hematuria at

A CLOSER LOOK AT A CLOSER LOOK AT HEMATURIAHEMATURIA

A CLOSER LOOK AT A CLOSER LOOK AT HEMATURIAHEMATURIA

Agnes A. Alarilla-Alba, MDAgnes A. Alarilla-Alba, MDAgnes A. Alarilla-Alba, MDAgnes A. Alarilla-Alba, MD

Good MorningGood MorningGood MorningGood Morning

A Closer Look at HematuriaA Closer Look at Hematuria A Closer Look at HematuriaA Closer Look at Hematuria

Aims:Aims: Give the status of hematuria and associatedGive the status of hematuria and associated

disease entities with hematuria in the Philippinesdisease entities with hematuria in the Philippines

Give the basic definition , clinical measurements in the Give the basic definition , clinical measurements in the detection and prognostication of hematuriadetection and prognostication of hematuria

Aims:Aims: Give the status of hematuria and associatedGive the status of hematuria and associated

disease entities with hematuria in the Philippinesdisease entities with hematuria in the Philippines

Give the basic definition , clinical measurements in the Give the basic definition , clinical measurements in the detection and prognostication of hematuriadetection and prognostication of hematuria

HematuriaHematuriaHematuriaHematuria

Aims:Aims: Discuss the causes and significance of Discuss the causes and significance of

hematuriahematuria

To provide the latest approach in the To provide the latest approach in the

evaluation of children with hematuriaevaluation of children with hematuria

Aims:Aims: Discuss the causes and significance of Discuss the causes and significance of

hematuriahematuria

To provide the latest approach in the To provide the latest approach in the

evaluation of children with hematuriaevaluation of children with hematuria

Status of Hematuria in the Status of Hematuria in the PhilippinesPhilippinesStatus of Hematuria in the Status of Hematuria in the PhilippinesPhilippines

Screening of Filipino School ChildrenScreening of Filipino School Children

5.7 M children5.7 M children

The Total Prevalence of Dipstick Abnormality The Total Prevalence of Dipstick Abnormality

23.97%23.97%

Screening of Filipino School ChildrenScreening of Filipino School Children

5.7 M children5.7 M children

The Total Prevalence of Dipstick Abnormality The Total Prevalence of Dipstick Abnormality

23.97%23.97%


Prevalence Rate of Hematuria using Prevalence Rate of Hematuria using the Dipstick Method the Dipstick Method (mainly hematuria )(mainly hematuria )

5%5%

Prevalence Rate of Hematuria using Prevalence Rate of Hematuria using the Dipstick Method the Dipstick Method (mainly hematuria )(mainly hematuria )

5%5%


PARADE DATAPARADE DATA:

5-15%5-15%Repeated Tests done (4X)Repeated Tests done (4X)

1.5%1.5% had hematuria had hematuria

PARADE DATAPARADE DATA:

5-15%5-15%Repeated Tests done (4X)Repeated Tests done (4X)

1.5%1.5% had hematuria had hematuria

Most common alarming symptom to Most common alarming symptom to

signal the presence of HEMATURIA signal the presence of HEMATURIA

is highly colored urineis highly colored urine

Most common alarming symptom to Most common alarming symptom to

signal the presence of HEMATURIA signal the presence of HEMATURIA

is highly colored urineis highly colored urine

s

Common causes of DARK URINECommon causes of DARK URINECommon causes of DARK URINECommon causes of DARK URINE

DrugsDrugs

RifampicinRifampicin NitrofurantoinNitrofurantoin

FurazolidoneFurazolidone MetronidazoleMetronidazole

SulfaSulfa PhenazopyridinePhenazopyridine

PyridiumPyridium MethyldopaMethyldopa

DrugsDrugs

RifampicinRifampicin NitrofurantoinNitrofurantoin

FurazolidoneFurazolidone MetronidazoleMetronidazole

SulfaSulfa PhenazopyridinePhenazopyridine

PyridiumPyridium MethyldopaMethyldopa

Common causes of DARK URINECommon causes of DARK URINECommon causes of DARK URINECommon causes of DARK URINE

