E) Asymptomatic isolated microscopic hematuria is often transient and not clinically significant
Microscopic hematuria in children, defined as > 5 RBCs/hpf, is often transient and not clinically significant if asymptomatic. It is as common with a prevalence in a single urine sample as high as 3-4%. Familial autosomal-dominant thin basement membrane disease is a common cause, and is diagnosed by checking the urines of close family members. While imaging work-up is recommended for adults with blunt abdominal trauma and gross hematuria only, some literature supports imaging children with blunt abdominal trauma and > 50 RBCs/hpf microscopic hematuria. Other etiologies in the differential diagnosis include: IgA nephropathy, Alport syndrome (associated with sensorineural hearing loss), poststreptococcal glomerulonephritis, hypercalciuria (urine calcium/creatinine ratio > 0.2), and nutcracker syndrome (compression of the left renal vein between the aorta and the proximal superior mesenteric artery).Wilms tumor is in the differential for hematuria, but since the microscopic hematuria is often transient, screening for it with US is not the first step in work-up. Consideration should be given to US as part of the ED work-up for unexplained gross hematuria.
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May 19, 2020 at 9:09 pm
E) Asymptomatic isolated microscopic hematuria is often transient and not clinically significant
Microscopic hematuria in children, defined as > 5 RBCs/hpf, is often transient and not clinically significant if asymptomatic. It is as common with a prevalence in a single urine sample as high as 3-4%. Familial autosomal-dominant thin basement membrane disease is a common cause, and is diagnosed by checking the urines of close family members. While imaging work-up is recommended for adults with blunt abdominal trauma and gross hematuria only, some literature supports imaging children with blunt abdominal trauma and > 50 RBCs/hpf microscopic hematuria. Other etiologies in the differential diagnosis include: IgA nephropathy, Alport syndrome (associated with sensorineural hearing loss), poststreptococcal glomerulonephritis, hypercalciuria (urine calcium/creatinine ratio > 0.2), and nutcracker syndrome (compression of the left renal vein between the aorta and the proximal superior mesenteric artery).Wilms tumor is in the differential for hematuria, but since the microscopic hematuria is often transient, screening for it with US is not the first step in work-up. Consideration should be given to US as part of the ED work-up for unexplained gross hematuria.