[Asymptomatic isolated microhaematuria--a reason for concern?]. / Asimptomatska izolovana mikrohematurija--razlog za brigu?

Nephrologists and urologists are frequently faced with patients with asymptomatic isolated microhaematuria (AIMH). This entity is defined as the presence of more than 5 red cells/uL in the sediment of first morning urine, in the absence of symptoms by the urinary tract and in the absence of proteinuria. From 201 children who were referred on the clinical examinations on the Pediatric Clinic in Sarajevo under the diagnosis haematuria in period from 01/01/1997 until 31/08/2002, 87 had AIMH. Age of life was from 0 to 16 years (mean 8 years). Fourteen children (16.1%) had a hypercalciuria, 10 (11.5%) had a state after purpura Henoch-Schonlein nad scarlatine, while 6 (6.9%) had glomerulopathy. Five children (5.7%) had anomalies of urinary system, 5 (5.7%) had evidence of nephrolithiasis, while 4 (4.6%) had asymptomatic urinary tract infection. Cause out of urinary system was found in 29 children (33.3%) and for 14 children (16.1%) etiology remained unknown. Transient microhaematuria was noted in 43 children (49.4%), recurrent in 37 (42.5%) and persistent in 7 (8.1%). Renal biopsy was performed in 5 children (5.7%) because of indications of glomerular disease and all of them had glomerular lesions. Sixty nine children of these 87 were followed up from 2 to 11 years (mean period of 3 years) and none of them developed hypertension or renal impairment. Most patients who have AIMH do not have clinically significant glomerular pathology and they don't need renal biopsy, but only periodic follow up. Any degree of proteinuria accompanying haematuria should be fully investigated, as proteinuria is often a sign of serious renal disease.

[Urinary tract infections and vesicoureteral reflux as a cause of renal parenchymal damage]. / Infekcija urinarnog trakta i vezikoureteralni refluks kao uzrok renalnog parenhimnog ostecenja.

GOAL: Infection of the urinary tract is a risk for the damage of parenchyma and kidney function. Dimercaptosuccinil acid (DMSA) scan was used based on the relation between vesicoureteral reflux (VUR), infection of the urinary tract (UTI) and parenchymal kidney damage. METHODOLOGY: The number of observed children was 79, 58 (73.41%) girls and 21 (26.58%) boys: following the first UTIs, recidiv infect and with positive VUR contrast voiding cistourethrography (VCUG) and ultrasound tests were compelted following the treatment of infect within 6 weeks and DMSA within 4 months. The classification of VUR was done of I to V degrees. The damage to the renal parenchyma after DMSA was defined as inhomogen distribution, reduced bonding with radio-farmake as well as portion of the kidney in the overall renal function smaller than 45%. RESULTS: Among 45.56% (36/79) patients VUR was registered. Reflux over III/V was registered among 27.84 (22/79) among whom 24.05% (19/79) were younger than 5 years of age. DMSA scan showed reduced kidney function bellow 45%, in one direction 33.33% (12/36) and 25.00% (9/36) in both directions. The correlation between clinically proved acute pielonephrities and damage to the parenchyma was not proven. It was proven in 30.37% (24/79) reoccurring urinal infection. CONCLUSION: DMSA is a sensitive method that should not be routinely used on every child with urinary infection. It should be left to assess the renal damage in cases of high degree reflux and reoccurring urinary infection.