Rollino Cristiana, Beltrame Giulietta, Ferro Michela, Quattrocchio Giacomo, Quarello Francesco
Nefrologia e Dialisi, Ospedale S. Giovanni Bosco, Torino, Italy.
G Ital Nefrol. 2010 Jul-Aug;27(4):367-73.
Isolated asymptomatic hematuria is frequently encountered in clinical practice but there are no established recommendations for its evaluation and management. There is controversy regarding which tests are necessary and whether renal biopsy is indicated. In the pediatric population, renal biopsy should be considered if there is evidence of progressive renal disease or when parents are worried about their child's diagnosis or prognosis. In adults, examinations for isolated microhematuria should include exclusion of pharmacological causes, journeys to endemic areas for S. haematobium or tuberculosis, sickle-cell disease, endometriosis and, in patients older than 40 years, kidney, ureteral or bladder cancer. Examination of urinary sediment may help in identifying the origin of microhematuria. If it is decided to perform a renal biopsy, the patient should be carefully informed of the possible complications of renal biopsy, including the possibility of finding normal renal tissue.
孤立性无症状血尿在临床实践中经常遇到，但对于其评估和管理尚无既定的建议。关于哪些检查是必要的以及是否需要进行肾活检存在争议。在儿科人群中，如果有进行性肾病的证据，或者家长对孩子的诊断或预后感到担忧，则应考虑进行肾活检。在成人中，孤立性镜下血尿的检查应包括排除药物性原因、前往血吸虫或结核病流行地区的旅行史、镰状细胞病、子宫内膜异位症，对于40岁以上的患者，还应排除肾、输尿管或膀胱癌。尿液沉渣检查可能有助于确定镜下血尿的来源。如果决定进行肾活检，应仔细告知患者肾活检可能的并发症，包括可能发现正常肾组织。
