Ocurrence enzootic hematuria in buffaloes in Brazil: epidemiological, clinical, and pathological aspects / Ocorrência de hematúria enzoótica em búfalos no Brasil: aspectos epidemiológicos, clínicos e patológicos

It is reported the occurrence of enzootic hematuria (EH) in buffaloes in Brazil after performing an epidemiological survey and clinicopathological analises. To date, EH caused by ingestion of Pteridium esculentum subsp. arachnoideum, a radiomimetic plant popularly known as "bracken fern", has not been described in this species in Brazil. Bovine EH is responsible for high economic losses in Brazil's Southeast Region not only because of the deaths it causes, but also owing to its negative effect on productivity. In São José do Barreiro County, São Paulo, some farmers in areas with a high incidence of bovine EH have been replacing cattle with buffaloes, based on the premise that the latter would be more resistant to poisoning by ingestion of Pteridium spp. However, even though initial observations indicated that buffaloes are indeed less sensitive than cattle to the toxic principle of Pteridium spp., cases of hematuria in this species have been reported. According to preliminary date, EH only occurs in buffaloes over six years of age. Macroscopic examination revealed a thickened urinary vesicle mucosa, along with multiple foci of ulcerated, exophytic, verrucous, and pedunculated lesions. In one of the buffaloes studied, the bladder wall was ruptured and exhibited marked secondary inflammation. Histologically, neoplastic and non-neoplastic changes similar to those described in cattle poisoned by Pteridium spp. were observed. The neoplasms found included papilloma, carcinoma in situ, urothelial carcinoma (low and high grade), inverted, microcystic, and trabecular variants, urothelial carcinoma with divergent differentiation (squamous and glandular), squamous cell carcinoma, lymphangioma, hemangioma, and hemangiosarcoma. There was also coexistence of epithelial and mesenchymal neoplasms. Bovine papillomavirus particles were not detected by polymerase chain reaction in the bladder samples analyzed.

Descreve-se, através de levantamento epidemiológico e avaliação clínico-patológica, a ocorrência de hematúria enzoótica (HE) em búfalos no Brasil. Essa condição, causada pela ingestão da planta radiomimética Pteridium esculentum subsp. arachnoideum, conhecida popularmente como "samambaia" ou "samambaia do campo", até então não havia sido descrita nessa espécie no Brasil. Na Região Sudeste, a HE bovina é responsável por elevadas perdas econômicas, devidas não apenas aos óbitos, mas também em função da queda de produtividade. No município de São José do Barreiro/SP, alguns produtores de áreas com alta incidência de HE bovina, vêm substituindo os bovinos por búfalos, com base na premissa de que estes seriam mais resistentes à intoxicação. Embora, de acordo com observações iniciais, os búfalos realmente sejam menos sensíveis que os bovinos ao princípio tóxico de Pteridium spp., ainda assim, tem-se verificado a ocorrência de casos de hematúria nessa espécie. De acordo com o levantamento inicial, a HE só ocorre em búfalos com idade a partir de seis anos. Ao exame macroscópico, verificou-se a mucosa da bexiga espessa, com múltiplos focos de lesões ulceradas, exofíticas, papiliformes, verrucosas, pedunculadas. Histologicamente, foram observadas alterações neoplásicas e não neoplásicas semelhantes às descritas nos bovinos com HE. Entre as neoplasias foram encontrados papiloma, carcinoma in situ, carcinoma urotelial (baixo e alto grau), variantes invertida, microcística e trabecular, carcinoma urotelial com diferenciação divergente (escamosa e glandular), carcinoma de células escamosas, linfangioma, hemangioma e hemangiossarcoma. Ocorreu também coexistência entre neoplasias epiteliais e mesenquimais. Não foram detectadas partículas de papilomavírus bovino pelo teste PCR nas amostras de bexiga analisadas.

