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Differential Diagnosis of Hematuria

Differential Diagnosis of Hematuria . Anatomy - renal cyst, AVM, hydronephrosis Boulders - renal stone, hypercalciuria Cancer - Wilm ’ s tumor , adenocarcinoma Drug-related - cyclophosphamide Exercise Foreign body ; Familial - Alport ’ s syndrome Glomerulonephritis

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Differential Diagnosis of Hematuria

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  1. Differential Diagnosis of Hematuria • Anatomy- renal cyst, AVM, hydronephrosis • Boulders- renal stone, hypercalciuria • Cancer- Wilm’s tumor , adenocarcinoma • Drug-related- cyclophosphamide • Exercise • Foreign body ; Familial- Alport’s syndrome • Glomerulonephritis • Hematology- hemoglobinopathy, coagulopathy • Infection- viral, bacterial, fungal

  2. Glomerular Brown or tea-colored RBC cast, cellular cast Tubular cells Proteinuria >2+ Dysmorphic erythrocytes Erythrocyte volume <50 um3 Non-glomerular Red-pink urine Blood clots No proteinuria or <2 Normal morphology of erythrocytes Erythrocyte volume > 50 um3 Localization of Hematuria

  3. Recurrent gross hematuria • IgA nephropathy • Idiopathic (benign familial) hematuria • Alport syndrome • Idiopathic hypercalciuria

  4. Renal biopsy- indication • Hematuria of unknown cause • Persistant non-orthstatic proteinuria • RPGN • NS resistant to steroid • Suspected familial nephritis • CRF of unknown cause • SLE, HSP • Monitor course of GN in response to Tx

  5. Renal biopsy- complication • Macroscopic hematuria, self-limited (5%) • Hematuria requiring transfusion (0.5-2%) • Perineral hematoma (0.5-1.5%) • AV fistula (0.5%) • Puncture of viscera, vessel, infection, sepsis • Death (< 0.1%)

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