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Zhong X, Ding J. Diagnosis and treatment of IgA nephropathy and IgA vasculitis nephritis in Chinese children. Pediatr Nephrol 2023; 38:1707-1715. [PMID: 36348077 PMCID: PMC10154255 DOI: 10.1007/s00467-022-05798-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
IgA nephropathy (IgAN) and IgA vasculitis-associated nephritis (IgAVN) are among the most frequent childhood glomerular diseases and are characterized by significant variability in clinical manifestations, pathological presentation and long-term outcomes. IgAVN, alternatively called purpura nephritis, is pathologically indistinguishable from kidney-limited IgAN. In Chinese children, the clinical presentations and pathological manifestations of IgAN and IgAVN are variable. The severity of proteinuria and abnormalities in kidney function and blood pressure of children in China are comparable to those of children in Europe, the USA, and Japan. Compared to Caucasian children and Japanese children, crescents were more common in Chinese children with IgAN or IgAVN. Approximately 10-20% of childhood IgAN or IgAVN progresses to impaired kidney function in China. Since 2007, a series of guidelines on the diagnosis and treatment of pediatric kidney diseases has been published following the principles of evidence-based medicine. However, a large difference exists between the Chinese evidence-based guidelines and the guidelines developed by Kidney Disease: Improving Global Outcomes (KDIGO) in 2021. Chinese children with IgAN or IgAVN were more likely to be treated with steroids or immunosuppressive agents. Further studies exploring the optimal treatment regimen for childhood IgAN or IgAVN are needed in the future.
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Affiliation(s)
- Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Chen T, Yang Q, Xu H, Gong Y, Guo X, Lin H, Yang J, Zhuang J, Lan J, Chu M, Wang D. Urine Screening and 9 Years' Medical Record System Follow-Up Among School Students in Wenzhou, China. Front Pediatr 2022; 10:862029. [PMID: 35547544 PMCID: PMC9081790 DOI: 10.3389/fped.2022.862029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
School urinary screening programming can be useful for the early detection of renal and urinary disorders. However, urine screening is not included in the school health check-up in our region. Therefore, from February 2012 to March 2021, 12,497 school students were screened for urinalysis, and a long-term follow-up took place via an electronic medical record system. Among these screened students, 719 (5.75%) positive individuals received a repeat urinalysis 2 weeks later. During the 9-year medical record system follow-up period, 5 children had renal biopsies and 2 children had a diagnosis of IgA nephropathy (IgAN), while the remaining 3 children were diagnosed with thin basement membrane disease (TBM), primary nephrotic syndrome (PNS), and were suspected of C3 glomerulopathy, respectively. By this, calling for the school urine screening program as a physical examination item for primary and secondary school-aged students will contribute to enabling early detection of urine abnormalities and allow for early treatment.
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Affiliation(s)
- Tingting Chen
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Yang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Yinv Gong
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoling Guo
- Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Children Genitourinary Diseases of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongzhou Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianhuan Yang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jieqiu Zhuang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junwei Lan
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Maoping Chu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dexuan Wang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Basic Medical Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Children Genitourinary Diseases of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Zhong X, Ding J, Wang Z, Gao Y, Wu Y, Shen Y, Song H, Zhao Z, Chen X, Zhang P, Xu G, Yao C, Zhang H, Zhong F, Tang Y, Wang H, Wang W, Li W, Zhang W, Zhu S, Shang M. Risk Factors Associated With Abnormal Urinalysis in Children. Front Pediatr 2021; 9:649068. [PMID: 33869116 PMCID: PMC8044805 DOI: 10.3389/fped.2021.649068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Targeted urinalysis has been suggested to improve screening efficiency in adults. However, there is no well-defined target population in children yet, with limited information on the risk factors for urinalysis abnormalities. Methods: Children from infants to 17 years old were randomly selected. Dipstick urinalysis was initially performed. Among those who were abnormal, a repeat dipstick or dipstick with microscopic urinalysis was performed for confirmation. Results: In total, 70,822 children were included, with 37,866 boys and 32,956 girls. Prevalence of abnormal urinalysis was 4.3%. Age was significantly associated with abnormal urinalysis, with the highest prevalence among 12-14-year-olds. Girls were 2.0 times more likely to exhibit abnormalities. Compared with children whose guardians had a college degree or higher, those whose guardians had a high school degree or lower had a higher likelihood of abnormalities. Geographic location was also associated with abnormal results. Conclusion: Girls, children aged 12-14 years old, and children whose guardians had a low educational level and children in certain geographic locations were significantly associated with abnormal urinalysis. Identification of children at high risk would contribute to targeted urinalysis screening.
