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Hematuria As First Sign of Presentation in Urolithiasis

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Hematuria As First Sign of Presentation in Urolithiasis Central Journal of Urology and Research Bringing Excellence in Open Access Short Communication *Corresponding author Francisco R Spivacow, Instituto de Investigaciones Metabólicas, Libertad 836, 1012 Buenos Aires, Hematuria as First Sign of Argentina, Fax: 541150319705; Email: Submitted: 01 October 2016 Presentation in Urolithiasis Accepted: 21 November 2016 Spivacow FR*, del Valle EE, LizcanoA, Negri AL, and Rey P Published: 23 November 2016 Instituto de Investigaciones Metabólicas (IDIM), Universidad del Salvador (USAL) ISSN: 2379-951X Buenos Aires, Argentina Copyright © 2016 Spivacow et al. Abstract OPEN ACCESS Hematuria as a sign of urolithiasis is associated with various conditions such as renal colic, urinary infection, kidney stone elimination and urologic procedures. Keywords • Hematuria Purpose: our aim was to determine the frequency of macro or microhematuria as • Kidney stones first sign of presentation in children and adults kidney stone formers. • Children Material and Methods: We analyzed 245 records of children between 2 to 16 • Adults years old and 245 records of adults aged 44.4 ± 14 all of them with urolithiasis confirmed by stone elimination or by ultrasonography, urinary tract X-ray, abdominal tomography, or by urologic stone removal. All of them with normal renal function and free from other renal or urologic pathology. They were asked if hematuria had been present previous to their knowledge of suffering kidney stones or if hematuria had been the first sign of their lithiasis. 1.3. Results: Hematuria was found in 17.1% of the 245 children population (microhematuria 71% and macrohematuria29%). In adults 14.3% had hematuria as first sign (68.6%microhematuria and 21.4%macrohematuria). Conclusion: as both macro or microhematuria can be present as first manifestation of urolithiasis, this condition should be considered when studying the origin of the hematuria. INTRODUCTION Our aim is to evaluate the presence of macro or microhematuria Urolithiasis may cause macroscopic or microscopic hematuria as a clinical sign in both children and adults, [1,2] it may also be asMATERIAL first sign of kidney AND METHODSstone disease in both children and adults. a cause of hematuria in absence of pain. Hematuria has multiple differential diagnosis including neoplasia, infection, lithiasis, as well as glomerular and interstitial renal parenchymal disease [3]. This is an observational study prospective and retrospective that selected from clinical reports two consecutive populations of stone formers, 245 children and 245 adults from 2003 to NurAzili et al find hematuria as first sign in 42.1% of children describe children with idiopathic hypercalciuria in whom painless 2015 to evaluate the frequency of macro or microhematuria as that consulted with renal stone disease [4]. Two previous reports hematuria preceded calcium oxalate stone formation by one to first sign. Urolithiasis was confirmed by X-ray, ultrasound or six years [5,6]. A report of the Southwest pediatric nephrology tomographic scans, or by spontaneous or surgically elimination of the stone. Macrohematuria is characterized by the massive presence of red blood cells in the urine, leading the latter study group describe in 76 children with hypercalciuria (≥ 4 crystalluria, a family history of urolithiasis and/or a family to acquire a clearly discernable red-brownish color, while mg/Kg/day), 33 (43.4%) with gross hematuria, calcium oxalate microhematuria can only be observed by dipstick or microscopic examination. Microhematuria was defined in children as five history of hematuria. They also find eight of 60 children (6 boys, renal colic during the one to four year follow-up period [7]. In or more red blood cells per high power field in a centrifuged 2 girls) with untreated hypercalciuria developed urolithiasis or addition to hypercalciuria, hypocitraturia and hyperuricosuria urine sample determined on at least two occasions and in adults are acknowledged as causes of hematuria and urolithiasis in three or more red blood cells per high power field. As exclusion children [5]. In adults with asymptomatic hematuria, Marumo et criteria we considered the presence of renal colic previous to hematuria detection or simultaneously present, positive urinary tract infection, hematuria caused by stone elimination al., find by ultrasonography 21.5% of urolithiasis [8]. Large renal renal function rather than colic, symptoms in children can be or urologic procedure. We also excluded menses, any cause of pelvic stones in adults may show hematuria, infection or loss of similar, and hematuria may be a unique manifestation, as well as trauma, exercise, and sexual activity,2 tumoral or glomerular and generalized abdominal pain or urinary tract infection [9]. interstitial renal parenchymal pathology. Creatinine clearance was above 60 ml/min/1.73m . Most of them have their 24 hour urine biochemical diagnosis evaluation for urolithiasis but these Cite this article: Spivacow