Hematuria

Davis TK, Hmiel P. Pediatric Hematuria Remains a Clinical Dilemma. Clin Pediatr (Phila). 2015 Aug;54(9):817-30.

“Hematuria in the pediatric population is a common clinical dilemma for the clinician. The clinician should attempt to categorize it further into gross versus microscopic, symptomatic versus asymptomatic, and transient versus persistent. Gross hematuria if confirmed to be persistent, regardless of symptoms, almost always warrants further diagnostic testing. A standardized approach toward microscopic hematuria cannot be recommended. The differential diagnosis is too broad. Recommendations toward screening for asymptomatic hematuria have been dynamic, but currently, the AAP recommends against screening.4 Although it is never normal to have blood in the urine, isolated microscopic hematuria is rarely an indicator of significant kidney disease. Admittedly, this can be difficult to convey to skeptical patients and families, but invasive diagnostic procedures are unlikely to yield a treatable diagnosis or guide management. Reassurance is warranted. However, reassurance without periodic follow-up is no longer acceptable because long-term data have now identified an overall small but statistically significant risk of chronic kidney disease progression during long-term follow-up.”

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Article of interest: Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age.

Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow TL. Diagnostic accuracy
of the urinalysis for urinary tract infection in infants < 3 months of age. Pediatrics. 2015 May 25. [Epub ahead of print]

This study sheds new light on the diagnostic characteristics of the UA in young infants. A definition of a positive UA that includes pyuria and/or positive LE was highly sensitive and specific. All but 1 of 203 infants with bacteremic UTI and recorded UA results for both LE and WBC/HPF were positive for 1 or both of these tests, and the one infant with negative results for these components was infected with an organism (GBS) not commonly described as a uropathogen. A negative LE and the absence of pyuria were also fairly specific (87.8%) in infants with negative urine cultures. UA bacteria, however, demonstrated poor specificity, suggesting that this component of the UA is not as useful as LE or pyuria for ruling in a UTI.

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