Etiology of Hematuria in Children: A Review Article

Mohsen Akhavan Sepahi, Mohammad Hoseinn Akhavan Sepahi

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,


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Background and Aim: The etiology of hematuria in children is different. Hematuria is
a known risk factor for developing chronic kidney disease (CKD). This narrative review
aimed to evaluate the etiology of hematuria in children, mainly new hematuria research, to
provide an update on the management, and complications that can improve the prognosis of

Methods: For this narrative review, articles from several sources, including Scopus, Google
Scholar, Embase, Web of Science, PubMed, and the Directory of Open Access Journals were used.
Results: Kidney and urinary tract infection (UTI) is the most common cause of hematuria
in children. Renal structural abnormalities, hypercalciuria, urinary stones, and extrarenal
abnormalities associated with hematuria.

Conclusion: Hematuria is a symptom and very dangerous, but due to various causes in these
patients, it is needed in all patients.

The challenge for pediatric nephrologists is the early diagnosis of children with progressive
forms of kidney disease from other causes. This manuscript reviews the multiple potential
causes of microscopic hematuria and provides a framework for the initial assessment and
monitoring of such patients. No internationally accepted, uniform, evidence-based algorithm
exists for its diagnostic evaluation anywhere. It is recommended that extensive public
attention be paid to the etiology and management of hematuria.


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Original Research Papers

The Epidemiology, Presentation, and Outcome of Acute Post-infectious Glomerulonephritis in North East India: A Single Centre Experience

Himesh Barman, Lima Sangla, Biswajit Dey, Rosina Ksoo, Wihiwot Valarie Lyngdoh, Manisha De

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Background and Aim: Acute post-infectious glomerulonephritis (PIGN) can occur due to
various etiologies. Among these, post-streptococcal glomerulonephritis is the common cause.
Though the burden has drastically decreased over the years in developed nations, it remains a
reason for concern in developing countries. This study aimed to document the burden, clinical
presentation, etiology, and outcome of PIGN referred to a tertiary care center in a developing
Methods: This retrospective study was conducted in a tertiary care teaching hospital in
northeast India. All cases diagnosed with acute PIGN were included in the study. Cases
with an alternate diagnosis and cases with incomplete records were excluded from the study.
Data on relevant clinical, demographic, and laboratory variables were extracted from the
case records and discharge summary. Simple descriptive statistics, such as frequency and
proportion were used.
Results: A total of 202 cases of PIGN were included in the study. The Mean±SD annual
admission rate was 22.4±6.1 per year. The Mean±SD age at presentation was 10.0±3.9 years
and the male to female ratio was 1.2 to 1. The most common clinical features at the time of
presentation were hypertension in 183 patients (90.59%), edema in 168 (83.16%), history of
oliguria in 146(72.27%), and hematuria in 168 patients (83.2%). Proteinuria was present in 95
cases (47.03%). Either clinical or serological evidence of preceding streptococcal infection
was observed in 160 children (83.2 %). Two cases had scrub typhus and one case had hepatitis
B seropositivity. Hypertensive encephalopathy and left ventricular failure were observed in
20(9.90%) and 44 children (21.78%), respectively. Admission to the pediatric intensive care
unit was required in 28.21%. No mortality was observed.
Conclusion: PIGN constitutes a significant burden in this part of India. The incidence of
complications was high but the outcome was good with adequate acute care.

