SYMPTOMLESS MICROHEMATURIA IN SCHOOLCHILDREN - CAUSES FOR VARIABLE MANAGEMENT STRATEGIES

We reviewed published data on the frequency of underlying disorders in schoolchildren with microscopic or gross isolated haematuria (IH), an d evaluated management strategies. We found five reports of microscopi c IH in screened asymptomatic schoolchildren, three reports of microsc opic IH detected by case-finding, and five surveys of kidney biopsies in referred children with microscopic and gross IH. We listed the repo rted underlying disorders, and estimated the benefit from their early detection and treatment. Most children with microscopic IH, whether de tected by screening or case-finding, had no significant underlying dis ease. Some had disorders that may benefit from early treatment (membra noproliferative glomerulonephritis, obstructive uropathy, urolithiasis ), or counselling (hereditary nephropathy, renal cystic disease). The combined prevalence of these five diseases was 0-7.2% in children with microscopic IH detected by screening, and 3.3%-13.6% in those with mi croscopic IH detected by case-finding. The combined prevalence of memb ranoproliferative glomerulonephritis and hereditary nephropathy among kidney biopsies was 11.6%-31.6% in children with microscopic IH, and 3 .6%-42.1% in children with gross IH. Variable management strategies fo r schoolchildren with IH result from uncertainty about the frequency o f underlying disorders and the efficacy of their early treatment. With no evidence that detecting IH leads to prevention of renal function i mpairment, screening for IH in symptomless schoolchildren is not warra nted. Once detected, however, IH justifies further investigation.