Child Kidney Dis.  2023 Jun;27(1):26-33. 10.3339/ckd.23.005.

Clinical practice pattern on hematuria and proteinuria in children: the report of a survey for the Korean Society of Pediatric Nephrology

• Min J
• Choi N
• Ahn YH
• Kang HG

• KMID: 2544234
• DOI: http://doi.org/10.3339/ckd.23.005

Abstract

Purpose
Hematuria and proteinuria have various causes and consequential outcomes in children. Immunosuppressants are needed in some children with biopsy-proven glomerulonephropathy but have many adverse effects. Since the clinical practice patterns of Korean pediatric nephrologists are diverse, we surveyed their opinions.
Methods
Using a clinical vignette, the survey was emailed to all Korean Society of Pediatric Nephrology members. The questionnaires included diagnosis, examination, medications, and dietary recommendations for patients with hematuria and proteinuria.
Results
A total of 32 clinicians (5.48%, 22 pediatric certificated nephrologists) responded to the survey. Most responders (87.5%) suspected immunoglobulin A nephropathy, and 68.8% replied that kidney biopsies were a diagnostic tool. Renin-angiotensin system inhibition (62.5%) or steroids (18.8%) were selected as the treatment. Salt and protein intakes were usually encouraged as dietary reference intakes (34.4% and 65.6%, respectively).
Conclusions
Children with abnormal urinalysis have various causes, treatments, and prognoses. As treatments such as immunosuppressants can have many adverse effects, it is necessary to confirm an accurate diagnosis and indications of treatments before starting the treatment. Recommendations for a diet should not hinder growth.

Keyword

Hematuria; Immunosuppressive agents; Proteinuria; Surveys and questionnaires

Figure

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  Fig. 1. Choice of approach to hematuria and proteinuria. The outside circle shows the diagnostic approach of the responders. Blue colors mean answers that they did not perform a kidney biopsy (10/32, 31.3%) and red colors mean answers that they would perform a kidney biopsy (22/32, 68.6%). The inside circle shows the management of responders. Yellow colors mean that they would use RAS blockers, while green color means that they would not use RAS blockers whether they use other medications. DRBC, dysmorphic red blood cells; RAS, renin-angiotensin system; RASi, RAS inhibition; AZT, azathioprine; MMF, mycophenolate mofetil.

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  Fig. 2. Dietary recommendation for patients with hematuria and proteinuria. The inner circle represents recommendations for protein intake, while the outer circle represents recommendations for salt intake. DRBC, dysmorphic red blood cell.

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  Fig. 3. Choice of clinical approach for persistent proteinuria and hematuria despite the use of steroids. CNI, calcineurin inhibitors; AZT, azathioprine; MMF, mycophenolate mofetil.

Reference

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