Abstract
The differential diagnosis of hematuria with or without proteinuria is extensive, and isolated hematuria is a common problem in children and adolescents. Extensive evaluation is often necessary for the child presenting with macroscopic plus microscopic hematuria including nonglomerular and glomerular etiologies, while children with only isolated microscopic hematuria can generally be followed after baseline evaluation to rule out infection, hypercalciuria, familial hematuria, sickle cell disease, post-streptococcal glomerulonephritis (GN), and structural abnormalities (cysts, stones, obstruction, Wilms tumor). Children with the combination of hematuria and proteinuria require rapid systematic evaluation, generally including renal biopsy, except in cases where post-streptococcal GN can be clearly documented. Post-streptococcal GN occurs 7–21 days after a streptococcal infection, is associated with an acute fall in C3 levels with return to normal by approximately 8 weeks, rarely causes acute renal failure, and in children has a pattern of gradual resolution of hypertension, hematuria, and proteinuria over a course of 6–12 months.
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Dodge WF, West EF, Smith EH, Bunce H III. Proteinuria and hematuria in school-children: Epidemiology and clinicopathologic evaluation.J Pediatr 1976; 88: 327–347.
Vehaskari VM, Rapola J, Koskimies O, Savilathi E, Vilska J, Hallman N Microscopic hematuria in school children: Epidemiology and clinicopathologic evaluation.J Pediatr 1979; 95: 676–684.
Rubin MI, Baliah T. Urine and urine analysis. In: Rubin MI, Barratt TM (eds),Pediatric Nephrology, 1 edn, Baltimore, Williams and Wilkins, 1975, p. 84.
Alon U, Warady BA, Hellerstein S. Hypercalciuria in the frequency-dysuria syndrome of childhood.J Pediatr 1990; 116: 103–105.
Brouhard BH, Travis LB. Acute postinfectious glomerulonephritis. In: Edelmann C.Pediatric Nephrology, 2 edn 1992, p. 1199–1221.
Andreoli SP. Chronic glomerulonephritis in childhood. Membranoproliferative glomerulonephritis, Henoch-Schonlein purpura nephritis, and IgA nephropathy.Pediatr Clin N Am 1995; 42: 1487–1503.
Fairley KF, Birch DF. Hematuria: A simple method for identifying glomerular bleeding.Kidney Int 1982; 21:105–108.
Stapleton FB Isolated hematuria in children.Kidney Int. 1984; 17: 24–28.
Lieu TA, Grasmeder HM III, Kaplan BS. An approach to the evaluation and treatment of microscopic hematuria.Pediatr Clin N Am 1991; 38: 579–592.
Stapleton FB, Roy S III, Noe HN, Jerkins G. Hypercalciuria in children with hematuria.N Engl J Med 1984; 310: 1345–1348.
Picqueras AI, White RHR, Raafat F, Moghal N, Millford DV. Renal biopsy diagnosis in children presenting with hematuria.Pediatr Nephrol 1988; 12: 386–391.
Feld LG, Stepleton FB, Duffy L. Renal biopsy in children with asymptomatic hematuria or proteinuria: Survey of pediatric nephrologists.Pediatr Nephrol 1993; 7: 441–443.
Ingelfinger JR, Davis AE, Grupe WE. Frequency and etiology of gross hematuria in a general pediatric setting.Pediatrics 1977; 59: 557–561.
Stapleton FB. Hematuria associated with hypercalciuria and hyperuricosuria: A practical approach.Pediatr Nephrol 1994; 8 756–761.
Piel CF, Biava CG, Goodman JR. Glomerular basement membrane attenuation in familial nephritis and “benign” hematuria.J Pediatr 1982; 101: 358–365.
Kashton CE, Michael AF. Alport syndrome.Kidney Int 1996; 50: 1445–1463.
Roy S III, Stapleton FB. Changing perspectives in children hospitalized with post-streptococcal glomerulonephritis.Pediatr Nephrol 1990; 4: 585–588.
Schoeneman MJ, Ghali V, Lieberman R, Reisman L. IgA nephropathy in a child with human immunodeficiency virus: A unique form of human immunodeficiency virus-associated nephropathy?Pediatr Nephrol 1992; 6: 46–49.
Lemmink HH, Nillesen WN, Mochizuki Tet al. Benign familial hematuria due to mutation of the Type IV collagen A gene.J Clin Invest 1996; 98: 1114–1118.
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Wood, E.G. Asymptomatic hematuria in childhood: A practical approach to evaluation. Indian J Pediatr 66, 207–214 (1999). https://doi.org/10.1007/BF02761210
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DOI: https://doi.org/10.1007/BF02761210