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HEMATURIA. Hematuria. Transient phenomenon of little significance. Sign of serious renal disease. Classification of hematuria. Macroscopic - Microscopic Symptomatic - Symptomless Transient - Persistent. Normal erythrocyte excretion rate

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hematuria

Hematuria

Transient phenomenon

of little significance

Sign of serious

renal disease

classification of hematuria
Classification of hematuria
  • Macroscopic - Microscopic
  • Symptomatic - Symptomless
  • Transient - Persistent
slide5
Normal erythrocyte excretion rate

* 0 – 425.000/12 h. ( mean – 65.750 )

T.Addis; J.of Clin Invest, 1926

  • Upperlimit in children

* 500.000 - 2.000.000/24h.

detection quantification of hematuria
Detection & quantificationof hematuria
  • 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
microscopic hematuria
Microscopic Hematuria
  • Definition> 3-5 RBC/HPF

> 5 RBC/mm³

> 8000 RBC/ml

causes of hematuria
Causes of Hematuria
  • Kidney disease
  • Lesions along the urinary tract
  • Conditions unrelated to kidney andurinary tract
hematuria not representing kidney or urinary tract disorder
Hematuria not representing kidney or urinary tract disorder
  • Following exercise
  • Febrile disorders
  • Gastroenteritis with dehydration
  • Contamination from external genitalia
renal causes of hematuria
Renal causes of Hematuria
  • 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

acute nephritic syndrome
Acute nephritic syndrome
  • Hematuria
  • Proteinuria
  • Reduced renal function
  • Edema
  • Hypertension
renal causes of hematuria1
Renal causes of Hematuria
  • Non-glomerular

- Infection ( Pyelonephritis )

- Interstitial Nephritis

- Metabolic ( Uric Acid, Nephrocalcinosis )

- Renal Malformation ( Cystic Kidney )

- Tumors ( Wilm’s, Acute Leukemia)

- Idiopatic Hypercalciuria

- Trauma

causes of urinary tract related hematuria
Causes of urinary tract related Hematuria
  • Infection
  • Urolithiasis
  • Obstruction ( UPJ Stenosis )
  • Trauma
  • Drugs ( Cyclophosphamide )
  • Tumors
isolated hematuria microscopic
Isolated Hematuria(microscopic)
  • 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

etiologies of isolated hematuria
Etiologies of isolated Hematuria
  • 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

hematuria with familial association
Hematuria with familial association
  • Glomerular

- Benign Familial Hematuria

- Alport syndrome

  • Non-glomerular

- Idiopathic Hypercalciuria

-Polycystic Kidney Disease

- Urolithiasis

- Tumors

idiopathic hypercalciuria
Idiopathic Hypercalciuria
  • 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
alport syndrome hereditary disorder of gbm
Alport syndrome- hereditary disorder of GBM
  • X-linked dominant
  • Autosomal recessive
  • Autosomal dominant
renal disease
Renal disease
  • Macro /Microhematuria
  • Proteinuria
  • Nephrotic syndrome
  • Hypertension
  • Renal failure- males
  • Progressive or juvenile – 20 y
  • Nonprogressive – 40 y
hearing defects
Hearing defects
  • Sensorineural bilateral
  • Never congenital
  • Boys- 85% . Girls – 18% < 15y
  • Progression of hearing loss parallels renal impairment
diagnosis of alport syndrome
Diagnosis of Alport syndrome
  • 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
familial benign essential hematuria
Familial benign essential hematuria
  • 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
continue
Continue
  • Autosomal dominant trait
  • Normal antigenicity of the GBM
thin basement membrane nephropathy
Thin basement membrane nephropathy
  • Hematuria
  • Proteinuria
  • Attenuation of the GBM
  • In children may be Alport
  • In adults m/p benign disorder
hereditary nephropathy

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

evaluation of hematuria history
Evaluation of HematuriaHistory
  • Detailed review of family history

hematuria

proteinuria

renal insufficiency

deafness

stones

  • Precipitating factors

infection

exercise

  • Abdominal pain

HSP

hydronephrosis

pyelonephritis

urolithiasis

evaluation of hematuria physical examination
Evaluation of HematuriaPhysical Examination
  • Growth failure
  • Hypertension
  • Pallor
  • Edema
  • Rash
  • Abdomen: search for a mass or tenderness
  • External genitalia: bleeding

infection

trauma

work up of a child with hematuria
Work-up of a child with Hematuria
  • 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

isolated hematuria
Isolated hematuria
  • 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
isolated hematuria possible outcome
Isolated hematuriaPossible outcome
  • Disappearance of hematuria
  • Hematuria will persist -

follow-up should be continued

  • The hematuria will no longer be “isolated” - further investigation
hematuria1

Hematuria

Transient phenomenon

of little significance

Sign of serious

renal disease