Haematuria
Macroscopic... is it haematuria > see Red urine
Haematuria = >5 RC/microL of urine
prevelance 1% children
normally excrete 1million rc / day
Increases with fever and exercise
Benign Haematuria: no UTI, growth failure, hypertension, oedema, proteinuria, urinary casts, renal impairment
Dipstick measures Hb or myoglobin ie up in haematuria, haemaglobinuria and myoglobinuria
Dipstick pos, micro neg = haemaglobinuria (haemolysis) or myoglobinuria (rhabdomyolysis)
Hx
Fever / dysuria > Urine MCS
NO
Trauma >
NO
Rash/brusing > ?ITP/HSP/other bleeding disorder > check plt/coags
NO
Proteinuria/oedema/HTN > ?nephritis glom V interstitial > Gen Paeds
(HTN Sx headache, mental status changes, visual changes (diploplia), epistaxis, or heart failure)
NO
Pain > ?Calculus
Abdominal mass > ?Wilms/?polycystic kidneys/?hydronephrosis
NO
Bloody diarrhoea > ?HUS > Hb/Plt/Ur
NO
Macroscopic > Nephrologist
NO
Isolate microscopic > GP > 3 x repeat micro for RC > if 3 x + > Nephrologist
FH
Ix
UA haem, protein (>100mg/dl = glomerular, <100 = below glomerulus)
Micro: dysmorphic red cells inc acanthocytes = glomerular
Casts: red cell casts = glomerular
US: Anatomical anomalies
Dx
tea/cola urine, oedema, HTN, oliguria > Acute nephritic syndrome:
Haematuria = >5 RC/microL of urine
prevelance 1% children
normally excrete 1million rc / day
Increases with fever and exercise
Benign Haematuria: no UTI, growth failure, hypertension, oedema, proteinuria, urinary casts, renal impairment
- repeat urine microscopy with GP
Dipstick measures Hb or myoglobin ie up in haematuria, haemaglobinuria and myoglobinuria
Dipstick pos, micro neg = haemaglobinuria (haemolysis) or myoglobinuria (rhabdomyolysis)
Hx
Fever / dysuria > Urine MCS
NO
Trauma >
NO
Rash/brusing > ?ITP/HSP/other bleeding disorder > check plt/coags
NO
Proteinuria/oedema/HTN > ?nephritis glom V interstitial > Gen Paeds
(HTN Sx headache, mental status changes, visual changes (diploplia), epistaxis, or heart failure)
NO
Pain > ?Calculus
Abdominal mass > ?Wilms/?polycystic kidneys/?hydronephrosis
NO
Bloody diarrhoea > ?HUS > Hb/Plt/Ur
NO
Macroscopic > Nephrologist
NO
Isolate microscopic > GP > 3 x repeat micro for RC > if 3 x + > Nephrologist
FH
Ix
UA haem, protein (>100mg/dl = glomerular, <100 = below glomerulus)
Micro: dysmorphic red cells inc acanthocytes = glomerular
Casts: red cell casts = glomerular
US: Anatomical anomalies
Dx
tea/cola urine, oedema, HTN, oliguria > Acute nephritic syndrome:
- with recent infection
- postinfectious glomerulonephritis
- HSP nephritis
- hemolytic-uremic syndrome
- with rash and arthritis
- HSP nephritis
- SLE nephritis
- IgA nephropathy (Berger)
- membranoproliferative glomerulonephritis
- Granulomatosis with polyangiitis (previously Wegener granulomatosis) ANCA pos
- microscopic polyarteritis nodosa
- Goodpasture syndrome
- Pyelonephritis
- Cystitis
- Urethritis
- Hydronephrosis
- renal cystic disease
- renal vein thrombosis
- tumour
- Renal contusion
- NAI