Asaf Vivante1, Ronit Calderon-Margalit, Karl Skorecki. 1. aDepartment of Pediatrics, Talpiot Medical Leadership Program, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv bHadassah-Hebrew University Braun School of Public Health, Jerusalem cDepartment of Nephrology; Rambam Healthcare Campus, Rappaport Faculty of Medicine and Research Institute, The Technion-Israel Institute of Technology, Haifa, Israel.
Abstract
PURPOSE OF REVIEW: Hematuria is a common clinical finding requiring medical attention and poses several clinical challenges. The main challenge is to predict the future risk for chronic kidney disease and therefore to design a long-term follow-up evaluation and treatment plan. This review focuses on the risk for subsequent end-stage kidney disease among young persons with persistent isolated microscopic hematuria. RECENT FINDINGS: It has been recently recognized that young persons with persistent isolated microscopic hematuria have an increased risk for end-stage kidney disease, mainly secondary to primary glomerular diseases. These predominantly include IgA nephropathy, thin basement membrane disease, and Alport syndrome. Among these causes, the association with progression to chronic kidney disease is best established for IgA nephropathy and Alport syndrome. Thin basement membrane disease had been considered 'benign' by most authors, although recent findings suggest otherwise. In addition, novel diagnostic markers and therapeutic interventions for these conditions have recently been studied. SUMMARY: Persistent isolated microscopic hematuria confers a risk for future chronic kidney disease, which is dependent on disease context, underlying genetics, environment interactions, and treatment. 'Benign (familial) hematuria' is a misnomer, which we recommend abandoning as it prompts loss to follow-up. Instead, we favor annual/biennial follow-up assessment that should include measurement of blood pressure, urinalysis, and kidney function tests.
PURPOSE OF REVIEW: Hematuria is a common clinical finding requiring medical attention and poses several clinical challenges. The main challenge is to predict the future risk for chronic kidney disease and therefore to design a long-term follow-up evaluation and treatment plan. This review focuses on the risk for subsequent end-stage kidney disease among young persons with persistent isolated microscopic hematuria. RECENT FINDINGS: It has been recently recognized that young persons with persistent isolated microscopic hematuria have an increased risk for end-stage kidney disease, mainly secondary to primary glomerular diseases. These predominantly include IgA nephropathy, thin basement membrane disease, and Alport syndrome. Among these causes, the association with progression to chronic kidney disease is best established for IgA nephropathy and Alport syndrome. Thin basement membrane disease had been considered 'benign' by most authors, although recent findings suggest otherwise. In addition, novel diagnostic markers and therapeutic interventions for these conditions have recently been studied. SUMMARY: Persistent isolated microscopic hematuria confers a risk for future chronic kidney disease, which is dependent on disease context, underlying genetics, environment interactions, and treatment. 'Benign (familial) hematuria' is a misnomer, which we recommend abandoning as it prompts loss to follow-up. Instead, we favor annual/biennial follow-up assessment that should include measurement of blood pressure, urinalysis, and kidney function tests.
Authors: Juan Antonio Moreno; Claudia Yuste; Eduardo Gutiérrez; Ángel M Sevillano; Alfonso Rubio-Navarro; Juan Manuel Amaro-Villalobos; Manuel Praga; Jesús Egido Journal: Pediatr Nephrol Date: 2015-05-17 Impact factor: 3.714