Síndrome de Klipper-Trenaunay-Weber con compromiso vesical y uterino tratado por vía endoscópica y endovascular / Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes

El síndrome de Klippel-Trenaunay-Weber (SKTW) es una rara malformación venosa que, en general afecta a los miembros inferiores y, más raramente, a los superiores. Se caracteriza por formaciones angiomatosas cutáneas, várices e hipertrofia del miembro afectado. El compromiso genitourinario es sumamente infrecuente. Se presenta el caso de una paciente de 14 años. Ingresó por hematuria macroscópica de 48 h de evolución y metrorragia con grave compromiso hemodinámico. Se encontraba en estudio por presentar un hemangioma en el miembro inferior izquierdo que se extendía hasta la región pelviana. La uretrocistofibroscopía demostró la presencia de múltiples lesiones angiomatosas diseminadas en forma amplia en la vejiga, algunas de ellas con sangrado activo. La angioresonancia mostró una voluminosa formación hipervascularizada en contacto con la pared vesical a la cual desplazaba y fístulas arteriovenosas a nivel pelviano y en el miembro inferior izquierdo confirmando el diagnóstico etiológico. Se realizó una embolización arterial selectiva de los territorios ilíacos interno y externo e inmediatamente después una endocoagulación láser de los focos angiomatosos sangrantes. La hematuria remitió completamente en las 24 h posteriores al procedimiento. La metrorragia asociada al SKTW fue controlada mediante la utilización de análogos LHRH y progestágenos.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.

Beta-Thalassemia Minor Is Associated with IgA Nephropathy

No abstract available.

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.

Malformación de abernethy tipo 1: presentación de un caso clínico y revisión de la literatura / Type-1 abernethy malformation: a clinic case presentation and review of literature

Se presenta caso de preescolar masculino de 5 años con antecedente de hepatoesplenomegalia desde el año de vida, quien consultó con clínica de hematuria, se realizó ecografía abdominal con hallazgos: de imágenes hipoecoicas difusas en el parénquima hepático, dificultad para valorar el sistema porta, esplenomegalia. Eco Doppler del sistema venoso portal presencia de anomalía vascular portal, no se observo porta principal, se realizó Angiotac multicorte del sistema arterial venoso portal y mesenterico que confirmo Agenesia de la vena Porta. Se diagnóstico malformación de Abernethy tipo I. Las malformaciones del sistema venoso abdominal son alteraciones vasculares raras. El primer acontecimiento de la ausencia congénita de la vena porta viene dado por un shunt cava mesenterico, los shunts portocava (SPC), son malformaciones infrecuentes descritas por Abernethy en 1973, se clasifican en dos grupos según la presencia tipo (II) o ausencia de la vena porta tipo (I). La malformación de Abernethy tipo I usualmente se relaciona a otras anomalías congénitas tales como: defectos cardiacos, atresia de vías biliares y poliesplenia, más frecuentes en el sexo femenino; en varones puede no encontrarse anomalías congénitas asociadas...

A 5-year old preschool male case is presented, with antecedent hepatosplenomegaly since one year old, who attended clinic consult with haematuria; abdominal echography was performed with the following findings: diffuse hypoecoic images on liver parenchyma, difficulties to assess the portal system, splenomegaly. Echo-Doppler of portal vein system evidenced the presence of portal vascular abnormality, no main portal vein was observed. A Multislice CT Angiography of the mesenteric and portal arterial-venous system was performed, which confirmed portal vein agenesis. Type-I Abernethy Malformation was diagnosed. The abdominal venous system’s malformations are rare vascular disturbances. The first event expressed by the portal vein congenital absence is evidenced by a caval-mesenteric shunt. Porta-Caval Shunt (PC-Shunts) are uncommon malformations described by Abernethy in 1973 that are classified into two groups as per the presence -Type II- or the absence -Type I- of portal vein. Type-I Abernethy Malformation is usually connected with other congenital abnormalities such as: heart defects, biliary tract atresia, and polysplenia, which are more frequent in females. Associated congenital abnormalities could not be found in males...

