A Clinical and Pathological Study of Recurrent Hematuria in Chilhood

Park, Moon Soo; Ko, Kwang Wook

Abstract

The clinical, laboratory, and renal biopsy finding in 22 chilren with recurrent hematuria are presented. 1.The mean age at oneset was 7 6/12 years, and male to female ratio was 1.8:1. The gross hematuric attack was preceded by upper respiratory infection in 15 cases(68%), while strenuo-us exercise in 10 cases(45%). Loin pain was accmpanied with gross hematuria in 4 cases(18%). 2. Casts were found on urinalysis in 12 cases(55%), and 7 cases(32%) revealed more than 0.5gm in 24 hour urinary protein excretion. Serum IgA level was elevated in 8 cases(50%) out of 16 tested. Persistent proteinuria and microscopic hematuria between gross hematuric attack-s were found in 5 cases(23%) and 11 cases(50%) respectively. 3. Light microscopy showed minimal change lesion in 7 cases(32%), mesangial proliferative glomerulonephritis in 7 cases(32%), mesangiopathic glomerulonephritis in 5 cases(23%), focal segmental glomerulosclerosis in 2 cases(9%), and membranoproliferative glomerulonephritis in 1 case. Immunofluorescent study, performed in 16 cases, revealed the mesangial deposition of IgA in 9 cases(56%), IgG in 7 case(44%), C3 in 11 cases(69%), and IgM in 2 cases(15%) out of 13 performed. Electron dense deposits were identified in 13 cases of 14 observed with electron microscopy. One or more findings of mesangial proliferation, focal segmental glomerulosclerosis, cresc-ent formation on light microscopy were regarded as severe pathological abnormalities and such findings were associated with more than 0.5gm of protein in 24hour urine, persistent proteinuria between attacks, and elevated serum IgA level. Statistically significant differences were also n-oted between the cases with severe pathological abnormalities and the cases without them in terms of mean serum IgA level and the amount of protein in 24 hour urine. No patient has developed complications, such as hypertension or chronic renal failure, duri-ng the follow-up periods ranging from 5 months to 9 6/12 years, being mean 2 8/12 years.