Incidence of Urologic Disease Among 95 Consecutive Filipino Patients Presenting With Asymptomatic Microscopic Hematuria

Objective@#One of the common clinical problems warranting urologic evaluation is asymptomatic microscopic hematuria (AMH). According to some studies, it has prevalence as high as 38% with a possibility of urologic disease or malignancy around 23%. The presence of AMH would be quite a dilemma to a urologist in terms of how aggressive urologic evaluation and follow up is recommended. The present study was to determine the incidence of significant urologic diseases among Filipino patients with AMH on initial evaluation and on follow-up. This study would also determine if there would be a significant difference in terms of incidence of urologic disease among patients less than 35 years old and more than 35 years old with AMH.@*Methods@#A total number of 95 patients (38 male, 57 female) were included in this study. All patients presented with AMH. They were grouped in terms of age, gender, and duration of follow-up. All patients underwent cystoscopy and a diagnostic imaging (ultrasound, CT urogram, or CT stonogram) on initial evaluation. Patients then were followed up. They were divided into two groups, those less than 2 years of follow-up and those more than 2 years of follow-up. Excluded from the study are those patients with gross hematuria, on indwelling catheter, with urinary tract infection, with previous malignancy, history of pelvic irradiation, and those who did not undergo cystoscopy, or any urologic imaging. @*Results@#Out of 95 patients with AMH who underwent urologic evaluation, the incidence of urologic disease was noted to be 12% (11 out of 95). There was no malignancy related cause of AMH discovered. Age and gender failed to show any significant difference in terms of developing urologic disease. Among patients with negative findings on initial urologic evaluation, no urologic disease was noted even on follow-up. Among those with positive findings on initial evaluation, no new urologic disease was discovered on follow-up.@*Conclusion@#AMH has a low incidence of urologic disease or any GUT malignancy. Age and gender alone are not sufficient risk factors warranting an invasive endoscopic procedure. They are recommended only to those patients with high risk of urologic disease and can be avoided in majority of the population. We would recommend a kidney, urinary bladder, and prostate (KUBP) ultrasound as the initial imaging of choice since the only findings noted on evaluation through imaging were just two cases of nephrolithiasis, one via CT stonogram and the other through a CT urogram, which can also be diagnosed with a regular KUBP ultrasound. This would be more cost-effective as well as beneficial in terms of the patient’s risk regarding radiation and contrast-related effects. Clinicians may decrease unnecessary repeated urologic evaluation and follow-ups on patients with AMH, as the results of the study failed to show any significant difference in developing urologic disease for patients with persistent AMH on initial assessment and even on follow-up.

Síndrome de Alport: una actualización en fisiopatología, genética, diagnóstico y tratamiento / Alportsyndrome: anupdate in pathophysiology, genetics, diagnosis, and treatment

RESUMEN El síndrome de Alport es una enfermedad renal hereditaria de curso progresivo, que ocurre por defectos genéticos en los genes responsables de la constitución de la membrana basal glomerular. Las mutacionespatogénicas en los genes para el colágeno tipo IV (COL 4A3/4/5) producen una alteración en el arreglo correcto de la membrana basal a nivel glomerular.La presentación clínica puede variar dependiendo de la mutación que presente el paciente. Luego de confirmar el diagnóstico,con estudios genéticoso mediante biopsia, se hace necesaria la correlación genotipo-fenotipo para determinar pronóstico y tratamiento. La reducción de la proteinuria, según sugieren las guías de manejo, ha resultado en un retraso en la progresión a enfermedad renal crónica, mientras se concluyen los estudios con medicamentos innovadores dirigidos a receptores específicos.

ABSTRACT Alportsyndromeis a renal hereditarydisease of progressivecourse, causedby geneticdefects in the genes responsible for the constitution of the glomerular basementmembrane. Mutation in genes fortype IV collagen occurs at COL 4A3/4/5, whichproducesinterference in thecorrectmembranearrangement. Clinicalpresentationmayvarydependingonmutationtype. Afterconfirming diagnosis, withgenetic studiesorbiopsies, managementincludesidentification of risk and treatment. Reduction of proteinuria, as managementguidelinessuggest, has resulted in delay in progressiontochronickidneydisease. In themeantime, studiesfor new treatmentdevelopments are in progress, directedtospecificreceptors.

