Paeds: Haematuria Flashcards
1
Q
Presentation
A
- Episode of marcoscopic haematuria (causes alarm to child/family)
- Incidental finding
- Family screening and routine urinalysis
2
Q
Other causes of ‘red urine’:
A
- Haemoglobinuria/myoglobinuria.
- Foods – colouring (e.g. beetroot)
- Drugs (e.g. rifampicin)
- Urate crystals (in young infants, usually ‘pink’ nappies).
- External source (e.g. menstrual blood losses).
- Fictitious –consider if no cause found.
3
Q
Causes of haematuria:
A
Non-glomerular or glomerular
4
Q
Non-glomerular
A
- Infection (bacterial, viral, TB, schistomiasis)
- Trauma to genitalia, urinary tract or kidneys
- Stones
- Tumours
- Sickle cell disease
- Bleeding disorders
- Renal vein thrombosis
Hypercalciuria
5
Q
Glomerular
A
- Acute glomerulonephritis (usually with proteinuria)
- Chronic glomerulonephritis (usually with proteinuria)
- IgA nephropathy, Henoch-Schonlein purpura, SLE
- Familial nephritis e.g. Alport syndrome, thin basement membrane
Thin basement membrane disease
6
Q
Other way to differentiate the causes
A
Urinary tract infections Glomerular Urinary tract stones Trauma Other renal tract pathology Vascular Haematological Drugs Exercise-induced
7
Q
Urinary tract infections
A
Bacterial
Viral (e.g. adenovirus in outbreaks);
Schistosomiasis (hx of foreign travel)
TB
8
Q
Glomerular
A
- Postinfectious glomerulonephritis
- Henoch-Schonlein purpura IgA nephropathy, SLE
Hereditary – thin basement membrane, Alport’s syndrome
9
Q
Urinary tract stones
A
E.g. due to hypercalciuria
10
Q
Other renal tract pathology
A
- Renal tract tumour
Polycystic kidney disease
11
Q
Vascular
A
- Renal vein thrombosis
Arteritis
12
Q
Haematological
A
Coagulopathy/sickle cell disease
13
Q
Drugs
A
Cyclophosphamide
14
Q
Hx
A
UTI Renal stones: Glomerular Coagulopathy Trauma Family Hx
15
Q
UTI symptoms
A
fever/freqeuncy/dysuria
16
Q
Renal stones:
A
colicky abdominal pain
17
Q
Glomerular
A
Sore throat/rashes
18
Q
Coagulopathy
A
Easy bruising
19
Q
Family Hx
A
Haematuria
Deafness (Alport’s)
Sickle cell disease
20
Q
Brown urine:
A
Glomerular haematuria – often accompanied with proteinuria
21
Q
Red urine:
A
Lower urinary tract haematuria – beginning or end of stream, no proteinuria –Unusual in children!
22
Q
Examination:
A
- BP
- Abdomen: palpable masses
- Skin: rashes
- Joints: pain/swelling
23
Q
Investigations:
A
During acute illness: exclude UTI by urine culture.
***Asymptomatic or ‘benign haematuria’ in children without growth failure, hypertension, oedema, proteinuria, urinary casts or renal impairment is a frequent finding.
24
Q
Investigation list
A
Urine Bloods US urinary tract Urinalysis of parents (hereditary causes). Cystoscopy; rarely indicated in children
25
Urine
- Microscopy (look for cats –suggestive of nephritis) and culture;
- Protein excretion: creatinine ratio (normal,
26
Bloods
- U&E/creatinine/albumin,
- FBC/clotting
- Complement – C3/C4, ASOT titres;
ANA/anti-dsDNA
27
ASOT titres
help determine whether a recent strep infection with group A Streptococcus:
• Is the cause of a person's or glomerulonephritis, a form of kidney disease
• Caused rheumatic fever in a person with signs and symptoms
28
Treatment:
- If obvious cause (e.g. UTI) treat
| - Complex diagnosis (impaired renal function, proteinuria, or family Hx) refer to paediatric nephrology unit
29
When do you monitor until it resolves
- If no cause found and normal renal function, BP, and no proteinuria monitor until resolves
30
If no resolution after 6 months or change in any of above parameters
refer
31
Post-streptococcl and post-infectious nephritis:
| Description
Usually follows a streptococcal sore throat or skin infection
32
Post-streptococcl and post-infectious nephritis: Diagnosis
Evidence of a recent streptococcal infection
Culture of the organism
Raised ASO/anti-DNAse B titres
Low Complement C3 levels (return to normal after 3-4 weeks)
33
Post-streptococcl and post-infectious nephritis: Epi
Common in developing countries
34
Post-streptococcl and post-infectious nephritis: Prognosis
Good
35
Henoch-Schnolein purpura: Signs and Symptoms
- Preceded by URTI
- Characteristic skin rash
- Arthralgia
- Peri-articular oedema
- Abdominal pain
Glomerulonephritis
36
Henoch-Schnolein purpura:
| Aetiology
- Between the ages of 3 and 10 years
- 2:1 boys:girls
Peaks during winter months
37
Henoch-Schnolein purpura:
| Presentation
Increase in circulating IgA and IgG interact to produce complexes that activate complement and are dposited in affected organs, precipitating an inflammatory response with vasculitis.
38
Henoch-Schnolein purpura: Presentation
Rash
- Buttocks
- Extensor surfaces of legs and arms
- Ankles
Joint pain and swelling: knees and ankles
Abdominal pain:
- Haematemesis and melaena (gastrointestinal petechiae)
- Intussusception
Renal
- Microscopic/macroscopic haematuria (80%)
Nephrotic syndrome (rare)
39
Henoch-Schnolein purpura:
| Rash type
Initially uticarial, rapidly becoming maculopapular and purpuric.
Characteristically palpable and may recur over several weeks.
40
Henoch-Schnolein purpura: Rare complications
Ileus
Protein-losing enteropathy
Orchitis
Occasionally CNS involvement
41
Henoch-Schnolein purpura: Prognosis
Children without risk factors for progressive renal disease make a full recovery
42
Henoch-Schnolein purpura:
| Risk factors for progressive disease
Heavy proteinuria
Oedema
Hypertension
Deteriorating renal function
43
Henoch-Schnolein purpura:
| Treatment
Severe cases can be treated with corticosteroids
44
Vasculitis: Causes
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Henoch-schlonein purpura
Renal involvement in:
- Polyarteritis nodosa
- Microscopic polyarteritis
Wegener gramulomatosis
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45
Vasculitis: Characteristic symptoms
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Fever
Malaise
Weight-loss
Skin rash
Arthropathy with prominent involvement of the respiratory tract in Wegener disease
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46
Vasculitis: Diagnosis
- ANCA are present and diagnostic in these disease
| Renal arteriography, to demonstrate the presence pf aneurysms, will diagnose polyarteritis nodosa
47
Vasculitis:
| Treatment
Steroids
Plasma exchange
IV cyclophosphamide
