Hematuria Flashcards
Causes of red urine (with a U/A negative for heme)
- Food (beets, rhubarb)
- Food dyes
- Antibiotics (rifampin, nitrofurantoin, metronidazole, sulfa)
What does a urine dip positive for blood mean when there are NO RBC’s on microscopy?
- Heme-positive (hemolysis) - free hemoglobin
- Myoglobin positive (ie: rhabdo) - check serum CK
Define hematuria
More than 5 RBC’s on urine microscopy (per microL of urine)
How do you distinguish renal vs. lower urinary system bleeding?
Renal:
- Dark cola urine
- Proteinuria (>1g)
- RBC casts (because RBCs are being deformed as they pass through the glomerulus)
- Deformed RBC on microscopy
Lower urinary (i.e.: pelvic collecting system, ureter, bladder, urethra):
- Bright red urine - LUTS (dysuria, frequency)
- Renal colic
- History of trauma
- Blood clots present
- RBCs are NOT deformed
Classic symptoms of glomerulonephritis:
- Dark urine 2. Oliguria 3. Edema 4. Hypertension
DDx for glomerulonephritis:
- IgA nephropathy (Berger disease) 2. Post-infectious glomerulonephritis 3. Lupus nephritis 4. Henoch-Schonlein purpura (HSP) 5. Hereditary nephritis (Alport Syndrome) 6. Hemolytic uremic syndrome (HUS)
True or False: Hematuria in glomerulonephritis is typically PAINLESS
True
DDx for abdominal mass:
- Tumour (Wilms) 2. Hydronephrosis 3. Polycystic kidney disease 4. Renal vein thrombosis
Hereditary causes of hematuria:
- Hereditary nephritis (Alport syndrome)
- SLE
- Thin glomerular basement membrane disease
- IgA nephropathy
- Atypical (D-) HUS
- Polycystic kidney disease
Genetic disorders associated with hematuria:
- VACTERL association (R = renal)
- Zellweger syndrome (cerebrohepatorenal syndrome)
- Tuberous sclerosis
- von Hippel Lindau syndrome
Classic features of glomerular injury:
- Proteinuria 2. Hematuria 3. Oliguria 4. Hypertension 5. Edema
Post-infectious glomerulonephritis:
- typical onset 10d post infection (usually GAS pharyngitis or impetigo, but also moraxella)
- pathophys is immune-mediated to bacterial proteins trapped in capillaries
- most common in children 2-12 years (M>F)
- sudden onset
- Low C3 only!
- resolves within 6-8 wks (acute phase)
Which type of glomerulonephritis typically has isolated low C3?
Post-infectious GN
Features of hypertensive encephalopathy:
- headache (severe) - altered LOC - seizures - hypertension - blurred vision
When does hematuria resolve in post-infectious GN?
1-2 years!
Diagnosis of post-infectious GN?
- documented recent infection (throat swab, ASOT) - low C3 - classic findings of acute GN
Most likely diagnosis for recurrent painless gross hematuria?
IgA nephropathy
Most common glomerular disease in children?
IgA nephropathy