Clinical Evaluation of the Child With Hematuria

Question 1

Hematuria, defined as….?

Answer 1

The persistent presence of more than 5 red blood cells (RBCs)/high power field (HPF) in uncentrifuged urine

occurs in 4–6% of urine samples from school-age children

Question 2

Significant hematuria is generally considered

Answer 2

> 50 RBCs/HPF

Question 3

False-negative results can occur in ……?

Answer 3

Formalin (used as a urine preservative) or high urinary concentrations of ascorbic acid (i.e., in patients with vitamin C intake > 2,000 mg/ day)

Question 4

False-positive results may be seen ….?

Answer 4

Alkaline urine (pH > 8), or more commonly following contamination with oxidizing agents such as hydrogen peroxide used to clean the perineum before obtaining a specimen

Question 5

Hemoglobinuria without hematuria can occur in….?

Answer 5

The presence of acute or chronic hemolysis

Question 6

Myoglobinuria…?

Answer 6

Myoglobinuria without hematuria occurs in the presence of rhabdomyolysis resulting from skeletal muscle injury and is generally associated with a 5-fold increase in the plasma concentration of creatinine kinase

Question 7

Lower urinary tract sources of hematuria originate from ….?

Answer 7

The pelvocaliceal system, ureter, bladder, or urethra

Question 8

Hematuria from within the glomerulus characteristics ..?

Answer 8

brown, cola- or tea-colored, or burgundy urine,

proteinuria > 100 mg/dL via dipstick,

urinary microscopic findings of RBC casts, and

deformed urinary RBCs (particularly acanthocytes

Question 9

Hematuria originating within the tubular system characteristics ….?

Answer 9

may be associated with the presence of leukocytes or renal tubular casts.

Question 10

Lower urinary tract sources of hematuria characteristics …?

Answer 10

may be associated with gross hematuria that is bright red or pink,

terminal hematuria (gross hematuria occurring at the end of the urine stream), 
blood clots, 

normal urinary RBC morphology, and

minimal proteinuria on dipstick (<100 mg/dL

Question 11

The classic symptoms of glomerulonephritis …?

Answer 11

Tea- or cola-colored urine, facial or body edema, hypertension, and oliguria

Question 12

VATER syndrome….?

Answer 12

vertebral body anomalies,
anal atresia,
tracheoesophageal fistula, and
renal dysplasia

Question 13

Abdominal masses may be caused by bladder distention dd

Answer 13

posterior urethral valves, hydronephrosis in ureteropelvic junction obstruction, polycystic kidney disease, or Wilms tumor

Question 14

The most common cause of gross hematuria is ….?

Answer 14

Bacterial or viral urinary tract infection

Question 15

Urethrorrhagia ….?

Answer 15

which is urethral bleeding in the absence of urine, is associated with dysuria and blood spots on underwear after voiding.

Question 16

Recurrent episodes of gross hematuria dd ?

Answer 16

IgA nephropathy, Alport syndrome, or thin glomerular basement membrane disease

Question 17

Dysuria and abdominal or flank pain are symptoms of ….?

Answer 17

idiopathic hypercalciuria, or urolithiasis

Question 18

Children with persistent asymptomatic isolated hematuria and a completely normal evaluation. Fallow up ..?

Answer 18

blood pressure and urine checked every 3 mo until the hematuria resolves

Question 19

Renal biopsy is indicated in hematuria …?

Answer 19

indicated for some children with persistent microscopic hematuria and for most children with recurrent gross hematuria associated with decreased renal function, proteinuria, or hypertension.

Question 20

Anemia in this setting may be caused by

Answer 20

hypervolemia with dilution associated with acute kidney injury;

decreased RBC production in chronic kidney disease; hemolysis from hemolyticuremic syndrome, a chronic hemolytic anemia, or SLE;

blood loss from pulmonary hemorrhage, as seen in Goodpasture syndrome; or melena in patients with HSP or hemolytic-uremic syndrome.

Inspection of the peripheral blood smear might reveal a microangiopathic process consistent with the hemolytic-uremic syndrome