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