Review of arginine and levodopa stimulation testing reports hematuria in pediatric patients.

BackgroundArginine growth hormone (GH) testing is a commonly used and generally safe pediatric procedure for assessing GH deficiency. The occurrence of gross hematuria following this testing is a rare adverse drug reaction that had not been previously encountered at our institution, raising significant concerns among both patients and clinicians.Case presentationAn 11-year-and-3-month-old boy presented with short stature. Approximately 7 h after undergoing a combined arginine and levodopa GH stimulation testing, he developed painful gross hematuria accompanied by blood clots. A subsequent comprehensive clinical evaluation ruled out other potential etiologies, leading to the diagnosis of drug-induced hematuria. The patient was treated with urine alkalinization, and the gross hematuria substantially resolved within 8 days. Furthermore, a review of the literature identified 9 case reports involving 15 patients who developed hematuria following arginine GH stimulation testing. The majority of these patients were male, with a broad age distribution. Most individuals presented solely with a change in urine color; hematuria typically manifested within 1–3 days post-administration and resolved spontaneously within approximately 1 week. Standard management strategies primarily include urine alkalinization and fluid supplementation. Current studies hypothesize that the underlying mechanism may involve drug-induced alterations in the permeability of the glomerular filtration membrane or a triggered immune response.ConclusionsHematuria induced by GH stimulation testing is a rare but noteworthy adverse drug reaction. Therefore, prior to initiating the test, clinicians must thoroughly inform patients and their families of this potential risk to alleviate unnecessary anxiety, and closely monitor for the possible onset of hematuria post-testing.