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)

An empirical study on medical selection of flying cadets with urinary system diseases between PLAAF and USAF / 军事医学

Objective To investigate the effect of different medical standards for the urinary system on the enlistment of pilots between PLAAF and USAF , and offer support to amendment .Methods Data on pilots′final enlistment between 2012 and 2015 were analyzed , and results of physical examinations of the urinary system were compared according to differ -ent medical standards .Results One hundred and twenty teenagers enrolled in this examination were disqualifiied due to defects of the urinary system while 97 applicants were qualified after comprehensive assessment of the urinary system .The main problems with the urinary system that affected results of pilots′enlistment were nephroptosia , renal cyst , microscopic hematuria , renal calcified foci and calculus .Conclusion Medical standards for the urinary system are different between PLAAF and USAF, especially those for nephroptosia , renal cyst and microscopic hematuria .The medical standards directo-ry about the urinary system approved by USAF can serve as a reference during our revision of current medical enlistment standards.

Glomerular Filtration Rate Difference between Renal Cyst Group and Control Group / 가정의학회지

BACKGROUND: The simple renal cyst is the most prevalent cystic deformation in adults and is most of them are incidentally found during medical examination. In this study, the clinical differences were compared between simple renal cyst and control groups diagnosed by abdominal ultrasonography during periodic medical examination. METHODS: We randomly selected 2,277 persons who took medical examination in one general hospital health promotion center. Among them, analysis was conducted for 188 subjects with simple renal cyst and 188 subjects without renal cyst whose sex, age, and body mass index were matched. Renal cyst subjects were compared with control group to search for their relationship with hypertension, renal function and microscopic hematuria, past medical history, social history, results of other abdominal ultrasonography findings, urine test, and blood test. RESULTS: Among 2,213 subjects, simple renal cyst was found in 188 subjects (8.5%). The subjects who had more than three simple renal cysts were significant older (P = 0.05) and the oldest age was 70's. Also, higher hypertension prevalence (P = 0.05), more microscopic hematuria, higher serum creatinine (P = 0.02), and lower glomerular filtration rate (P < 0.01) were observed in simple renal cyst group. CONCLUSION: It is needed to survey size, shape and change of simple renal cyst using abdominal ultrasonography as well as how its progression may be related to developing hypertension, decreased renal function and microscopic hematuria.

A case of percutaneous coil embolization of renal artery aneurysm / 대한내과학회지

Renal artery aneurysms are relatively uncommon, being found in approximately 0.09% of the general population. They are usually found incidentally during investigation of patients with microscopic hematuria or high blood pressure. Rupture is the most lethal complication of renal aneurysms. Surgical treatment had been common for these aneurysms. We report a case of about 2-cm-diameter renal artery aneurysm successfully treated by embolization with non-detachable platinum coil.

Follow-up of children with isolated microscopic hematuria detected in a mass school urine screening test / 소아과

PURPOSE: The isolated microscopic hematuria is the most common abnormality detected by school urinary screening, but there is no consensus about the range of investigations and long-term outcomes of isolated hematuria in children yet. This study aims to elucidate the prognosis of hematuria and the range of diagnostic studies by follow-up results. METHODS: Students with isolated hematuria who were referred to the Department of Pediatrics, Asan Medical Center from Aug. 1990 to Feb. 2004 were analysed retrospectively. Cases that presented Through significant proteinuria(>250 mg/day), other symptoms of nephritis or renal dysfunction (creatinine clearance <85 mL/min/1.73m2) were excluded. Follow-up was done every six months with checking urinalysis, serum creatinine, protein and albumin. When albuminuria was detected, 24 hour urine protein was checked. Renal biopsy was done when urine protein was over 500 mg/day. RESULTS: A total of 331 students were enrolled in this study. There were 157 males and 174 females. The mean age at presentation was 9.9+/-2.3 years(7-15 years) and mean follow-up period was 2.2+/-1.6 years(1-10 years). Seventy five(22.7 percent) patients showed the resolution of microscopic hematuria. The mean resolution period was 2.6+/-1.7 years(1-8 years). Eight(2.4 percent) patients developed significant proteinuria and renal biopsy was done in four of them. Two cases of mild IgA nephropathy and two of minimal change were detected. None of them developed hypertension. At the end of the follow-up, renal function had remained stable in all subsets of patients. CONCLUSION: The prognosis of isolated microscopic hematuria was good. This study suggests that invasive studies including renal biopsy are not necessary and a regular follow-up of urinalysis is enough for children with isolated microscopic hematuria.

