Case 6 - change in urine colour

Question 1

What should you do with any urine that is red in colour and +ve for Hb on dip?

Answer 1

• send for microscopy
• Can confirm haematuria - >10 RBCs/field

Question 2

Causes of haematuria - glomerular

Answer 2

Acute nephritis:
* Post infectious (inc streptococcal)
* Vasculitis - HSP, SLE, Wegeners
* IgA nephropathy
* Basement membrane disease eg Goodpastures
* Familial - Alports

Question 3

Non glomerular causes of haematuria

Answer 3

• Infection
• Trauma - genitalia, urinary tract, kidneys
• Stones
• Tumours - nephroblastoma
• Hypercalcuria
• Sickle cell
• Renal vein thrombosis
• Bleeding disorders

Question 4

When is glomerular haematuria suggested?

Answer 4

• Rusty/cola colour - deformed red cells as they pass through BM
• Painless
• Oliguria + HTN

Question 5

When is non-glomerular haematuria suggested?

Answer 5

• Red/cranberry colour
• Painful (but can be painless)

Question 6

Urine microscopy glomerular vs non-glomerular haematuria

Answer 6

Glomerular:
* Small and dysmorphic RBC
* Red cell casts
* Spikes/blebs on RBC
* Loss of RBC circumferential halo

Non glomerular:
* Monomorphic
* No casts
* No spikes
* RBC circumferential halo present

Question 7

Most common cause glomerulonephritis UK

Answer 7

• Post infectious glomerulonephritis
• Usually due to streptococcal infection (pharyngitis, cellulitis, impetigo) up to 3-4 weeks earlier

Question 8

Test most likely to suggest recent strep infection for ?PIGN

Answer 8

• ASOT - anti-streptolysin titre
• Anti-DNAse B titre

Question 9

Clues to causes of glomerulonephritis

Answer 9

• FH haematuria - benign familial haematuria
• Deafness - Alport syndrome
• Strep infection 2 weeks prior - post streptococcal
• Concurrent URTI - IgA nephropathy
• Previous gastroenteritis - haemolytic uraemic syndrome
• Palpable purpuric rash buttocks - Henoch Schonlein purpura
• Photosensitive rash, joint pain - SLE

Question 10

Haematuria + abdominal pain - which differentials to consider

Answer 10

• Henoch schonlein purpura - IgA vasculitis, AI, precipitated by infections/vaccines. Rash + joint pain too
• Kidney stones
• UTI

Question 11

Define CKD

Answer 11

Any one of the following for >3 months:
* Structural abnormalities seen on imaging
* Functional abnormalities seen within kidney eg urea/creatinine
* Abnormal eGFR (<60)

Question 12

Complications of CKD

Answer 12

• Anaemia
• Electrolytes abnormal = metabolic acidosis + low Na+ and high K+
• CV disease - dyslipidaemia, HTN
• Growth impairement - GH metabolism
• Bleeding tendency - increased urea

Question 13

Management nephritis

Answer 13

• Supportive often
• If oedema, HTN - antihypertensivs, diuretics (as long as IV is not deplete)
• Low sodium
• IgA nephropathy - steroids ca be used