Other CausesOther Causes

Hemoglobin- hemolysisHemoglobin- hemolysis

MyoglobinMyoglobin BeetsBeets

BerriesBerries UratesUrates

Serratia MarcesensSerratia Marcesens AlkaptonuriaAlkaptonuria

BilirubinBilirubin

Other CausesOther Causes

Hemoglobin- hemolysisHemoglobin- hemolysis

MyoglobinMyoglobin BeetsBeets

BerriesBerries UratesUrates

Serratia MarcesensSerratia Marcesens AlkaptonuriaAlkaptonuria

BilirubinBilirubin


If highly suspicious:May do DIPSTICK testIf highly suspicious:May do DIPSTICK test However take note of false positive results However take note of false positive results

which is seen in myoglobin and hemoglobinwhich is seen in myoglobin and hemoglobin

TO CONFIRMTO CONFIRM microscopic analysismicroscopic analysis of the urine of the urine

is warrantedis warranted

If highly suspicious:May do DIPSTICK testIf highly suspicious:May do DIPSTICK test However take note of false positive results However take note of false positive results

which is seen in myoglobin and hemoglobinwhich is seen in myoglobin and hemoglobin

TO CONFIRMTO CONFIRM microscopic analysismicroscopic analysis of the urine of the urine

is warrantedis warranted

Diagnostic Test for HematuriaDiagnostic Test for HematuriaDiagnostic Test for HematuriaDiagnostic Test for Hematuria


Definition Among ChildrenDefinition Among Children Presence of five or more red blood cells per Presence of five or more red blood cells per

high powerfield in three consecutive centrifuged high powerfield in three consecutive centrifuged specimens at least one week apartspecimens at least one week apart

Definition Among ChildrenDefinition Among Children Presence of five or more red blood cells per Presence of five or more red blood cells per

high powerfield in three consecutive centrifuged high powerfield in three consecutive centrifuged specimens at least one week apartspecimens at least one week apart


Characterize:Characterize:

Gross vs MicroscopicGross vs Microscopic

Symptomatic vs no symptomsSymptomatic vs no symptoms

Transient vs persistentTransient vs persistent

Isolated or with associationIsolated or with association

Characterize:Characterize:

Gross vs MicroscopicGross vs Microscopic

Symptomatic vs no symptomsSymptomatic vs no symptoms

Transient vs persistentTransient vs persistent

Isolated or with associationIsolated or with association

Causes of HematuriaCauses of Hematuria Causes of HematuriaCauses of Hematuria

Glomerular: brown colored, RBC casts and Glomerular: brown colored, RBC casts and

dysmorphic RBC and proteinuriadysmorphic RBC and proteinuria

Non Glomerular: reddish or pink urine, Non Glomerular: reddish or pink urine,

passage of blood clots and eumorphic passage of blood clots and eumorphic

red blood cellsred blood cells

Glomerular: brown colored, RBC casts and Glomerular: brown colored, RBC casts and

dysmorphic RBC and proteinuriadysmorphic RBC and proteinuria

Non Glomerular: reddish or pink urine, Non Glomerular: reddish or pink urine,

passage of blood clots and eumorphic passage of blood clots and eumorphic

red blood cellsred blood cells

Glomerular Hematuria:Glomerular Hematuria:

Thin Basement MembraneThin Basement Membrane

Alport SyndromeAlport Syndrome IgA NephropathyIgA Nephropathy

HUS/HSPHUS/HSP

Post infectious GNPost infectious GN

MPGNMPGN

SLE SLE

Glomerular Hematuria:Glomerular Hematuria:

Thin Basement MembraneThin Basement Membrane

Alport SyndromeAlport Syndrome IgA NephropathyIgA Nephropathy

HUS/HSPHUS/HSP

Post infectious GNPost infectious GN

MPGNMPGN

SLE SLE

b

Glomerular HematuriaGlomerular HematuriaGlomerular HematuriaGlomerular Hematuria

Isolated Renal Disease (recurrent gross Isolated Renal Disease (recurrent gross hematuria)hematuria)

IgA nephropathy (Berger disease) IgA nephropathy (Berger disease) Alport syndrome (hereditary nephritis) Alport syndrome (hereditary nephritis) Thin glomerular basement membrane Thin glomerular basement membrane

nephropathy nephropathy

Isolated Renal Disease (recurrent gross Isolated Renal Disease (recurrent gross hematuria)hematuria)

