Review

Authors: Bernarda Viteri, Jessica Reid-Adam

PRACTICE GAP

Pediatricians must be aware of screening indications and the evaluation and management of a child with hematuria and/or proteinuria.

OBJECTIVES

After completing this article, readers should be able to: 1. Understand the common causes of proteinuria and hematuria and be able to differentiate between benign and serious causes. 2. Describe screening techniques for initial evaluation of hematuria and proteinuria. 3. Recognize the criteria for diagnosis of proteinuria and hematuria. 4. Plan the appropriate initial evaluation for hematuria and proteinuria and interpret laboratory findings essential for diagnosis. 5. Recognize serious causes of hematuria and proteinuria that warrant immediate referral.

Topics: Adolescent; Child; Child, Preschool; Hematuria; Humans; Proteinuria; Urinalysis

PubMed: 30504250
DOI: 10.1542/pir.2017-0300

Review

Authors: Christian Bolenz, Bernd Schröppel, Andreas Eisenhardt...

BACKGROUND

Hematuria can be either grossly visible (macrohematuria) or only detectable under a microscope (microhematuria). Microhematuria is often asymptomatic and has a prevalence of 4-5% in routine clinical practice. It may be due to an underlying disease of the kidneys or the urogenital tract. In this article, we provide an overview of the causes of hematuria and of the recommendations of current guidelines for its diagnostic evaluation. A risk-adapted diagnostic strategy for the evaluation of asymptomatic microhematuria (aMH) is presented.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on guidelines from Germany and abroad.

RESULTS

Hematuria has many causes, and a broad urological and nephrological differential diagnosis must be considered. In the absence of high-quality scientific evidence, the recommendations of current guidelines for the diagnostic evaluation of hematuria are not uniform; this is particularly so for aMH. Microhematuria is said to be present when urine microscopy reveals three or more erythrocytes per highpower field. The basic diagnostic evaluation consists of a thorough history and physical examination, measurement of inflammatory parameters and renal function tests, and ultrasonography of the kidneys and bladder. Patients with non-glomerular aMH who have risk factors such as smoking, advanced age, and male sex are more likely to have relevant underlying conditions and should therefore undergo augmented, risk-adapted diagnostic evaluation with urethrocystoscopy, urine cytology, and, when indicated, CT urography. Patients with isolated glomerular hematuria are at elevated risk for renal disease and should undergo follow-up checks at six-month intervals.

CONCLUSION

Although hematuria is common, there is no uniform, internationally accepted, evidence-based algorithm for its diagnostic evaluation. All potential causes of hematuria must be considered, and all individual risk factors taken into account, so that an underlying disease requiring treatment can be identified or ruled out.

Topics: Diagnostic Techniques and Procedures; Germany; Hematuria; Humans; Practice Guidelines as Topic; Risk Factors

PubMed: 30642428
DOI: 10.3238/arztebl.2018.0801

Review

Authors: Ramesh Khanna

Because the differential diagnosis for glomerulonephritis (GN) is broad, using a classification schema is helpful to narrow the causes of GN in a systematic manner. The etiology of glomerulonephritis can be classified by their clinical presentation (nephrotic, nephritic, rapidly progressive GN, chronic GN) or by histopathology. GN may be restricted to the kidney (primary glomerulonephritis) or be a secondary to a systemic disease (secondary glomerulonephritis). The nephrotic syndrome is defined by the presence of heavy proteinuria (protein excretion greater than 3.0 g/24 hours), hypoalbuminemia (less than 3.0 g/dL), and peripheral edema. Hyperlipidemia and thrombotic disease may be present. The nephritic syndrome is associated with hematuria and proteinuria and abnormal kidney function and carries poorer prognosis and is typically associated with hypertension. The predominant cause of the nephrotic syndrome in children is minimal change disease. The most common causes of nephritic syndrome are post infectious GN, IgA nephropathy and lupus nephritis. Chronic GN is slowly progressive and is associated with hypertension and gradual loss of kidney function. Treatment includes non-specific measure aimed at controlling hypertension, edema, proteinuria and disease modifying immunosuppression.

Topics: Glomerulonephritis; Hematuria; Humans; Kidney Diseases; Nephrology; Nephrotic Syndrome

PubMed: 21462608
DOI: No ID Found

Review

Authors: D Maharaj, S R Mohammed, K Caesar...

The nutcracker phenomenon, also known as left renal vein entrapment, occurs when there is extrinsic compression of the left renal vein, most often between the abdominal aorta and the superior mesenteric artery. Nutcracker syndrome refers to the constellation of clinical symptoms that may arise from the nutcracker phenomenon, typically inclusive of haematuria, flank/pelvic pain, orthostatic proteinuria and (in male patients) varicocele. We provide a short review of the nutcracker syndrome including various diagnostic and therapeutic modalities. We utilise our own experience with a patient as a case study and highlight the modern management option of endovascular stenting.

