ESPN 50th Annual Meeting

ESPN 2017


 
PERSISTENT ISOLATED MIROHEMATURIA IN CHILDREN: IS RENAL BIOPSY REALY UNNECESSARY?
DANICA BATINIC 1 DANKO MILOSEVIC 2 MARIJANA CORIC 2 MARIJA TOPALOVIC-GRKOVIC 2 DANKO BATINIC 1 DANIEL TURUDIC 2

1- CHILDREN HOSPITAL SREBRNJAK1
2- UNIVERSITY CLINICAL HOSPITAL CENTER ZAGREB, UNIVERSITY OF ZAGREB SCHOOL OF MEDICINE, ZAGREB, CROATIA2
 
Introduction:

Isolated microhematuria (IMH) is frequently encountered in pediatric practice. No definite conclusions have been reached about the natural history of patients with IMH. There is controversy too, whether besides other examinations there is need of performing renal biopsy in children with persistent IMH. The aim of the study was to evaluate the contribution of renal biopsy to the diagnosis of the diasease in IMH and prognosis of such patients.

Material and methods:

Renal biopsy was performed in 92 children with IMH (46 boys and 46 girls with mean age of 9.44 and 9.74 years respectively) in whom urological abnormalities, hypercalciuria, systemic diseases, coagulopathy or overt family history of renal disease were excluded. The mean duration of IMH prior to biopsy was 2 years and 5 months. Biopsy speciments were examined by light (LM), immunofluorescent (IF) and electron microscopy (EM). After biopsy the patients were followed-up for 3-13 years.

Results:

Seventy-seven (83.6%) children had pathological histologic finding. The most common were EM changes consistent with Alport syndrome found in 27 (35.0 %) cases, followed with IgA nephropathy in 18 (23.4 %) cases and changes consistent with acute postinfectious glomerulonephritis in resolution in 15 (19.5 %) cases. Diffuse thinning of GBM was found in 13 (16.9 %) cases, membranoproliferative glomerulonephritis in 3 (3.9 %) and fibrillary glomerulonephritis in 1 (1.3 %) case. On follow-up, in 7 of 27 children with EM changes consistent with Alport syndrome appeared proteinuria and in 2 perceptive hearing impairment. Further surveillance is needed to confirm the significance of EM findings in others.

Conclusions:

In children with IMH of proven glomerular origin renal bioipsy is justified and specimen should always be analyzed by light, immunofluorescent and electron microscopy.