Long term analysis of cases diagnosed with hematuria in the pediatric clinic: A retrospective analysis

Objective: Hematuria is defined as the presence of five or more red blood cells per high-power field in urine specimens. Hematuria might be an alert for many renal or urinary tract diseases. The frequency of hematuria in children is approximately %1-3. There are various classifications for hematuria: macroscopic or microscopic; symptomatic or asymptomatic etc. In our study we aim to evaluated diagnosis and the progression of disease and also the prognosis of short-long term follow ups in a group of previously healthy, 0-18 age patients whom applied to our clinic with macroscopic hematuria or detected microscopic hematuria in during routine examinations. Material and method: A retrospective study was conducted in patients who applied to the Dokuz Eylul University Hospital Department of Pediatric Nephrology with asymptomatic hematuria between years 1990-2014. The aim was to evaluate the causes of hematuria, follow up diagnosis and treatment process. We searched the medical records for the complaints upon first application, age, gender, familiy history for renal disease, physical examination findings, urine and blood findings accompanying hematuria, radiological imaging studies, renal biopsy results, detected reasons of hematuria and treatments applied. Results: 111 patients with asymptomatic hematuria were included in the study. 48 of them were girls (%43,2), and 63 were boys (%56,8). Mean age was 7,8 (± 3,5) years. Based on hematuria type; 59 cases (%53,2) are diagnosed as microscopic hematuria while 52 cases (%46,8) are diagnosed as macroscopic hematuria. Of the patients with microscopic hematuria, 28 (%47,4) of them had glomerular origin, while 26 cases (%44) had a non-glomerular origin. The most common caus e in the non-glomerular microscopic hematuria is the renal stone disease (%28,8). The Most common glomerular originated cause for microscopic hematuria is Benign Familial Hematuria (%18,6). Of the patients with macroscopic hematuria; 33 (%63,5) patients had glomerular originated causes while 19 patients had (%36,5) non-glomerular originated causes. The most common cause in the non-glomerular originated causes is the renal stone disease (%19,2). Most commonly diagnosed cause for macroscopic hematuria with glomerular origin is APSGN (%28,8). In our study group renal biopsy is performed to 20 cases with microscopic hematuria, and 18 cases with macroscopic hematuria (38 cases in total). Biopsy results showed that most of the cases with macroscopic hematuria had mesangioproliferative glomerulonephritis(%22,2) and mesangial proliferation(%27,8). Whereas; Ig A Nephropathy(%20), Thin Glomerular Basement Membrane Disease(%15) and Alport Syndrome(%15) are detected more frequently in microscopic hematuria. Conclusion: In conclusion; in short or mid term follow up of patients with incidental microscopic hematuria or patients with macroscopic hematuria without systemic signs as a presenting symptom; if the renal function tests are normal, the important finding is persistance of microscopic hematuria (which is more commonly seen in microscopic hematuria cases). With these findings it might be plausible to follow these patients for additional signs as long as microscopic hematuria persists even though it is the only finding. Key words: Asymptomatic hematüria, acute post streptococcal glomerulonephritis, thin glomerular basement membrane disease