Intoxicação experimental aguda por samambaia (Pteridium aquilinum) em bovinos / Experimental acute poisoning by bracken fern (Pteridium aquilinum) in cattle

Este experimento foi delineado para investigar os seguintes pontos em relação à intoxicação aguda por samambaia (Pteridium aquilinum) em bovinos: 1) a intensidade da trombocitopenia em diferentes momentos da intoxicação e sua relação com possíveis déficits na hemostasia secundária, 2) a relação da neutropenia com as manifestações morfológicas de septicemia ocasionalmente observadas na necropsia, e 3) o mecanismo da anemia e sua relação com a perda de sangue, a vida média eritróide e a evolução da doença. As hastes superiores mais verdes de P. aquilinum foram administradas a quatro bovinos sem raça definida, com idade média de 1,5 ano e pesos entre 190-215 kg. Um bovino de idade e peso semelhantes foi usado como controle e, exceto por não ter recebido P. aquilinum, foi mantido nas mesmas condições que os outros quatro. Os quatro bovinos que receberam a planta morreram com quadro característico da intoxicação aguda por samambaia após receberem durante 53-58 dias, doses diárias de 8,0, 8,6, 10,2 e 10,6g/kg de peso corporal, que totalizaram, ao final do experimento, respectivamente, 112,7, 107,6, 85,7, 90,15 kg da planta, o que corresponde, respectivamente, a 59,3 por cento, 63,3 por cento, 47,4 por cento, 47,5 por cento da planta em relação ao peso dos bovinos. A doença caracterizou-se por febre de até 42,5 graus C e diversos graus de hemorragias observadas clinicamente, na necropsia e na histopatologia. A morte ocorria 6-7 dias após o início do quadro febril. As alterações hematológicas revelaram trombocitopenia e neutropenia acentuadas. Em dois dos quatro bovinos havia anemia leve. Não houve variações significativas nos tempos de coagulação dos bovinos intoxicados, quando avaliados os fatores de coagulação (secundária), excluindo-se assim a possibilidade da participação de distúrbios da hemostasia secundária na patogênese das hemorragias nessa intoxicação. A determinação dos produtos da degradação da fibrina no soro revelou dados conflitantes...

This experiment was design to address the following points in relation to the acute poisoning by bracken fern (Pteridium aquilinum) in cattle: 1) the severity of the thrombocytopenia in different stages of the intoxication and its relationship to possible deficits in the secondary hemostasis, 2) the relationship between neutropenia and the morphological signs of septicemia occasionally found at necropsy, and 3) the mechanism of anemia and its relationship with blood loss, medium life of erythrocytes and the progress of the disease. The fresh green upper parts of P. aquilinum were fed to four mixed breed calves with average age of 18 months and weights ranging from 190 to 215 kg. A calf of similar age and weight was kept together with the other four under the same conditions, except for the ingestion of P. aquilinum. The four fern-fed calves died with typical features of acute bracken fern poisoning after being fed with the plant for 53-58 days daily doses of 8.0, 8.6, 10.2, and 10.6g/kg body weight totaling at the end of the experiment, respectively, 59.3 percent, 63.3 percent, 47.4 percent, and 47.5 percent of bracken fern in relation to their body weight. The disease was characterized by fever up to 42.5 grades C and varying degrees of hemorrhages observed clinically, at necropsy and on histological examination. Death occurred 6-7 days after the onset of fever. The hematological changes consisted mainly of marked thrombocytopenia and neutropenia. Two of the four affected calves had mild anemia. The deficits in secondary hemostasis were mild in each case. There were no significant changes thus permitting to rule out the role of secondary hemostasis in the pathogenesis of the hemorrhages in the bracken fern poisoning. The measurement of fibrin degradation products in the serum showed conflicting results and did no allow for a solid conclusion regarding the role of disseminated intravascular coagulation in the pathogenesis of the hemorrhages...

Dr. José León Tapia: el recuerdo de un eminente cirujano y un reconocido intelectual venezolano artículo homenaje al Dr. José León Tapia / Dr. José León Tapia: the memory of an eminent surgeon and a re-cognized venezuelan intellectual tribute to article Dr. José León Tapia

Evaluar la labor desempeñada por el doctor José León Tapia como cirujano y su obra como intelectual venezolano. Se realizó una evaluación de las obras escritas por el Dr. José León Tapia para resaltar su aporte como cirujano y como intelectual venezolano. El Dr. José León Tapia realizó su labor como cirujano e intelectual en la ciudad de Barinas-Venezuela. La obra del Dr. José León Tapia como cirujano significó una renovación y la modernización de la cirugía en el estado Barinas, y su obra literaria lo distingue como uno de los intelectuales más destacados en la Venezuela contemporanea.

