Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis
-
Mohammad-Javad Khosousi
,
Fariborz Mansour-Ghanaei
,
Forough Heidarzad
,
Farahnaz Joukar
,
Saman Maroufizadeh
,
Elham Abdzadeh
,
Hamed Delam
,
Ehsan Amini-Salehi
,
Morteza Arab-Zozani
,
Siavash Falahatkar
,
Ardalan Akhavan
,
Soheil Hassanipour
Abstract
Background: Hematuria is one of the most common symptoms in nephrology and urology. Due to the lack of extensive meta-analysis studies on the epidemiology of hematuria in Iran, this study was conducted to determine the epidemiological status of hematuria in Iran.
Methods: In Sep 2020, researchers studied six international databases such as PubMed, ISI/WOS, ProQuest, Embase, Scopus, and Google Scholar for English papers and Iranian databases (SID and MagIran) for Persian papers. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Heterogeneity between studies was assessed by Cochran's test and its composition using I2 statistics.
Results: After several screening phase, the number of 25 article included to the final analysis. The prevalence of hematuria in the general population and children, in Iran were estimated at 16.4% (95% CI, - 0.05-37.9) and 1.6% (95% CI, 0.9-2.3) respectively. The odds ratio (OR) of women to men in the prevalence of hematuria in the general population 1.74, 95% CI: 1.20-2.52, P=0.003, patients with beta-thalassemia major 2.02, 95% CI: 1.11-3.65, P=0.020, children 2.61, 95% CI: 1.19-5.71, P=0.016, the elderly 1.50, 95% CI: 1.15-1.94, P=0.002, and taxi drivers 3.73, 95% CI: 2.58-5.38, P<0.001 was obtained.
Conclusion: The prevalence of hematuria in the general population is relatively high. Hematuria is a good predictor for detecting of bladder cancer and Idiopathic hypercalciuria and the physician should attention to microscopic hematuria.
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2. Davis R, Jones JS, Barocas DA, et al (2012). Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol, 188(6 Suppl):2473-81.
3. Ghandour R, Freifeld Y, Singla N, Lotan Y (2019). Evaluation of Hematuria in a Large Public Health Care System. Bladder Cancer, 5:119-129.
4. Moreno JA, Sevillano A, Gutierrez E, et al (2019). Glomerular Hematuria: Cause or Consequence of Renal Inflammation? Int J Mol Sci, 20(9):2205.
5. Grossfeld GD, Litwin MS, Wolf JS, et al (2001). Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part I: definition, detection, prevalence, and etiology. Urology, 57:599-603.
6. Sevillano AM, Gutierrez E, Yuste C, et al (2017). Remission of Hematuria Improves Renal Survival in IgA Nephropathy. J Am Soc Nephrol, 28:3089-3099.
7. Vivante A, Afek A, Frenkel-Nir Y, et al (2011). Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA, 306:729-36.
8. Deltas C, Pierides A, Voskarides K (2013). Molecular genetics of familial hematuric diseases. Nephrol Dial Transplant, 28:2946-60.
9. Ahmadi M, Ranjbaran H, Amiri MM, et al (2012). Epidemiologic and socioeconomic status of bladder cancer in Mazandaran Province, northern Iran. Asian Pac J Cancer Prev, 13:5053-6.
10. Bignall ONR, 2nd, Dixon BP (2018). Management of Hematuria in Children. Curr Treat Options Pediatr, 4(3):333-349.
11. Qvigstad C, Tait RC, de Moerloose P, Holme PA (2020). Hematuria in aging men with hemophilia: Association with factor prophylaxis. Res Pract Thromb Haemost, 4:309-317.
12. Gonzalez AN, Lipsky MJ, Li G, et al (2019). The Prevalence of Bladder Cancer During Cystoscopy for Asymptomatic Microscopic Hematuria. Urology, 126:34-38.
13. Halpern JA, Chughtai B, Ghomrawi H (2017). Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria. JAMA Intern Med, 177:800-807.
