Objectives To reveal etiologies of persistent isolated hematuria(PIH) through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH. Methods we retrospectively studied 155 PIH patients receiving renal biopsy between January, 2003 and December, 2008 in Peking Union Medical College Hospital. All the clinical data and follow-up result were analyzed. Results All subjects included 38 children and 117 adults, with mean age of 11.38±3.25 years for children and 35.17±8.44 years for adults. Thin basement membrane nephropathy(TBMN) was the most common pathology(55.3% of children and 49.6% of adults), followed by IgA nephropathy(18.4% of children and 32.5% of adults, mainly grade 2-3) and mesangial proliferative glomerulonephritis(MsPGN) without IgA deposition(13.2% of children and 12.8% of adults). Besides, Alport syndrome(2.6% of children) and membrane nephropathy(2.6% of children and 0.9% of adults) were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological types of PIH. Totally, 86 patients were followed up and 37 cases therein stayed on track for long term(mean duration 41.11±28.92 months, range 8-113 months). Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN(without IgA deposition), and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention. Conclusions Close follow-up should be required as the primary management for PIH. Equally important is careful monitoring for early identification of undesirable predictors; while renal biopsy and other timely intervention are warranted if there is hypertension, significant proteinuria or renal impairment. Objectives To reveal etiologies of persistent isolated hematuria (PIH) through ultrastructural pathological examination, to disclose clinicopathological correlation in cases with PIH, and to summarize appropriate management of patients with PIH. Methods we retrospectively studied 155 PIH patients receiving renal biopsy between January, 2003 and All subjects included 38 children and 117 adults, with a mean age of 11.38 ± 3.25 years for children and 35.17 ± 8.44 years for adults. Results All subjects included 38 children and 117 adults, with a mean age of 11.38 ± 3.25 years for children and 35.17 ± 8.44 years for adults. Thin basement membrane nephropathy (TBMN) was the most common pathology (55.3% of children and 49.6% of adults), followed by IgA nephropathy (18.4% of children and 32.5% of adults, mainly grade 2-3) and mesangial proliferative glomerulonephritis In addition, Alport syndrome (2.6% of children) and membrane nephropathy (2.6% of children a nd 0.9% of adults) were demonstrated as other causes of PIH. Elevated mean arteral pressure or protein excretion rate, as well as episodic macrohematuria, indicated higher risk for MsPGN rather than TBMN. On the other hand, severity of microhematuria was irrelevant to pathological Totally, 86 patients were followed up and 37 cases admitted on track for long term (mean duration 41.11 ± 28.92 months, range 8-113 months). Most cases had benign clinical course except 3 cases with TBMN, 5 cases with IgA nephropathy, 1 case with MsPGN without IgA deposition, and 1 case with Alport syndrome, who developed hypertension or proteinuria. All of them were administered timely intervention. Equally important is careful monitoring for early identification of prospective predictors; while renal biopsy and other timely interventions are warranted if there is hypertension, significant proteinuria or renal impairment.