Small cell carcinoma of the urinary bladder: virtual CT cystoscopic findings.

A 74-year-old man underwent multidetector CT virtual cystoscopy due to macroscopic hematuria. A large, irregularly-surfaced, solid bladder mass was detected, infiltrating the perivesical fat, the seminal vesicles and the prostate. CT examination of the chest and abdomen showed no distant metastases. Radical cystectomy was performed and pathology reported pure small cell carcinoma of the urinary bladder.

Glomerular basement membrane thickness in normal adults and its application to the diagnosis of thin basement membrane disease: an Indian study.

Microscopic hematuria of non-urologic origin warrants ultrastructural study of renal biopsy. Thinning and variations in the texture of glomerular basement membrane (GBM) are difficult to be recognized under light microscope; transmission electron microscope (TEM) therefore plays a vital role in identifying such changes. Ultrastructural morphometry is a valuable diagnostic aid when GBM is suspected of being abnormally thin. In an effort to determine the normal GBM thickness (GBMT) in Indian adults and to determine the cutoff value of GBMT for a diagnosis of thin basement membrane disease (TBMD), we determined GBM thickness in 25 normal adults. Postmortem biopsies of 25 normal adults (16 males and 9 females) aging between 18-58 years were included in the study. GBM thickness was determined through ultrastructural morphometry on accurately enlarged electron micrographs as harmonic mean of 50 orthogonal intercepts across the GBM in each case. Study revealed a mean GBM thickness of 321 nm with a standard deviation (SD) of 28 nm. Mean-2SD (321-56), that is 265 nm, was fixed as cutoff value of GBMT for the diagnosis of TBMD. A systematic split study of control subjects revealed thicker GBM (329+/-38 nm) in higher age group (35-60 years) as compared to GBMT (316+/-21 nm) in lower age group (18-30 years). Males in higher age group also revealed thicker GBM (males: 343+/-39 nm versus females: 300+/-12 nm). Ten patients with non-urologic hematuria and having GBMT<265 nm were diagnosed as cases of TBMD. Patients with TBMD revealed significantly attenuated GBM as compared to age and sex matched controls (214 +/- 40 nm versus 311 +/- 17 nm; p<0.0005). No overlap was observed in the distribution of GBMT in patients of TBMD and age and sex matched controls. Ultrastructural morphometry is the ultimate and appropriate method for diagnosing TBMD.

Adenocarcinoma mucosecretor de vejiga / Adenocarcinoma of urinary bladde

Tras una revisión retrospectiva documental, describimos el caso de un paciente masculino de 69 años de edad que consultó por cuadro de hematuria el año 2000. Tras el estudio se indicó una RTU (Resección Transuretral) del tumor vesical, sin embargo, el paciente no acudió a sus controles. Dos años más tarde se evidencia un avance importante de la patología con un precario pronóstico para el paciente.

Synchronous primary malignant neoplasms of colon and bladder.

Extracolonic and synchronous malignancies are rare in colorectal carcinomas. We report a 68-year-old man with complaints of rectal bleeding and hematuria. Endoscopic biopsies revealed synchronous adenocarcinoma of the colon and transitional cell carcinoma of the bladder. The patient was started on chemotherapy, and is alive (with disease) nine months later.

Pharmacological and histopathological study of cyclophosphamide-induced hemorrhagic cystitis - comparison of the effects of dexamethasone and Mesna