IgA nephropathy (Berger disease) IgA nephropathy (Berger disease) Alport syndrome (hereditary nephritis) Alport syndrome (hereditary nephritis) Thin glomerular basement membrane Thin glomerular basement membrane

nephropathy nephropathy


Isolated Renal DiseaseIsolated Renal Disease Postinfectious GNPostinfectious GN Membranous Membranous Membranoproliferative GNMembranoproliferative GN FSGS FSGS

Isolated Renal DiseaseIsolated Renal Disease Postinfectious GNPostinfectious GN Membranous Membranous Membranoproliferative GNMembranoproliferative GN FSGS FSGS


Multisystemic Renal DiseaseMultisystemic Renal Disease Systemic lupus erythematosus nephritisSystemic lupus erythematosus nephritis[[

Henoch-Schönlein purpura Henoch-Schönlein purpura Hemolytic Uremic SydromeHemolytic Uremic Sydrome Polyarteritis nodosa Polyarteritis nodosa

Multisystemic Renal DiseaseMultisystemic Renal Disease Systemic lupus erythematosus nephritisSystemic lupus erythematosus nephritis[[

Henoch-Schönlein purpura Henoch-Schönlein purpura Hemolytic Uremic SydromeHemolytic Uremic Sydrome Polyarteritis nodosa Polyarteritis nodosa

Glomerular HematuriaGlomerular HematuriaGlomerular HematuriaGlomerular Hematuria Polyarteritis nodosa Polyarteritis nodosa Goodpasture syndrome Goodpasture syndrome Sickle cell glomerulopathy Sickle cell glomerulopathy HIV nephropathyHIV nephropathy

Polyarteritis nodosa Polyarteritis nodosa Goodpasture syndrome Goodpasture syndrome Sickle cell glomerulopathy Sickle cell glomerulopathy HIV nephropathyHIV nephropathy

Non Glomerular Hematuria:Non Glomerular Hematuria:

FEVERFEVER

Strenuous exerciseStrenuous exercise Mechanical Trauma ( masturbation)Mechanical Trauma ( masturbation)

MenstruationMenstruation

Foreign BodiesForeign Bodies

UTIUTI


FEVERFEVER

Strenuous exerciseStrenuous exercise Mechanical Trauma ( masturbation)Mechanical Trauma ( masturbation)

MenstruationMenstruation

Foreign BodiesForeign Bodies

UTIUTI

b


FEVER:FEVER:

1.1. non pathological cause of non pathological cause of hematuriahematuria

2.2. Repeat urinalysis 48 hours after Repeat urinalysis 48 hours after lysis of feverlysis of fever


FEVER:FEVER:


2.2. Repeat urinalysis 48 hours after Repeat urinalysis 48 hours after lysis of feverlysis of fever

b


FEVER/Strenuous Exercise:FEVER/Strenuous Exercise:


2.2. Repeat urinalysis 48 hours after Repeat urinalysis 48 hours after lysis of fever or strenous exerciselysis of fever or strenous exercise


FEVER/Strenuous Exercise:FEVER/Strenuous Exercise:


2.2. Repeat urinalysis 48 hours after Repeat urinalysis 48 hours after lysis of fever or strenous exerciselysis of fever or strenous exercise

b

Non Glomerular Hematuria:Non Glomerular Hematuria: Hypercalciuria/ urolithiasisHypercalciuria/ urolithiasis

1.1. About 30% with isolated hematuria have About 30% with isolated hematuria have elevated urinary calcium levelselevated urinary calcium levels

2.2. Oral thiazides for one month is the usual Oral thiazides for one month is the usual therapytherapy

3.3. Urolithiasis: will warrant Ca: crea ratio or 24 Urolithiasis: will warrant Ca: crea ratio or 24 hr calcium excretion: stone analysis is hr calcium excretion: stone analysis is warrantedwarranted

Non Glomerular Hematuria:Non Glomerular Hematuria: Hypercalciuria/ urolithiasisHypercalciuria/ urolithiasis

1.1. About 30% with isolated hematuria have About 30% with isolated hematuria have elevated urinary calcium levelselevated urinary calcium levels

2.2. Oral thiazides for one month is the usual Oral thiazides for one month is the usual therapytherapy

3.3. Urolithiasis: will warrant Ca: crea ratio or 24 Urolithiasis: will warrant Ca: crea ratio or 24 hr calcium excretion: stone analysis is hr calcium excretion: stone analysis is warrantedwarranted

b

Ig A Nephropathy ( glomerular) Ig A Nephropathy ( glomerular) Ig A Nephropathy ( glomerular) Ig A Nephropathy ( glomerular)

Most Common cause of chronic glomerular Most Common cause of chronic glomerular disease in the world.disease in the world.

