Diagnostic approach of hematuria in pediatrics

Enfoque diagnóstico de la hematuria en pediatría

Hematuria is a clinical finding observed by the patient or a family member when it is macroscopic or incidental in a routine urine batch. The prevalence is low but the diagnostic approach to which the clinician is confronted is broad. Hematuria indicates disease, injury or malformation of the urinary tract, therefore the general practitioner and the pediatrician must be able to determine in time some of the causes with severe prognosis or complex diagnosis that require referral to the pediatric nephrologist. The emphasis is on differentiating whether or not it is of glomerular origin, adopting a diagnostic approach algorithm that guides the clinician. A limited search of 2001-2014 was conducted in the main databases in English and Spanish, finding reviews of the literature, consensus of experts and clinical practice guidelines based on the opinion of paediatricians, nephrologists and pediatric urologists, as well as radiologists who They offer a real approach to imaging. It is aimed at health personnel, general practitioners and pediatricians who face this clinical condition on a daily basis.

1. Vehaskari VM, Rapola J, Koskimies O, Savilahti E, Vilska J, Hallman N. Microscopic hematuria in school children: epidemiology and clinicopathologic evaluation. J Pediatr. 1979; 95(5 Pt 1):676-84.

2. Dodge WF, West EF, Smith EH, Bruce H, 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. 1976; 88(2): 327-47.

3. Iitaka K, Igarashi S, Sakai T. Hypocomplementaemia and membranoproliferative glomerulonephritis in school urinary screening in Japan. Pediatr Nephrol. 1994;8(4):420-2.

4. Vara Martin J, Hidalgo-Barquero del Rosal E, García Blanco JM. Diagnóstico de la hematuria. Protocolos Diagnósticos y terapéuticos de la AEP. 2008;1:169-81.

5. Ingelfinger JR, Davis AE, Grupe WE. Frequency and etiology of gross hematuria in a general pediatric setting. Pediatrics. 1977;59(4):557-61.

6. Kher K, Schnaper HW, Makker SP. Clinical pediatric nephrology. 2 ed. London: Taylor & Francis; 2006.

7. Moore GP, Robinson M. Do urine dipsticks reliably predict microhematuria? The bloody truth!. Ann Emerg Med. 1988;17(3):257-60.

8. Fassett RG, Horgan BA, Mathew TH. Detection of glomerular bleeding by phase-contrast microscopy. Lancet. 1982;1(8287):1432-4.

9. Feld LG, Waz WR, Perez LM, Joseph DB. Hematuria. An integrated medical and surgical approach. Pediatr Clin North Am. 1997; 44(5): 1191-210.

10. Diven SC, Travis LB. A practical primary care approach to hematuria in children. Pediatr Nephrol. 2000;14(1):65-72.

11. Kalia A, Travis L. Hematuria, leukocyturia and cylinduria. In: Edelmann CM, editor. Pediatric kidney disease. 2nd ed. Boston: Little Brown; 1992. p. 553-63.

12. Vijayakumar M, Nammalwar BR. Diagnostic approach to a child with hematuria. Indian Pediatr. 1998; 35(6):525-32.

13. Meyers KE. Evaluation of hematuria in children. Urol Clin North Am. 2004;31(3):559-73, x.

14. Kincaid-Smith P, Fairley K. The investigation of hematuria. Semin Nephrol. 2005; 25(3):127-35.

15. Stapleton FB. Morphology of urinary red blood cells: a simple guide in localizing the site of hematuria. Pediatr Clin North Am. 1987;34(3):561-9.

16. Mehta K, Tirthani D, Ali U. Urinary red cell morphology to detect site of hematuria. Indian Pediatr. 1994;31(9):1039-45.

17. Cilento BG, Jr., Stock JA, Kaplan GW. Hematuria in children. A practical approach. Urol Clin North Am. 1995;22(1):43-55.

18. Vijayakumar M. Acute and crescentic glomerulonephritis. Indian J Pediatr. 2002;69(12):1071-5.

19. Kashtan CE. Familial hematuria. Pediatr Nephrol. 2009;24(10):1951-8.

20. Stapleton FB. Hematuria associated with hypercalciuria and hyperuricosuria: a practical approach. Pediatr Nephrol. 1994;8(6):756-61.

21. Phadke KD, Vijayakumar M, Sharma J, Iyengar A, Indian Pediatric Nephrology Group. Consensus statement on evaluation of hematuria. Indian Pediatr. 2006;43(11):965-73.

22. Milla SS, Coley BD, Karmazyn B, Dempsey-Robertson ME, Dillman JR, Dory CE, et al. ACR Appropriateness Criteria(R) limping child--ages 0 to 5 years. J Am Coll Radiol. 2012;9(8):545-53.