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Affiliation(s)
- Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zheng Wang
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
| | - Yan Gao
- Department of Pediatric Nephrology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yubin Wu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Shen
- Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyan Zhao
- Department of Child Healthcare, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinxin Chen
- Department of Infant Healthcare Section, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Puhong Zhang
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Guobin Xu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Hui Zhang
- Department of Pediatrics, Sichuan University West China Second University Hospital, Chengdu, China
| | - Fu Zhong
- Department of Pediatric Nephrology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ying Tang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hui Wang
- Department of Pediatric Nephrology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Wenhao Li
- Department of Child Healthcare, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wanxia Zhang
- Department of Infant Healthcare Section, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Meixia Shang
- Department of Biostatistics, Peking University First Hospital, Beijing, China
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Arslan Z, Koyun M, Erengin H, Akbaş H, Aksoy GK, Çomak E, Akman S. Orthostatic proteinuria: an overestimated phenomenon? Pediatr Nephrol 2020; 35:1935-1940. [PMID: 32394189 DOI: 10.1007/s00467-020-04586-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although orthostatic proteinuria (OP) is the most common cause of childhood proteinuria, excluding transient proteinuria, data regarding prevalence and long-term prognosis are limited. We aimed to determine prevalence of OP in healthy schoolchildren evaluating relationships with age, gender and body mass index, and determine follow-up. METHODS A total of 1701 healthy children aged 6-15 years were selected using a population-based, stratified, cluster-sampling method; and random urine samples were taken. For proteinuria ≥ 1+ in first urine samples, second and third random samples were taken at least 2 weeks apart to exclude transient proteinuria. For continuing proteinuria after third samples, first morning urine samples were collected. Cases where proteinuria was not detected in first morning urine samples were diagnosed as OP. RESULTS Sixty-four of 1701 children (3.7%) had proteinuria on first random urine samples. After second and third urine samples, proteinuria persisted in only 16 (0.94%). OP was detected in 11 (0.65%). Prevalence of OP tended to decrease with increasing BMI, though not statistically significant. All 7 cases with OP who were re-evaluated later, had no proteinuria 3 years after diagnosis. CONCLUSIONS Prevalence of OP in our study was lower than the literature. At least three random urine samples should be taken to exclude transient proteinuria in an asymptomatic child/adolescent before making a diagnosis of OP using first morning urine samples. OP is a benign condition and resolves spontaneously in most cases. Underweight children had a tendency for OP compared with overweight and obese children; however, further studies with larger number of patients are needed.
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Affiliation(s)
- Zümrüt Arslan
- School of Medicine, Department of Pediatrics, Akdeniz University, Antalya, Turkey
| | - Mustafa Koyun
- School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University, Antalya, Turkey.
| | - Hakan Erengin
- School of Medicine, Department of Public Health, Akdeniz University, Antalya, Turkey
| | - Halide Akbaş
- School of Medicine, Department of Biochemistry, Akdeniz University,, Antalya, Turkey
| | - Gülşah Kaya Aksoy
- School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Elif Çomak
- School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Sema Akman
- School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
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Suthar KS, Vanikar AV, Nigam LA, Patel RD, Kanodia KV, Thakkar UG, Gandhi PA, Chandak SA, Prajapati AV, Patel MH. Urinary Screening for Early Detection of Kidney Diseases. Indian J Pediatr 2018; 85:607-612. [PMID: 29170923 DOI: 10.1007/s12098-017-2494-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Urinary screening is a simple inexpensive tool to evaluate kidney functions. The authors carried out urinary screening of school children for early detection of kidney diseases. METHODS Children in the age group 5-15 y were screened for urinalysis. They were divided in 2 groups; group-1 included 5-10 y and group-2 included >10-15 y old children. RESULTS Urine samples of 3340(78%) out of 4283 enrolled children were tested. Abnormal samples were found in 5.75%; with proteinuria in 4.59%, pyuria in 3.29% and hematuria in 4.31%. Males constituted 47.71% in group-1 and 54.64% in group-2. Low body mass index was found in 94.1% group-1 and 78.99% group-2 children. Mild proteinuria was found in 1.2% group-1 and 2.56% group-2 children. Severe proteinuria was more in group-2 (0.77% vs. 0.06%) with female preponderance. Glucosuria was found in 1 boy of group-2. Urobilinogen was more in group-2 (0.65% vs. 0.24%) with male preponderance. Nitrituria was found in 9 girls. Pyuria (2.02% vs. 1.27%) and hematuria were more in group-2 (3.04% vs. 1.87%) with female preponderance. Combined proteinuria and hematuria (0.42% vs. 0.24%) as well bacteruria and fungaluria were more in group-2 (4.11% vs. 1.39%). Six of 192 children with abnormal urinary findings were treated; 1 for urinary calculus and 5 for urinary tract infection. CONCLUSIONS Abnormal urinary findings were more common in children >10 y of age. Thus urinary screening program of children can become useful for early detection of kidney diseases and contribute towards building up of a healthy nation.
