Zdorovʹe Rebenka (Apr 2017)
Тhe сlinical and мorphological сharacteristics оf nephropathy first manifested with isolated hematuria
Abstract
Background. Nephropathy associated with hematuria progress represent the greatest differential diagnostic difficulties because of the similarity of clinical manifestations, especially at the early stages of the disease, which tend to prolonged and chronic course and, in some cases, lead to chronic renal failure. A differential approach to the diagnosis of these diseases is important for the choice of therapy in this group of children. The main method for differential diagnosis of nephropathy is to conduct morphological study of the kidney tissue in vivo. The purpose was to study the clinical manifestations of renal functional state and morphological features of nephropathy with hematuria syndrome in children to improve differential diagnosis of these diseases. Materials and methods. The study involved 158 children with kidney disease with hematuria deterioration, aged 1 to 18 years. The survey group included children observed for hematuria from micro to gross hematuria without extrarenal manifestations over a year. The level of hematuria, urine albuminuria, blood biochemical parameters, glomerular filtration rate, morphological changes of the kidney tissue according to kidney biopsy lifetime were studied. Results. Kidney biopsy carried out in terms from 1 year up to 3 years after the onset of the disease in children with clinically diagnosed glomerulonephritis, hematuria form, and hereditary nephritis, has revealed the heterogeneity of the morphological forms of nephropathy, with IgA nephropathy prevalence (48.4%), thin basement membrane disease (29 %), hereditary nephritis (Alport syndrome) (22.6%). Conclusion. Despite the similarity of clinical manifestations, especially at the early stages of the disease, it was identified a number of clinical-anamnestic and laboratory differences of these dise-ases, that underlines the need for a differentiated approach to the interpretation of the changes in the urine and diagnosis formulating in patients with isolated hematuria, determines the treatment tactics and further rehabilitation.
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