Etiología de la hematuria monosintomática en pediatría / Etiology of monosymptomatic hematuria in Pediatrics

Introducción: La hematuria es el hallazgo clínico más frecuente entre las enfermedades genitourinarias, después de las infecciones del tracto urinario a cualquier edad. Objetivo: Identificar las características generales y etiología de la hematuria monosintomática en pacientes pediátricos. Métodos: Investigación descriptiva longitudinal y prospectiva con los pacientes atendidos con hematuria monosintomática en el Servicio de Nefrología del Hospital Pediátrico Docente William Soler entre el primero de enero de 2014 y 31 de diciembre de 2015. Resultados: Se reclutaron 45 pacientes. Predominó en escolares (40 por ciento) y adolescentes (40 por ciento), sexo masculino (55,5 por ciento). Se recogió el antecedente personal o familiar de hematuria en 44,5 por ciento y 55,5 por ciento, respectivamente. La urolitiasis familiar estuvo presente en 37,7 por ciento. El tipo de hematuria más frecuente fue la macroscópica (75,8 por ciento), no glomerular (71,2 por ciento), sin proteinuria (77,8 por ciento), y hematíes eumórficos (62,2 por ciento). La causa más frecuente fue la hipercalciuria idiopática (51,1 por ciento) y el 80 por ciento de todos los pacientes solo recibió tratamiento higieno-dietético. En 20 por ciento de los pacientes no se pudo precisar la causa etiológica. Conclusiones: La causa más frecuente de hematuria fue no glomerular (hipercalciuria idiopática) y en aquellos con hematuria cuya causa etiológica no se pudo precisar, es obligado mantener un seguimiento prolongado(AU)

Introduction: Hematuria is the most frequent clinical finding among genitourinary diseases afterwards urinary tract infection at any age. Objective: To identify general characteristics and etiology of monosymptomatic hematuria in in pediatrics patients. Methods: Descriptive, longitudinal and prospective research of the patients by monosymptomatic hematuria attended at the Nephrology service in William Soler Teaching Pediatric Hospital from January 1, 2014 to December 31, 2015. Results: 45 patients were recruited. Schoolchildren (40 percent) were predominant and adolescents (40 percent), and males (55.5 percent). It was collected personal or familial records of hematuria in 44.5 percent and 55.5 percent, respectively. Familial urolithiasis was present in 37.7 percent. The most common type of hematuria was the macroscopic (75.8 percent), non-glomerular (71.2 percent), without proteinuria (77.8 percent) and with eumorphic hematies (62.2 percent). The most frequent etiological cause was idiopathic hypercalciuria (51.1 percent), and 80 percent of all patients only received hygiene-dietetic treatment. In the 20 percent of the patients was not possible to determine the etiological cause. Conclusions: The most frequent cause of hematuria was non-glomerular (idiopathic hypercalciuria); and in those patients with hematuria of non-precised etiological cause, it is mandatory to keep long-term follow-up(AU)

Factores de riesgo de corticoresistencia en síndrome nefrótico en un hospital pediátrica de referencia: Análisis de 10 años / Risk factors for the development of severe bronchiolitis in children under 2 years of age admitted to the Hospital del Niño, Panama December 2013 to April 2014

Introducción: el síndrome nefrótico idiopático es una de las causas más comunes de enfermedad renal en la población pediátrica. Afecta 16 en 100,000 niños y está asociado a alta morbilidad y progresión a enfermedad renal crónica. El Síndrome nefrótico corticoresistente ocurre en un 10 a 20% de los niños con síndrome nefrótico idiopático. Materiales y métodos: estudio de casos y controles no pareados, incluye los pacientes con síndrome nefrótico atendidos en el Hospital del Niño José Renán Esquivel desde enero 2006 a diciembre 2015, se determinan los factores de riesgo asociados a corticorresistencia: hipertensión arterial, hematuria ≥ 30 eritrocitos por campo, y disminución de la tasa de filtración glomerular, todos al momento del diagnóstico. Resultados: 276 pacientes fueron hallados en la base de datos del Hospital del Niño José Renán Esquivel egresados con el diagnóstico de Síndrome Nefrótico entre 2006 al 2015, de los cuales se incluyeron 141; 40 pacientes los casos y 101 los controles. Al momento del diagnóstico, 52.48% presentaban hipertensión arterial y 20,57% hematuria ≥ 30 eritrocitos por campo. El 79.43% presentaban tasa de filtración glomerular (TFG) ≥ 90 ml/min/1.73m2, 12.77% TFG 60-89 ml/min/1.73m2 y 8.51% (12) TFG < 60 ml/min/1.73m2. Conclusión: La hematuria ≥ de 30 eritrocitos por campo y la TFG < de 90ml/min/1.73m2 al momento del diagnóstico sugieren ser factor de riego para corticoresistencia. TFG ≥ 90mL/min/1.73m2 al momento del diagnóstico es un posible factor protector para corticoresistencia. La hipertensión arterial al momento del diagnóstico no es factor de riesgo estadísticamente significativo para corticoresistencia.