Topics: Adult; Humans; Male; Endovascular Procedures; Flank Pain; Hematuria; Renal Nutcracker Syndrome; Renal Veins; Stents

PubMed: 38038139
DOI: 10.1308/rcsann.2023.0090

Authors: Tahir Ismailoglu

Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. NCS may present with unexplained hematuria. This case report presents a 43-year-old healthy female without any complaints who had newly-detected hematuria in urinalysis during her annual examination. Her physical examination and the whole abdominal ultrasonography failed to explain the cause of hematuria. Further investigation with contrast-enhanced upper abdominal computed tomography revealed a NCS. In unexplained cases of asymptomatic hematuria NCS should be taken into account after excluding other preliminary diagnoses.

Topics: Adult; Female; Hematuria; Humans; Mesenteric Artery, Superior; Renal Veins; Syndrome; Tomography, X-Ray Computed

PubMed: 35711687
DOI: 10.3941/jrcr.v16i5.4339

Authors: Caitlyn Vlasschaert, Matthew B Lanktree

Topics: Cystoscopy; Hematuria; Humans; Kidney Diseases; Urinalysis

PubMed: 32392525
DOI: 10.1503/cmaj.191615

Authors: P P Varma, P Sengupta, R K Nair...

The incidence of exercise-induced hematuria is reported to be between 5% and 25% and available literature suggests that it lasts for a few hours to a maximum of 3 days. We analyzed the urine sediment of healthy participants between the age of 20 and 50 years before and after a 5 km run. Anyone with abnormal pre-exercise sediment was excluded from the study. Of 491 participants, 59 (12%) developed post exercise hematuria when the run had to be completed in allotted time. However, when the run was completed without time limit, only 1.3% (4 of 316) developed hematuria (p < 0.001). We found that the younger participants (age < 30 years) had a significantly higher incidence of hematuria as compared to their older compatriots (p = 0.019). The mean duration of hematuria was 1.98 ± 1.89 days and 81% of the participants cleared their hematuria within 3 days. In 12% it lasted between 3 and 7 days and in 7% it continued beyond 7 days. Three individuals had persistence of hematuria beyond day 14 and all these were found to have primary glomerular disease on renal biopsy [two had IgA nephropathy and one focal segmental glomerulosclerosis (FSGS)]. We conclude that exercise-induced hematuria can last up to a fortnight. However, if it persists beyond a fortnight, it is unlikely to be functional and an underlying cause is likely. Hematuria following exercise seems to be related to the intensity of effort during exercise rather than its duration.

Topics: Adult; Exercise; Healthy Volunteers; Hematuria; Humans; India; Male; Middle Aged; Young Adult

PubMed: 24865509
DOI: 10.3109/0886022X.2014.890011

Review

Authors: Joris Delanghe, Marijn Speeckaert, Sigurd Delanghe...

Detection of hemoglobin (Hb) and red blood cells in urine (hematuria) is characterized by a large number of pitfalls. Clinicians and laboratory specialists must be aware of these pitfalls since they often lead to medical overconsumption or incorrect diagnosis. Pre-analytical issues (use of vacuum tubes or urine tubes containing preservatives) can affect test results. In routine clinical laboratories, hematuria can be assayed using either chemical (test strips) or particle-counting techniques. In cases of doubtful results, Munchausen syndrome or adulteration of the urine specimen should be excluded. Pigmenturia (caused by the presence of dyes, urinary metabolites such as porphyrins and homogentisic acid, and certain drugs in the urine) can be easily confused with hematuria. The peroxidase activity (test strip) can be positively affected by the presence of non-Hb peroxidases (e.g. myoglobin, semen peroxidases, bacterial, and vegetable peroxidases). Urinary pH, haptoglobin concentration, and urine osmolality may affect specific peroxidase activity. The implementation of expert systems may be helpful in detecting preanalytical and analytical errors in the assessment of hematuria. Correcting for dilution using osmolality, density, or conductivity may be useful for heavily concentrated or diluted urine samples.

Topics: Humans; Hematuria; Peroxidase; Hemoglobins; Erythrocytes; Osmolar Concentration

PubMed: 37079906
DOI: 10.1515/cclm-2023-0260

Authors: Nery Sablón González, Noel Lorenzo Villalba, Yanet Parodis López...

Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in nutcracker syndrome include pelvic pain, flank pain, haematuria, gonadal varices or simply asymptomatic. We are presenting two cases, one of them with macroscopic haematuria and flank pain and the other was studied for hypertension but with previous antecedents of left renal vein embolization in the setting of varicocele. We discuss the clinical presentation as well as diagnostic and therapeutic aspects related to this syndrome.

Topics: Adolescent; Adult; Computed Tomography Angiography; Female; Hematuria; Humans; Renal Nutcracker Syndrome; Renal Veins

PubMed: 31048282
DOI: No ID Found

Authors: Chandy Ellimoottil, Casey Dauw

Topics: Attitude to Health; Health Services Accessibility; Hematuria; Humans; Male; Urinary Retention

PubMed: 24726146
DOI: 10.1016/j.urology.2014.01.039