Paeds: Haematuria Flashcards Preview

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Flashcards in Paeds: Haematuria Deck (47):
1

Presentation

- Episode of marcoscopic haematuria (causes alarm to child/family)
- Incidental finding
- Family screening and routine urinalysis

2

Other causes of ‘red urine’:

- Haemoglobinuria/myoglobinuria.
- Foods – colouring (e.g. beetroot)
- Drugs (e.g. rifampicin)
- Urate crystals (in young infants, usually ‘pink’ nappies).
- External source (e.g. menstrual blood losses).
- Fictitious –consider if no cause found.

3

Causes of haematuria:

Non-glomerular or glomerular

4

Non-glomerular

- Infection (bacterial, viral, TB, schistomiasis)
- Trauma to genitalia, urinary tract or kidneys
- Stones
- Tumours
- Sickle cell disease
- Bleeding disorders
- Renal vein thrombosis
Hypercalciuria

5

Glomerular

- Acute glomerulonephritis (usually with proteinuria)
- Chronic glomerulonephritis (usually with proteinuria)
- IgA nephropathy, Henoch-Schonlein purpura, SLE
- Familial nephritis e.g. Alport syndrome, thin basement membrane
Thin basement membrane disease

6

Other way to differentiate the causes

Urinary tract infections
Glomerular
Urinary tract stones
Trauma
Other renal tract pathology
Vascular
Haematological
Drugs
Exercise-induced

7

Urinary tract infections

Bacterial
Viral (e.g. adenovirus in outbreaks);
Schistosomiasis (hx of foreign travel)
TB

8

Glomerular

- Postinfectious glomerulonephritis
- Henoch-Schonlein purpura IgA nephropathy, SLE
Hereditary – thin basement membrane, Alport’s syndrome

9

Urinary tract stones

E.g. due to hypercalciuria

10

Other renal tract pathology

- Renal tract tumour
Polycystic kidney disease

11

Vascular

- Renal vein thrombosis
Arteritis

12

Haematological

Coagulopathy/sickle cell disease

13

Drugs

Cyclophosphamide

14

Hx

UTI
Renal stones:
Glomerular
Coagulopathy
Trauma
Family Hx

15

UTI symptoms

fever/freqeuncy/dysuria

16

Renal stones:

colicky abdominal pain

17

Glomerular

Sore throat/rashes

18

Coagulopathy

Easy bruising

19

Family Hx

Haematuria
Deafness (Alport’s)
Sickle cell disease

20

Brown urine:

Glomerular haematuria – often accompanied with proteinuria

21

Red urine:

Lower urinary tract haematuria – beginning or end of stream, no proteinuria –Unusual in children!

22

Examination:

- BP
- Abdomen: palpable masses
- Skin: rashes
- Joints: pain/swelling

23

Investigations:

During acute illness: exclude UTI by urine culture.

***Asymptomatic or ‘benign haematuria’ in children without growth failure, hypertension, oedema, proteinuria, urinary casts or renal impairment is a frequent finding.

24

Investigation list

Urine
Bloods
US urinary tract
Urinalysis of parents (hereditary causes).
Cystoscopy; rarely indicated in children

25

Urine

- Microscopy (look for cats –suggestive of nephritis) and culture;
- Protein excretion: creatinine ratio (normal,

26

Bloods

- U&E/creatinine/albumin,
- FBC/clotting
- Complement – C3/C4, ASOT titres;
ANA/anti-dsDNA

27

ASOT titres

help determine whether a recent strep infection with group A Streptococcus:
• Is the cause of a person's or glomerulonephritis, a form of kidney disease
• Caused rheumatic fever in a person with signs and symptoms

28

Treatment:

- If obvious cause (e.g. UTI) treat
- Complex diagnosis (impaired renal function, proteinuria, or family Hx) refer to paediatric nephrology unit

29

When do you monitor until it resolves

- If no cause found and normal renal function, BP, and no proteinuria monitor until resolves

30

If no resolution after 6 months or change in any of above parameters

refer

31

Post-streptococcl and post-infectious nephritis:
Description

Usually follows a streptococcal sore throat or skin infection

32

Post-streptococcl and post-infectious nephritis: Diagnosis

Evidence of a recent streptococcal infection
Culture of the organism
Raised ASO/anti-DNAse B titres
Low Complement C3 levels (return to normal after 3-4 weeks)

33

Post-streptococcl and post-infectious nephritis: Epi

Common in developing countries

34

Post-streptococcl and post-infectious nephritis: Prognosis

Good

35

Henoch-Schnolein purpura: Signs and Symptoms

- Preceded by URTI
- Characteristic skin rash
- Arthralgia
- Peri-articular oedema
- Abdominal pain
Glomerulonephritis

36

Henoch-Schnolein purpura:
Aetiology

- Between the ages of 3 and 10 years
- 2:1 boys:girls
Peaks during winter months

37

Henoch-Schnolein purpura:
Presentation

Increase in circulating IgA and IgG interact to produce complexes that activate complement and are dposited in affected organs, precipitating an inflammatory response with vasculitis.

38

Henoch-Schnolein purpura: Presentation

Rash
- Buttocks
- Extensor surfaces of legs and arms
- Ankles
Joint pain and swelling: knees and ankles
Abdominal pain:
- Haematemesis and melaena (gastrointestinal petechiae)
- Intussusception
Renal
- Microscopic/macroscopic haematuria (80%)
Nephrotic syndrome (rare)

39

Henoch-Schnolein purpura:
Rash type

Initially uticarial, rapidly becoming maculopapular and purpuric.
Characteristically palpable and may recur over several weeks.

40

Henoch-Schnolein purpura: Rare complications

Ileus
Protein-losing enteropathy
Orchitis
Occasionally CNS involvement

41

Henoch-Schnolein purpura: Prognosis

Children without risk factors for progressive renal disease make a full recovery

42

Henoch-Schnolein purpura:
Risk factors for progressive disease

Heavy proteinuria
Oedema
Hypertension
Deteriorating renal function

43

Henoch-Schnolein purpura:
Treatment

Severe cases can be treated with corticosteroids

44

Vasculitis: Causes

Henoch-schlonein purpura
Renal involvement in:
- Polyarteritis nodosa
- Microscopic polyarteritis
Wegener gramulomatosis

45

Vasculitis: Characteristic symptoms

Fever
Malaise
Weight-loss
Skin rash
Arthropathy with prominent involvement of the respiratory tract in Wegener disease

46

Vasculitis: Diagnosis

- ANCA are present and diagnostic in these disease
Renal arteriography, to demonstrate the presence pf aneurysms, will diagnose polyarteritis nodosa

47

Vasculitis:
Treatment

Steroids
Plasma exchange
IV cyclophosphamide

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