Pediatric hematuria

Question 1

Hematuria

Answer 1

is the presence of five or more RBCs per high-power (40×) field in three consecutive fresh, centrifuged specimens obtained over the span of several weeks.
Note: Hematuria can be recognized in a single event, especially with gross hematuria.

Question 2

Confirmation of hematuria is critical.

Answer 2

A positive urine dipstick test may result from myoglobinuria or hemoglobinuria, in which the urine often is discolored, but no RBCs are noted on microscopic evaluation.

In addition, certain drugs (sulfonamides, nitrofurantoin, salicylates, phenazopyridine, phenolphthalein), toxins (lead, benzene), and foods (food coloring, beets, blackberries, rhubarb, paprika) may falsely discolor urine, in which case the urine dipstick test is negative for heme.

In newborns, a red or pink discoloration in the diaper can be seen when urate crystals precipitate in the urine.

Question 3

Glomerular bleeding hallmarks

Answer 3

discolored urine, RBC casts, and distorted RBC morphology

smoky, tea or cola-colored, or red urine.

proteinuria more than 2+

Question 4

Extraglomerular bleeding- hallmarks

Answer 4

red or pink urine
normal RBC morphology
no casts
clots present or not
less than 2+ proteinuria

Question 5

Asymptomatic Microscopic Hematuria

Answer 5

Asymptomatic microscopic hematuria has a prevalence of 3-6% in school aged children.
With repeat evaluations this drops to 0.5%-1%.
Of these pathology is exquisitely rare.

Routine urinalysis screening is discouraged by current recommendations.

Hematuria comes to the attention of the practitioner either incidentally or when evaluating a child who has urinary tract symptoms or gross hematuria.

Hematuria may be either microscopic or macroscopic (gross hematuria).

Microscopic hematuria may be either persistent or transient.

Question 6

Gross Hematuria

Answer 6

Gross hematuria is suspected when urine is discolored, usually red or tea-colored.

In evaluating gross hematuria, it is important to confirm the presence of RBCs by microscopy.

Following centrifugation of the urine:
Red urinary sediment with a positive dipstick test for hemoglobin is indicative of hematuria
Red supernatant with negative dipstick testing for hemoglobin is indicative of myoglobinuria, hemoglobinuria, or other causes of discolored urine

Aside from renal disease, common causes of gross hematuria include:
Urinary tract infection, trauma, coagulopathy, crystalluria, and nephrolithiasis
In contrast to microscopic hematuria, underlying causes of gross hematuria are identified in 56% of cases

Question 7

Normal blood pressure for a kid

Answer 7

70 + age in years x 2

Question 8

Diagnosis of hematuria

Answer 8

is greater than 5 RBCs per high power field

Question 9

Orthostatic proteinuria:

Answer 9

Normal protein/creatinine urine with first morning void, but abnormal during day. May occur due to physical activity during daytime

Question 10

Normal BMP:

Answer 10

Sodium 140, Potassium 4, Chloride 110, Bicarbonate 24, Creatinine 1.0, BUN 10,
Glucose 80-100, Calcium 10. (These are common normals, each lab will have ranges of normals when labs are reported, also infant and child creatinine levels start at 0.1, must evaluate based on their size and age)