Chemotherapy with oxazaphosphorines, such as cyclophosphamide (CYP), is often limited by unacceptable urotoxicity. Without uroprotection, hemorrhagic cystitis (HC) becomes dose-limiting. To compare the uroprotective efficacy of classical 2-mercaptoethanesulfonic acid (Mesna) treatment with dexamethasone in CYP-induced HC, male Wistar rats (150-200 g; N = 6 in each group) were treated with saline or Mesna (40 mg/kg, ip) immediately and 4 and 8 h after ip administration of CYP (200 mg/kg). One, 2 or 3 doses of Mesna were replaced with dexamethasone (1 mg/kg, ip). The animals were sacrificed 24 h later. Cystitis was evaluated by determining the changes in bladder wet weight (BWW) and by macroscopic and microscopic analysis. CYP treatment induced a marked increased in BWW 162 percent 0.05, which was significantly inhibited by treatment with 3 doses of Mesna 0.05; 80 percent. The replacement of 1 or 2 doses of Mesna with dexamethasone reduced the increase in BWW by 83.3 and 95 percent, respectively. Macroscopic analysis of the bladder of rats with CYP-induced HC showed severe edema and hemorrhage, confirmed by microscopic analysis, that also showed mucosal erosion, inflammatory cell infiltration and ulcerations. The replacement of 1 or 2 doses of Mesna with dexamethasone inhibited the CYP-induced increase in BWW and almost abolished the macroscopic and microscopic alterations, with no significant difference between the effects of Mesna and dexamethasone, indicating that both drugs were efficient in blocking HC. However, although the replacement of all Mesna doses with dexamethasone reduced the edema, it did not prevent HC, suggesting that Mesna is necessary for the initial uroprotection

Biópsia renal percutânea, em crianças, com pistola automática sob orientaçäo ultrassonográfica / Percutaneous kidney biopsy, in children, with ultrasound guidance automatic pistole

Relata-se a experiência de nosso serviço com a realizaçao de biópsia renal percutânea com pistola automática sob visao ultrassonográfica, no período de 12/92 a 11/94. Utilizou-se o aparelho Diasonics SPA 1000 e guia acoplado para direcionamento da agulha. As crianças foram sedadas, previamente, com midazolam e submetidas a anestesia local com xilocaína. Após o procedimento, todos os pacientes foram internados para observaçao por 24 horas. Foram biopsiados 60 casos com idade média 10,3 + 3,2 anos e peso médio 34.2 + 11,7 kg. Utilizou-se agulha tipo Tru-Cut 16G em 58 casos e 14G em 2 casos. A biópsia renal foi efetuada à direita em 58/60 casos. O número de punçoes renais necessárias para obtençao de material para análise histológica completa foi 3,10 + 1,5. O número de glomérulos obtidos por punçao foi de 13,8 + 8,6 para Miscrocopia Optica (M.O) e 7,4 + 5,5 para Imunofluorescência (I.F.). O material obtido foi tecnicamente insatisfatório em 1/60 casos. O controle ultrassonográfico realizado 24 horas após a biópsia mostrou hematoma pericapsular em 14/60 pacientes. 5/60 apresentaram hematúria macroscópica autolimitada e 1/60 desenvolveu choque neurogênico secundário à formaçao de hematoma pericapsular, sem hematúria concomitante. Nao houve correlaçao entre número total de punçoes e incidência de complicaçoes pós-biópsia renal percutânea feita nos moldes descritos, confirma-se em nossa experiência como procedimento útil, resolutivo e de baixa morbidade.

Enfermedad de Alport y hematuria recidivante: estudio comparativo y revisión de la literatura / Alport disease and recurrent hematuria: comparative study and review of the literature

Se estudian 10 casos de nefropatías con patología de la membrana basal (M.B.), recibidas en la Fundación Jiménez Díaz. Seis corresponden a Enfermedad de Alport (EA), uno a Nefropatía Familiar Benigna (H.F.B.) y tres a Hematuria Recidivante (H.R.) no urológica. Se realiza una valoración clínico-evolutiva, y los hallazgos histológicos y ultraestructurales en ocho de ellos mediante Indices Morfológicos de actividad y cronicidad (valor númerico). Resultados: Encontramos engrosamiento predominante de la membrana basal en EA, excepto en uno de los casos que tuvo laminación extensa y poco compromiso de la función renal. La HFB mostró adelgazamiento extenso y uniforme (media de 213 nm., y espesor mínimo de 120 nm.). Las HR presentaron engrosamiento e irregularidades de la MB, ninguno presentó laminación y uno adelgazamiento y ruptura. Conclusiones: La relación encontrada con la función renal permite concluir que el Indice morfológico puede ser útil para la valoración de los pacientes con Nefropatías hereditarias, sobre todo, aquellas de naturaleza progresiva

Glomerular alterations in idiopathic haematuria--ultrastructural and morphometric analysis.

