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Pediatric Clinics of North America Feb 2019The causes of macroscopic and microscopic hematuria overlap; both are often caused by urinary tract infections or urethral/bladder irritation. Coexistent hypertension... (Review)
Review
The causes of macroscopic and microscopic hematuria overlap; both are often caused by urinary tract infections or urethral/bladder irritation. Coexistent hypertension and proteinuria should prompt investigation for glomerular disease. The most common glomerulonephritis in children is postinfectious glomerulonephritis. In most patients, and especially with isolated microscopic hematuria, the diagnostic workup reveals no clear underlying cause. In those cases whereby a diagnosis is made, the most common causes of persistent microscopic hematuria are thin basement membrane nephropathy, immunoglobulin A nephropathy, or idiopathic hypercalciuria. Treatment and long-term prognosis varies with the underlying disease.
Topics: Child; Diagnosis, Differential; Glomerulonephritis, IGA; Hematuria; Humans; Hypercalciuria; Hypertension; Kidney Diseases; Proteinuria; Urinary Tract Infections
PubMed: 30454740
DOI: 10.1016/j.pcl.2018.08.003 -
Indian Journal of Pediatrics Aug 2020Hematuria is one of the alarming manifestations of a renal disease. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or... (Review)
Review
Hematuria is one of the alarming manifestations of a renal disease. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or non-glomerular disorders. Clinical presentation and urine microscopy can differentiate glomerular from non-glomerular hematuria. In the majority, a good clinical examination and basic investigations including a urine microscopic examination with sophisticated tools like phase contrast and automated microscopes can help differentiate glomerular from non-glomerular causes for hematuria. Drug induced hematuria, especially secondary to use of analgesics needs to be recognized in routine clinical practice. Rarer causes of hematuria may need more detailed evaluation with a renal biopsy, electron microscopy, urine biochemical testing and imaging. There is no specific treatment to resolve or prevent hematuria. Resolution of hematuria usually occurs with appropriate management of the underlying disorder. Persistent microscopic hematuria indicates the presence of a renal disease that warrants close monitoring and evaluation. Prompt referral to a pediatric nephrologist is indicated in situations when hematuria does not resolve within 2 weeks of onset of glomerulonephritis, there is a need for a renal biopsy, in the presence of persistent microscopic hematuria and need for specific urine biochemistry testing or imaging studies.
Topics: Child; Glomerulonephritis; Hematuria; Humans; Kidney Diseases; Microscopy; Urinalysis
PubMed: 32026313
DOI: 10.1007/s12098-020-03184-4 -
Renal Failure Dec 2021Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need...
BACKGROUND
Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom.
METHODS
The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group.
RESULTS
Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, < .001).
CONCLUSION
Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.
Topics: Acute Kidney Injury; Adult; Aged; Animals; China; Female; Hematuria; Humans; Insect Bites and Stings; L-Lactate Dehydrogenase; Logistic Models; Male; Middle Aged; Multivariate Analysis; Renal Dialysis; Retrospective Studies; Rhabdomyolysis; Severity of Illness Index; Wasp Venoms; Wasps
PubMed: 33706645
DOI: 10.1080/0886022X.2021.1896547 -
Nefrologia 2023
Topics: Humans; Glomerulonephritis, IGA; Hematuria; Proteinuria
PubMed: 37914637
DOI: 10.1016/j.nefroe.2023.10.003 -
Clinical Journal of the American... Jan 2012Hematuria is a common finding in various glomerular diseases. This article reviews the clinical data on glomerular hematuria and kidney injury, as well as the... (Review)
Review
Hematuria is a common finding in various glomerular diseases. This article reviews the clinical data on glomerular hematuria and kidney injury, as well as the pathophysiology of hematuria-associated renal damage. Although glomerular hematuria has been considered a clinical manifestation of glomerular diseases without real consequences on renal function and long-term prognosis, many studies performed have shown a relationship between macroscopic glomerular hematuria and AKI and have suggested that macroscopic hematuria-associated AKI is related to adverse long-term outcomes. Thus, up to 25% of patients with macroscopic hematuria-associated AKI do not recover baseline renal function. Oral anticoagulation has been associated with glomerular macrohematuria-related kidney injury. Several pathophysiologic mechanisms may account for the tubular injury found on renal biopsy specimens. Mechanical obstruction by red blood cell casts was thought to play a role. More recent evidence points to cytotoxic effects of oxidative stress induced by hemoglobin, heme, or iron released from red blood cells. These mechanisms of injury may be shared with hemoglobinuria or myoglobinuria-induced AKI. Heme oxygenase catalyzes the conversion of heme to biliverdin and is protective in animal models of heme toxicity. CD163, the recently identified scavenger receptor for extracellular hemoglobin, promotes the activation of anti-inflammatory pathways, opening the gates for novel therapeutic approaches.
Topics: Acute Kidney Injury; Animals; Anticoagulants; Glomerulonephritis, IGA; Hematuria; Heme; Hemoglobinuria; Humans
PubMed: 22096039
DOI: 10.2215/CJN.01970211 -
Pediatric Nephrology (Berlin, Germany) Jul 2022
Topics: COVID-19; COVID-19 Vaccines; Child; Glomerulonephritis, IGA; Hematuria; Humans; Vaccination
PubMed: 35301586
DOI: 10.1007/s00467-022-05517-1 -
Pediatric Nephrology (Berlin, Germany) Feb 2016Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews. (Review)
Review
BACKGROUND
Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews.
METHODS
We performed a search of the National Library of Medicine database for peer-reviewed publications using the terms "renal vein" or "nutcracker" and "hematuria".
