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41 Cards in this Set

  • Front
  • Back
Which sort of hematuria (HU) is most common in kids?
Microscopic --much more common
--most causes are benign
List some causes of Heme negative red urine?
Meds (chlorquine, doxorubicine)
Food Dyes (beets, black berries)
Metabolites (biles, melanin, tyrosinosis)
What is brick dust urine
In babies
--conc urine so that urates actually fall out of soln in 2-3 day olds
MOst common cause of Gross HU?
50%-UTI --viral or bacteria (rotavirus)
18%-Local Irritation
7%- Trauma
Least common cause of Gross HU?
Stones, SSDx/Trait, coagulopathy
glomerular dx, Malignancy, drugs
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
with UA for a HU case, what are 4 indications that it's a glomerular cause of HA?
Red Cell Casts (NO clots usuallY)
Red Cells w/ Dysmorphic appr.
Brown urine
Elevation of Pr (early AM)
with UA for a HU case, what are 4 indications that it's a Nonglomerular cause of HA?
HU is Red or Pink
Micro shows Uniform Size & Shape of RBC
-Clots
--No casts (kidney boogers)
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
What can mimic bacterial UTI with severe cystitis?
Adenovirus
why might you get an ANA?
Lupus Nephritis
--other misc things to check (not nec. for above)
--Creatinine, Strep Ab (ASO titer)
-CBC, C3, C4, Albumin
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
WHy might you test parents and sibs for HU?
If thin basement membrrane Dz or hereditary Nephritis
What test might be done in SSDx?Trait suspected?
Hemoglobin electrophoresis
What might be evaluated if asian heritage?
Nutcracker
--Compression of L. Renal V. btw SMA
NOW moving on to??
Microscopic Hematuria (MHU)

-3-4% of kids have it---very comma
What is first consideration for MHU?
Whether its Glomerular vs Nonglomerular
What is ORthostatic Proteinuria?
Benign
PR in Urine when active
--NOT in there when UNACTIVE, ie when first up
Since MHU is common, what is process in kids with MHU on 2+ samples?
If just MHU (no protein)
have come back in 6 mos

--Keep eval if Pr in Urine + MHU
What are 3 etiologies of MHU?
1. Glomerulopathies
2. HyperCalciuria
3. Nutcracker Syndrome
3 Types of Glomerulonephropathy
IgA Nephropathy
Alport Syndrom
Thin Basement Membrane Dx
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
What is common Hx of IgA nephropathy?
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
What is ALport Syndrome?
Genetics?
Sx?
Outcome?
Recessive X-linked
-Males
-High frequency hearing loss
-Ocular Abnorms
-progressive renal failure-
What if female is heterozygous with an X with Alport gene?
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)
What is affected by Alport gene?
Type 4 collagen
--much thickened renal basement membrane
aka as Benign familial hematuria?
Thin Basement Membrane Dz
How is Thin B. Mem. Dz diagnosed?
Genetics?
Biopsy reveals thinning of membrane
--Auto DOminant
What Dz can be secondary to Streptococcal infection?
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
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
What is Tx for Hypercalciuria
Thiazide diuretics CAN dec/elimiate HU in Pts.
-however, best to change water source
How is Nutcracker diagnosed in asians?
U/S
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
What if aSx MHY persists?
Culture
Measure Ca/Creat
Test Sibs and Parents
Approach for aSx MHU but WITH Proteinuria
Measure Ca/Creat & Urinary Protein
--if normal, follow in 2-3 wks
---most resolve
if this Persists?
refer to nephrologist
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
What clues for Symptomatic MHU? What are Hx?
Recent Trauma
Hx of New onset Incontinence, Dysuria, Freq/Urgency suggest UTI
--Flank Pain that radiates
What clinical Dz/Treatments cause you to suspect Symptomatic MHU in their history?
SSD or Trait, Coagulopathy (hemophilia)
-Deafness (alports)
-Exposure meds known to cause interstitial nephritis/cystitis
-Chemo
WHat does Hx of weight loss, mass effect in abdomen make you think?
Tumor (WIlm's Tumor
What are 2 systemic possible etiologies of MHU ?
Lupus
Henoch-Scholein Purpura