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41 Cards in this Set
- Front
- Back
Which sort of hematuria (HU) is most common in kids?
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Microscopic --much more common
--most causes are benign |
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List some causes of Heme negative red urine?
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Meds (chlorquine, doxorubicine)
Food Dyes (beets, black berries) Metabolites (biles, melanin, tyrosinosis) |
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What is brick dust urine
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In babies
--conc urine so that urates actually fall out of soln in 2-3 day olds |
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MOst common cause of Gross HU?
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50%-UTI --viral or bacteria (rotavirus)
18%-Local Irritation 7%- Trauma |
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Least common cause of Gross HU?
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Stones, SSDx/Trait, coagulopathy
glomerular dx, Malignancy, drugs |
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In Hx--among vigorous actvity, Hx of onset of unilateral flank pain, etc...
What are colors assc/ HU due to UTIs? |
Brown Urine--think upper UTI
Red Urine --think lower UTI |
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with UA for a HU case, what are 4 indications that it's a glomerular cause of HA?
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Red Cell Casts (NO clots usuallY)
Red Cells w/ Dysmorphic appr. Brown urine Elevation of Pr (early AM) |
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with UA for a HU case, what are 4 indications that it's a Nonglomerular cause of HA?
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HU is Red or Pink
Micro shows Uniform Size & Shape of RBC -Clots --No casts (kidney boogers) |
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Evaluation of SYMPtomatic HU?
Image? If FLank pain in Hx? If Dysuria/Fever? |
Trauma--CT spiral scan
Flank: U/S for stone Dysuria/Fever--Urine Culture/Gram/UA |
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What can mimic bacterial UTI with severe cystitis?
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Adenovirus
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why might you get an ANA?
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Lupus Nephritis
--other misc things to check (not nec. for above) --Creatinine, Strep Ab (ASO titer) -CBC, C3, C4, Albumin |
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In add to UA, what serum Pr do you look for in Gross HU?
What else |
Creatinine and C3
-Urine Culture Note: Ca++ : Creatinine of >.2 = Hypercalciuria |
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WHy might you test parents and sibs for HU?
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If thin basement membrrane Dz or hereditary Nephritis
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What test might be done in SSDx?Trait suspected?
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Hemoglobin electrophoresis
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What might be evaluated if asian heritage?
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Nutcracker
--Compression of L. Renal V. btw SMA |
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NOW moving on to??
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Microscopic Hematuria (MHU)
-3-4% of kids have it---very comma |
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What is first consideration for MHU?
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Whether its Glomerular vs Nonglomerular
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What is ORthostatic Proteinuria?
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Benign
PR in Urine when active --NOT in there when UNACTIVE, ie when first up |
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Since MHU is common, what is process in kids with MHU on 2+ samples?
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If just MHU (no protein)
have come back in 6 mos --Keep eval if Pr in Urine + MHU |
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What are 3 etiologies of MHU?
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1. Glomerulopathies
2. HyperCalciuria 3. Nutcracker Syndrome |
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3 Types of Glomerulonephropathy
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IgA Nephropathy
Alport Syndrom Thin Basement Membrane Dx |
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What is MOST common cause of Glomerulonephritis in kids causing HU?
HOw is it diagnosed? |
IgA Nephropathy
--diag by Renal Biopsy showing Mesangial Deposits of IgA |
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What is common Hx of IgA nephropathy?
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Gross HU preceeded by an URI or Gastroenteritis
--with URI, time btw Infection adn HU is 1-5 days -MHU may persist indefinitely in chronic form follwing the Gross HU |
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What is ALport Syndrome?
Genetics? Sx? Outcome? |
Recessive X-linked
-Males -High frequency hearing loss -Ocular Abnorms -progressive renal failure- |
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What if female is heterozygous with an X with Alport gene?
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Has Hematuria but NOT progressive renal dx
-not there are other kinds of this Dz (ie, auto rec, but Alpha-5 chain /X linked is most common) |
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What is affected by Alport gene?
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Type 4 collagen
--much thickened renal basement membrane |
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aka as Benign familial hematuria?
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Thin Basement Membrane Dz
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How is Thin B. Mem. Dz diagnosed?
Genetics? |
Biopsy reveals thinning of membrane
--Auto DOminant |
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What Dz can be secondary to Streptococcal infection?
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Post-Strep Glomerfulopnef.
--most resolve in 6 mos or leass --Rarely has recurrent HU, after period of Gross HU --most occur 10-21 days post infxn -1% can have irreversible damage |
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What is Ration for Hypercalciuria?
Age Group? Type of HU? |
Ca++ : Creat >.2
--usually older than 6 yrs -aSx of MHU --increase risk of stones |
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What is Tx for Hypercalciuria
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Thiazide diuretics CAN dec/elimiate HU in Pts.
-however, best to change water source |
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How is Nutcracker diagnosed in asians?
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U/S
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How are Asympto MHU cases treated (most common cases of HU)?
aprraoch? re-eval? |
Since almost always transient/rarely assc/ significant Dz
--Observe --Repeated Urine Eval every 2-3 wks |
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What if aSx MHY persists?
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Culture
Measure Ca/Creat Test Sibs and Parents |
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Approach for aSx MHU but WITH Proteinuria
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Measure Ca/Creat & Urinary Protein
--if normal, follow in 2-3 wks ---most resolve |
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if this Persists?
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refer to nephrologist
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What are 3 signs for referal?
think Protein |
Urinary Pr. > 0.2 mg PR/mg Creat on AM void
oR >4mg Protein/m2 per hour Or Elevated Serum Creatinine |
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What clues for Symptomatic MHU? What are Hx?
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Recent Trauma
Hx of New onset Incontinence, Dysuria, Freq/Urgency suggest UTI --Flank Pain that radiates |
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What clinical Dz/Treatments cause you to suspect Symptomatic MHU in their history?
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SSD or Trait, Coagulopathy (hemophilia)
-Deafness (alports) -Exposure meds known to cause interstitial nephritis/cystitis -Chemo |
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WHat does Hx of weight loss, mass effect in abdomen make you think?
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Tumor (WIlm's Tumor
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What are 2 systemic possible etiologies of MHU ?
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Lupus
Henoch-Scholein Purpura |