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Pediatric Nephrology

, Volume 7, Issue 1, pp 27–31 | Cite as

Glomerular lesions in adolescents with gross hematuria or the nephrotic syndrome

Report of the Southwest Pediatric Nephrology Study Group
  • Ronald J. Hogg
  • Fred G. Silva
  • Philip L. Berry
  • James E. Wenz
Original Article

Abstract

We report clinical and pathological data in 56 adolescents presenting with gross hematuria (GH) and 65 presenting with idiopathic nephrotic syndrome (INS). IgA nephropathy (present in 52%) and other mesangial lesions were found in the majority of the 56 patients with GH. Many of these patients had complex urological procedures prior to consideration of a nephrological problem. This often led to significant delays in making the appropriate diagnosis. Pathological lesions in the 65 patients with INS included minimal change NS (MCNS) in 31%, membranous glomerulonephritis (MGN) and focal segmental glomerulosclerosis (FSGS) in 18.5% each, and membranoproliferative GN (MPGN) in 12%. In 47 of the patients with INS, in whom no specific treatment had been given prior to renal biopsy, MCNS and MGN were observed with a similar frequency (26% and 23%, respectively), with FSGS and MPGN being found in 21% and 11%. These results indicate that the pathological lesions in adolescents with INS who undergo a renal biopsy more closely resemble those in adults, and are usually more severe than those in young children. However, it should be noted that our study was retrospective. Hence, there were probably some adolescents with INS who had a successful response to therapy and therefore did not have a renal biopsy performed.

Key words

Nephrotic syndrome Adolescents Gross hematuria IgA nephropathy 

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References

  1. 1.
    Harrison WE, Habib HN, Smith EI (1966) Non-traumatic hematuria in children. J Urol 96: 95–100PubMedGoogle Scholar
  2. 2.
    Northway JD (1971) Hematuria in children. J Pediatr 78: 381–396PubMedGoogle Scholar
  3. 3.
    Given GZ (1973) Hematuria in childhood: differential diagnosis. Urol Clin North Am 1: 561–572Google Scholar
  4. 4.
    Wyatt RJ, McRoberts JW, Holland NH (1977) Hematuria in childhood: significance and management. J Urol 117: 366–368PubMedGoogle Scholar
  5. 5.
    Ingelfinger JR, Davis AE, Grupe WE (1977) Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics 59: 557–561PubMedGoogle Scholar
  6. 6.
    International Study of Kidney Disease in Children (1980) Clinical pathological correlation in recurrent and persistent hematuria syndromes. Pediatr Res 14: 995AGoogle Scholar
  7. 7.
    Piel CF, Biava CG, Goodman JR (1984) Unexplained hematuria: histologic diagnosis in 61 children. Pediatr Res 18: 376AGoogle Scholar
  8. 8.
    Trachtman H, Weiss RA, Bennett B, Greifer I (1984) Isolated hematuria in children: indications for a renal biopsy. Kidney Int 25: 94–99PubMedGoogle Scholar
  9. 9.
    Vehaskari VM (1987) Symptomless hematuria in children. In: Murakami K, Kitagawa T, Yabuta, Sakai T (eds) Recent advances in pediatric nephrology. Proceedings of the 7th International Congress of Pediatric Nephrology. Excerpta Medica, Amsterdam, pp 333–336Google Scholar
  10. 10.
    Tiebosch ATMG, Frederik PM, Breda Vriesman PJC van, Mooy JMV, Rie H van, Wiel TWM van de, Wolters J, Zeppenfeldt E (1989) Thin-basement membrane nepbropathy in adults with persistent hematuria. N Engl J Med 320: 14–18PubMedGoogle Scholar
  11. 11.
    Hogg RJ (1988) Recent advances in the diagnosis of hematuria in children. Pediatr Ann 17: 560–565PubMedGoogle Scholar
  12. 12.
    Copley JB (1986) Isolated asymptomatic hematuria in the adult. Am J Med Sci 291: 101–111PubMedGoogle Scholar
  13. 13.
    Cornfeld D (1978) Nephrosis in childhood. Hosp Med March: 98–111Google Scholar
  14. 14.
    International Study of Kidney Disease in Children (1978) Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. Kidney Int 13: 159–165Google Scholar
  15. 15.
    Barnett HL (1978) The natural and treatment history of glomerular diseases in children — what can we learn from internationl cooperative studies? A report of the International Study of Kidney Disease in Children. Proceedings of the 6th International Congress of Nephrology. Karger. Basel, pp 470–485Google Scholar
  16. 16.
    Bolton WK, Atuk NO, Sturgill BC, Westervelt FB Jr (1977) Therapy of the idiopathic nephrotic syndrome with alternate day steroids. Am J Med 62: 60–70PubMedGoogle Scholar
  17. 17.
    Nolasco F, Cameron JS, Heywood EF, Hicks J, Ogg C, Williams DG (1986) Adult-onset minimal change nephrotic syndrome: a long-term follow-up. Kidney Int 29: 1215–1223PubMedGoogle Scholar
  18. 18.
    Coggins CH (1981) Minimal change nephrosis in adults. In: Zurukzoglu W (ed) Proceedings of the 8th International Congress of Nephrology. Karger, Basel, pp 336–344Google Scholar
  19. 19.
    Southwest Pediatric Nephrology Study Group (1982) A multicenter study of IgA nephropathy in children. Kidney Int 22: 643–652Google Scholar
  20. 20.
    Southwest Pediatric Nephrology Study Group (1985) Focal segmental glomerulosclerosis in children with idiopathic nephrotic syndrome. Kidney Int 27: 442–449Google Scholar
  21. 21.
    Southwest Pediatric Nephrology Study Group (1986) Comparison of idiopathic and systemic lupus erythematosus associated membranous glomerulonephropathy in children. Am J Kidney Dis 7: 115–124Google Scholar
  22. 22.
    Roy S III, Stapleton FB, Noe HN, Jerkins G (1981) Hematuria preceding renal calculus formation in children with hypercalciuria. J Pediatr 99: 712–715PubMedGoogle Scholar
  23. 23.
    Kalia A, Travis LB, Brouhard BH (1981) The association of idiopathic hypercalciuria and asymptomatic gross hematuria in children. J Pediatr 99: 716–719PubMedGoogle Scholar
  24. 24.
    Stapleton FB, Roy S III, Noe HN, Jerkins G (1984) Hypercalciuria in children with hematuria. N Engl J Med 310: 1345–1348PubMedGoogle Scholar
  25. 25.
    Stapleton FB (1990) Idiopathic hypercalciuria: a prominent cause of isolated hematuria in children: a report of the Southwest Pediatric Nephrology Study Group. Kidney Int 37: 807–811PubMedGoogle Scholar
  26. 26.
    Silva FG, Hogg RJ (1989) IgA nephropathy. In: Tisher CC, Brenner BM (eds) Renal pathology with clinical and functional correlations. Lippincott Philadelphia, pp 434–493Google Scholar
  27. 27.
    Takada T, Yanagihara T, Kuwabara H, Hongoh K, Igarashi T, Yoshizumi A, Kihara I (1989) Clinicopathological study in 50 adolescent patients with primary nephrotic syndrome. Pediatr Nephrol 3: C9Google Scholar

Copyright information

© IPNA 1993

Authors and Affiliations

  • Ronald J. Hogg
    • 1
  • Fred G. Silva
    • 1
  • Philip L. Berry
    • 1
  • James E. Wenz
    • 1
  1. 1.Southwest Pediatric Nephrology Study Group, Central Office: Department of PediatricsBaylor UniversityMedical CenterDallasUSA

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