14. Barahimi H, Najafi I, Esmailian R, et al (2011). Distribution of albuminuria and low glomerular filtration rate in a rural area, Shahreza, Iran. Iran J Kidney Dis, 5:374-9.
15. Mansour-Ghanaei F, Joukar F, Naghipour MR, et al (2019). The PERSIAN Guilan Cohort Study (PGCS). Arch Iran Med, 22:39-45.
16. Mazhari R, Kimmel PL (2002). Hematuria: an algorithmic approach to finding the cause. Cleve Clin J Med, 69(11):870, 872-4, 876 passim.
17. Moudi E, Hosseini S-R, Bijani A (2016). Higher rate of microscopic hematuria in elderly patients who take regular doses of aspirin: Result from AHAP Study. Caspian J Intern Med, 7(4):278-282.
18. GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395:709-733.
19. Chen M-C, Wang J-H, Chen J-S, et al (2020). Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study. Front Pediatr, 8:600907.
20. Orlandi PF, Fujii N, Roy J, Chen HY, et al (2018). Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Nephrol, 19:150.
21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6:e1000097.
22. Institute JB (2017). The Joanna Briggs Institute Critical Appraisal Tools for Use in JBI Systematic Reviews Checklist for Analytical Cross Sectional Studies. North Adelaide, Australia The Joanna Briggs Institute.
23. Motamed S, Aminsharifi A, Vardanjani H (2018). Bladder cancer in southwestern Iran: Histopathologic and clinical. Pakistan Journal of Medical and Health Sciences, 12(2):884-888.
24. Akhavan Sepahi M, Eftekhari SS, Rashidinia S, et al (2017). Relationship between urinary reflux and nephrolithiasis in children-a cross-sectional study. Int J Pediatr, 5:4965-4973.
25. Esteghamati M, Ghasemi K, Nami M (2017). Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014. Electron Physician, 9:5261-5264.
26. Moghtaderi M, Noohi AH, Safaeyan B, et al (2014). Screening for microscopic hematuria in school-age children of Gorgan City. Iran J Kidney Dis, 8:70-2.
27. Safaei Asl A, Heidarzadeh A, Maleknejad S, Moradi B (2013). Hypercalciuria in school-aged children of Rasht: a single-center study. Iran J Kidney Dis, 7:265-7.
28. Shafi H, Ali Ramaji A, Akbarzadeh Pasha A, et al (2013). A Survey on 175 Cases of Bladder Cancer in the Patients Who Referred to the Hospitals Affiliated to Babol University of Medical Sciences, Iran (2001-2011). Journal of Babol University of Medical Sciences, 15:116-122.
29. Madani A, Kermani N, Ataei N, et al (2012). Urinary calcium and uric acid excretion in children with vesicoureteral reflux. Pediatr Nephrol, 27:95-9.
30. Salehi A, Khezri AA, Malekmakan L, Aminsharifi A (2011). Epidemiologic status of bladder cancer in Shiraz, southern Iran. Asian Pac J Cancer Prev, 12:1323-7.
31. Mahdavi-Mazdeh M, Saeed Hashemi Nazri S, Hajghasemi E, et al (2010). Screening for decreased renal function in taxi drivers in Tehran, Iran. Ren Fail, 32:62-8.
32. Emamghorashi F, Davami MH, Rohi R (2010). Hypercalciuria in Jahrom's school-age children: what is normal calcium-creatinine ratio? Iran J Kidney Dis, 4:112-5.
33. Sepahi MA, Heidari A, Shajari A (2010). Clinical manifestations and etiology of renal stones in children less than 14 years age. Saudi J Kidney Dis Transpl, 21:181-4.
34. Fallahzadeh MH, Fallahzadeh MK, Shahriari M, et al (2010). Hematuria in patients with Beta-thalassemia major. Iran J Kidney Dis, 4:133-6.
35. Shajari A, Shajari H, Zade MH, Kamali K, Kadivar MR, Nourani F (2009). Benefit of urinalysis. Indian J Pediatr, 76:639-41.
