32. Differential diagnosis of hematuria in childhood.

Question 1

DD of Red Urine/Hematuria

Answer 1

• Facitious Hematuria
  
  • Nonpathological
  • Pathological
• Glomerular
  
  • Immunological injury
  • Structural disorder
  • Toxin-mediated infury
• Tubulointerstitial/Parenchymal
  
  • Inflammation
  • Vascular
  • Structural
• Lower Urinary Tract
  
  • Inflammation
  • Injury
  • Hypercalciuria

Question 2

Facitious Hematuria

Answer 2

• Nonpathological
  
  • urate crystals in infants
  • injested foods
  • medications
  • dyes
• Pathological
  
  • hemoglobinuria from hemolytic anemia
  • myoglobinuria from rhabdomyolysis

Question 3

Glomerular Hematuria

Answer 3

• Immunological injury
  
  • GN-eg. PSGN
  • IgA nephropathy
  • MPGN
  • systemic diseases
• Structural disorder
  
  • Alport syndrome
  • thin basement membrane disease
• Toxin-mediated infury
  
  • HUS

Question 4

Tubulointerstitial/Parenchymal Hemoglobinuria

Answer 4

• Inflammation
  
  • interstitial nephritis
  • pyelonephritis
• Vascular
  
  • sickle cell trait/disease
  • Nutcracker syndrome
• Structural
  
  • cyst rupture
  • Wilms tumor
  • urinary tract obstruction
  • renal trauma

Question 5

Lower Urinary Tract

Answer 5

• Inflammation
  
  • cystitis
  • hemorrhagic cystitis
  • urethritis
• Injury
  
  • trauma
  • kidney stone
• Hypercalciuria

Question 6

History taking in Hematuria

Answer 6

Dysuria

Frequency, Urgency

Flank & Abdominal pain

Exercise, Trauma (foreign body, catheterization, abuse)

Medication, Drugs, Diet

Oliguria

Hypertension

Family history

Question 7

Hematuria

Lab Diagnosis

Answer 7

• Serum electrolytes, calcium, creatinine
• urine calcium:creatinine ratio
• Urine culture (if dysuria)
• CBC/PT/PTT
• Sickle screen
• Imaging (US, CT, KUB)
• Cytoscopy
• Urinanalysis of family members
• BUN/creatinine
• Complement C3, C4
• Anti-streptokokkal Abs
• Cholesterol
• ANA