Clinical Significance of Renal Biopsy in Adults with Asymptomatic Microscopic Hematuria / 대한신장학회잡지

BACKGROUND: Hematuria is most frequently detected on routine urinalysis and the prevalence of hematuria in adults has been reported to range from 5 to 10 percent. Hematuria can originate from any site along the urinary tract and whether gross or microscopic, may be a sign of serious underlying disease including malignancy. The literature agrees that gross hematuria warrants a thorough diagnostic evaluation. By contrast, whether physicians should test for hematuria in asymptomatic patients remains at issue, and the role of renal biopsy in the investigation of this condition is still debated. The purpose of this study was to assess the clinical significance of renal biopsy in adults with asymptomatic microscopic hematuria on urinalysis. METHODS: From January 1993 to December, 2002, 119 patients (72 men, 47 women) with mean age 26.4 years (range 15 to 40 years), in whom renal biopsy was performed for evaluation of asymptomatic microscopic hematuria, were included. All patients were normotensive, with normal serum creatinine, sterile urine, and no abnormality on IVP and abdominal ultrasonography. RESULTS: In 119 patients, renal biopsy abnormalities were found in 100 patients (84.0%) whereas no histologic abnormality in 19 patients (16.0%). Histologic abnormalities included IgA nephropathy in 73 (61.3%), thin glomerular basement membrane disease in 12 patients (10.1%), minimal mesangiopathy in 7 (5.9%), and other glomerular diseases in 8 patients (6.7%). When the patients were divided into two groups based on the presence of proteinuria, 55 patients belonged to isolated hematuria group (H) and 64 patients to concomitant hematuria and proteinuria group (H+P). Histologic abnormalities were statistically more common in H+P group (62/64, 96.9%) compared to H group (38/55, 69.1%) (p<0.05). On the other hand, when the renal biopsy findings were analyzed according to the amount of hematuria (3-10/HPF vs. 10-20/HPF vs. many/HPF), there was no significant difference in the results of renal biopsy among the three groups. CONCLUSION: Eighty four percent of patients with asymptomatic microscopic hematuria had renal biopsy abnormalities. Therefore, renal biopsy should be performed in patients with asymptomatic microscopic hematuria, especially in patients with concomitant hematuria and proteinuria, if renal imaging is normal.

Hypercalciuria and Hyperuricosuria in Adults with Microscopic Hematuria / 대한신장학회잡지

PURPOSE: We investigated the prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria and whether specific underlying diseases were associated with it. METHODS: A total of 36 patients with microscopic hematuria were divided into hypercalciuria or normocalciuria and hypercalciuria or normouricosuria and compared between groups in their clinical characteristics and laboratory findings. RESULTS: Of the 36 patients, 27 patients (75%) had normocalciuria but 9 (25%) had hypercalciuria. Twenty-eight patients (78%) had normouricosuria but 8(22%) had hyperuricosuria. All 8 patients in the hyperuricosuric group were male but 6 were male and 3 female in the hypercalciuric group. Other basal parameters and clinical characteristics were comparable between hypercalciuric and normocalciuric groups as well as between hyperuricosuric and normouricosuric groups except for significantly higher proteinuria in the latter. Underlying or associated diseases were hypertension (11), nephrolithiasis (5), simple renal cysts (3), hepatitis B carrier (3), diabetes mellitus (2), poststreptococcal glomerulonephritis (1), and membranous nephropathy (1). The degrees of calciuria and uricosuria were not different between patients with or without specific underlying or associated diseases but relative hypercalciuria in diabetic patients and hyperuricosuria in hepatitis B carriers were noted. CONCLUSION: We found a high prevalence of hypercalciuria and hyperuricosuria in adults with microscopic hematuria. In view of relatively higher proteinuria in hyperuricosuric patients in addition to some differences in clinical characteristics of patients with hypercalciuria or hyperuricosuria, a simple cost- effective examination of the degree of calciuria and uricosuria would be helpful in the clinical evaluation of microscopic hematuria.