36. Badeli H, Heydarzadeh A, Ahmadian M (2009). Prevalence of hematuria and proteinuria in healthy 4 to 6 year old children in daycare centers of Rasht (Northern Iran). Iranian Journal of Pediatrics, 19:169-172.
37. Ali D, Mehran K, Moghaddam AG (2008). Comparative evaluation of renal findings in Beta-thalassemia major and intermedia. Saudi J Kidney Dis Transpl, 19:206-9.
38. Ahmadzadeh A, Hakim Zm, Safa AA (2008). Idiopathic hypercalciuria in Iranian children. (In Persian)
39. Sadeghi Majd S, Hadian MA, Rakhshani F (2008). Prevalence of asymptomatic hematuria and proteinuria among school children in Zahedan. Zahedan Journal of Research in Medical Sciences, 10:59-64.
40. Esfahani ST, Madani A, Siadati AA, Nabavi M (2007). Prevalence and symptoms of idiopathic hypercalciuria in primary school children of Tehran. Iranian Journal of Pediatrics, 17:353-358.
41. Safary M, Darogheh Z, Derakhshan M, Nabavizadeh S (2005). Abnormal Uri-nary Findings In School Aged Chil-dren In Hamedan. Medical Journal of Mashhad University of Medical Sciences, 48:17-22.
42. Ghasemi K, Beigi S, Shojaee M (2004). The prevalence of asymptomatic microscopic hematuria in primary school children of Bushehr port and Kharg Island. Iranian South Medical Journal, 7:54-60.
43. Vazirian S, Golpaygani M, Aminzadeh M, et al (2004). Evaluation of Urinalysis Results in Asymptomatic Primary School Children in Kermanshah city (2003). J Kermanshah Univ Med Sci, 8:e81316.
44. Shahidi S, Salek M, Adilipour H (2001). Hematuria in asymptomatic adults: its prevalence and its follow up. Journal of Research in Medical Sciences, 6.
45. Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Dräger BJ, Grimm M-O (2018). The Investigation of Hematuria. Dtsch Arztebl Int, 115(48):801-807.
46. Karnes RJ, Fernandez CA, Shuber AP (2012). A noninvasive multianalyte urine-based diagnostic assay for urothelial cancer of the bladder in the evaluation of hematuria. Mayo Clin Proc, 87:835-842.
47. Jung H, Gleason JM, Loo RK, et al (2011). Association of hematuria on microscopic urinalysis and risk of urinary tract cancer. J Urol, 185:1698-703.
48. Richter LA, Lippmann QK, Jallad K, et al (2016). Risk factors for microscopic hematuria in women. Female Pelvic Med Reconstr Surg, 22(6):486-490.
2. Davis R, Jones JS, Barocas DA, et al (2012). Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol, 188(6 Suppl):2473-81.
3. Ghandour R, Freifeld Y, Singla N, Lotan Y (2019). Evaluation of Hematuria in a Large Public Health Care System. Bladder Cancer, 5:119-129.
4. Moreno JA, Sevillano A, Gutierrez E, et al (2019). Glomerular Hematuria: Cause or Consequence of Renal Inflammation? Int J Mol Sci, 20(9):2205.
5. Grossfeld GD, Litwin MS, Wolf JS, et al (2001). Evaluation of asymptomatic microscopic hematuria in adults: the American Urological Association best practice policy--part I: definition, detection, prevalence, and etiology. Urology, 57:599-603.
6. Sevillano AM, Gutierrez E, Yuste C, et al (2017). Remission of Hematuria Improves Renal Survival in IgA Nephropathy. J Am Soc Nephrol, 28:3089-3099.
7. Vivante A, Afek A, Frenkel-Nir Y, et al (2011). Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA, 306:729-36.
8. Deltas C, Pierides A, Voskarides K (2013). Molecular genetics of familial hematuric diseases. Nephrol Dial Transplant, 28:2946-60.
9. Ahmadi M, Ranjbaran H, Amiri MM, et al (2012). Epidemiologic and socioeconomic status of bladder cancer in Mazandaran Province, northern Iran. Asian Pac J Cancer Prev, 13:5053-6.
