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