FR, del Valle EE, Lizcano A, Negri AL, Rey P (2016) Hematuria as First Sign of Presentation in Urolithiasis. J Urol Res 3(7): 1075. Spivacow et al. (2016) Email: Central Bringing Excellence in Open Access Table 1: Demographic characteristics, creatinine clearance and idiopathic hypercalciuria, hypocitraturia and hyperuricosuria Kidney Stone Formers Children (n=245) Adults (n=245) hematuria present in children and adults. [5,7]. In adults macroscopic hematuria occurs most frequently Sex (M/W) 133/112 125/120 with larger stones and it may be in absence of pain. Our results Age (years of age) 11 ± 3.9 44.4 ± 14 in adults show 14.3% of hematuria as first clinical manifestation, Height (m) 1.46 ± 0.19 1.67 ± 9.7 significantly lower than the 88.5% found in 93 kidney stone 2 formers detected by ultrasonography by RajaieEsfahani et al.,12 and Weight (kg) 43.6 ± 16 72 ± 16 2 in 69.5% of 77 patients evaluated byintravenousurography and BMI (kg/height ) 19.6± 1.4 25.7 ± 4.6 only mild lower than the report by Marumo K et al., who * Cl Cr mil/min/1.73m 127 ± 42 116 ± 17 find hematuria in 21.5% of kidney stone disease seen by * MicrohematuriaHematuria (%) 17.1 14.3 ultrasonography [8]. Macrohematuria * (%) 71 68.6 In conclusion macro or microhematuria as first sign of * (%) 29 31.4 presentation must warn urologists and the medical community no statistical significance to rule out urolithiasis among other conditions in both children andREFERENCES adults. are not considered for this communication. Informed consent was obtained from all individual participants adults and parents 1. Teichman JMH. Acute renal colic from ureteral calculus. N Engl J Med. of children included in the study. Statistical data were generated 2004; 350: 684-693. withRESULTS a commercially available software package. 2. Sas DJ, Becton LJ, Tutman J, Lindsay LA, Wahlquist AH. Clinical, demographic, and laboratory characteristics of children with nephrolithiasis. Urolithiasis. 2016; 44: 241-246. Table (1) shows demographic characteristics, renal function 3. Bushinsky DA, Coe FL, Moe OW. Nephrolithiasis. In Brenner & Rector’s. and presence of macro and microhematuria in the total group The Kidney. 2012. Ç of children and adults. From 245 children kidney stone formers 4. Azili MN, Ozturk F, Inozu M, ayci FŞ, Acar B, Ozmert S, et al. (2 to 16 years old), 133 were male (M) mean age 11 ± 3.9 and Management of stone disease in infants. Urolithiasis. 2015; 43: 513- 112 women (W), mean age 11 ± 3.8, (1.19:1). Girls kidney 519. stone formers n=112, 17 (15.2%) had hematuria as first sign, 12 microhematuria and 5 macrohematuria and in 133 boys 24 5. Roy S III, Stapleton FB, Noe HN, Jerkins G. Hematuria preceding renal calculus formation in children with hypercalciuria. J Pediatr. 1981; 99: (18%) had hematuria as first sign, 18 microhematuria y 6 gross 712-715. or macrohematuria. 6. Kalia A, Travis LB, Brouhard BH. The association of idiopathic From 245 adults kidney stone formers125 were male, mean hypercalciuria and asymptomatic gross hematuria in children. J age 45 ± 14 and 120 women, mean age 44.1 ± 14, (1.04:1), from Pediatr. 1981; 99: 716-719. the total adult population 35 (14.3%) had hematuria as first 7. Bruder Stapleton FB. Idiopathic hypercalciuria: Association with urolithiasis sign, 22microhematuria and 13 with macrohematuria. isolated hematuria and risk for urolithiasis in children. The southwest OnlyDISCUSSION one patient had large pelvic kidney stone. pediatric nephrology study group. Kidney Int. 1990; 37: 807-811. 8. Marumo K, Horiguchi Y, Nakagawa K, Oya M, Ohigashi T, Asakura H, et al. Significance and diagnostic accuracy of renal Calculi found Macroscopic or microscopic hematuria may be a frequent by ultrasonography inpatients with asymptomatic microscopic sign of urolithiasis in both children and adults [6,10]. In hematuria. Int J Urol. 2002; 9: 363-367. general it appears simultaneously with renal colic, kidney 9. Worcester EM, Coe FL. Nephrolithiasis. Prim Care. 2008; 35: 369. stones elimination, urologic procedures, urinary infection and uncommonly as unique sign of presentation. In this series we 10. Kobayashi T, Nishizawa K, Mitsumori K, Ogura K. Impact of date of onset On the absence of hematuria in Patientswithacute renal colic. only consider hematuria in patients free from renal or urologic TheJournalof Urology. 2003; 170: 1093-1096. conditions other than urolithiasis. We found 17.1% of children and 14.3% of adults with hematuria as first sign of their kidney 11. Diven SC, Travis LV. A practical primary care approach to hematuria in stone disease most of them microhematuria. This result is higher children. PediatrNephrol. 2000; 14: 65-72. than the 2% reported by Diven et al., [11] in children with 12. Rajaie Esfahani M, Momeni A. Comparison of ultrasonography and macrohematuria but significantly lower than the 42.1% reported intravenous urography in the screning and diagnosis of hematuria by NurAzili [4] or the 30% in hematuria and children with causes. Urol J. 2006; 3: 54-60. Cite this article Spivacow FR, del Valle EE, Lizcano A, Negri AL, Rey P (2016) Hematuria as First Sign of Presentation in Urolithiasis.
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