Clinical Predictors of Neurocognitive Status in Children With Chronic Kidney Disease

Ranjit Ranjan Roy , Afroza Begum , Kaniz Fatema kaniz, Saimul Hauque, Amina Akter, Shaheen Akhter

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Background and Aim: Chronic kidney disease (CKD) is often associated with a variety of
cognitive deficits. This will have significant lifelong implications. Therefore, we measure the
clinical predictors of cognitive impairment.
Methods: This cross-sectional study was conducted in a third-level hospital from October
2017 to December 2018. A total of 41 patients with CKD stage III to V and V on dialysis,
aged 6 to 14 years of both sexes were included in this study. CKD was staged according to
the estimated glomerular filtration rate (eGFR). The Wechsler intelligence scales for childrenrevised
(WISC-R) were provided as an individualized measure of verbal and performance
abilities. Then individual score was compared among the study population.
Results: A total of 41 patients were studied. The Mean±SD age was 10.35±2.19 years. The
majority were male (56%) and the male-to-female ratio was 1.3:1. Full-scale intelligence
quotient (IQ) deficits were found in 31 patients (75.6%) and most of them had mild cognitive
deficits (96.8%). Among them, verbal IQ deficit was found in 7 patients (17.1%), performance
IQ deficit in 6(14.6%), and combined IQ deficit in 18(43.9%). IQ score did not depend on
the severity of the disease. The duration of the disease was longer and the age at initiation
of renal replacement therapy (RRT) was lower, for those with the cognitive deficit, was not
significant. School attendance and performance were significantly poor in cognitive deficit
patients but anemia and hypertension had no significant impact.
Conclusion: The mild cognitive deficit was often associated with childhood CKD but not
related to the severity of the disease. Therefore, the cognitive function should be routinely
screened and monitored during the evaluation of children with CKD.

Peritoneal Dialysis Associated Peritonitis in Children With End-stage Renal Disease: A Single Center Experience in Iran

Ahmad Shajari, Marzieh Amiri Bakhtiari, Mohammad Golshan Tafti

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Background and Aim: The present study aimed to evaluate the frequency and risk factors
of peritonitis end-stage renal disease (ESRD) pediatrics on peritoneal dialysis (PD) in Yazd
City, Iran.
Methods: This cross-sectional study was conducted on ESRD pediatrics on PD in Shahid
Sadoughi hospital, Yazd City, Iran from 2016 to 2020. Demographic characteristics, such
as age, sex, body mass index (BMI) at the commencement of PD, underlying medical
conditions, the microbiology of peritonitis, and the recovery rate were investigated. Results
were evaluated using SPSS software, version 26 (SPSS Institute, Inc., Chicago, IL, USA).
Results: A total of 23 children (56.5% females) were included in this study. The Mean±SD
age was 13.30±4.38 years, and the mean BMI was 15.71±5.53. PD-associated peritonitis
was diagnosed in 18 cases (78.3%). A total of 21.7% had at least one underlying disease. No
significant relationship was observed between sex (P=0.9), mean age (P=0.41), mean BMI
(P=0.24), and underlying condition (P=0.29) according to pediatrics with and without PDassociated
peritonitis. Bacterial and fungal infections were responsible for peritonitis in 15
(62.5%) and 3 (13%) pediatrics on PD, respectively.
Conclusion: The frequency of PD-associated peritonitis in the ESRD children of our study
was 78.3%.

Clinical Spectrum of Recurrent Urinary Tract Infections in Children

Asma Wani, Mohd Ashraf, Nisar Ahmed Wani, Suhail Ahmed Naik, Syed Ashiq Nisar Andrabi, Waseem Shafi Sheikh

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Background and Aim: Urinary tract infection (UTI), is a common bacterial infection in
pediatric group, can be easily diagnosed, but its recurrence can indicate underlying serious
anatomical defects of the urogenital tract, leading to acute morbidity and chronic medical
condition, such as hypertension and renal insufficiency.
Objective: To know the clinical spectrum and the frequency of recurrent UTI among children
visiting our hospital.
Methods: This prospective study was conducted during the period from April 2020 to March
2021, in the department of pediatrics and pediatric nephrology, Governmental Medical
College, Srinagar. All children aged between 6 months to 18 years presenting with a history
of recurrent urinary tract were included in the study. A detailed history, relevant clinical
examination, and the ultrasonography of kidney ureters and bladder (USG KUB) followed
by voiding cystourethrography (VCUG), were carried out and subsequently analyzed.
Results: A total of 38 patients with recurrent UTI were evaluated during one year. The
commonest age group was 6 months to 2 years (68%), with female preponderance (F: M
3.2:1). Urine culture grew E. coli in 95% of patients, while USG abnormalities and the
presence of vesicoureteral reflux (VUR) on voiding cystourethrography (VCUG) were seen
in 14 patients (36%).
Conclusion: Recurrent UTI are common between 6 months to 2 years, and E coli is the most
common cause. Children with the past history of UTI seem more predisposed to have another
E.coli-associated UTI.