Painless intermittent gross hematuria followed Painless intermittent gross hematuria followed by persistent hematuriaby persistent hematuria

Usually benign but may progress to ESRD in Usually benign but may progress to ESRD in 20-30%.20-30%.

Diagnosis: by biopsy onlyDiagnosis: by biopsy only No definite treatment strategy but FISH OIL No definite treatment strategy but FISH OIL

may helpmay help

Most Common cause of chronic glomerular Most Common cause of chronic glomerular disease in the world.disease in the world.

Painless intermittent gross hematuria followed Painless intermittent gross hematuria followed by persistent hematuriaby persistent hematuria

Usually benign but may progress to ESRD in Usually benign but may progress to ESRD in 20-30%.20-30%.

Diagnosis: by biopsy onlyDiagnosis: by biopsy only No definite treatment strategy but FISH OIL No definite treatment strategy but FISH OIL

may helpmay help

b

Alport SyndromeAlport SyndromeAlport SyndromeAlport Syndrome

Triad of persistent Triad of persistent hematuria, deafness, hematuria, deafness, eye abnormalityeye abnormality

MalesMales ESRD ESRD Sex linked dominantSex linked dominant Transplantation-> good Transplantation-> good

prognosisprognosis

Triad of persistent Triad of persistent hematuria, deafness, hematuria, deafness, eye abnormalityeye abnormality

MalesMales ESRD ESRD Sex linked dominantSex linked dominant Transplantation-> good Transplantation-> good

prognosisprognosis

Hemolytic Uremic SyndromeHemolytic Uremic SyndromeHemolytic Uremic SyndromeHemolytic Uremic Syndrome

Most common cause of acute renal failureMost common cause of acute renal failure Thrombocytopenic microangiopathic Thrombocytopenic microangiopathic

hemolytic anemia and renal failurehemolytic anemia and renal failure Usually preceeded by bloody diarrheaUsually preceeded by bloody diarrhea Note of microscopic hematuriaNote of microscopic hematuria Treatment is supportiveTreatment is supportive

Most common cause of acute renal failureMost common cause of acute renal failure Thrombocytopenic microangiopathic Thrombocytopenic microangiopathic

hemolytic anemia and renal failurehemolytic anemia and renal failure Usually preceeded by bloody diarrheaUsually preceeded by bloody diarrhea Note of microscopic hematuriaNote of microscopic hematuria Treatment is supportiveTreatment is supportive

Henoch Schoenlein PurpuraHenoch Schoenlein PurpuraHenoch Schoenlein PurpuraHenoch Schoenlein Purpura

Glomerular Hematuria:Glomerular Hematuria: Similar pathophysio with IgA Similar pathophysio with IgA

butmore prominent vasculitisbutmore prominent vasculitis Peaks at 4-5 yrs/M>FPeaks at 4-5 yrs/M>F Abdominal pain, arthritis and Abdominal pain, arthritis and

purpura_. Prognosis is renal purpura_. Prognosis is renal involvementinvolvement

No specific treatmentNo specific treatment

Glomerular Hematuria:Glomerular Hematuria: Similar pathophysio with IgA Similar pathophysio with IgA

butmore prominent vasculitisbutmore prominent vasculitis Peaks at 4-5 yrs/M>FPeaks at 4-5 yrs/M>F Abdominal pain, arthritis and Abdominal pain, arthritis and

purpura_. Prognosis is renal purpura_. Prognosis is renal involvementinvolvement

No specific treatmentNo specific treatment

Henoch Schoenlein PurpuraHenoch Schoenlein PurpuraHenoch Schoenlein PurpuraHenoch Schoenlein Purpura

