Recurrent hematuria and focal nephritis

Recurrent unexplained haematuria and risk of urological cancer. A follow-up study

To evaluate the risk of urological cancer in patients with unexplained haematuria, 93 patients, who had undergone complete urological examination and who were classified as having unexplained haematuria, were followed. Mean age was 46 years, range 16-84 years. Seventy-seven patients had gross haematuria and 16 patients had microscopic haematuria. Mean follow-up time was 62 months (range 6-360 months). Urological neoplasms were found in 7 of 38 patients (18%; 95% confidence limits 8-34%) with recurrent haematuria after primary urological examination, and in 1 of 36 patients (3%; 95% confidence limits 0.07-14%) without additional haematuria after primary examination. Regular urological examination of patients with recurrent unexplained haematuria is justified. In patients without additional incidents of haematuria after primary urological examination the risk of urological cancer is not significantly increased.

Significance of microhaematuria in young adults

The medical records of 1000 asymptomatic male air force personnel were examined retrospectively for the results of 15 yearly examinations of urinary sediment. The study covered the period 1968-82, beginning with the subjects aged 18-33 years. The cumulative incidence of two to four or more red blood cells per high power field found at one or more examinations was 38.7% after an average of 12.2 yearly examinations per person. In 161 subjects two to four or more red blood cells per high power field were found at two or more yearly examinations within a five year period. Intravenous pyelography in 58 cases disclosed asymptomatic nephrolithiasis in six. Cystoscopy performed in 11 cases identified one patient with urethritis, one with a vesical calculus, and one with transitional cell carcinoma of the bladder. Two years before diagnosis the patient with carcinoma had had a single transient finding of 10-12 red blood cells per high power field which was not investigated further. Cystoscopy was performed after an episode of macroscopic haematuria. Renal biopsy in one subject with recurrent microhaematuria and trace proteinuria disclosed focal glomerulonephritis. None of the remaining subjects with microhaematuria developed hypertension or proteinuria, and at the end of the study period all were active and free of urinary symptoms. The observed cumulative incidence of urological neoplasms at 15 years (0.1%) was consistent with that expected in Israeli men aged 18-40 (0.09%). Hence microhaematuria detected during a screening examination probably should not be regarded as a specific sign of a significant lesion and does not of itself warrant urological investigation in adults aged 40 or less.

Basement membrane nephropathy: a new classification for Alport's syndrome and asymptomatic hematuria based on ultrastructural findings

Renal biopsy specimens from 19 patients with asymptomatic hematuria, normal glomeruli on light microscopic examination, and negative immunofluorescence were studied to characterize the ultrastructural changes of the glomerular basement membrane. Three groups of patients were identified. Four patients (group 1) had type I basement membrane nephropathy, characterized by marked thickening and lamellation of the basement membrane in a pattern resembling that of Alport's syndrome. Seven patients (group 2) had type II basement membrane nephropathy, which was characterized by extensive attenuation of the basement membrane with only occasional small areas of lamellation or fragmentation. Eight patients (group 3) had moderate variability in basement membrane thickness with no other structural alterations. The authors propose that this pathologic classification be used in patients with asymptomatic hematuria as a basis for long-term clinical investigations, in hopes of distinguishing the natural history of each group.

Chronic membranoproliferative glomerulonephritis. A patient with recurrent episodes simulating rheumatic fever and acute nephritis

A most unusual case of chronic membranoproliferative glomerulonephritis with nodule formation is reported in an elderly man in whom it was possible to document many episodes of acute oilguric and hemorrhagic glomerulonephritis and a syndrome resembling acute rheumatic fever. Severe renal failure necessitating peritoneal dialysis occurred on three occasions. Renal function returned to near preexacerbation levels in each episode. Although there was strong clinical evidence for streptococcal hypersensitivity, convincing laboratory documentation was lacking. The histologic and immunopathologic findings changed comparatively little during the several exacerbations. Impairment in fibrinolytic and coagulation activities by circulating macromolecular complexes is postulated for the induction and perpetuation of the glomerular injury.

Haematuria of unknown origin

Sixty-four cases of haematuria of unknown origin are reviewed. The results are compared with findings from other centres and discussion follows regarding the management of these patients.

Symptomless haematuria in childhood

The clinical, laboratory, and renal biopsy findings in 47 children with symptomless haematuria are reported. In 41 the haematuria was recurrent. Local causes were excluded by means of intravenous urography, which was normal in all but one child, who had a horseshoe kidney.Since all the patients had presented in a similar manner they were classified into four groups according to the severity of glomerular changes on renal biopsy. In group I the glomeruli were optically normal. In group 2 they showed a variable degree of mesangial thickening with absent or minimal cellular proliferation. In group 3 there was diffuse mesangial thickening and proliferation-an appearance indistinguishable from that of subsiding post-streptococcal glomerulonephritis. Compared with groups 1 and 2, more patients in this group had persistent proteinuria, as well as evidence of streptococcal infection preceding the initial haematuria. Only two patients showed severe proliferative glomerulonephritis on biopsy (group 4); both had heavy proteinuria and one repeatedly had low serum beta1(c)-globulin levels.

Recurrent haematuria in 17 children

Images