10. Bignall ONR, 2nd, Dixon BP (2018). Management of Hematuria in Children. Curr Treat Options Pediatr, 4(3):333-349.
11. Qvigstad C, Tait RC, de Moerloose P, Holme PA (2020). Hematuria in aging men with hemophilia: Association with factor prophylaxis. Res Pract Thromb Haemost, 4:309-317.
12. Gonzalez AN, Lipsky MJ, Li G, et al (2019). The Prevalence of Bladder Cancer During Cystoscopy for Asymptomatic Microscopic Hematuria. Urology, 126:34-38.
13. Halpern JA, Chughtai B, Ghomrawi H (2017). Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria. JAMA Intern Med, 177:800-807.
14. Barahimi H, Najafi I, Esmailian R, et al (2011). Distribution of albuminuria and low glomerular filtration rate in a rural area, Shahreza, Iran. Iran J Kidney Dis, 5:374-9.
15. Mansour-Ghanaei F, Joukar F, Naghipour MR, et al (2019). The PERSIAN Guilan Cohort Study (PGCS). Arch Iran Med, 22:39-45.
16. Mazhari R, Kimmel PL (2002). Hematuria: an algorithmic approach to finding the cause. Cleve Clin J Med, 69(11):870, 872-4, 876 passim.
17. Moudi E, Hosseini S-R, Bijani A (2016). Higher rate of microscopic hematuria in elderly patients who take regular doses of aspirin: Result from AHAP Study. Caspian J Intern Med, 7(4):278-282.
18. GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395:709-733.
19. Chen M-C, Wang J-H, Chen J-S, et al (2020). Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study. Front Pediatr, 8:600907.
20. Orlandi PF, Fujii N, Roy J, Chen HY, et al (2018). Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Nephrol, 19:150.
21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6:e1000097.
22. Institute JB (2017). The Joanna Briggs Institute Critical Appraisal Tools for Use in JBI Systematic Reviews Checklist for Analytical Cross Sectional Studies. North Adelaide, Australia The Joanna Briggs Institute.
23. Motamed S, Aminsharifi A, Vardanjani H (2018). Bladder cancer in southwestern Iran: Histopathologic and clinical. Pakistan Journal of Medical and Health Sciences, 12(2):884-888.
24. Akhavan Sepahi M, Eftekhari SS, Rashidinia S, et al (2017). Relationship between urinary reflux and nephrolithiasis in children-a cross-sectional study. Int J Pediatr, 5:4965-4973.
25. Esteghamati M, Ghasemi K, Nami M (2017). Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014. Electron Physician, 9:5261-5264.
26. Moghtaderi M, Noohi AH, Safaeyan B, et al (2014). Screening for microscopic hematuria in school-age children of Gorgan City. Iran J Kidney Dis, 8:70-2.
27. Safaei Asl A, Heidarzadeh A, Maleknejad S, Moradi B (2013). Hypercalciuria in school-aged children of Rasht: a single-center study. Iran J Kidney Dis, 7:265-7.
28. Shafi H, Ali Ramaji A, Akbarzadeh Pasha A, et al (2013). A Survey on 175 Cases of Bladder Cancer in the Patients Who Referred to the Hospitals Affiliated to Babol University of Medical Sciences, Iran (2001-2011). Journal of Babol University of Medical Sciences, 15:116-122.
29. Madani A, Kermani N, Ataei N, et al (2012). Urinary calcium and uric acid excretion in children with vesicoureteral reflux. Pediatr Nephrol, 27:95-9.
30. Salehi A, Khezri AA, Malekmakan L, Aminsharifi A (2011). Epidemiologic status of bladder cancer in Shiraz, southern Iran. Asian Pac J Cancer Prev, 12:1323-7.
31. Mahdavi-Mazdeh M, Saeed Hashemi Nazri S, Hajghasemi E, et al (2010). Screening for decreased renal function in taxi drivers in Tehran, Iran. Ren Fail, 32:62-8.