Needed to evaluate the extent of renal involvement Needed to evaluate the extent of renal involvement

because it prognosticatesbecause it prognosticates

Renal involvement may be none, as hypertension, Renal involvement may be none, as hypertension,

active glomerulonephritis, nephrotic syndrome, acute active glomerulonephritis, nephrotic syndrome, acute

renal failurerenal failure

2% long term renal impairment2% long term renal impairment

Needed to evaluate the extent of renal involvement Needed to evaluate the extent of renal involvement

because it prognosticatesbecause it prognosticates

Renal involvement may be none, as hypertension, Renal involvement may be none, as hypertension,

active glomerulonephritis, nephrotic syndrome, acute active glomerulonephritis, nephrotic syndrome, acute

renal failurerenal failure

2% long term renal impairment2% long term renal impairment

Acute Post Infectious Acute Post Infectious GlomeulonephritisGlomeulonephritisAcute Post Infectious Acute Post Infectious GlomeulonephritisGlomeulonephritis

Presents with acute onset of EDEMA or tea Presents with acute onset of EDEMA or tea colored urine( 33%)colored urine( 33%)

History of antecedent infection or impetigoHistory of antecedent infection or impetigo May have elevated BPMay have elevated BP Labs: C3 depressed, dilutional anemia, ASO if Labs: C3 depressed, dilutional anemia, ASO if

strep induced , BUN and creastrep induced , BUN and crea If it does not follow course of AGNRPGN

Presents with acute onset of EDEMA or tea Presents with acute onset of EDEMA or tea colored urine( 33%)colored urine( 33%)

History of antecedent infection or impetigoHistory of antecedent infection or impetigo May have elevated BPMay have elevated BP Labs: C3 depressed, dilutional anemia, ASO if Labs: C3 depressed, dilutional anemia, ASO if

strep induced , BUN and creastrep induced , BUN and crea If it does not follow course of AGNRPGN

Throat infectionThroat infection

Streptococcus

Skin infectionSkin infection

LATENT PERIOD

Ag-Ab Reaction

or

1-2 wks 3-6 wks

Serotype 12Serotype 12 Serotype 49

PATHOGENESIS OF APSGN

Antigen-IgG-C3 Complex

Infiltration of inflammatory cells &

proliferation of glomerular cells & matrix expansion

basement membrane permeability

glomerular filtration surface

GFR

Na & water retention

Clinical signs & symptoms

PATHOPHYSIOLOGY

Systemic Lupus ErythematosusSystemic Lupus ErythematosusSystemic Lupus ErythematosusSystemic Lupus Erythematosus

4 out of 11 criteria4 out of 11 criteria Prognostication is Prognostication is

dependent on renal dependent on renal involvementinvolvement

With depressed C3With depressed C3 Five classesFive classes

4 out of 11 criteria4 out of 11 criteria Prognostication is Prognostication is

dependent on renal dependent on renal involvementinvolvement

With depressed C3With depressed C3 Five classesFive classes

UTIUTIUTIUTI

includes cystitis, pyelonephrittis and urethritisincludes cystitis, pyelonephrittis and urethritis Dysuria,nocturia, urinary frequency,fever, Dysuria,nocturia, urinary frequency,fever,

abdominal painabdominal pain Urinalysis/ urine culture and sensitivityUrinalysis/ urine culture and sensitivity If culture is negative but signs and symptoms If culture is negative but signs and symptoms

are highly suggestiveare highly suggestive adenovirus usual cause adenovirus usual cause of hemorrhagic cystitisof hemorrhagic cystitis

includes cystitis, pyelonephrittis and urethritisincludes cystitis, pyelonephrittis and urethritis Dysuria,nocturia, urinary frequency,fever, Dysuria,nocturia, urinary frequency,fever,

abdominal painabdominal pain Urinalysis/ urine culture and sensitivityUrinalysis/ urine culture and sensitivity If culture is negative but signs and symptoms If culture is negative but signs and symptoms

are highly suggestiveare highly suggestive adenovirus usual cause adenovirus usual cause of hemorrhagic cystitisof hemorrhagic cystitis