The Role of Renal Ultrasonography in Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: Serious urologic lesions have been reported in 4.8% to 16.5% of patients referred for asymptomatic microscopic hematuria. This study aimed to demonstrate the cause of microscopic hematuria and to evaluate the diagnostic efficacy of urologic workup methods. MATERIALS AND METHODS: Between February 1995 and July 1999, 970 patients with asymptomatic microscopic hematuria were examined by urinalysis, urine culture, intravenous pyelography and renal ultrasonography. Patients with proterinuria of 2+ or more and RBC casts were excluded from the study. Average patient age was 53 years (20-82 years). The male-to-female ratio was approximately 1:1 (473:497). RESULTS: Among 970 patients with asymptomatic microscopic hematuria, the cause was detected in 96 patients, including 2 renal cell carcinoma and 2 bladder tumor. In patients over the age of 50 years, the incidence of malignancy was 6.6% (4/610) and higher incidence of significant lesions was found (11.0%) compared to patients under the age of 50 (8.1%). Malignancy was not found in any of the 360 patients under the age of 50 years. Neither the degree of hematuria nor sexual difference correlates with clinically significant lesions. In 96 patients with significant lesions, the detection rate of abnormalities by renal ultrasonography and IVP was 26% (25/96) and 12.5% (12/96), respectively (p=0.004). CONCLUSIONS: Our report has shown that 9.9% of the patients had significant urologic lesions including 4 malignancies. We demonstrate that renal ultrasonography was more beneficial than IVP for the evaluation of the upper tract in patients with asymptomatic microscopic hematuria. It may be more appropriate to consider renal ultrasonography in addition to IVP as an initial examination in the evaluation of microscopic hematuria.

Analysis of Urinary Mass Screening for Second Grade of Elemantary School Children in Paju City

PURPOSE: We performed urinary mass screening(UMS) program for 2,804 children of second grade elemantary school 8 years of age in Paju city with cooperation of Paju City Health Center to determine the prevalence of asymptomatic proteinuria and hematuria, and to estimate the risk of incipient renal diseases. Also we attempted to evaluate the significance of hematuria in UMS in addidtion to proteinuria. METHODS: 2,804 children of the 2nd grade of elementary school who lived in Paju city were included to our UMS program in 2000. They were constituted with 1,428 boys and 1,376 girls. The screening program was carried out in 3 steps. The 1st screenig test was performed at schools and then students with abnormal results were examined repeatedly at Paju City Health Center and our hospital. Those students who showed proteinuria and/or hematuria in the 1st and 2nd test were referred to our hospital to undertake the 3rd close examination including physical examination, laboratory tests and radiologic tests. RESULTS: (1) The prevalence of urinary abnormality in the 1st screening test was 8.3%(233 students), comprised of 5.9% of boys, 10.8% of girls. (2) Among 2,804 children tested in the first screening, prevalences of asymptomatic proteinuria and isolated hematuria were 64(2.3%), 163(5.8%) respectively, and the prevalence of proteinuria with hematuria was 6(0.2%). (3) Among 233 students with urinary abnormalities at the 1st screening test, 102 students applied to the 2nd test. 32 children, about one third of them, were also found to have abnormal urinary findings; isolated hematuria 30, proteinuria with hematuria 2. (4) Those findings of clinical evaluation for children with isolated hematuria at the hospital showed as follows: idiopathic isolated microscopic hematuria 21, normal 6, urinary tract infection 1, idiopathic hypercalciuria 1 and simple renal cyst 1. Those 2 students with proteinuria and hematuria seemed to have chronic glomerulonephritis. CONCLUSION: (1) The clinical evaluation for children who showed positive results at the 1st screening test should be done judiciously. Because of high false positive rate, almost who showed positive results was normal, only a few of them had pathologic conditions. In this study, actual incidence of incipient renal diseases in children of 8 year old was calculated to be 0.4%. (2) The definite conclusion whether a urinary mass screening test can alter the prognosis of incipient renal diseases could not be drawn with this study. Further study must be necessary. (3) We could acknowledge the significance of hematuria in UMS, but it is necessary that one should be judicious in managing and follow-up those that show abnormal results.

