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.

Renal Biopsy Findings of Prospective Kidney Donors and Clinical Course of Renal Allografts / 대한이식학회지

PURPOSE: To evaluate the pathology of prospective kidney donors and assess the clinical outcomes of the renal allografts. METHODS: We reviewed the records of 12 prospective kidney donors who underwent kidney biopsy. The indications of kidney biopsy were asymptomatic microscopic hematuria (n=88, 66.7%), decreased glomerular filtration rate (GFR, n=22, 16.7%), mild proteinuria (n=11, 8.3%), history of gross hematuria (n=11, 8.3%). RESULTS: Kidney biopsy in 8 prospective donors with asymptomatic microscopic hematuria showed: 5 (62.5%) thin basement membrane disease (TBMD); 1 IgA nephropathy; 1 Alport's syndrome; 1 mild mesangial widening. Two prospective donors with decreased GFR showed IgA nephropathy and tubulointerstitial lesion. The one with mild proteinuria showed arterionephrosclerosis and the one with a history of gross hematuria showed tubulointerstitial lesion. 4 (33.3%) of the 12 who underwent kidney biopsy were accepted as kidney donors.; 3 donors with TBMD and the donor with mild mesangial widening, who all had microscopic hematuria. Among the 4 donations, there was 1 graft failure and 3 allografts (1 mild mesangial widening, 2 TBMD) have maintained graft function at latest follow up. CONCLUSION: The most common cause of asymptomatic microscopic hematuria in prospective kidney donors was TBMD. Long-term follow up is needed to assess the clinical outcomes of these allografts.

Flow Velocity of Left Renal Vein in Children with Asymptomatic Hematuria or Proteinuria

PURPOSE: Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuria or proteinuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. METHODS: Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortomesenteric portion and at the hilar portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. RESULTS: Of 304 children with asymptomatic hematuria or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54+/-0.73, which was not affected by sex, age or urinalysis findings. CONCLUSION: Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinuria in children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings.

A Histological and Clinical Study of the Children with Thin Glomerular Basement Membrane

PURPOSE: Thin glomerular basement membrane disease(TGBMD) is found in patients with family history of hematuria. TGBMD is autosomal dominant and is known to be one of the commonest causes of asymptomatic hematuria. This study was conducted to evaluate the histological and clinical features of patients with TGBMD. METHODS: 150 cases diagnosed with TGBMD by renal biopsy while admitted in the department of pediatrics, Kyungpook National University Hospital between January 1999 and December 2003 comprised the study group. The following parameters were retrospectively analyzed:age of onset, hematuria pattern, existence of proteinuria, process of diagnosis, laboratory findings, thickness and character of basement membrane and family history. RESULTS: The mean age at the time of diagnosis was 7.9 years. The male to female ratio was 65:77. 94 patients or 66% visited the hospital with a chief complaint of persistent microscopic hematuria. Gross hematuria accounted for 13 cases or 9%. 78 cases(55%) were found to have hematuria for the first time from a routine school urinalysis screening. The renal biopsy showed the thickness of basement membrane to be 186+/-36 nm. Focal lamellation of the basement membrane was found in eight cases. In the family history, hematuria was shown in 10 cases on the paternal side, 13 on the maternal side and none on both sides. In seven cases, hematuria was shown among siblings. No significant differences were found among the laboratory test results which were conducted at an average interval of fifteen months. CONCLUSION: TGBMD is one of the major causes of asymptomatic hematuria in children, which was diagnosed in increasing numbers since school urinary mass screening test started in 1998. In cases with familial progressive renal disease or focal duplication in the basement membrane Alport syndrome should be considered.

Significance of IVP in Asymptomatic Microscopic Hematuria in Adult Male / 대한비뇨기과학회지

The causes of asymptomatic microscopic hematuria in adult male are variable. In spite of various urologic investigations, the causes of asymptomatic microscopic hematuria is not identified in most cases, and most of identified causes are benign nature. So, it is very hard to decide to what extent should the evaluation of these causes be carried. 2l,157 cases was visited to the Department of Health Service, Kyung Hee University Hospital from January, 1983 to December, 1984 for evaluation prior to occupy at foreign countries. Among 21,157 cases, 131 cases was checked IVP for asymptomatic microscopic hematuria. The results as follows: l. Among 21,157 cases, 131 cases were checked IVP for asymptomatic hematuria and male all. 2. The range of age in 131 cases of checked IVP was 22 to 52 year, average of age was 32.5 years. 3. IVP was revealed abnormal in l8 cases (13.7%), that 12 cases of urinary stone, 3 cases of wandering kidney, 2 cases of caliceal diverticulum and 1 case of old pyelonephritic scar. 4. Endoscopy was done in 12 cases of 113 cases that was revealed normal on IVP, but there was no abnormal findings. 5. 1 case that revealed normal IVP and proteinuria was diagnosed mesangial proliferative glomerulonephritis on renal biopsy. As above results, IVP is necessary for evaluation of asymptomatic microscopic hematuria in adult male. If IVP is normal no more studies are necessary.

Hematuria and Proteinuria in School Children

The following results were obtained through the screening survey to detect the prevalence of hematuria & proteinuria in the healthy Korean schoolchildren. A total of 2,888 primary schoolchildren in Seoul, examined to be healthy by the author were tested for hematuria and proteinuria during the period of 3 months from Apr. 1979 to June 1979. Hemacombistix of Ames Company, U.S.A. was used in this examination. 1. The prevalence of hematuria detected with Hema-combistix was 1.97%(57 children) and that of microscopic hematrua was 0.93% (27 children). The prevalence of proteinuria was noted in 2.04%(59 children). 2. The prevalence of hematuria detected with Hema-combistix was higher in female children as 2.66% among 1,355 children, compared to 1.37% among 1,533 male children, which was ore prominent in the age 9 year-old group. The prevalence in female was higher than in male in all but 7 year-old age group. 3. The prevalence of microscopic hematuria was higher in female children as 1.40% compared to 0.52% in male. The prevalence was higher in female children in all but 7 year-old age group. 4. The correlation of tests of hematuria between Hema-combistix and microscopcy showed 85.2% in sensitivity and 59.0% in specificity. And there showed a statistically significant difference in the prevalence rates detected as above one positive in the both tests. 5. The prevalence of proteinuria was higher in female children as 2.8%, compared to 1.37% in male, which was more prominent in the 11 year-old age group. The age prevalence of proteinuria showed increasing frequency as age increases. The highest age prevalence was 1.94% in 12 year-old age group among males and 4.91% in 11 year-old age group among females. 6. The prevalence of co-existence of microscopic hematuria and proteinuria was 0.07%, which was noted in 2 cases in each 8 year and 10 year-old group. 7. Microscopic hematuria was present mostly in the range of one positive(5-20 RBC/HPF), which was prominent in female children. However, hematuria detected as above three positive (above 40 RBC/HPF) was found in male children. 8. Proteinuria was noted mostly in the range of one positive(30mg/dl) and the prevalence of proteinuria above 100mg/dl was 9.52% in males & 13.16% in females. And proteinuria above 300 mg/dl was noted in one male child.