engleski

Evaluation of the renal biopsy importance in isolated microhematuria in children

Isolated microscopic hematuria(IMH)in children always raises the question of the necessity of renal biopsy.Many authors consider IMH as minor abnormality where glomerular changes are not expected, but general agreement has not yet been achieved.The aim of this study was to evaluate contribution of renal biopsy to diagnosis of glomerular disease in IMH. Material and methods. Biopsy was performed in 54 children with IMH of proven glomerular origin.Mean duration of IMH prior to biopsy was 2.8 years.Biopsy specimens were examined by light(LM), immunofluorescence(IF)and electron microscopy(EM). Results. 43 patients(79.6%)were found to have glomerular abnormalities.On LM 18 patients had normal glomeruli(NG), 22 mesangial proliferative glomerulonephritis(MEPGN), 9 focal segmental glomerulosclerosis(FGS), 3 focal glomerulonephritis(FGN)and 2 membranoproliferative glomerulonephritis(MPGN).IF revealed 10 cases as IgA nephropathy.EM discovered GBM changes consistent with Alport syndrome in 21 patients and diffuse thinning of GBM in 10.In 5 children, subepithelial hump-like deposits were found and considered as the sign of acute postinfectious glomerulonephritis in resolution.One of 2 cases of MPGN showed to be type II(DDD).On follow-up, 6 of 21 children with Alport-like GBM changes developed full clinical picture of the syndrome.Further surveillance is needed to confirm the significance of EM findings in others. Conclusion. In children with IMH renal biopsy is justified and should always be analyzed by light, immunofluorescence and especially electron microscopy, because EM was decisive for final diagnosis in about 66% of all cases.

renal biopsy; isolated microhematuria

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