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PEDIATRICS Vol. 102 No. 4 October 1998, p. e42

ELECTRONIC ARTICLE:
Limited Evaluation of Microscopic Hematuria in Pediatrics

Received Feb 10, 1998; accepted May 15, 1998.

Leonard G. Feld*, Kevin E. C. MeyersDagger , Bernard S. KaplanDagger , and F. Bruder Stapleton*

From the * Divisions of Pediatric Nephrology, Children's Hospital of Buffalo, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; and Dagger  Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Objective.  The purpose was to determine the value of the standard laboratory and radiologic evaluation of microscopic hematuria in children, and to determine the prevalence of idiopathic hypercalciuria in those children referred for evaluation of unexplained microscopic hematuria.

Methods.  This was a retrospective study of 325 children referred from 1985 to 1994 for the evaluation of asymptomatic microscopic hematuria. The diagnostic studies reviewed included serum creatinine, blood urea nitrogen, serum electrolyte studies, serum complement concentration, antinuclear antibody, urinalysis, urine calcium to creatinine ratios, urinary protein to creatinine ratio and/or 24-hour urinary protein excretion, renal ultrasounds, intravenous pyelograms, voiding cystourethrograms, and historical information.

Results.  All creatinine and electrolyte values were normal for age, and none of the biochemical tests obtained in the children with hypercalciuria was abnormal. Of the 325 patients with idiopathic microscopic hematuria, only 18 had abnormal renal ultrasound examinations and 9 voiding cystourethrograms showed low-grade reflux. Hypercalciuria was found in 29 patients. The family history was positive for urolithiasis in 16% of patients without hypercalciuria compared with 14% of patients with hypercalciuria. A positive family history of hematuria was reported in 25% of patients; 62 patients did not have hypercalciuria and 4 of the patients had hypercalciuria. Microscopic hematuria in children is a benign finding in the vast majority of children.

Conclusions.  Our data demonstrate that a renal ultrasound, voiding cystourethrogram, cystoscopy, and renal biopsy are not indicated in the work-up of microscopic hematuria, and microhematuria in the otherwise healthy child is a minimal health threat, rarely indicative of serious illness.  Key words:  proteinuria, hematuria, microscopic hematuria, renal ultrasound.




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