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Sydney Child Health Program > 2.1 Haematuria And Proteinuria > Flashcards

2.1 Haematuria And Proteinuria Flashcards

1
Q

What causes dark brown or black urine?

A

Blood
Bile pigment
Methaemoglobinaemia

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2
Q

What foods or drugs can cause red or pink urine?

A

Beetroot
Chloroquine
Blackberries

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3
Q

Definition of haematuria?

A

> 5rbc/UK in uncentrifuged MSU

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4
Q

Causes of bleeding from upper tract leading to haematuria?

A 
Glomeruli
Glormerulonephritis, 
HUS
Alport’s
RVT
Ruptured cyst
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5
Q

Causes of lower tract bleeding leading to haematuria?

A 
UTI
Stone
Trauma
Chemical cystitis
Malingnancy

Menstrual
Fictitious

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6
Q

What causes macroscopic haematuria?

A

UTI
Post-infectious GN
Hypercalcinuria/Stones
IgA nephropathy

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7
Q

Causes of microscopic haematuria?

A

> 50% benign familial haematuria = thin basement membrane disease

  • IgA, Lupus,
  • Hypercalciuria
  • alport’s
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8
Q

Most common primary Glomerulonephritis?

A

Post-infectious

Membraneoproliferative

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9
Q

Most common secondary glomerulonephritis?

A

Lupus
Henoch-Schloien Purpura
ANCA
Polyarteritis nodosa

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10
Q

How to treat haematuria for most patients?

A

No treatment

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11
Q

How to treat acute nephritis?

A

Fluid restriction
Salt restriction
Diuretics
Anti-hypertensives

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12
Q

How to treat renal stones/hypercalciuria?

A

Low sodium diet

Increased fluids

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13
Q

What confirms an upper tract haemauria cause?

A

Dysmorphic RBCs
RBC casts
Proteinuria

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14
Q

What features are suggestive of acute GN?

A

Recent URTI

Or impetigo

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15
Q

Most common glomerulonephritis? How does it work?

A 
Post-strep
Immune complexes in Basement Membrane
Complement
Damage: haem/proteinurea
Oliguria
Oaedema/hypertension
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16
Q

How long does micro haematuria last in post-strep GN?

A

Up to a year

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17
Q

How to treat post-strep GN?

A

Treat the fluid overload and hypertension.

Diurectics, sodium restriction +/-hypertensive

Loop diuretic + Ca2+ blocker

Antibiotics to prevent strep spread

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18
Q

What is a common complication of post-strep GN?

A

Hyperkalaemia

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19
Q

When does gross haematuria resolve by in post-strep GN?

A

1-3 weeks

20
Q

When does proteinuria resolve by in post-strep GN?

A

6-8 weeks

21
Q

Proteinuria in urine of children common?

A

Yes, usu. benign

22
Q

What is the glomerular barrier? 3 layers

A

Fenestrated endothelium
Basement membrane
Podocytes + slit diaphragms

23
Q

How does the glomerular barrier prevent proteins from passing through?

A

Size selective
Electrostatic

Filtered
Reabsorbed in proximal tubule

24
Q

How to do get proteinuria? 2 main mechanisms

A
  • Increased size/charge of basement membrane

- impaired reabsorption of filtered proteins

25
Q

How to measure for proteinuria?

A

Urine dipstick

26
Q

When is proteinuria abnormal on urine dipstick?

A

If more than +1

27
Q

Dipsticks and proteinuria false positives most common?

A

If pH >8
Left in urine too long
Haematuria
On penicillins

28
Q

How to investigate proteinuria?

A

Urinary protein:creatinine ratio

29
Q

How much protein is normally excreted in 24 hours?

A

<150mg

30
Q

What is the normal urine:creatinine ratio? And for infants?

A

<0.02g/mmol

Infants <2: 0.06g/mmol

31
Q

What are intermittent causes of proteinuria?

A 
Fever
Exercise
Stress
Orthostatic
Cold exposure
32
Q

What are glomerular causes of proteinuria?

A

Primary GN
Secondary GM
HUS, DM, reflux

33
Q

3 causes of proteinuria?

A

Intermittent
Glomerular
Tubular

34
Q

What makes proteinuria more significant?

A

Associated haematuria
Heavy losses: >1g/L
Hypertension
Family hx

35
Q

Diagnostic evaluation of asymptomatic children with proteinuria? 2 main things

A
  1. Repeat urinalysis (early morning urine)

2. Rule out orthostatic proteinuria

36
Q

When is proteinuria benign?

A 
If orthostatic/transient, 
Asymptomatic
No haematuria
Normal GFR
Normal blood pressure
37
Q

How to follow up patient with minor persistent abnormality?

A

Annual urinanalysis
Annual blood pressure
Annual, UECs

38
Q

What do you do in children’s with isolated microscopic haematuria or low grade proteinuria?

A

Repeat urine several times over >3/12 if they are well
BEFORE referring

Record BP

Check early morning urine

Send urine for dysmorphic red cells

39
Q

What is nephrotic syndrome?

A

Oedema
Proteinuria
Hypoalbuminaemia
Hypercholesterolaemia

40
Q

nephrotic syndrome, treatment and response?

A

> 80% respond to steroids

41
Q

How many will relapse in nephrotic syndrome?

A

70-80% relapse

42
Q

What is a systemic cause of secondary cause of nephrotic syndrome?

A

SLE

HSP

43
Q

What infections cause of secondary cause of nephrotic syndrome?

A

Hep B
Hep C
Malaria
Schistosomiasis

44
Q

What drugs cause of secondary cause of nephrotic syndrome?

A 
NSAIDS
ACEi
Heroin
Pamidronate
Penicillamine
45
Q

How to treat first presentation of Nephrotic Syndrome?

A

Pred 2mg/kg for 6/52
Then
1.5mg/kg alternate days for 6/52
STOP

46
Q

How to treat relapses in Nephrotic Syndrome?

A

Pred 2mg/kg until protein free for 3 consecutive days
THEN
1.5mg/kg weaning over 6 weeks

47
Q

What infections are you more susceptible in Nephrotic Syndrome?

A

Pneumococcus and HiB

Because losing so much protein

Sydney Child Health Program (113 decks)

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