Clinical and Pathologic Analysis of Thin Glomerular Basement Membrane Disease in Children

PURPOSE : Clinical manifestations and pathologic findings of thin glomerular basement membrane disease, recognized as a common underlying disease of benign, familiar and asymptomatic hematuria has not been reported systemically in Korea. We analyzed clinical and pathologic findings of patients who were diagnosed as thin glomerular basement membrane disease. METHODS : We analyzed clinical and pathologic findings of twenty-six patients who were diagnosed as thin glomerular basement membrane disease by renal biopsy among who complained asymptomatic hematuria from 1990 to 2000. RESULTS : The subjects were aged 9.4+/-3.2 (3.0-15.8) years-old at onset of hematuria, and 11.1+/-2.2 (4.7-16.3) years-old at renal biopsy. Sexual discrepancy was more common in girls (eight boys and eighteen girls). A family history of hematuria was found in 8 patients(30.7%). Major clinical manifestation on admission was microscopic hematuria according to the findings of 3cases(11.5%) of gross hematuria, 23cases(88.5%9) of microscopic hematuria, and 1case(3.8%) of proteinuria. Microscopic hematuria persisted in all cases. Kidney biopsy showed few changes by light microscopy, but IgM, C3 and fibrinogen deposit in mesangium was found by immunofluorescent microscopy in a few cases. Electron microscopic findings have revealed thinning of the glomerular basement membrane varied from 180.9+/-35.8nm. CONCLUSION : Thin glomerular basement membrane disease might be a common cause of microscopic hematuria of children and family history was revealed in about 30%. Clinical progression was good in majorities.

Membranous Glomerulopathy Showing Asymptomatic Isolated Microscopic Hematuria Only

PURPOSE: Membranous glomerulopathy is a glomerular disease characterized by the presence of subepithelial immune deposits with thickening of the capillary wall of the glomerulus without inflammatory change. The pathogenesis of membranous glomerulopathy is still unknown. Its incidence is higher in males, and it is rarely found in infants and adolescents. Among the clinical manifestations proteinuria is most common, while edema and hematuria are present. According to reports from other countries, among few patients diagnosed with membranous glomerulopathy by renal biopsy, show isolated microscopic hematuria without the clinical manifestations. Little research in this area has been performed in Korea, and so we conducted retrograde studies on membranous glomerulopathy associated with isolated microscopic hematuria. MATERIALS AND METHODS: We analyzed retrogradely 109 cases of asymptomatic isolated microscopic hematuria that were diagnosed as membranous glomerulopathy by renal biopsy at Yonsei University Severance hospital from January, 1992 to July, 2001. RESULTS: In 87 of the 109 cases patients were over 15 years old while in 22 cases patients were under 15 at the time of dignosis. Only three patients showed isolated microscopic hematuria without the clinical manifestations and abnormal laboratory findings and they were all male patients under 15 years old. CONCLUSION: Few cases of the membranous glomerulopathy show only asymptomatic isolated microscopic hematuria. However, since membranous glomerulopathy can be found in patients who present with asymptomatic isolated microscopic hematuria only, if adequate indication for renal biopsy is present, we conclude that renal biopsy must be aggresively pursued in order to find the underlying disease.

