.9%, the commonest cause was renal injury in the painless gross hematuria, urethral injury in the painful gross hematuria. 7. The incidence of initial, terminal and total gross hematuria were 4.7%, 22.1% and 73.2%. 8. The surgical treatment was required in 48 cases (37.8%) of inpatients with gross hematuria.

Clinical Observation on Gross Hematuria / 대한비뇨기과학회지

A clinical observation was made on 199 cases of gross hematuria who were admitted to the Department of Urology. Capital Armed Forces General Hospital during the period from January, 1978 to December, 1980. The following results were obtained; 1. The incidence of gross hematuria was 27.5% of all urological in-patients and male to female ratio was 4.5:1. 2. The most frequent incidence of gross hematuria on male were trauma and calculus and infection on female. 3. The commonest disease of gross hematuria were ureteral stone, renal injury, renal stone and renal tuberculosis. 4. The most frequent incidence of gross hematurias were calculus and trauma under the age of 40 and tumor over the age of 40. 5. Etiology of gross hematuria were highest in calculi (30.7%), injury (27.6%), tumor (13.6%). 6. The sites of gross hematuria were it the kidney (48.2%), ureter (20.1%), bladder (17.6%). urethra (6.5%), prostate (3.0%). 7. Painless gross hematuria was 63.3% and the commonest cause was renal injury. Painful gross hematuria was 36.7% and the commonest cause was ureteral stone. 8. Total gross hematuria was 75.4% and the commonest causes were upper urinary tract lesions. Terminal gross hematuria was 21.2% and the commonest causes were mid urinary tract lesions. Initial hematuria was 3.4% and the commonest causes were lower urinary tract lesions.

Frequency and Etiology of Gross Hematuria in an Urinary Tract / 대한비뇨기과학회지

Gross hematuria is most frequently used to describe the findings of blood-stained urine. Virtually inexhaustible literature has been accumulated emphasizing the important of gross hematuria as a signpost pointing to lesions of greater hazard especially in the urinary tract. A statistical survey was made on gross hematuria of the in-patients at the department of Urology of Sacred Heart Hospital for past 7 years. (1971-1977) Results are as follows: 1. During the period of 7 years. 218 cases (18.7 %) were found to be gross hematuria among 1166 cases hospitalized. Of the 218 patients there were 161 males and 57 females, 2.8:1 in ratio. 2. Etiology of the 218 cases with gross hematuria showed the highest in urinary tract tumor 65 cases (29.8 %) U-T calculus 64 cases (29.4 %). U-T infection 36 cases (16.5 %), U-T obstruction 9 cases (4.1 %) and ether 3 cases (1.4 %) in order. 3. Diagnosis in 218 cases with gross hematuria showed highest in bladder tumor 51 cases (23.4 %) ureteral stone 48 cases (22.0 %), and pyelonephritis 12 cases (5.5 %) in order. 4. The site of bleeding in 218 cases with gross hematuria was in the kidney 35.8 %. bladder 29.4 %, ureter 22.0 % and urethra 5.1 %. 5. Most frequent incidences of gross hematuria were found to be inflammation in child age group (under 20), calculus and inflammation in middle aged group (21-40) and tumor in older male but inflammation in older female group (over 41).