RESULTS
We identified 187 published reports/studies that covered 736 patients, of whom 288 had microscopic hematuria and 448 had macroscopic hematuria. The patient cohort comprised 159 patients aged ≤17 years. Abdominal pain was absent in approximately 65% of all patients, and a clinically relevant left-sided varicocele was observed in 29% of the male patients. A normal pre-aortic left renal vein and an anomalous anatomy were noted in 680 and 56 patients, respectively. The body mass index (BMI) was lower in patients with renal vein entrapment than in the controls, with a regression of hematuria correlating with an increase in BMI. A surgical procedure was attempted in 34% of the patients, of which the most common were endovascular stenting and transposition of the renal vein distally into the vena cava.
CONCLUSIONS
In cases of unexplained hematuria with or without abdominal pain, clinicians should consider the diagnosis of renal vein congestion, especially in males with varicocele. Ultrasonic Doppler flow scanning is the recommended initial diagnostic modality in these patients. Expectation management is advised in the great majority of cases.
Topics: Adolescent; Adult; Child; Constriction, Pathologic; Female; Hematuria; Humans; Male; Renal Nutcracker Syndrome; Renal Veins; Young Adult
PubMed: 25627663
DOI: 10.1007/s00467-015-3045-2 -
Nature Reviews. Disease Primers Feb 2016Globally, IgA nephropathy (IgAN) is the most common primary glomerulonephritis that can progress to renal failure. The exact pathogenesis of IgAN is not well defined,... (Review)
Review
Globally, IgA nephropathy (IgAN) is the most common primary glomerulonephritis that can progress to renal failure. The exact pathogenesis of IgAN is not well defined, but current biochemical and genetic data implicate overproduction of aberrantly glycosylated IgA1. These aberrant immunoglobulins are characterized by galactose deficiency of some hinge-region O-linked glycans. However, aberrant glycosylation alone is insufficient to induce renal injury: the participation of glycan-specific IgA and IgG autoantibodies that recognize the undergalactosylated IgA1 molecule is required. Glomerular deposits of immune complexes containing undergalactosylated IgA1 activate mesangial cells, leading to the local overproduction of cytokines, chemokines and complement. Emerging data indicate that mesangial-derived mediators that are released following mesangial deposition of IgA1 lead to podocyte and tubulointerstitial injury via humoral crosstalk. Patients can present with a range of signs and symptoms, from asymptomatic microscopic haematuria to macroscopic haematuria. The clinical progression varies, with 30-40% of patients reaching end-stage renal disease 20-30 years after the first clinical presentation. Currently, no IgAN-specific therapies are available and patients are managed with the aim of controlling blood pressure and maintaining renal function. However, new therapeutic approaches are being developed, building upon our ever-improving understanding of disease pathogenesis.
Topics: Genetic Predisposition to Disease; Glomerulonephritis, IGA; Hematuria; Humans; Hypertension; Immunoglobulin A; Kidney; Proteinuria; Renal Insufficiency
PubMed: 27189177
DOI: 10.1038/nrdp.2016.1 -
Indian Pediatrics Jan 2022To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital. (Observational Study)
Observational Study
OBJECTIVE
To study the demographic, clinical and etiological profile of macroscopic hematuria in children presenting to a tertiary care hospital.
METHODS
This prospective observational study, conducted between January, 2018 and December, 2019, enrolled children aged 3 months to 12 years, presenting with gross hematuria.
RESULTS
Of the 62 children (44 males) enrolled, (mean (SD) age of 7.3 (2.6) years), glomerular hematuria was seen in 59.7%. Post-infectious glomerulonephritis was the commonest etiology of glomerular hematuria; hypercalciuria and renal calculi predominated among non-glomerular hematuria. After a median (IQR) follow up of 8 (6,14.2) months, microscopic hematuria persisted in 10 (7, glomerular hematuria) children. The median time to resolution of gross as well as microscopic hematuria tended to be longer in glomerular etiologies.
CONCLUSION
Majority of children with gross hematuria had glomerular etiologies, thus requiring monitoring and follow-up.
Topics: Child; Hematuria; Humans; Kidney Diseases; Kidney Glomerulus; Male; Prospective Studies
PubMed: 33506806
DOI: No ID Found -
Medicine Feb 2020Ageing people with hemophilia (PWH) have a higher prevalence of hypertension than the general population. This study aimed to determine whether macroscopic hematuria was...
Ageing people with hemophilia (PWH) have a higher prevalence of hypertension than the general population. This study aimed to determine whether macroscopic hematuria was associated with hypertension in PWH in a post hoc analysis using data from a cross-sectional study conducted by the ADVANCE Working Group (the H3 study), which included PWH ≥ 40 years of age. Data from 16 contributing centers, located in 13 European countries and Israel, were analyzed using logistic regression models. Of 532 recruited PWH in the H3 study, 117 had hypertension and a positive family history of hypertension (hypertension FH+), 75 had hypertension and a negative family history of hypertension (hypertension FH-), 290 had no diagnosis of hypertension, and the remaining 50 had missing hypertension data. Logistic regressions showed that macroscopic hematuria was associated with hypertension FH+, both in the univariate (OR = 1.84 [1.17-2.90], P = .01) and in the multivariate model (OR = 1.80 [1.03-3.16], P = .04). Macroscopic hematuria was not associated with hypertension FH-. Moreover, in a multivariate logistic regression the odds of hypertension FH+ were increased with the number of macroscopic hematuria episodes. The association between macroscopic hematuria and hypertension was significant for PWH with a family history of hypertension.
Topics: Adult; Aged; Aged, 80 and over; Aging; Cross-Sectional Studies; Female; Hematuria; Hemophilia A; Humans; Hypertension; Israel; Logistic Models; Male; Middle Aged; Risk Factors
PubMed: 32118768
DOI: 10.1097/MD.0000000000019339