German Clinical Practice Guideline on Microhematuria in Children and Young Adults: Evaluating Early Detection of Kidney Disease.

BACKGROUND

Finding traces of blood in the urine (microhematuria) is common in about 10% of children and young adults, and is often temporary and harmless. However, if it continues, particularly if it contains a high number of abnormal red blood cells called acanthocytes, it can be a sign of underlying glomerular kidney disease. This new guideline is intended to give doctors a practical, evidence-based approach to identify kidney disease early in these young patients.

METHODS

A systematic review of 474 publications up to January 2023 was conducted using PubMed, the Cochrane, and Livivo databases. The retrieved studies were then summarized and evaluated for their evidence level.

RESULTS

Approximately 1% of children and young adults have undiagnosed chronic kidney disease (CKD), and microhematuria can be an early indicator. A kidney specialist evaluation is necessary if microhematuria persists for 3 to 6 months, if there are ≥ 5% acanthocytes in the urine, or if other signs like proteinuria, high blood pressure, or decreased kidney function are present. An ultrasonography of the kidneys and urinary tract is the recommended imaging test, whereas cystoscopy is not advised in most patients. For cases of microhematuria because of a glomerular disease, molecular genetic testing is advised. A renal biopsy may be necessary for active glomerular diseases, particularly in children, after other tests have been completed.

CONCLUSION

Previously, the lack of clear guidelines led to inconsistent and sometimes inappropriate medical evaluations, causing valuable opportunities for early treatment to be missed. This new guideline seeks to correct this by providing a standard approach to diagnosis and management.