ESPN 50th Annual Meeting

ESPN 2017


 
Grosshematuria in children
PATRIZIA DI MATTEO 2 FRANCESCA NUZZI 1 MARIA DARMIENTO 2 GIUSEPPINA MARINO 3 VINCENZO TIPO 1 EDUARDO PONTICIELLO 1 ROSAMUNDA DARCANGELO 1 SIMONA SPADARELLA 2 CARMINE PECORARO 1

1- CHILDREN HOSPITAL SANTOBONO, NAPLES, ITALY
2- UNIVERSITY "FEDERICO II NAPLESITALY
3- OSPEDALE A. CARDARELLI, NAPLES, ITALY
 
Introduction:

 Gross hematuria (GH) is rare in children. In a previous retrospective USA study a prevalence of 158 cases of 128.395 accesses to pediatric ER was reported; main causes were documented (26%) or suspicious (23%) UTI.To determine the prevalence and causes of GH in Italian children presenting at pediatric ER we conducted a prospective study.

Material and methods:

 All children with GH were sent to the nephrologist for full assessment until the final diagnosis; traumatic and surgical causes were excluded. In 17 months 155.833 children were observed ; 111.073 had medical problems; 97 of these (0.09%) showed GH.

Results:

 Data: M/F ratio 1.36; mean age 7.6 ± 4.6 yrs. Main diagnosis 54 (55.6%) Glomerulonephritis (GN) of which 38 post infectious, 8 primary IgAN  and 4 secondary to Henoch-Schonlein syndrome, 3 Alport syndromes and 1 SLE nephritis; 17 documented UTI (17%) ; 18 Idiopathic Hypercalciuria (17%), 3 Hyperuricosuria; 2 Myoglobinuria; 2 HUS and 1 not identified. 

Conclusions:

 In Italy, as well as in the US, prevalence of GH in children is low (0.09 %). Compared to US data,  causes of GH, in our series, were different: most frequent cause was hematuric  GN, mainly in males, meanwhile UTI, in females, represented main cause in USA. Our results are closer to reality because: 1) they derived from a prospective study, 2) the systematic evaluation of children with GH by nephrologists allowed to establish the correct diagnosis in all cases. Only in one case the diagnosis remained uncertain against the 35 cases of "suspicious" UTI  and 13 undefined causes of the US series. The true prevalence of GH in our children is probably underestimated for the under-representation of UTI. In fact in Italy the different organization of pediatric health system prevents the trivial causes (i.e. UTI) of GH should come to the ER.