Renal StonesRenal StonesRenal StonesRenal Stones

Renal colic, abdominal pain, recurrent UTIRenal colic, abdominal pain, recurrent UTI Strong family historyStrong family history Get calcium to crea ratioGet calcium to crea ratiohigh if Calcium high if Calcium

stone but if not consider other etiologystone but if not consider other etiology Stone Burden dictates the management if Stone Burden dictates the management if

single stone with size of less than 3 mm in single stone with size of less than 3 mm in the distal ureter it will spontaneously passthe distal ureter it will spontaneously pass

adults= 5mmadults= 5mm

Renal colic, abdominal pain, recurrent UTIRenal colic, abdominal pain, recurrent UTI Strong family historyStrong family history Get calcium to crea ratioGet calcium to crea ratiohigh if Calcium high if Calcium

stone but if not consider other etiologystone but if not consider other etiology Stone Burden dictates the management if Stone Burden dictates the management if

single stone with size of less than 3 mm in single stone with size of less than 3 mm in the distal ureter it will spontaneously passthe distal ureter it will spontaneously pass

adults= 5mmadults= 5mm

Evaluation of HematuriaEvaluation of HematuriaEvaluation of HematuriaEvaluation of Hematuria

History and Physical ExaminationHistory and Physical Examination

Laboratory Work UP: dependent on index of suspicionLaboratory Work UP: dependent on index of suspicion

Urinalysis/ urine culture- urine dipstick may be employedUrinalysis/ urine culture- urine dipstick may be employed

Microscopic analysis Microscopic analysis RBC of > 5 is abnormal, look for RBC of > 5 is abnormal, look for

castscasts

U

History and Physical ExaminationHistory and Physical Examination

Laboratory Work UP: dependent on index of suspicionLaboratory Work UP: dependent on index of suspicion

Urinalysis/ urine culture- urine dipstick may be employedUrinalysis/ urine culture- urine dipstick may be employed

Microscopic analysis Microscopic analysis RBC of > 5 is abnormal, look for RBC of > 5 is abnormal, look for

castscasts

U


Phase Contrast Microscopy:Phase Contrast Microscopy:

detect dysmorphic RBCdetect dysmorphic RBC

Sensitivity of 83-95% and specificity of 81-95%Sensitivity of 83-95% and specificity of 81-95%

BUN and Creatinine- renal etiologyBUN and Creatinine- renal etiology

Hematologic and coagulation studiesHematologic and coagulation studies

Phase Contrast Microscopy:Phase Contrast Microscopy:

detect dysmorphic RBCdetect dysmorphic RBC

Sensitivity of 83-95% and specificity of 81-95%Sensitivity of 83-95% and specificity of 81-95%

BUN and Creatinine- renal etiologyBUN and Creatinine- renal etiology

Hematologic and coagulation studiesHematologic and coagulation studies


Urine Calcium: Hypercalciuria is common: check 24 hr Urine Calcium: Hypercalciuria is common: check 24 hr

urine calcium excretion urine calcium excretion

( Ca excretion of greater than 4mg/kg/d)( Ca excretion of greater than 4mg/kg/d)

or spot urine calcium- creatinine ratio of greater than or spot urine calcium- creatinine ratio of greater than

0.21 is abnormal0.21 is abnormal

Serologic Testing: high ASO, Anti DNASE, ANA dsDNASerologic Testing: high ASO, Anti DNASE, ANA dsDNA

Urine Calcium: Hypercalciuria is common: check 24 hr Urine Calcium: Hypercalciuria is common: check 24 hr

urine calcium excretion urine calcium excretion

( Ca excretion of greater than 4mg/kg/d)( Ca excretion of greater than 4mg/kg/d)

or spot urine calcium- creatinine ratio of greater than or spot urine calcium- creatinine ratio of greater than

0.21 is abnormal0.21 is abnormal

Serologic Testing: high ASO, Anti DNASE, ANA dsDNASerologic Testing: high ASO, Anti DNASE, ANA dsDNA


Imaging Studies:Imaging Studies:

Renal and bladder UltrasoundRenal and bladder Ultrasound

Ct ScanCt Scan

Procedures: Renal BiopsyProcedures: Renal Biopsy

rarely indicated in isolated asyptomatic rarely indicated in isolated asyptomatic

hematuriahematuria

Imaging Studies:Imaging Studies:

Renal and bladder UltrasoundRenal and bladder Ultrasound

Ct ScanCt Scan

Procedures: Renal BiopsyProcedures: Renal Biopsy

rarely indicated in isolated asyptomatic rarely indicated in isolated asyptomatic

hematuriahematuria


Relative Indications for Renal Biopsy:Relative Indications for Renal Biopsy:

