Haematuria

Question 1

Causes of heme positive urine

Answer 1

In children most often non-urological problem 
Nephrological cause 
haemoglobinuria 
myoglobinuria 
food dyes, beetroot, berry juices 
drugs - rifampicin

Question 2

Haematuria from glomeruli and tubules

Answer 2

brown, cola or black tea coloured 
often associated proteinuria >/= +2 
microscopy red cell casts and dysmorphic RBC > 80%
may be accompanied by leukocytes 
epithelial cell casts

Question 3

Haematuria from lower urinary tract

Answer 3

gross haematuria, blood clots 
non-dysmoprhic RBC's 
terminal haematuria 
microscopy: normal red cell morphology 
minimal proteinuria 
non glomerular RBC's 
round, biconcave, smooth walled, similar size, originate extra glomerular, UTI/hypercalciuria, stones

Question 4

Special investigations NB

Answer 4

2 important diagnostic tests required: Glomerulonephritis
- microscopic examination of urine for RBC and casts
- test for proteinuria
specific tests based on diff diagnosis

Question 5

Differential diagnosis of haematuria

Answer 5

Glomerular cuases

• APSGN
• Henoch Schonlein Purpura HSP
• Haemolytic uremic syndrome HUS
• IgA nephropathy
• Alport syndrome

Non-glomerular causes

• UTI
• Calculi
• Bilharzia
• Tumour
• Trauma

Neonates
acute tubular necrosis - hypoxia
UTI, Hypercalciuria, Morphological kidney abnormalities, Renal vein thrombosis

Question 6

Acute Post Streptococcal glomerulonephritis

Answer 6

group A beta haemolytic streptococcus 
macroscopic haematuria 
oliguria 
oedema 
hypertension 
preceding impetigo 
periorbital swelling 
headache/convulsions 

urine dipstick: haematuria, +/- proteinuria
red cells: granular and red cell casts
positive streptococcus serology
- anti strep DNase B titre
- ASO titre
decreased S-compliment C3 level
well over 90% of patients recover completely

Question 7

Complications of acute nephritis

Answer 7

fluid volume overload
pulmonary oedema and congestive cardiac failure
HT and hypertensive encephalopathy - may have seizures
rapidly progressive glomerulonephritis - usually crescentic on biopsy
acute renal failure
chronic renal failure
posterior Leuko-encephalopathy - may have seizures

Question 8

Patients with APSGN must admitted

Answer 8

oliguria 
hyperkalaemia 
hypertension 
seizures 
congestive heart failure

Question 9

Differential diagnosis of PSGN – NB!!!!!!!!!!!!

Answer 9

HSP 
IgA glomerulonephritis 
SLE 
other infections - HBV, HIV GN 
Alport syndrome 
other causes macroscopic haematuria