32. Emamghorashi F, Davami MH, Rohi R (2010). Hypercalciuria in Jahrom's school-age children: what is normal calcium-creatinine ratio? Iran J Kidney Dis, 4:112-5.
33. Sepahi MA, Heidari A, Shajari A (2010). Clinical manifestations and etiology of renal stones in children less than 14 years age. Saudi J Kidney Dis Transpl, 21:181-4.
34. Fallahzadeh MH, Fallahzadeh MK, Shahriari M, et al (2010). Hematuria in patients with Beta-thalassemia major. Iran J Kidney Dis, 4:133-6.
35. Shajari A, Shajari H, Zade MH, Kamali K, Kadivar MR, Nourani F (2009). Benefit of urinalysis. Indian J Pediatr, 76:639-41.
36. Badeli H, Heydarzadeh A, Ahmadian M (2009). Prevalence of hematuria and proteinuria in healthy 4 to 6 year old children in daycare centers of Rasht (Northern Iran). Iranian Journal of Pediatrics, 19:169-172.
37. Ali D, Mehran K, Moghaddam AG (2008). Comparative evaluation of renal findings in Beta-thalassemia major and intermedia. Saudi J Kidney Dis Transpl, 19:206-9.
38. Ahmadzadeh A, Hakim Zm, Safa AA (2008). Idiopathic hypercalciuria in Iranian children. (In Persian)
39. Sadeghi Majd S, Hadian MA, Rakhshani F (2008). Prevalence of asymptomatic hematuria and proteinuria among school children in Zahedan. Zahedan Journal of Research in Medical Sciences, 10:59-64.
40. Esfahani ST, Madani A, Siadati AA, Nabavi M (2007). Prevalence and symptoms of idiopathic hypercalciuria in primary school children of Tehran. Iranian Journal of Pediatrics, 17:353-358.
41. Safary M, Darogheh Z, Derakhshan M, Nabavizadeh S (2005). Abnormal Uri-nary Findings In School Aged Chil-dren In Hamedan. Medical Journal of Mashhad University of Medical Sciences, 48:17-22.
42. Ghasemi K, Beigi S, Shojaee M (2004). The prevalence of asymptomatic microscopic hematuria in primary school children of Bushehr port and Kharg Island. Iranian South Medical Journal, 7:54-60.
43. Vazirian S, Golpaygani M, Aminzadeh M, et al (2004). Evaluation of Urinalysis Results in Asymptomatic Primary School Children in Kermanshah city (2003). J Kermanshah Univ Med Sci, 8:e81316.
44. Shahidi S, Salek M, Adilipour H (2001). Hematuria in asymptomatic adults: its prevalence and its follow up. Journal of Research in Medical Sciences, 6.
45. Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Dräger BJ, Grimm M-O (2018). The Investigation of Hematuria. Dtsch Arztebl Int, 115(48):801-807.
46. Karnes RJ, Fernandez CA, Shuber AP (2012). A noninvasive multianalyte urine-based diagnostic assay for urothelial cancer of the bladder in the evaluation of hematuria. Mayo Clin Proc, 87:835-842.
47. Jung H, Gleason JM, Loo RK, et al (2011). Association of hematuria on microscopic urinalysis and risk of urinary tract cancer. J Urol, 185:1698-703.
48. Richter LA, Lippmann QK, Jallad K, et al (2016). Risk factors for microscopic hematuria in women. Female Pelvic Med Reconstr Surg, 22(6):486-490.
| Files | ||
| Issue | Vol 51 No 10 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i10.10978 | |
| Keywords | ||
| Epidemiology Microscopic hematuria Systematic review Meta-analysis Iran | ||
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How to Cite
1.
Khosousi M-J, Mansour-Ghanaei F, Heidarzad F, Joukar F, Maroufizadeh S, Abdzadeh E, Delam H, Amini-Salehi E, Arab-Zozani M, Falahatkar S, Akhavan A, Hassanipour S. Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(10):2194-2206.
