Acute Hemorrhagic Cystitis(AHC) in Children

Pyo, Jin Won; Choi, Eun Hwa; Park, Jin Young; Lee, Hoan Jong; Cheong, Hae Il; Ha, II Soo; Choi, Yong; Kim, Kwang Myung; Choi, Hwang; Chi, Je Geun

Abstract

PURPOSE: AHC characterized by sudden onset of gross hematuria, dysuria and frequency occurs in children and young adults as a self-limited disease that should be differentiated from serious renal disorders. We have performed this study to establish the cause and characterize the clinical features of this illness in Korean children.
METHODS
19 cases collected prospectively for 30 month-period over 1991-1993 were reviewed. Urine specimens were obtained after normal voidings and inoculated into Hep-2 cell monolayers for virologic study, and cultured as standard method for bacteria. Isolates producing a cytopathic effect characteristic of adenovirus were confirmed by indirect immunofluorescent staining with monoclonal antibody specific to adenovirus and also by electron microscopy. Adeno-viruses were typed by hemagglutination-inhibition test by Dr. Piedra at the Texas Medical Center, USA.
RESULTS
The ages of the patients were between 5 months and 14 years. Adenovirus was isolated from the urine in 8 cases(42%) and E. coli in 2(10.5%). Of 8 patients with positive culture, adenovirus type 7a was recovered in 4 cases, and adenvirus type 11 in 4 cases. Seven of the 8 patients with positive adenovirus culture were boys while E. coli was isolated only in girls. No sexual difference was found in cultur-negative group(M:F=4:5). The sudden onset of painful hematuria was the most impressive manifestation. Gross hematuria continued for 3 to 15(average 8.9) days. Suprapubic pain was present in 4. Only one patient had mild fever. Ten of 11 ultrasonic examinatinons showed thickening of bladder wall and decreased filling capacity.
CONCLUSIONS
These data suggest that culture for viruses may be useful method for differential diagnosis of AHC and adenovirus type 7a is newly identified to be one of the important causes of this illness. Further studies on ABC are needed to investigate the unexplained part of etiology.