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Affiliation(s)
- Kamlesh S Suthar
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Aruna V Vanikar
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India. .,Department of Regenerative Medicine and Cell Therapy, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.
| | - Lovelesh A Nigam
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Rashmi D Patel
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Kamal V Kanodia
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Umang G Thakkar
- Department of Regenerative Medicine and Cell Therapy, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Paulin A Gandhi
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Sheetal A Chandak
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Amit V Prajapati
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
| | - Minaxi H Patel
- Department of Pathology, Lab Medicine, Transfusion Services & Immunohematology, G.R. Doshi and K.M Mehta Institute of Kidney Diseases and Research Centre and Dr. H.L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, 380016, India
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Jari M, Merrikhi A, Kelishadi R, Ghaffarzadeh Z. The First Report on the Frequency of Asymptomatic Proteinuria in Iranian School-aged Children. Adv Biomed Res 2018. [PMID: 29531933 PMCID: PMC5840999 DOI: 10.4103/2277-9175.225923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Proteinuria is a well-known indicator of renal dysfunction. In this study, we evaluated the frequency of proteinuria in a sample of healthy Iranian elementary school students using both dipsticks and urine albumin-to-creatinine ratio (UACR) methods. Materials and Methods This cross-sectional study was performed on 478 school students aged 7-9 years who were selected by multistage random cluster sampling from Isfahan city, Iran. A clean midstream first-morning urine sample was obtained from each subject. Urine samples were examined by dipstick method, and accordingly, they were reported as negative; trace; 1+; 2+; 3+; and 4+. UACR was determined in samples with positive dipstick proteinuria (defined as trace or greater). Results This study included 478 students (42.8% boys), with mean age of 7.0 ± 0.4 years. Positive dipstick was detected in 124 (25.9%) cases. The frequency of positive dipstick proteinuria was significantly higher in the girls than boys (29.6% vs. 20.9%, respectively; P = 0.04). In cases with a positive dipstick, 10 (2.1%) cases had UACR 30-300 mg/g. The frequency of UACR of 30-300 mg/g was 1.4% and 2.5% in boys and girls, respectively. There was no significant difference in the frequency of UACR 30-300 mg/g in terms of gender (P = 0.4). None of the subjects had UACR above 300 mg/g. Conclusion While the frequency of asymptomatic proteinuria varies widely across different studies, we found a higher rate of proteinuria in Iranian children. Cost-effectiveness analyses are needed to justify large screening program for detecting asymptomatic proteinuria, as a cardinal manifestation of kidney disease, in Iranian children.
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Affiliation(s)
- Mohsen Jari
- Department of Pediatrics, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Merrikhi
- Department of Pediatric Nephrology, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Ghaffarzadeh
- Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Moreno JA, Yuste C, Gutiérrez E, Sevillano ÁM, Rubio-Navarro A, Amaro-Villalobos JM, Praga M, Egido J. Haematuria as a risk factor for chronic kidney disease progression in glomerular diseases: A review. Pediatr Nephrol 2016; 31:523-33. [PMID: 25980470 DOI: 10.1007/s00467-015-3119-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 12/18/2022]
Abstract
Haematuria has long been considered to be a benign condition associated with glomerular diseases. However, new evidences suggest that haematuria has a pathogenic role in promoting kidney disease progression. An increased risk for end-stage renal disease has been reported in adolescents and young adults with persistent microscopic haematuria. A persistent impairment of renal function has been also reported following macroscopic haematuria-associated acute kidney injury in immunoglobulin A nephropathy. Haematuria-induced renal damage has been related to oxidant, cytotoxic and inflammatory effects induced by haemoglobin or haem released from red blood cells. The pathophysiological origin of haematuria may be due to a more fragile and easily ruptured glomerular filtration barrier, as reported in several glomerular diseases. In this review we describe a number of the key issues associated with the epidemiology and pathogenesis of haematuria-associated diseases, provide an update of recent knowledge on the role of haematuria on renal function outcome and discuss specific therapeutic approaches in this setting. KEY SUMMARY POINTS: 1. Glomerular haematuria is a common observation in a number of renal diseases that may lead to persistent renal injury. 2. Haematuria in children differs from that in adults in specific aspects, particularly in the frequency of glomerular diseases and renal disease outcome. 3. Regular follow-up of renal function in children with isolated microhaematuria may be recommended.
