Clinical Evaluation of the Child with Hematuria Flashcards
Hematuria is defined as the presence of at least ___ RBCs per ___ of urine
5, uL
Normal children can excrete more then ___ RBCs per 12hr period
500,000
RBC excretion in urine can increase with what activities
1) Fever 2) Exercise
Significant hematuria is generally considered as
> 50 RBCs/uL urine
Can cause false-negative hematuria with the use of dipstick
1) Formalin 2) High concentrations of ascorbic acid >2000 mg/day
Can cause false-positive hematuria with the use of dipstick
1) Alkaline urine (pH >8) 2) Contamination with oxidizing agents such as H2O2
Amount of urine essential for microscopic analysis to confirm presence of RBCs
10-15mL freshly voided and centrifuged
Presence of RBC in urine is suggested by presence of how many RBCs
> 10 RBCs/uL or a +1 urinary dipstick
Clinically significant heme-positive urine without RBCs may be caused by the presence of
1) Hemoglobin 2) Myoglobin
Upper urinary tract sources of hematuria originate where
Within the nephron (glomerulus, tubular system, or insterstitium)
Lower urinary tract sources of hematuria originate where
Pelvocaliceal system to urethra
Hematuria from the glomerulus is often associated with (4)
1) Brown, cola- or tea-colored, or burgundy urine 2) Proteinuria >100 mg/dL via dipstick 3) Urinary microscopic findings of RBC casts 4) Deformed urinary RBCs (particularly acanthocytes)
Hematuria originating within the tubular system may be associated with the presence of
1) Leukocytes 2) Renal tubular casts
Lower urinary tract sources of hematuria may be associated with (5)
1) Gross hematuria that is bright red or pink 2) Terminal hematuria 3) Blood clots 4) Normal urinary RBC morphology 5) Minimal proteinuria on dipstick
T/F Hematuria associated with glomerulonephritis is typically painless
T
MCC of gross hematuria
Bacterial UTI
Urethral bleeding in the absence of urine
Urethrorrhagia
Urethrorrhagia usually occurs in what age group
Prepubertal boys
T/F Urethrorrhagia has a mild self-limited course
T
Recurrent episodes of gross hematuria suggest what clinical entities (3)
1) IgA nephropathy 2) Alport syndrome 3) Thin GBM disease
T/F Asymptomatic patients with isolated gross hematuria should undergo extensive diagnostic evaluation
F, such hematuria is often transient and benign
Initial evaluation for the child with completely asymptomatic isolated microscopic hematuria that persists on at least 3 urinalyses observed over a minimum of a 2 wk period
1) Urine culture 2) Spot urine for hypercalciuria 3) If culture-negative, do calcium:creatinine ratio 4) If African-American, sickle cell screen 5) UA of all first-degree relatives if all of the above are normal
Test that is most informative in patients presenting with gross hematuria, abdominal pain, flank pain, or trauma
Ultrasonography of the urinary tract
Cause of Hematuria: Anemia d/t hypervolemia with dilution
ARF
Cause of Hematuria: Anemia d/t decreased RBC production
CRF
Cause of Hematuria: Anemia d/t hemolysis
HUS, chronic hemolytic anemia, SLE
Cause of Hematuria: Anemia d/t blood loss
Pulmonary hemorrhage ( Goodpasture syndrome)
Cause of Hematuria: Anemia d/t melena
HSP, HUS
Cause of hematuria presenting with peripheral blood smear that might reveal a microangiopathic process
HUS
Cause of hematuria presenting with (+) Coombs’ test, (+) ANA, leukopenia, and multisystem disease
SLE
T/F Urinary RBC morphology is sensitive enough to unequivocally delineate the site of hematuria
F, NOT sensitive enough
T/F Coagulation studies should be routinely obtained in all cases of hematuria
F
A voiding cystourethrogram is indicated for patients with
1) UTI 2) Renal scarring 3) Hydroureter 3) Pyelocaliectasis
T/F Cystoscopy is an unnecessary and costly procedure in most pediatric patients with hematuria
T
The diagnosis of “possible urethral stenosis” as an indication for cystoscopy should be viewed with a high degree of suspicion, because
True urethral stenosis is quite rare
Cystoscopy should be reserved for evaluating the rare child with
1) Bladder mass on UTZ 2) Urethral abnormalities caused by trauma, posterior urethral valves, or tumor
Finding of unilateral gross hematuria localized by cystoscopy is rare, but it can indicate what
A vascular malformation or another anatomic abnormality
Surveillance for children with persistent asymptomatic isolated hematuria and a completely normal evaluation
BP and urinalysis every 3 months until hematuria resolves
Referral to a pediatric nephrologist should be considered for patients with persistent asymptomatic hematuria of what duration
Greater than 1 yr