A Case of Lupus Nephritis with Positive Antiphospholipid Antibodies, Initially Detected Through Analysis of Urinary Mass Screening

Antiphospholipid syndrome is a thrombotic disorder characterized by the association of arterial and venous thrombosis with the antibodies directed toward phospholipids. The presence of these antibodies in systemic lupus erythematosus(SLE) has been shown to be related to several clinical and analytical alterations. We experienced one case of lupus nephritis with positive antiphospholipid antibodies in a 10-year-old girl whose chief complaint was persistent microscopic hematuria. We report this case with a brief review of related literatures.

A Clinical Study on Microscopic Hematuria Caused by Recent Sexual Intercourse in Women / 中国医师杂志

Objective To observe whether recent sexual intercourse might cause microscopic hematuria, and investigate the cause of hematuria. Methods Eighty healthy volunteers (40 men and 40 women) consented to have intercourse with their married couples and provide samples of urine for testing before intercourse and the first day morning, noon, evening and the second day morning after intercourse. After appropriate instruction, volunteers tested their own urine for the presence of blood using standard dipsticks. Any volunteer with hematuria after intercourse was offered a comprehensive hematuria assessment and followed-up for two years. Results None of the volunteers had positive hematuria before sexual intercourse. 9 of the 40 women, but no men, had positive hematuria at the first day morning after intercourse, and 3 of the nine patients with hematuria still had positive hematuria at the noon of the first day. Five women of 9 patients with hematuria accepted two years follow-up and no abnormal was identified. Conclusion It suggested that recent sexual intercourse was a cause of asymptomatic microscopic hematuria in women, and a history of recent sexual intercourse should be considered when assessing the clinical significance of microscopic hematuria in women.

Clinicopathologic Studies of Asymptornatic Urinary Abnormalities / 대한신장학회잡지

Asymptomatic urinary abnormalities are one of the most frequent abnormalities in clinical nephrology. Between April 1981 and February 1999, we conducted retrospective follow-up studies of 159 patients with asymptomatic urinary abnormality that was proven by kidney biopsy, and evaluated their histologic findings and natural course. Mean age was 34.7 years old and sex ratio of male to female was 78: 81. They were divided into three groups according to the initial urinalysis findings' six patients with isolated hematuria, 33 patients with isolated proteinuria, and 120 patients with concomitant hematuria and proteinuria. The mean follow-up period was 35.5+/-30.5 months. In pathologic findings, 95 cases(59.3%) had IgA nephropathy, 27 cases(17.5%) had minor lesion, 12 cases(7.5%) showed focal and segmental glomerulo- sclerosis, 10 cases(6.3%) had membrannvs glomer-ulonephritis, 9 cases(5.6%) had mesangial prolifera- tive glomerulonephritis. Amyloidosis and thin base-ment membrane disease were seen in two cases, respectively. There were no specific correlations between morphologic patterns and degree of proteinuria. During the mean follow-up period, hematuria or proteinuria disppeared in 14%, persisted in 49%, and developed renal insufficiency in 21%. During the mean follow-up period, isolated proteinuria disappeared in 24%, persisted in 36%, and developed renal insufficiency in 21%. We conclude that the most common cause of asymptomatic urinary abnormalities was IgA nephropathy and early diagnosis through renal biopsy and management is needed to prevent or slow the progression to chronic renal failure.

