CLINICAL OUTCOMES OF HEMATURIA IN CHILDREN: SINGLE-CENTER EXPERIENCE

Abstract

  Hematuria in children is common and may be transient or benign, but persistent cases can signal glomerular disease or structural abnormalities. It is increasingly recognized as a risk factor for chronic kidney disease, as ongoing hematuria may contribute to renal injury. Careful evaluation and long-term follow-up are essential to distinguish benign cases from those at risk of progression, with genetic testing and early treatment helping to improve outcomes. Objectives: The objective of this study was to evaluate the clinical outcomes of children presenting with hematuria, with particular focus on the persistence of hematuria, proteinuria, and changes in estimated glomerular filtration rate (eGFR) over time. Material and methods: The study, conducted between 2018 and 2022 at the University Children’s Hospital in Skopje, included children with confirmed hematuria. The diagnostic workup comprised detailed family history, physical examination, ultrasound of the urinary tract and laboratory investigations. Clinical outcomes were assessed by monitoring urinary abnormalities and evaluating renal function through eGFR. Results: Of 441 children with hematuria, 317 (72%) had microhematuria and 124 (28%) had macrohematuria. Follow-up was conducted in 174 patients (39.4%), with a mean duration of 27.51 ± 23.84 months and a median of 20 months. There was a statistically significant difference between eGFR1 and eGFR2 (p < 0.001). On average, eGFR values increased markedly from the first visit (mean = 74.73 ml/min/1.73m²) to the follow-up visit (mean = 99.05 ml/min/1.73m²), indicating substantial improvement in renal function over time. There was significant association between etiology and long-term kidney outcome (p=0.0003). Patients with COL4 related nephropathy and glomerulonephritis were more likely to develop impaired renal outcomes compared to APSGN or pyelonephritis. During follow-up, hematuria persisted in 49 patients (28%), mostly microscopic, with only three macroscopic cases. Proteinuria was present in 20 (14%), including 4 with nephrotic-range levels. Eight developed CKD stages 2–5, and eight progressed to end-stage renal failure; six received transplants, while two remained on dialysis. Three patients (0.7%) died, all with severe underlying disease. Conclusion: outcomes of hematuria in children is largely determined by etiology. Most children recover renal function, but those with glomerular or genetic disorders face higher risk of CKD and ESRD. Early etiologic classification and monitoring of proteinuria are critical for identifying patients who require intensive long-term follow-up.

Key words: hematuria, macroscopic, microscopic, children, outcome.