Clinical Evaluation of the Child with Hematuria

Question 1

Hematuria is defined as the presence of at least ___ RBCs per ___ of urine

Answer 1

5, uL

Question 2

Normal children can excrete more then ___ RBCs per 12hr period

Answer 2

500,000

Question 3

RBC excretion in urine can increase with what activities

Answer 3

1) Fever 2) Exercise

Question 4

Significant hematuria is generally considered as

Answer 4

> 50 RBCs/uL urine

Question 5

Can cause false-negative hematuria with the use of dipstick

Answer 5

1) Formalin 2) High concentrations of ascorbic acid >2000 mg/day

Question 6

Can cause false-positive hematuria with the use of dipstick

Answer 6

1) Alkaline urine (pH >8) 2) Contamination with oxidizing agents such as H2O2

Question 7

Amount of urine essential for microscopic analysis to confirm presence of RBCs

Answer 7

10-15mL freshly voided and centrifuged

Question 8

Presence of RBC in urine is suggested by presence of how many RBCs

Answer 8

> 10 RBCs/uL or a +1 urinary dipstick

Question 9

Clinically significant heme-positive urine without RBCs may be caused by the presence of

Answer 9

1) Hemoglobin 2) Myoglobin

Question 10

Upper urinary tract sources of hematuria originate where

Answer 10

Within the nephron (glomerulus, tubular system, or insterstitium)

Question 11

Lower urinary tract sources of hematuria originate where

Answer 11

Pelvocaliceal system to urethra

Question 12

Hematuria from the glomerulus is often associated with (4)

Answer 12

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)

Question 13

Hematuria originating within the tubular system may be associated with the presence of

Answer 13

1) Leukocytes 2) Renal tubular casts

Question 14

Lower urinary tract sources of hematuria may be associated with (5)

Answer 14

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

Question 15

T/F Hematuria associated with glomerulonephritis is typically painless

Answer 15

T

Question 16

MCC of gross hematuria

Answer 16

Bacterial UTI

Question 17

Urethral bleeding in the absence of urine

Answer 17

Urethrorrhagia

Question 18

Urethrorrhagia usually occurs in what age group

Answer 18

Prepubertal boys

Question 19

T/F Urethrorrhagia has a mild self-limited course

Answer 19

T

Question 20

Recurrent episodes of gross hematuria suggest what clinical entities (3)

Answer 20

1) IgA nephropathy 2) Alport syndrome 3) Thin GBM disease

Question 21

T/F Asymptomatic patients with isolated gross hematuria should undergo extensive diagnostic evaluation

Answer 21

F, such hematuria is often transient and benign

Question 22

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

Answer 22

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

Question 23

Test that is most informative in patients presenting with gross hematuria, abdominal pain, flank pain, or trauma

Answer 23

Ultrasonography of the urinary tract

Question 24

Cause of Hematuria: Anemia d/t hypervolemia with dilution

Answer 24

ARF

Question 25

Cause of Hematuria: Anemia d/t decreased RBC production

Answer 25

CRF

Question 26

Cause of Hematuria: Anemia d/t hemolysis

Answer 26

HUS, chronic hemolytic anemia, SLE

Question 27

Cause of Hematuria: Anemia d/t blood loss

Answer 27

Pulmonary hemorrhage ( Goodpasture syndrome)

Question 28

Cause of Hematuria: Anemia d/t melena

Answer 28

HSP, HUS

Question 29

Cause of hematuria presenting with peripheral blood smear that might reveal a microangiopathic process

Answer 29

HUS

Question 30

Cause of hematuria presenting with (+) Coombs’ test, (+) ANA, leukopenia, and multisystem disease

Answer 30

SLE

Question 31

T/F Urinary RBC morphology is sensitive enough to unequivocally delineate the site of hematuria

Answer 31

F, NOT sensitive enough

Question 32

T/F Coagulation studies should be routinely obtained in all cases of hematuria

Answer 32

F

Question 33

A voiding cystourethrogram is indicated for patients with

Answer 33

1) UTI 2) Renal scarring 3) Hydroureter 3) Pyelocaliectasis

Question 34

T/F Cystoscopy is an unnecessary and costly procedure in most pediatric patients with hematuria

Answer 34

T

Question 35

The diagnosis of “possible urethral stenosis” as an indication for cystoscopy should be viewed with a high degree of suspicion, because

Answer 35

True urethral stenosis is quite rare

Question 36

Cystoscopy should be reserved for evaluating the rare child with

Answer 36

1) Bladder mass on UTZ 2) Urethral abnormalities caused by trauma, posterior urethral valves, or tumor

Question 37

Finding of unilateral gross hematuria localized by cystoscopy is rare, but it can indicate what

Answer 37

A vascular malformation or another anatomic abnormality

Question 38

Surveillance for children with persistent asymptomatic isolated hematuria and a completely normal evaluation

Answer 38

BP and urinalysis every 3 months until hematuria resolves

Question 39

Referral to a pediatric nephrologist should be considered for patients with persistent asymptomatic hematuria of what duration

Answer 39

Greater than 1 yr