Etiologies of asymptomatic microscopic hematuria in children - systematic review of 1092 subjects

Abstract

Background: Asymptomatic microscopic hematuria is common in children. No systematic review providing an evidence based approach for the differential diagnosis of these children has been performed.

Contents: Multiple data bases were search. The PRISMA criteria were followed. Data regarding the etiology of the hematuria were extracted using a standardized extraction tool. Seven studies encompassing 1092 children (857 with isolated microscopic hematuria and 235 with combined microscopic hematuria and proteinuria), comprise this review. A total 42.4% of isolated microscopic and 81.3% of microscopic hematuria and proteinuria subjects had identified etiologies. Thin basement membrane nephritis (15.2%), IgA nephropathy (10.4%), and hypercalciuria without nephrolithiasis (7.7%), were the most common etiologies among children with isolated microscopic hematuria. IgA nephropathy (44.3%), thin basement membrane disease (12.8%), and mesangial proliferative glomerulosclerosis (8.9%) were the most common etiologies among children with combined microscopic hematuria and proteinuria.

Conclusion: The present study provides an evidenced based resource, based on a systematic review, for the differential diagnosis of asymptomatic hematuria in children. Additionally, these observations suggest that children with isolated microscopic hematuria should be followed for persistence of hematuria or the development of proteinuria. Children with combined microscopic hematuria and proteinuria should be comprehensively evaluated.

Keywords: children; diagnosis; etiology; hematuria; proteinuria.