266 - Outcomes of recurrent non-glomerular gross hematuria in children

Recurrent non-glomerular gross hematuria poses a unique diagnostic challenge. A battery of non-invasive and invasive testing is usually performed to confirm the etiology. The diagnostic approach is unclear due to the scarcity of pediatric literature.


Objective:

The purpose of this study is to describe the prevalence and characterize the cases that present with recurrent gross hematuria of non-glomerular nature, as well as report their outcomes. 


Design/Methods:

A retrospective chart review of patients aged ≤21 years seen at Children’s Hospital of Michigan with gross hematuria from July 2005 to July 2021 was performed. Recurrent gross hematuria was defined as the presence of visibly bright red hematuria on at least 3 separate occasions. Exclusion criteria were patients with non-recurrent course and incomplete documentation.


Results: A total of 447 patients’ charts with gross hematuria were screened, of which 197 were excluded. 250 patients with recurrent gross hematuria were included in the analysis. Overall, identifiable causes of recurrent gross hematuria were trauma (20.4%), calculi (19.6%), glomerulonephritis (15.6%), urinary tract infection (14.8%), congenital anomalies (6.8%), and others (12%). The remainder of 27 (10.8%) children with recurrent gross hematuria had no identifiable cause, had a normal clinical examination, negative family history of hematuria and normal initial screening test results. This subgroup was further studied. Their median age was 12 years (IQR 8, 15) with male predominance (70%). Hematuria was present throughout micturition in 78% patients; 63% had accompanying urinary tract symptoms, 96% were normotensive and the median estimated GFR was 106 ml/min/1.73m2 (IQR 91, 144). Seven underwent ureterocystoscopy to lateralize hematuria; four (57%) had efflux of blood from the left ureteral orifice. Out of these 4 patients, one (25%) had a filling defect in left renal pelvis. Hematuria resolved in 43% of patients after ureterocystoscopy. Overall, 67% of the patients had spontaneous resolution over a median follow up of 12 months (0, 50).

Conclusion(s):

Recurrent gross hematuria has no identifiable cause in 10.8% children on standard initial testing. Two-third had spontaneous resolution at the last follow up suggesting a benign etiology of hematuria. Invasive testing may be required only in selected patients. A simplified diagnostic algorithm may help streamline investigations and formulate definitive recommendations.