Introduction: Idiopathic nephrotic syndrome is one of the most common causes of renal disease in the pediatric population. It affects 16 per 100,000 children and is associated with high morbidity and progression to chronic kidney disease. Corticosteroid nephrotic syndrome occurs in 10% to 20% of children with idiopathic nephrotic syndrome Materials and methods: a study of unpaired cases and controls, including patients with nephrotic syndrome treated at the Hospital del Niño José Renán Esquivel from January 2006 to December 2015, determine the risk factors associated with corticoresistance: arterial hypertension, hematuria ≥ 30 Erythrocytes per field, and decreased glomerular filtration rate, all at the time of diagnosis. Results: 276 patients were find in the database of the Hospital del Niño José Renán Esquivel discharged with the diagnosis of Nephrotic Syndrome between 2006 and 2015, of which 141 were included; 40 were cases and 101 controls. At the time of diagnosis, 52.48% had arterial hypertension and 20.57% hematuria ≥ 30 erythrocytes per field. 79.43% presented glomerular filtration rate (GFR) ≥ 90 ml / min / 1.73m2, 12.77% GFR 60-89 ml / min / 1.73m2 and 8.51% (12) GFR <60 ml / min / 1.73m2. Conclusion: Hematuria ≥ 30 erythrocytes per field and GFR <90ml / min / 1.73m2 at the time of diagnosis suggest to be an irrigation factor for corticoresistance. TFG ≥ 90mL / min / 1.73m2 at the time of diagnosis is a possible protective factor for corticoresistance. Arterial hypertension at the time of diagnosis is not a statistically significant cant risk factor for corticoresistance.

Análise comparativa de duas metodologias para a identificação de cilindros hemáticos urinários / Comparative analysis of two methodologies for the identification of urinary red blood cell casts

INTRODUÇÃO: A presença de hemácias dismórficas na urina é um forte indicativo da origem glomerular do sangramento, sendo uma ferramenta importante no diagnóstico de glomerulonefrites. Os cilindros hemáticos geralmente acompanham as hemácias dismórficas, sendo também fortes indicadores de hematúria glomerular, embora não sejam encontrados com frequência no exame parcial de urina. OBJETIVO: Comparar duas técnicas de concentração de amostras em uma série de exames de urina com hematúria dismórfica. MATERIAL E MÉTODOS: Foram selecionadas 249 amostras com hematúria dismórfica a partir de 4.277 amostras de urina de rotina. As amostras foram processadas utilizando-se duas técnicas: a convencional e a de concentração. O percentual de identificação dos cilindros hemáticos foi comparado de acordo com a metodologia utilizada. RESULTADOS: A presença de cilindros hemáticos pela técnica de concentração foi estatisticamente maior (52,6 por cento) em comparação com a positividade pela metodologia convencional (8,4 por cento) (p < 0,001). DISCUSSÃO E CONCLUSÃO: Sugere-se que a técnica convencional não concentrou suficientemente a amostra de urina e os cilindros hemáticos ficaram no sobrenadante, sendo descartados. A utilização da técnica de concentração aumentou a sensibilidade técnica para a pesquisa dos cilindros hemáticos. Portanto, a técnica de concentração, associada à presença de hemácias dismórficas, mostrou-se útil para aumentar a concordância dos dois parâmetros laboratoriais para a detecção da hematúria de origem glomerular como auxílio diagnóstico das glomerulopatias, importante causa de doença renal crônica.

INTRODUCTION: Dysmorphic red blood cells (RBCs) in the urine are a strong indicator of a glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria. OBJECTIVE: This study tested the superiority of a urine concentration technique (CT) over the standard method (SM) for RBC cast identification in a group of patients suspected of glomerular hematuria. MATERIAL AND METHODS: Of a total of 4,227 routine urinary samples, 249 with dysmorphic hematuria were selected. The samples were processed according to two techniques: standard method (SM) and concentration technique (CT). The percentages of RBC cast identification according to each method were compared. RESULTS: The CT showed a higher rate of RBC casts (52.6 percent) compared to the SM (8.4 percent) (p < 0.001). DISCUSSION AND CONCLUSION: We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded. The CT increased the sensitivity of the RBC cast yield. The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification of glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.