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Affiliation(s)
- Juan Antonio Moreno
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autonoma University, Av. Reyes Católicos 2, 28040, Madrid, Spain.
| | - Claudia Yuste
- Department of Nephrology, Gregorio Marañon Hospital, 28007, Madrid, Spain
| | - Eduardo Gutiérrez
- Department of Nephrology, 12 de Octubre Hospital, 28041, Madrid, Spain
| | - Ángel M Sevillano
- Department of Nephrology, 12 de Octubre Hospital, 28041, Madrid, Spain
| | - Alfonso Rubio-Navarro
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autonoma University, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Juan Manuel Amaro-Villalobos
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autonoma University, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, 12 de Octubre Hospital, 28041, Madrid, Spain
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autonoma University, Av. Reyes Católicos 2, 28040, Madrid, Spain.,Spanish Biomedical Research Network in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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Yuste C, Rivera F, Moreno JA, López-Gómez JM. Haematuria on the Spanish Registry of Glomerulonephritis. Sci Rep 2016; 6:19732. [PMID: 26818712 PMCID: PMC4730139 DOI: 10.1038/srep19732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/15/2015] [Indexed: 12/24/2022] Open
Abstract
Recent studies suggest a pathogenic role for glomerular haematuria among renal function. However, there is no data on the prevalence of haematuria from a large renal biopsy registry. We analysed the prevalence of gross (GH) and microscopic (mH) haematuria in 19,895 patients that underwent native renal biopsies from the Spanish Registry of Glomerulonephritis. Haematuria's overall incidence was 63% (GH 8.6% and mH 55.1%), being more frequent in males (64.7% vs. 62.4%). GH was more prevalent in patients <18 years (21.3% vs. 7.7%). The commonest clinical presentation associated with GH was acute kidney injury (31.5%) and IgA Nephropathy (IgAN) (33.6%) was the most frequent histological finding. GH patients showed a significantly (p < 0.05) lower eGFR and proteinuria levels as compared with patients with mH and without haematuria. Moreover, mH was more prevalent in adults (56.3%). Nephrotic syndrome was the commonest clinical presentation in mH patients (32.2%) and IgAN (18.5%) the most frequent histological finding. In conclusion, haematuria, is a frequent urinalysis finding in patients underwent native renal biopsy. The most frequent histological finding in both GH and mH is IgAN. Whereas, GH is more frequent in young males with acute kidney injury, mH is commoner among adults with nephrotic syndrome.
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Affiliation(s)
| | | | - Juan Antonio Moreno
- Renal,Vascular and Diabetes Research Lab. IIS-Fundación Jiménez Díaz. Autonóma University, Madrid, Spain
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9
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Zhai Y, Xu H, Shen Q, Cao Q, Zhu G, Wei M, Sun L, Liu H, Rao J, Fang X, Chen J, Guo W. Renal histological features of school-age children with asymptomatic haematuria and/or proteinuria: a multicenter study. Nephrology (Carlton) 2015; 19:426-31. [PMID: 24720478 DOI: 10.1111/nep.12260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 11/27/2022]
Abstract
AIM The risk of asymptomatic haematuria and/or proteinuria development into chronic progressive glomerulonephritis (CPG) is unclear. The indications for renal biopsy and follow-up on these asymptomatic children remain controversial. METHODS A multicenter, retrospective study was performed to investigate the renal histological features of school-age children with asymptomatic urine abnormalities. RESULTS A total of 112 asymptomatic children's renal biopsy data were studied. Most of the children (71%) received a renal biopsy because of isolated microscopic haematuria (IH), and these children were predominantly (60%) proven to have only mild lesions in the glomeruli. Approximately 30% of the children were biopsied because of asymptomatic proteinuria with or without microscopic haematuria (HP or isolated asymptomatic proteinuria (IP)), and these children were mostly (44-83%) indicated to have CPG, such as IgA nephropathy, focal segmental glomerulosclerosis, and Alport syndrome. The junior high school students had a greater percentage of HP than the primary school children. IgA nephropathy was the most common diagnosis in children who received renal biopsy because of HP. CONCLUSIONS Our findings indicate that IP and especially HP may have a high risk of development into CPG. IH, however, has a relatively low risk of severe histological lesions. Thus, IH per se might not be suggested as an indication for early renal biopsy. Long-term follow-up is necessary for these asymptomatic children.