Background and Aim: Acute kidney injury (AKI) is an acute decline in function and inability
to regulate acid, electrolyte, and fluid balance. AKI can be classified as community-acquired
AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) depending on the time of onset. Most
studies have been conducted on critically ill populations, mainly considering the HA-AKI
cases. Limited studies were conducted on CA-AKI, especially in non-critically ill children.
Methods: A prospective cohort study in 505 non-critically ill hospitalized children (1
month to 12 years) after screening 750 children. Baseline creatinine was calculated using a
computational method assuming a normal glomerular filtration rate (GFR) for age, hence all
communities, as well as hospital-acquired AKI, were included. Kidney disease improving
global outcome (KDIGO) criteria was used for classification and also serum cystatin -C
levels were done to diagnose AKI.
Results: Fifteen percent (15.64%) of children had AKI, of which 83.54% had CA-AKI and
16.46% had HA-AKI. Of all patients with AKI, 54.43% were exposed to nephrotoxic drugs
and 53.49% (23) had received 2 or more nephrotoxic drugs, and 34.18% of patients had
sepsis, 35.44% of patients had dehydration. Patients with HA-AKI had a significantly longer
duration of stay (15.23±5.42 days) compared to CA-AKI patients (7.48±6.42 days) and were
also exposed to nephrotoxic drugs. Cystatin C had a specificity of 88.50% and a negative
predictive value of 93.80%.
Conclusion: Non-critically ill hospitalized children are at significant risk for AKI and need
more vigilant monitoring. CA-AKI should be detected proactively because they are often
underreported. Cystatin-C has good specificity and negative predictive value for diagnosing

Case Reports

Bartter Syndrome Type 4a in an Adolescent With Lower Extremity Pain: A Case Report

Reza Dalirani, Paniz Pourpashang, Mahbubeh Mirzaee, Mahnaz Jamee

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Bartter syndrome is a rare genetic disease with 5 subtypes. In Bartter syndrome type 4,
patients suffer from deafness and renal dysfunction since infancy. In this report, we introduced
a 16-year-old girl with congenital deafness without any previous renal complaints referred to
our center due to ankle pain.

An Enigmatic Color Change of Urine: Alkaptonuria

Azmeri Sultana, Jubaida Rumana, Abdul Qader, Shabnam Shahidullah, Ismail Rashid, Rita Majumder

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Alkaptonuria is an exceedingly rare tyrosine metabolism disorder of autosomal recessive
inheritance. Only a few instances of it have been observed in Bangladeshi children. Here,
we talk about a 2-year-old boy who had dark urine and was later found to have alkaptonuria.

Potter Syndrome and Congenital Heart Disease

Semira Mehralizadeh, Shamsollah Nooripoor

Journal of Pediatric Nephrology, Vol. 10 No. 4 (2022), 15 March 2023,

Potter syndrome is a lethal congenital anomaly resulting from oligohydramnios due to
renal agenesis and dysfunction. Because neonates with Potter syndrome have pulmonary
hypoplasia, it is incompatible with life and the neonates will expire with respiratory distress
during the first hours of life. Potter syndrome is rarely accompanied by congenital heart
disease. We report a case of severe Potter syndrome with pulmonary valve atresia that expired
a few hours after birth.