engleski

Persistent isolated microhematuria in children: is renal biopsy realy unnecessary?

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 respec- tively) in whom urological abnormalities, hypercalciuria, systemic dis- eases, coagulopathy or overt family history of renal disease were exclud- ed. 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 find- ing. 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, membranoproliferativ e 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 pro- teinuria and in 2 perceptive hearing i mpairment. 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.

persistent microhematuria, children, renal biopsy

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