Re-evaluation of kidney biopsies has been done along with morphometric analysis of glomerular basement membrane thickness (G.B.M.) in 41 cases of idiopathic haematuria, in whom the initial routine light, immunofluorescent and electron microscopic examination had not shown any significant alterations. Extreme attenuation of G.B.M. (mean thickness of 2581 +/- 488 A) had been found in thirty one patients in contrast to mean GBM thickness of 4295 +/- 470 A found in control group. Absence of any history of familial haematuria in these patients distinguished them from hereditary nephropathies and hence categorized under the term thin basement membrane nephropathy. Follow up of these patients for upto 8 years had shown persistence of symptoms without further deterioration of renal function as well as morphology.

Hematuria en la infancia: casuistica y estrategia diagnóstica / Haematuria in children: casuistical and diagnostic strategy

Revisamos las historias médicas de nuestros pacientes que presentaron hematuria macro o microscópica. Encontramos 124 casos con edades comprendidas entre 0 y 14 años, 78 varones y 46 hembras. Se pudo determinar la etiología en 91 pacientes (73,4//). Analizamos los hallazgos clínicos y la estrategia diagnóstica utilizada

Hematúria recorrente na infância: estudo de 250 casos / Recurrent hematuria in children: a study of 250 cases

Para avaliarmos a prevalência de determinadas patologias e esquematizar protocolo de investigaçäo pouco invasivo, estudamos 250 crianças com hematúria, de seis meses a 17 anos, acompanhadas ambulatorialmente, sendo 102 do sexo feminino e 148 do sexo masculino, submetendo-se aos seguintes exames: urina tipo I, urocultura, uréia, creatinina e complemento sérico total e fraçöes, eletroforese de hemoglobina, proteinúria em volume urinário de 24h, pesquisa de dismorfismo eritrocitário nas hemácias da urina, uricosúria e calciúria em urina de 24h (três amostras) e prova de sobrecarga oral de cálcio nas crianças com hipercalciúria (HCa). Realizamos avaliaçäo radiológica e biópsia renal quando necessário. O diagnóstico etiológico foi possível em 83% das crianças, sendo: 1) glomerulopatia em 79 casos (31%), 45 casos de outras glomerulopatias (48%), 19 casos de doença de Alport (7%) e 15 casos de doença de Berger (6%); 2) hipercalciúria em 67 casos (27%); 3) calculose renal em 27 pacientes (11%); 4) infecçäo urinária (ITU) em 14 casos (6%); 5) malformaçöes renais em oito casos (3%). Permanecem ainda em estudo 43 criançs (17%). Podemos concluir, através desses resultados, que, uma vez estabelecida metodologia de investigaçäo adequada, nos casos de hematúria recorrente, poderemos obter diagnóstico etiológico, utilizando métodos invasivos em apenas alguns casos, quando houver suspeita de glomerulopatia

Erythrocyte morphology under phase contrast microscopy in haematuria.

Fresh urine samples from twenty patients with macroscopic haematuria were examined by phase contrast microscopy to study the erythrocyte morphology. Other appropriate investigation like - renal biopsy in suspected glomerulonephritis and appropriate urological investigations in other cases to prove the site of origin of erythrocyte were done in all cases. Changes in erythrocyte morphology were observed in all the 12 patients with histological evidence of proliferative glomerulonephritis. These changes included extrusion of cell cytoplasm (39.5%), 'Doughnut' cell (26.5%) budding cell (15%) and cell membrane rupture with loss of cytoplasm (15%). Overall 83.3% of the erythrocytes showed some morphologic change or the other. In 8 patients where bleeding was into the pelvicalyceal system, ureter or bladder, 95% of RBCs showed no discernible morphologic change. It is concluded that the morphological changes in the erythrocyte identified under the phase contrast microscope can help to differentiate between glomerular and non glomerular causes of bleeding.