Haematuria Flashcards
Haematuria is common first thing to do is to rpt the urine
On first catch in children about 9.5% of children have it
On 2nd testing 0.5-1% have it
Dd between the upper tract and the lower tract
Upper tract dysmorphic RBC and CAST
Lower tract nil
Upper tract causes of Hematuria
Post strep GN SLE Allports GN HUS
Lower tract
UTI
Stones
Trauma
Catheter
Other causes of Hematuria
Vasculitis SLE/HSP ITP Period Factiticious Vigorous exercise
Macro haematuria
UTI
Stones
Post Strep GN
IgA
Microcytic Hematuria
>50% BEnign facial thin basement membrane disease test the other family members Other cuases IGA, SLE HSP Allports Deafness family history HyperCa++
Primary GN
Post strep (Raised ASOT/C3C4 down)
Mb proliferate
IgA GN
MB GN
2ary causes of GN
SLE
HSP
ANCA
PAN
Investigations of Haematuria
Urine MCS and rpt it and then check the family RBC casts and dyspmophia U/E eGFR Renal USS ANA, anti dsDNA/ASOT Urine port/cr ratio C3 C4
Presentation of post Strep GN
Fluid overload Hypertensive headache reduced UO Ix Micro/macro H +/- proteinuira C3 C4 down ASOT up BP high Protienuria gets better 6-8 weeks Macro H gone 1-3 weeks Micro H can take up to 1 year to go not prognostic C3C4 better 6-8week ( if stays low ?SLE)
Proteinuria is usually benign
10% of children school age have + Prot Rpt it 0.1% Proteinuria increases with Aging of child Adolescents peaks Higher in girls
False +ve Proteinuria
Pyuria eg chlamydia Gross Haematuria Alkaline urine Antibiotics can cause P Urine left too long
False +ve
Acidic urine
Do the Urine Protien /CR ratio in the morning
Helps to exclude the cause of orthostatic proteinuria
Urine ACR <0.02 normal
Causes of proteinuria
Intermittent Fever, exercise, orthostatic normal variant that will do morning urine Stress cold GN 1ary FSGN 2ary SLE HSP Allports Tubular Wilson’s disease Acquired pylonephritis.drugs
Most children with Proteinuria and Haematuria have nothing significant
When are we concerned
Heavy hematuria
Heavy proteinuria
Hypertension
Family history of renal disease
Care with ACE in adolescent girls and V/D
True
If true Nephrotic syndrome most of them are minimal change nephrotic syndrome
Rare 2-7/100000 Oedema Proteinuria Low Albumin Normal/high BP Normal eGFR 2-10 years of age is classical minimal change NS >80% respond to steroids 70-80% relapse
If you see a child with true nephrotic syndrome right age group
Assume its minimal change GN and treat with steroids
High dose steroids will need sick day management
Complications of Nephrotic syndrome
Infection more prone to the encapsulated infections pneumococcal HIB and meningococcal
Thrombosis headache,limb pain, abdo pain
Hyperlipidemia
Pericardial effusions
Side effects of long term steroids bone/growth cataracts hypertension, mood
