Asymptomatic Primary Hematuria in Children

Lee, Jung-Mi; Park, Woo-Saeng; Ko, Cheol-Woo; Koo, Ja-Hoon; Kwak, Jung-Sik

J Korean Soc Pediatr Nephrol > Volume 4(1); 2000 > Article

J Korean Soc Pediatr Nephrol 2000;4(1): 25-32.

소아의 무증상성 일차성 혈뇨에 관한 고찰

이정미, 박우생, 고철우, 구자훈, 곽정식

¹경북대학교 의과대학 소아과학교실
²경북대학교 의과대학 소아과학교실
³경북대학교 의과대학 소아과학교실
⁴경북대학교 의과대학 소아과학교실
⁵경북대학교 의과대학 병리학 교실

Asymptomatic Primary Hematuria in Children

Jung-Mi Lee, Woo-Saeng Park, Cheol-Woo Ko, Ja-Hoon Koo, Jung-Sik Kwak

¹Department of Pediatrics, Kyungpook University, College of Medicine
²Department of Pediatrics, Kyungpook University, College of Medicine
³Department of Pediatrics, Kyungpook University, College of Medicine
⁴Department of Pediatrics, Kyungpook University, College of Medicine
⁵Department of Pathology, Kyungpook University, College of Medicine

ABSTRACT

Purpose: This retrospective study of 126 children with symptomless primary hematuria was undertaken to determine the distribution of various histologic types by renal biopsy, clinical outcome according to the biopsy findings and also to find out feasibility of performing renal biopsy in these children.
Patients and Methods : Study population consisted of 126 children with symptom-less primary hematuria who have been admitted to the pediatric department of Kyung-poot National University Hospital for the past 11 years from 1987 to 1998 and renal biopsy was performed percutaneously. Hematuric children with duration of less than 6 months, evidences of systemic illness such as SLE or Henoch-Schonlein purpura, urinary tract infection, and idiopathic hypercalciuria were excluded from the study.
Results : Mean age of presentation was 9.2${pm}$3.3 years (range ; 1.5-15.3 years) and male preponderance was noted with male to female ratio of 2:1. IgA nephropathy was the most common biopsy finding occuring in 60 children ($47.6%$), followed by MsPGN in 13 ($10.3%$), MPGN in 5 ($3.9%$), TGBM in 6 ($4.7%$), Alport syndrome in 2 ($1.6%$), FSGS in 1 ($0.8%$), and in 39 children ($30.9%$), 'normal' glomeruli were noted. Recurrent gross hematuria was more common than persistent microscopic hematuria (84 versus 42), and especially in IgA nephropathy, recurrent gross hematuria was the most prevalent pattern of hematuria. In 58 out of 126 cases ($46.0%$), hematuria was isolated without accompa-nying proteinuria and this was especially true In cases of MsPGN and 'normal' glomer-uli by biopsy finding. Normalization of urinalysis (disappearance of hematuria) in IgA nephropathy, MsPGN and 'normal' glomuli group were similar and it was $14%,;27%;and;21%$ respectively during 1-2 years of follow-up period, and $37.1%,;40%;and;35%$ respectively during 3-4 years of follow-up periods. However, abnormal urinalysis persi-sted in the majority of children with MPGN, TGBM. Alport syndrome and FSGS. Renal function deteriorated progressively in 6 cases (3 with IgA nephropathy, 2 with Alport syndrome and 1 with TGBM).
Conclusion : In summary, present study demonstrates that in 126 children with symptomless primary hematuria, IgA nephropathy was the most common biopsy findings followed by MsPGN, MPGN, TGBM, Alport syndrome and FSGS, and 'normal glomeruli' was also seen in 39 cases ($30.9%$). Renal histology could not be predictable on the clinical findings, so that to establish appropriate long-term planning for these children, we would recommend to obtain precise histologic diagnosis by renal biopsy.

Key words: Primary hematuria | Asymptomatic hematuria | IgA nephropathy | Thin basement membrane disease