Evaluation of the Indications of Renal Biopsy in Children with Primary Nephrotic Syndrome

PURPOSE: Percutaneous renal biopsy in children with primary nephrotic syndrome(NS) contributed to establish the renal pathology and clinicopathological correlation. The most common minimal change lesion(MCL) was steroid sensitive and could be predicted by clinical and laboratory findings. It was uniformly agreed that most nephrotic children who were predicted as MCL, should receive an 8 week course of prednisolone before considering renal biopsy. Early indications of renal biopsy has been those nephrotic children with the age below 1 year and above 8 years, hypertension, hematuria, low serum C3, renal insufficiency which are not compatible with MCL. Late indications has been frequent relapser(FR), steroid dependent(SDNS) and steroid resistant nephrotic syndrome(SRNS). The indications have been challenging recently and we tried to evaluate the commonly recommended indications. METHODS: Clinical, laboratory, pathologic findings and therapeutic responses were compared in 81 children with primary nephrotic syndrome who had renal biopses beteen 1984 and 1996. RESULTS: 1) Among 11 children with the age indication, MCLs were diagosed in 9(81.8%), mesangial proliferative glomerulonephritis(MsPGN) in 1(9.1%) and membranous nephropathy(MGN) in 1(9.1%). 2) Among 4 children with microscopic hematuria, MCLs were diagosed in 3(75.0%), MsPGN in 1(25.01%). In 13 children with hypertension, macrohematuria, azotemia and low serum C3, focal segmental glomerulosclerosis(FSGS), membrano-proliferative glomerulonephritis(MPGN) and IgA nephropathy(IgA) were frequently diagnosed instead of MCL. 3) All 5(100%) frequent relapsers were diagnosed as MCLS Among 30 children with the indication of SDNS, MCLs were diagosed in 28(93.3%), MsPGN in 2(6.7%) 4) Among 18 children with the indication of SRNS, MCLs were diagosed in 6(33.3%), MsPGN in 6(33.3%), FSGS in 6(33.3%) 5) The probability to diagnose MCL was 81.8%(9/11) in age indication, 75.0%(3/4) in microscopic hematuria, 100%(5/5) in FR and 93.3%(28/30) in SDNS. 6) The response rate to standard steroid treatment were 81.8%(9/11) in age indication 75.0%(3/4) in microscopic hematuria, 100%(5/5) in FR and 96.7%(29/30) in SDNS. CONCLUSIONS: Among the commmon indications of renal biopsy in children with primary nephrotic syndrome, age, microscopic hematuria, frequent relapser and steroid dependant should be reevauated to reduce the unnecessary renal biopsy.

Prevalence and evaluation of asymptomatic microscopic hematuria in adults / 대한비뇨기과학회지

To knew the prevalence and nature of asymptomatic microscopic hematuria in a community. we evaluated 13,678 cases(M; 12.198 cases, F; 1,480 cases) that visited to the Department of Health Service. Kang Nam General Hospital from April to October, 1992 for annual physical examination. For the detection of hematuria urine dipstick test was done. and then urine microscopy was done in cases with positive dipstick test (262 cases). Hematuria was defined as 3 or more RBCs/HPF on microscopic examination of the urinary sediment(189 cases). Repeated urinalysis was done in cases with 3-4 RBCs/HPF (30 cases). And in cases with 5 or more RBCs/HPF on urine microscopy, excretory urography(105 cases) was primarily checked and in addition, renal ultrasonography. cystoscopy. RGP. urine culture. urine cytology. serum IgA, C3. C4 were performed for investigation ofThe results were as follows: I. Prevalence of asymptomatic microscopic hematuria was 1.38% and significantly increased with age (p<0.01). 2. Urologic abnormalities associated with hematuria were identified in 23 cases (21.9 %)-6 cases of renal stone. 4 cases of BPH. 4 cases of UPJ stricture, 3 cases or cystitis, 2 cases of ureteral stone. 1 case or ureteral stricture. nephroptosis. renal cyst. renal tuberculosis. S. In 82 cases, urologic abnormalities could not be found and then serum IgA. C3 C4 checked in 36 cases among these. IgA was increased in 21 cases (58.3%). From the above result. the causes of asymptomatic microscopic hematuria in adults could not be found in 78.1% and serious urologic diseases tumor and so on) were almost not found. We conclude that in order to obtain the detection of accurate prevalence and various urologic diseases. repeatedurine dipstick test and long-term followup in larger populations would be needed, and that screening test for the evaluation of hematuria would consist of performing excretory urography only in relative young adults and excretory urography with selective urine cytology after age 50 years.