الفهرس 
Introduction and Aim of the Study
Classification and Pathophysiology of Pediatric Macroscopic HematuriaOnly 14 pages are availabe for public view
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Abstract
Hematuria is defined by the presence of an abnormal quantity of red blood cells (RBCs) in urine (>3 RBCs/hpf) in a centrifuged urine sample being either visible to the naked eye (macroscopic or gross) or apparent only upon urine analysis (microscopic) [1]. In one pediatric center, pediatric macroscopic hematuria had an estimated prevalence of 1.3 cases per 1000 urgent visits [2].
Hematuria in children may be of glomerular origin as in PSGN, Alport syndrome and IgA nephropathy, or non-glomerular origin as in urolithiasis, UTIs, hypercalciuria and urologic tumors [5].
The study enrolled children below the age of 16 years presented to the pediatric urology outpatient clinic in Assiut university urology and nephrology hospital over one year starting from (November, 2014) to (October, 2015). All cases were subjected to basic evaluation (history taking, clinical examination, complete urine analysis, CBC, serum creatinine, abdominal ultrasound and KUB radiograph). Further studies including laboratory studies such as (urine culture and sensitivity, ASOT and ESR), abdominopelvic MSCT with or without contrast, and urethrocystoscopy and biopsy, were done in selected cases.
Out of 2896 cases of children presented to the pediatric urology outpatient clinic in Assiut university urology and nephrology hospital, 76 cases (2.6%) presented with macroscopic hematuria.
Males were more than females in the study group (72.4% vs. 27.6). The mean age at presentation was 7.5 years. The majority of cases presented from Assiut governorate (72.4%) followed by Minia (18.4%).
Loin pain (35.5%) and burning micturition (18.4%) were the most common associated symptoms. Isolated macroscopic hematuria (without associated symptoms) was present in 30 cases (39.5%). No positive clinical examination findings were present in 56 cases (73.4%), with enlarged tonsils being the most common positive finding in the remaining cases (14.4%).
Pyuria (73.6%), followed by proteinuria (59.2%), crystalluria (55.2%), bacteriuria (21%) and bilharzial ova (18.4%) were the most common urine analysis findings in these cases.
Normocytic normochromic anaemia was found in 4 cases (5.3%), while leucocytosis and thrombocytosis were found in 2 cases (2.6%).
Raised serum creatinine was found in 2 cases (2.6%) due to PSGN and bilharzial granuloma obstructing both ureteric orifices.
Urinary stones (59.2%), hydronephrosis (27.6%), increased renal echogenicity (19.7%) and echogenic bladder growth (9.2%) were the most common sonographic findings in these cases.
No abnormal KUB radiograph findings were present in 45 cases (59.2%) of children with macroscopic hematuria (statistically significant with p.value 0.023). Nephrolithiasis was the most common KUB radiograph finding in these cases (31.5%), while 34% of urinary stones were radioluscent.
Urolithiasis (61.8%), bilharzial cystitis (18.4%) and PSGN (11.8%) constituted the major causes of macroscopic hematuria in this study.
Urolithiasis was significantly the most common cause of macroscopic hematuria in children less than 10 years in both genders. Urolithiasis was significantly associated with total bright red hematuria, loin pain, the presence of (proteinuria, crystalluria, pyuria and bacteriuria) on urine analysis and hydronephrosis on abdominal ultrasound. In the meanwhile, urolithiasis still had statistical significance with cases of macroscopic hematuria lacking other associated symptoms and clinical examination findings. Abdominal ultrasound was considered a better diagnostic test for urolithiasis in comparison to KUB X-ray film with (95.7%) & (66%) sensitivity, respectively.
Bilharzial cystitis was significantly the most common cause of macroscopic hematuria in children more than 10 years. Bilharzial cystitis was significantly associated with terminal hematuria and echogenic bladder growth. The presence of bilharzial ova was diagnostic of bilharzial cystitis in these cases.
Poststreptococcal glomerulonephritis was significantly associated with dark brown or cola-colored hematuria, enlarged tonsils on clinical examination and increased renal echogenicity on abdominal ultrasound. The presence of RBC casts was considered a better diagnostic test for PSGN in comparison to proteinuria with (44.4%) & (100%) sensitivity and (95.5%) & (46.3%) specificity, respectively.
The urologist should not miss cases of hematuria of medical causes or glomerular origin and the opinion of a nephrologist is warranted.