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Park E, Kim SW, Kim SJ, Baek M, Ahn YH, Yang EM, Cho MH, Lee HK, Han KH, Kim YL, Choi M, Kang HG, Suh JS. Asymptomatic hematuria in children: Korean Society of Pediatric Nephrology recommendations for diagnosis and management. Kidney Res Clin Pract 2024; 43:565-574. [PMID: 38738274 PMCID: PMC11467358 DOI: 10.23876/j.krcp.23.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/12/2023] [Indexed: 05/14/2024] Open
Abstract
Hematuria is a relatively common condition among school-aged children. Because international guidelines for asymptomatic hematuria in children are unavailable, developing practical guidelines for the diagnosis and management of asymptomatic hematuria based on scientific evidence while considering real-world practice settings, values, and patient and physician preferences is essential. The Korean Society of Pediatric Nephrology developed clinical guidelines to address key questions regarding the diagnosis and management of asymptomatic hematuria in children.
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Affiliation(s)
- Eujin Park
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sang Woon Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea
| | - Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyun Kyung Lee
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hee Han
- Department of Pediatrics, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Yae Lim Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Soon Suh
- Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Moustafa FEH, Eid R, Hamdy N. Pediatric glomerular hematuria: a clinicopathological study. Clin Exp Nephrol 2020; 24:613-621. [PMID: 32198715 DOI: 10.1007/s10157-020-01872-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hematuria is a common problem in pediatric practice and necessitates exhausting studies to detect etiology and establish proper management and counselling. SUBJECTS AND METHODS We reviewed the clinical and pathological findings in 95 children presented between 2013 and 2019 with gross or microscopic hematuria with or without proteinuria in whom non-glomerular causes were excluded. In addition, a reference range for normal glomerular basement membrane thickness (GBMT) is introduced based on the assessment of biopsies of 20 steroid-resistant nephrotic syndrome cases aged 3-15 years, and with minimal change pathology. RESULTS Fifty-seven males and 38 females with a mean age of 7.72 ± 3.27 years were included. Recurrent gross hematuria was the most frequent presentation (42%) while accidentally discovered hematuria was reported in 34.7% of patients. Alport syndrome (AS) was the most frequent diagnosis (66.3%) followed by thin basement membrane disease (TBMD) (29.5%) and Immunoglobulin A nephropathy (IgAN) (4%). A reference for normal GBMT was 360.3 ± 87.5 nm which is comparable to published references. Males with AS had a higher incidence of progression to renal failure and requirement for dialysis (p = 0.006 and 0.03, respectively) compared to females. Persistent proteinuria and lower glomerular filtration rate at diagnosis were associated with poor outcomes (p < 0.001 each). CONCLUSION Alport Syndrome is the most common cause of glomerular hematuria in Egyptian children. Persistence of proteinuria and lower GFR at initial presentation were the main predictors of poor outcomes. The establishment of GBMT reference range for each locality is mandatory for the proper diagnosis of such cases.
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Affiliation(s)
| | - Riham Eid
- Pediatric Nephrology Unit, Departement of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Nashwa Hamdy
- Pediatric Nephrology Unit, Departement of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
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