Metabolic risk factors in children with asymptomatic hematuria
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Transcript of Metabolic risk factors in children with asymptomatic hematuria
METABOLIC RISK FACTORS IN CHILDREN WITH ASYMPTOMATIC HEMATURIAFrancisco Rodolfo Spivacow, Elisa Elena del Valle, Paula Gabriela Rey
Dr.Mohammad Reza RazaviDr.Mohammad Mahdi Shater
INTRODUCTION• Hematuria is one of the most common genitourinary abnormalities in
children
• clinical presentations
• associate signs and/or symptoms , past medical history, family history
• Idiopathic or benign hematuria
• Some of these patients may subsequently suffer from kidney stones with hypercalciuria , hyperuricosuria , or hyperoxaluria , with most of these having a positive family history of urolithiasis
INTRODUCTION• The aim of this study was to evaluate the clinical presentation, family
history, and metabolic risk factors of 60 children with asymptomatic hematuria without kidney stones
PATIENTS & METHODS• retrospective and cross-sectional analysis
• patients under 16 years of age who were referred to our institution between 1996 and 2012 for evaluation of metabolic risk factors
• referred to our institution by pediatric nephrologists and came from the general population
• Negative for any explained cause of hematuria(PMH, DH ,…)
• Family history of kidney stones
PATIENTS & METHODS• Sampling
• Blood sample
• Urine sample
Hypercalciuria (HC), i.e., excretion of >4 mg/kg/day urinary calcium
Hyperoxaluria (OX), i.e., overproduction of oxalate[>50 mg/1.73 m2 body surface area (BSA)/day] in the kidneys
Hypocitraturia (CiT), i.e., urinary excretion of <400 mgcitrate/g creatinine
Hypomagnesuria (MG), i.e. urinary excretion of<1.24 mg magnesium/kg body weight/day
Hyperuricosuria (HU), i.e., urinary excretion of excessamounts of uric acid (>815 mg/1.73 m2 BSA/day).
RESULTS• Study
• Family history of renal stone
• At least one urinary metabolic abnormality was present in 49 patients, while 11 patients had no metabolic abnormality.
• Befor metabolic study
RESULTS• Single urinary metabolic risk factors
RESULTS• Multiple urinary metabolic risk factors
RESULTS• The most common urinary risk factor was idiopathic hypercalciuria (single
or associated), which was found in 43.5 % of patients, followed by hypocitraturia (single or associated), present in 31.7 %. Unduly acidic urine pH as a single abnormality was found in 10 % of this pediatric patient population.
RESULTS• Metabolic risk factors in children with hematuria and in pediatric kidney
stone-formers
CONCLUSIONS• Asymptomatic idiopathic hematuria in pediatric patients may often be
associated to different urinary biochemical abnormalities, similar to what is observed in pediatric kidney stone-formers.
• Long-term monitoring of children with hematuria and metabolic disorders may clarify the true association with kidney stone disease.
• Finally, hematuria of unknown etiology demands a biochemical risk factor evaluation that allows definition of its cause and treatment