HEMATURIA - PowerPoint PPT Presentation

HEMATURIA

Hematuria

Transient phenomenon

of little significance

Sign of serious

renal disease

• Macroscopic - Microscopic
• Symptomatic - Symptomless
• Transient - Persistent

* 0 – 425.000/12 h. ( mean – 65.750 )

T.Addis; J.of Clin Invest, 1926

• Upperlimit in children

* 500.000 - 2.000.000/24h.

• Screening test ( dipsticks)

- 0.02-0.03 mg/dL of Hb, myoglobin

- ~5-20 RBC/mm³

• Semiquantitative estimation

- centrifugation of 10-15 ml of urine

- resuspention of sediment in 1 ml of

residual urine

- high-power microscopy

• Counting chamber - the number of cells in 1 microliter of unspun urine

• Definition> 3-5 RBC/HPF

> 5 RBC/mm³

> 8000 RBC/ml

• Kidney disease
• Lesions along the urinary tract
• Conditions unrelated to kidney andurinary tract

• Following exercise
• Febrile disorders
• Gastroenteritis with dehydration
• Contamination from external genitalia

• Glomerular

- Acute Postinfectious Glomerulonephritis

- IgA Nephropathy

- Hereditary Nephritis ( Alport syndrome)

- Benign Recurrent or Persistent Hematuria ( Thin Membrane Disease )

1.Sporadic

2.Familial

- Membranoproliferative Glomerulonephritis

- Crescentic Glomerulonephritis

- Lupus Nephritis

- Nephritis of Henoch-Shönlein Purpura

- Focal Glomerulosclerosis

- Hemolityc-Uremic Syndrome

• Hematuria
• Proteinuria
• Reduced renal function
• Edema
• Hypertension

• Non-glomerular

- Infection ( Pyelonephritis )

- Interstitial Nephritis

- Metabolic ( Uric Acid, Nephrocalcinosis )

- Renal Malformation ( Cystic Kidney )

- Tumors ( Wilm’s, Acute Leukemia)

- Idiopatic Hypercalciuria

- Trauma

• Infection
• Urolithiasis
• Obstruction ( UPJ Stenosis )
• Trauma
• Drugs ( Cyclophosphamide )
• Tumors

• No other urinary abnormalities
• No renal insufficiency
• No evidence for systemic disease

Incidence ( school-aged children )

4-6% - single urine examination

0.5-1% - repeated testing over 6-12 months

• Glomerular

- Benign Recurrent or Persistent Hematuria

1.Sporadic

2.Familial

- IgA Nephropathy

- Alport syndrome

- PSAGN

• Non-glomerular

- Idiopathic Hypercalciuria

-Cystic Kidneys

- Urinary Tract obstruction

- Tumors

- Trauma

• Glomerular

- Benign Familial Hematuria

- Alport syndrome

• Non-glomerular

- Idiopathic Hypercalciuria

-Polycystic Kidney Disease

- Urolithiasis

- Tumors

• Definition: Calcium excretion > 4 mg/kg/day

Urinary Ca/Creatinine > 0.2

• Possible mechanism of hematuria: microcrystals damaging the tubular or mucosal epithelia. Resolution of hematuria with anticalciuric therapy

• X-linked dominant
• Autosomal recessive
• Autosomal dominant

• Macro /Microhematuria
• Proteinuria
• Nephrotic syndrome
• Hypertension
• Renal failure- males
• Progressive or juvenile – 20 y
• Nonprogressive – 40 y

• Sensorineural bilateral
• Never congenital
• Boys- 85% . Girls – 18% < 15y
• Progression of hearing loss parallels renal impairment

• Hematuria with or without proteinuria
• Hypertension
• Renal failure
• Ocular defects – anterior lenticonus
• Familial hematuria
• Sensorineural hearing loss
• Progression to renal failure occurring in at least one affected subject

ALPORT’S SYNDROME

• Familial hematuria without proteinuria and without progression to renal failure or hearing defect
• Diffuse attenuation of the GBM is usually considered the hallmark of the condition
• It’s non pathognomonic of FBEH

• Autosomal dominant trait
• Normal antigenicity of the GBM

• Hematuria
• Proteinuria
• Attenuation of the GBM
• In children may be Alport
• In adults m/p benign disorder

HEREDITARY NEPHROPATHY

Alport Syndrome

Benign Familial

Hematuria

Overlap of histological findings

The prognosis appears to be depend more on the degree of clinical expression in other members of the family and less on the histological findings

• Detailed review of family history

hematuria

proteinuria

renal insufficiency

deafness

stones

• Precipitating factors

infection

exercise

• Abdominal pain

HSP

hydronephrosis

pyelonephritis

urolithiasis

• Growth failure
• Hypertension
• Pallor
• Edema
• Rash
• Abdomen: search for a mass or tenderness
• External genitalia: bleeding

infection

trauma

• Phase I:Urinalysis ( sediment examination )

RBC’s morphology

Urine culture

BUN, Creatinine, Proteins, Electrolytes

Antibodies against strept. & other antigens

Complement, ANF, Immunoglobulins

Renal US

Urinalysis of 1st degree relatives

24h urine collection: Ca, Creat.,Protein, UA

• Phase II: Hearing test

Cystoscopy

Renal biopsy

• The child needs to be monitored for the appearance of new clinical signs:

hypertension

proteinuria

changes in the pattern or severity of hematuria

• If there is no change in the first year,observation at yearlyintervals is adequate

• Disappearance of hematuria
• Hematuria will persist -

follow-up should be continued

• The hematuria will no longer be “isolated” - further investigation

Hematuria

Transient phenomenon

of little significance

Sign of serious

renal disease