1- A kidney biopsy is rarely indicated in the evaluation of isolated asymptomatic hematuria. Most studies reveal minimal histopathological abnormalities in such children. In a survey of pediatric nephrologists in North America, only 5% of responders indicated that they would perform a kidney biopsy on a child with asymptomatic hematuria. The main reasons for performing a biopsy in that survey were academic interest, parental pressure for a diagnosis, and concern for future economic impact on the child. On the other hand, the simultaneous presence of proteinuria, elevated serum creatinine, hypertension, a suspicious clinical history, or other imaging/laboratory abnormalities may justify a kidney biopsy.
Thus, relative indications for performing a kidney biopsy in patients with hematuria are as follows:
· Significant proteinuria
· Abnormal renal function
· Recurrent persistent hematuria.
· Serologic abnormalities (abnormal complement, ANA, or dsDNA levels).
· Recurrent gross hematuria.
· A family history of end-stage renal disease
2- Cystoscopy is not generally required in children with nonglomerular hematuria. The only indication is a suspicious bladder mass revealed on ultrasonography.