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Approach to red urine in children

Approach to red urine in children. Kamal Akl MD Professor of Pediatrics & Pediatric Nephrology. Objectives. Red urine is not always hematuria Hematuria is not always renal Focused Hx  Focused PE Focused Labs & imaging- Focused management. Examples of Urine Color.

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Approach to red urine in children

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  1. Approach to red urine in children KamalAkl MD Professor of Pediatrics & Pediatric Nephrology

  2. Objectives • Red urine is not always hematuria • Hematuria is not always renal • Focused Hx Focused PE Focused Labs & imaging- Focused management

  3. Examples of Urine Color

  4. Causes of red urine • Food • Medications • Others

  5. Hematuria • Microscopic • Macroscopic • Definition of Microhematuria

  6. Reagent Strips

  7. Urine Dipstick

  8. Causes of hematuria in Jordan • UTI------------------------------- Around 1/3rd • Glomerulopathy-------------- Around 1/3rd • Crystals & Stones -------------Around 1/3rd • Rest: Miscellaneous

  9. Causes of Hematuria in Children • Upper Urinary Tract vs Lower • Glomerular bleeding vsNonglomerular

  10. Glomerularhematuria • Color • Presence of proteinuria • RBC morphology • RBC casts

  11. RBC Cast

  12. Hematuria • Painless • Painfull

  13. Hematuria • Importance of Medical & Diet History • Importance of Family History

  14. Medical History • Lower vs upper urinary tract symptoms • Dietary Intake • Skin rash • History of URTI • Trauma/ Exercise • Medication intake • Geography • Prevalent conditions in the community

  15. Hematuria • Persistent micro • Persistent micro + Proteinuria • Intermittent macro • Persistent micro OR Intemittent Macro

  16. Alport Syndrome • Hematuria • Sensorineural Deafness • Renal Failure • May diagnose by skin biopsy instead of renal biopsy Look for Epidermal staining for collagen IV

  17. Dietary History • Very Important • Water intake • For Hyperuricosuria Not only importance of purine intake such as red meat • BUT: Fructose intake

  18. Diet History • Examples: • Hematuria after Mansaf : Hyperuricosuria(HU) • BBQ : HU • Mulukhia: Oxalate • Tomatoes: Oxalate • Sweetened Beverages: HU

  19. Family History • Consanguinity • Similar cases • Deafness • ESRF • Familial Hematuria • Stones • Gout

  20. Importance of PE • Complete PE + Focused on the condition • Check BP; edema • Evidence of systemic disease eg Rash

  21. Presentations of Glomerular Disease • Asymptomatic Urinary Abnormalities • Hypertension • Acute Kidney Injury • Chronic Kidney Disease • Nephrotic Syndrome • Rapidly Progressive Glomerulonephritis

  22. Focused Lab • Depends on • Medical History • Diet Hx • Family Hx

  23. Focused Investigations • Based on Hx & PE

  24. Focused Management • Depends on • Medical Hx • Diet Hx • Family Hx • Labs: Note  treat the patient not the lab

  25. Conclusions • Thank you

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