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Affiliation(s)
- Yihui Zhai
- Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai, China
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Prevalence Rate of Urinary Tract Infection and Disorder of Urinary Profiles in the 7-12 Years Old Healthy Children in Tabriz, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2013. [DOI: 10.5812/pedinfect.10347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Iyengar A, Goud BR, Kamath N, Phadke KD, Kasthuri A. Feasibility of screening for urinary abnormalities as a part of school health appraisal. Indian J Nephrol 2012; 22:235-6. [PMID: 23087572 PMCID: PMC3459541 DOI: 10.4103/0971-4065.98807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- A Iyengar
- Division of Pediatric Nephrology, Department of Pediatrics, St. John's Medical College, Bangalore, India
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Yang H, Wang Q, Luo J, Li Q, Wang L, Li CC, Zhang G, Xu Z, Tao H, Fan Z. Ultrasound of urinary system and urinary screening in 14 256 asymptomatic children in China. Nephrology (Carlton) 2010; 15:362-7. [PMID: 20470308 DOI: 10.1111/j.1440-1797.2009.01262.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study is to assess the characteristics of urinary system diseases and the role of the ultrasound screening and urinalysis screening for chronic kidney disease (CKD) in asymptomatic children in China. METHODS Between September 2008 and November 2008, 14 256 children excluding those with obvious symptoms and signs were enrolled in our study. All the subjects accepted ultrasound and urinary screening. A case-control study was performed to evaluate the relative risk of having stones in those children exposed to melamine formula. RESULTS Of the enrolled children, 6.10% (869 of 14 256) showed abnormalities, of which 409 (2.87%) were established by ultrasound, 572 (4.01%) by urinalysis and 112 (0.79%) by both ultrasound screening and urinalysis. The abnormalities included congenital anomalies of kidney and urinary tract, urinary stones and/or hydronephrosis, leucocyturia and haematuria and/or proteinuria. Children exposed to melamine formula were 5.17 times as likely to have kidney stones as children exposed to no-melamine formula (95% confidence interval, 3.28-8.14; P < 0.001); the probability of kidney stones in melamine-fed infants were 6.28 times as likely as those no melamine-fed (95% confidence interval, 3.71-10.65; P < 0.001). CONCLUSION Ultrasonography and urinalysis could complement each other and play important roles in the early diagnosis of anomalies of the urinary system, but urinalysis is a more cost-effective screening tool for CKD in children in China. Exposure to melamine-contaminated formula associated with urinary stones, especially in infants, was significantly higher than the control group.
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Affiliation(s)
- Haiping Yang
- Department of Nephroimmunology and Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Yuzhong District, Chongqing 400014, China
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Abstract
This review addresses the relevance of urinary screening for chronic kidney disease (CKD) in children. Ambiguity about screening children exists because of the uncertainty as to whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who subsequently progress to ESRD. A related concern is whether the adoption of urinary screening programs is cost effective. The most common method that is used for screening children for CKD involves the measurement of spot samples of urine for hematuria and or proteinuria. Although mass screening is now well established in Japan, Taiwan, and Korea, there appears to be movement away from mass screening to detect CKD in children and adolescents in North America and Europe. In December 2007, the American Academy of Pediatrics published their latest recommendations, in which no urinalyses were recommended at any age during childhood. The second issue addressed in this review is the reporting of estimated glomerular filtration rates (GFR) in children by clinical laboratories.
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Affiliation(s)
- Ronald J Hogg
- The Children's Hospital at Scott & White, 2401 South 31st Street, Temple, TX 76508, USA.
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