Hematuria in Children: Concerns and Next Steps

Q: Hematuria in Children: Concerns and Next Steps

Hello： In response to your question, the text mentions that hematuria and mild proteinuria were discovered in December 2002 and have been monitored and treated. <br>In general, when hematuria is found, nephrologists will first rule out the possibility of urinary tract stones or u

Hematuria

Dear Dr.
Yang,
Hello.
In late December of 2002, my child, Xiaodi Zhan, discovered blood in his urine.
He subsequently visited a teaching hospital where he underwent urinalysis, blood tests, and an ultrasound.
The results indicated mild kidney inflammation, accompanied by proteinuria and hematuria.
Since then, he has continued to have monthly urine tests, and both proteinuria and occult blood symptoms have persisted (initially, he had gross hematuria, with Protein >150, RBC >500, Blood 4+).
As of now, the results are as follows: RBC: 28, Blood: 3+ (urine color is normal), and protein levels have returned to normal, with all other results being normal.
He does not experience edema, but occasionally has lower back pain.
The doctor has ultimately suggested a kidney biopsy.
As parents, we find it difficult to consent to such a risky medical procedure for our young child.
However, we are also concerned that if we do not proceed, could our child face the possibility of needing dialysis in the long term? We are in a dilemma and would sincerely appreciate it if you could take the time to address this question, allowing us to reach a conclusion as soon as possible to avoid impacting our child's future.

Thank you very much!

Zhan Xiaodi, 0~9 year old female. Ask Date: 2004/02/05

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, the text mentions that hematuria and mild proteinuria were discovered in December 2002 and have been monitored and treated.
In general, when hematuria is found, nephrologists will first rule out the possibility of urinary tract stones or urological malignancies.
If these issues are excluded and hematuria persists or is accompanied by proteinuria, glomerular disease must be considered.
Blood tests often cannot confirm the diagnosis; a kidney biopsy with electron microscopy is necessary for a definitive diagnosis.
Regardless of the type of glomerulonephritis causing hematuria and proteinuria, long-term monitoring and treatment are essential, along with dietary and lifestyle modifications, to prevent the potential deterioration of kidney function.

Reply Date: 2004/02/05

More Info

Dear Parent,
Thank you for reaching out with your concerns regarding your child's hematuria and the potential need for a kidney biopsy. I understand how distressing it can be to consider invasive procedures for a young child, and I appreciate your desire to make the best decision for your child's health.

Hematuria, or the presence of blood in urine, can be a concerning symptom in children. It can arise from various causes, ranging from benign conditions to more serious underlying issues. In your child's case, the presence of proteinuria alongside hematuria suggests that there may be some level of kidney involvement. The fact that your child has experienced persistent symptoms, including visible blood in the urine and protein levels above normal, warrants careful evaluation.

Understanding the Risks and Benefits of Kidney Biopsy
A kidney biopsy is a procedure where a small sample of kidney tissue is taken for examination under a microscope. This can help determine the underlying cause of kidney issues, such as inflammation, infection, or glomerular disease. While it is true that any medical procedure carries risks, including bleeding, infection, or damage to surrounding tissues, the benefits of obtaining a definitive diagnosis often outweigh these risks, especially if there is a concern for progressive kidney disease.

In your case, the recommendation for a kidney biopsy likely stems from the ongoing presence of hematuria and proteinuria, which could indicate a condition that may require specific treatment. If left undiagnosed and untreated, certain kidney conditions could potentially lead to chronic kidney disease or even end-stage renal failure, necessitating dialysis in the future. Therefore, understanding the exact nature of your child's kidney condition is crucial for appropriate management.

Alternative Approaches
Before proceeding with a biopsy, it is essential to have a thorough discussion with your child's nephrologist. They may consider additional non-invasive tests, such as:
1. Repeat Urinalysis: Monitoring the urine for changes over time can provide insight into whether the hematuria and proteinuria are persistent or resolving.

2. Imaging Studies: Ultrasound or other imaging techniques can help visualize the kidneys and urinary tract for any structural abnormalities.

3. Blood Tests: Comprehensive blood work can assess kidney function and rule out systemic conditions that may be contributing to the symptoms.

4. Observation: In some cases, if the symptoms are mild and there are no alarming signs, a period of observation may be warranted, with regular follow-ups to monitor kidney function and urinary symptoms.

Conclusion
Ultimately, the decision to proceed with a kidney biopsy should be made collaboratively between you, your child's healthcare team, and possibly a pediatric nephrologist. They can provide you with a clearer understanding of the potential risks and benefits based on your child's specific situation. It is also important to express your concerns about the procedure to the medical team, as they can offer reassurance and additional information to help you feel more comfortable with the decision.

In summary, while the thought of a kidney biopsy can be daunting, it is often a necessary step in diagnosing and managing kidney issues effectively. Early intervention can make a significant difference in outcomes, so I encourage you to have an open dialogue with your child's doctors to explore all options available.

Wishing you and your child the best of health.

Sincerely,
Doctor Q&A Teams

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