TYPES

  • Macroscopic haematuria (visible to naked eye)-
    • 10 or more red blood cells per high-power field (HPF) in two of the three consecutive urine samples
  • Microscopic haematuria (not visible to naked eye). –
    • >5 RBCs to 10 RBCs /hpf

PATHOLOGY

  • Glomeruli– (more common -have RBC casts/ deformed RBCs/ proteinuria/ hypertension/ Oedema)
  • Renal tubules/ Interstitium
  • Ureter/ Bladder/ Urethra– (Bright red-or pink-coloured urine/ Painful +/-)
  • Renal papillae– (sickle cell nephropathy/ medications/ toxins).

CAUSES OF DISCOLORED URINE ( False Positive)

RED COLOUR URINE

  • Haematuria
  • Myoglobinuria/ Haemoglobinuria
  • Porphyria
  • Urate crystals
  • Foods (food colouring/ beetroot/ blackberries)
  • Drugs(chloroquine/ iron/ desferrioxamine)

DARK ORANGE URINE

  • Concentrated urine
  • Drugs (rifampin)

DARK BROWN URINE

  • Bile pigments
  • Methemoglobinemia
  • Melanin
  • Alkaptonuria

MACROSCOPIC HEMATURIA

CAUSES

  • Post infectious glomerulonephritis/ Membranoproliferative glomerulonephritis(may have hypertension and oedema )
  • IgA nephropathy/ Henoch-Schönlein purpura
  • Haemolytic-uremic syndrome
  • Hypertension
  • Tumour/ Trauma
  • Hydronephrosis
  • Renal calculus
  • Cystitis/ Urinary tract infection- schistosomiasis/ tuberculosis/ sickle cell trait
  • Coagulopathy/ Renal artery or renal vein thrombosis
  • Polycystic kidney disease

MICROSCOPIC HAEMATURIA

TYPES

  • Asymptomatic isolated microscopic haematuria
  • Symptomatic microscopic haematuria

HISTORY

  • Colour of the urine-Glomerular( Cola coloured/ Generally painless) and non-glomerular haematuria(Bright red-coloured urine)
  • Renal colic/ Nephrolithiasis- Flank pain/ dysuria.
  • Urinary tract infection- Dysuria/ fever/ suprapubic pain/ increased micturition/ nocturnal enuresis.
  • Post infectious glomerulonephritis-sore throat (2-3 weeks prior), rash (4–6 weeks prior) .
  • Henoch-Schönlein purpura- Petechial rash/ abdominal pain / joint pains.
  • SLE- Facial rash/ joint pain/ weight loss.
  • IgA nephropathy-upper respiratory infection(2-4 weeks prior)
  • Trauma, exercise, menstruation
  • Drug/ food history
  • Tumour/ Hydronephrosis- Abdomen mass/ Proteinuria
  • Child abuse
  • Pyelonephritis-fever and loin pain

PHYSICAL EXAMINATION

  • Fever
  • Loin tenderness
  • Rashes
  • Arthritis
  • Abdominal mass
  • Blood pressure

MANAGEMENT

MACROSCOPIC HAEMATURIA

  • Urine dipsticks
  • Urine microscopy / Culture
  • Renal function (BUN and creatinine)/ Electrolytes/ Serum albumin
  • Complement studies (C3 and C4),
  • Streptozyme test (ASO)/ Anti-DNAse B
  • Antinuclear antibody (ANA)/ Antineutrophil cytoplasmic antibodies (ANCA)
  • Renal ultrasound.
  • Cystoscopy-(bladder pathology)
  • Paediatric nephrology referral

MICROSCOPIC HAEMATURIA

  • Repeat urine dipstick/ microscopy 2-3 weeks.
  • Spot urine calcium creatinine ratio and urinalysis on parents/siblings
  • Yearly blood pressure measurement
  • If no other problems, yearly follow up

URINE DIPSTICK

  • False positive
    • Haemoglobin
    • Myoglobin
    • Hypochlorite in the urine
  • False negative
    • High urine specific gravity
    • Reducing agents (ascorbic acid)

RENAL BIOPSY CRITERIA

  • Hypertension
  • Severe proteinuria(>2 g/24 hr urine)
  • Family history of renal disease
  • Renal dysfunction
  • Persistent haematuria/ or proteinuria for >12 months
  • Thin basement membrane disease
  • IgA nephropathy
  • Membranoproliferative glomerulonephritis
  • Hypercalciuria
  1. dr.m.niranjan kumar

    this app is very much useful to the pediatricians.thank you very much for this nice app.please include a topic on dengue fever and drug dosage chapter.

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