Isolated Glomerular Diseases with Recurrent Gross Hematuria

Published on 25/03/2015 by admin

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Last modified 25/03/2015

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Chapter 504 Isolated Glomerular Diseases with Recurrent Gross Hematuria

Approximately 10% of children with gross hematuria have an acute or a chronic form of glomerulonephritis that may be associated with a systemic illness. The gross hematuria, which is usually characterized by brown or cola-colored urine, may be painless or associated with vague flank or abdominal pain. Presentation with gross hematuria is common within 1-2 days after the onset of an apparent viral upper respiratory tract infection in immunoglobulin A (IgA) nephropathy, and typically resolves within 5 days. This relatively short period contrasts to a latency period of 7-21 days occurring between the onset of a streptococcal pharyngitis or impetiginous skin infection and the development of poststreptococcal acute glomerulonephritis. Gross hematuria in these circumstances can last as long as 4-6 wk. Gross hematuria can also be seen in children with glomerular basement membrane (GBM) disorders such as hereditary nephritis (Alport syndrome [AS]) and thin GBM disease. These glomerular diseases can also manifest as microscopic hematuria and/or proteinuria without gross hematuria.

504.1 Immunoglobulin A Nephropathy (Berger Nephropathy)

IgA nephropathy is the most common chronic glomerular disease. It is characterized by a predominance of IgA immunoglobulin within mesangial glomerular deposits in the absence of systemic disease (e.g., symptomatic systemic lupus erythematosus or Henoch-Schönlein purpura). Diagnosis requires renal biopsy, which is performed when clinical features warrant confirmation of the diagnosis or characterization of the histologic severity, which might affect therapeutic decisions.

Prognosis and Treatment

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