Hematuria

Question 1

Microscopic hematuria

Answer 1

> 5 red blood cells/hpf

X3, obtained over several weeks

Urine not discolored

Normal in 2-3% of school-age children
Just repeat a UA with microscopy
Only 1% are still positive at 6 months follow up

Question 2

If dipstick +blood, what is next step?

Answer 2

Get a UA with microscopy

Blood could be hemoglobin
Myoglobin
Porphyrins

Question 3

Benign familial hematuria

Answer 3

Hematuria is usually microscopic

Monitor for hypertension and proteinuria

No treatment needed

Question 4

Transient hematuria causes

Answer 4

Minor trauma
exercise
fever

Question 5

Persistent microscopic hematuria

Answer 5

UA positive on repeat

1. Check urine Ca/Cr ratio
   - if >0.25, check 24 hr Ca excretion. +hypercalciuria if >4 mg/day. Then need a renal US (r/o kidney stone)

-if <0.25, get other labs

Patient could have SS or sickle trait

Question 6

When is cystoscopy indicated?

Answer 6

Never

Question 7

What are urate crystals?

Answer 7

Newborn diaper will be pink/red
Normal UA
Not blood
No workup/treatment

Question 8

Causes of gross hematuria

Answer 8

HEMATURIA

Henoch Schonlein Purpura, hereditary nephritis
Easy benign familial
Membranoproliferative
IgA nephropathy and Alport
Trauma
Ureteropelvic junction obstruction
Renal stones
post-Infectious (strep)
Abnl RBCs (SS)

Question 9

Tea/Coke colored urine

Answer 9

Glomerular disease (upper urinary tract)

Question 10

Bright red urine with clots

Answer 10

Lower urinary tract

• stone
• UPJ issue
• Wilma tumor
• cystic kidney disease

Question 11

Kidney stones

Answer 11

In children, need a full metabolic work up

All need US/X-ray

Usually Ca stones

• RTA
• hyperparathyroidism
• hypercalcemia
• loop diuretics

Question 12

Kidney stone treatment

Answer 12

If <5mm, usually passes on own

Percutaneous nephrolithotomy
Increase fluid intake
Restrict salt

Thiazides diuretic