1.1. Significant proteinuriaSignificant proteinuria

2.2. Abnormal renal functionAbnormal renal function

3.3. Recurrent persistent hematuriaRecurrent persistent hematuria

4.4. Serologic abnormalitiesSerologic abnormalities

5.5. Recurrent gross hematuriaRecurrent gross hematuria

6.6. Family history of end stage renal diseaseFamily history of end stage renal disease

Relative Indications for Renal Biopsy:Relative Indications for Renal Biopsy:

1.1. Significant proteinuriaSignificant proteinuria

2.2. Abnormal renal functionAbnormal renal function

3.3. Recurrent persistent hematuriaRecurrent persistent hematuria

4.4. Serologic abnormalitiesSerologic abnormalities

5.5. Recurrent gross hematuriaRecurrent gross hematuria

6.6. Family history of end stage renal diseaseFamily history of end stage renal disease

TreatmentTreatmentTreatmentTreatment

Medical Care: asymptomatic (Isolated) Medical Care: asymptomatic (Isolated) hematuria does not require treatmenthematuria does not require treatment

Surgical Care:in cases of obstructive Surgical Care:in cases of obstructive lesions and urolithiasislesions and urolithiasis

Diet:modification in hypertensive patientsDiet:modification in hypertensive patients Activity: norestriction in asyptomatic, Activity: norestriction in asyptomatic,

isolated hematuriasisolated hematurias

Medical Care: asymptomatic (Isolated) Medical Care: asymptomatic (Isolated) hematuria does not require treatmenthematuria does not require treatment

Surgical Care:in cases of obstructive Surgical Care:in cases of obstructive lesions and urolithiasislesions and urolithiasis

Diet:modification in hypertensive patientsDiet:modification in hypertensive patients Activity: norestriction in asyptomatic, Activity: norestriction in asyptomatic,

isolated hematuriasisolated hematurias

FOLLOW- UPFOLLOW- UPFOLLOW- UPFOLLOW- UP

If with persistent miroscopic hematuria If with persistent miroscopic hematuria monitored at 6 to 12months to wtch out monitored at 6 to 12months to wtch out for signs and symptoms of progressive for signs and symptoms of progressive disease like proteinuria, hypertension and disease like proteinuria, hypertension and decrease renal functiondecrease renal function

Depends on etiology of hematuriaDepends on etiology of hematuria

If with persistent miroscopic hematuria If with persistent miroscopic hematuria monitored at 6 to 12months to wtch out monitored at 6 to 12months to wtch out for signs and symptoms of progressive for signs and symptoms of progressive disease like proteinuria, hypertension and disease like proteinuria, hypertension and decrease renal functiondecrease renal function

Depends on etiology of hematuriaDepends on etiology of hematuria

Usual Questions:Usual Questions:Usual Questions:Usual Questions:

1.1. A kidney Biopsy is essential in the evaluation A kidney Biopsy is essential in the evaluation of asymptomatic hematuria. T/Fof asymptomatic hematuria. T/F

2.2. Pyelonephritis is a common cause of gross Pyelonephritis is a common cause of gross hematuria in children and adolescents. T/Fhematuria in children and adolescents. T/F

3.3. Microscopic evaluation of the urinary Microscopic evaluation of the urinary sediment for the presence of RBC is indicated sediment for the presence of RBC is indicated in cases of hematuria even if fdipstick is in cases of hematuria even if fdipstick is positivepositive

1.1. A kidney Biopsy is essential in the evaluation A kidney Biopsy is essential in the evaluation of asymptomatic hematuria. T/Fof asymptomatic hematuria. T/F

2.2. Pyelonephritis is a common cause of gross Pyelonephritis is a common cause of gross hematuria in children and adolescents. T/Fhematuria in children and adolescents. T/F

3.3. Microscopic evaluation of the urinary Microscopic evaluation of the urinary sediment for the presence of RBC is indicated sediment for the presence of RBC is indicated in cases of hematuria even if fdipstick is in cases of hematuria even if fdipstick is positivepositive

GlomerulusGlomerulusGlomerulusGlomerulus

Pathologic HematuriaPathologic HematuriaPathologic HematuriaPathologic Hematuria

Membrano Proliferative GNMembrano Proliferative GNMembrano Proliferative GNMembrano Proliferative GN

Thank YouThank YouThank YouThank You

My Happiness!!!My Happiness!!!My Happiness!!!My Happiness!!!

hematuria at

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