Microscopic Hematuria-How To Approach
Microscopic Hematuria-How To Approach
Microscopic Hematuria-How To Approach
HOW TO APPROACH?
Presentation:
Cause of hematuria
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Introduction:
Microscopic hematuria
Detected by dipstick & confirmed by microscopy
Initial determination based on examination from a
freshly voided, clean-catch urine
No consensus to define microscopic hematuria
Microscopic hematuria:
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Case 1:
Transient Hematuria :
Exercise
Febrile disorders
Gastroenteritis with dehydration
Contamination from external genitalia
Trauma
Drugs
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Transient Vs Persistent Hematuria:
Look for
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Hints:To differentiate glomerular from
non_glomerular
History
Physical examination
Urinalysis
Laboratory Testing
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Common causes - Glomerular hematuria
MPGN Hemolytic-uremic
syndrome
FSGS
Case 2:
10 years old girl presented with h/o vomiting for 3 days , her
family physician has prescribed a medication. She also gives h/o
intake of native medicines for past one year. She notices red urine
for 2 days which was painless and decreased urine output.
Further evaluvation shows:
Mild edema, B.P – 130/ 80 mm Hg, S.Cr – 2.8 mg/dL, S.K – 5.9
mEq/L Urinalyses: Albumin – 2+, pus cells- 10 – 12, RBC – field full
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HISTORY:
Glomerular causes Non Glomerular causes
PHYSICAL EXAMINATION:
Hypertension Normotension
Edema Costovertebral angle tenderness
Rash Suprapubic pain
Arthritis Signs of Trauma
Pallor
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Case 3:
6 years old Mast. K was brought to the OPD with c/o passing
red urine. Urinalysis shows dysmorphic RBCs
When do we call as significant glomerular hematuria ?
URINALYSIS:
GLOMERULAR CAUSES NON GLOMERULAR CAUSES
Brown, Tea or Cola – colouerd Bright red urine
urine Proteinuria +/_
Proteinuria >2+ No red blood cell casts
Red blood cell casts Positive nitrates or Leukocyte
> 20 % dysmorphic RBC s
esterase
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LABORATORY TESTING :
CATEGORISATION OF
MICROHEMATURIA FOR
CLINICAL APPORACH
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Three categories of microhematuria
have been proposed:
Red urine
Urinalysis No RBCs
≥5 RBCs/hpf Pigmenturia
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Hematuria
Confirm presence of blood in urine
Exclude:
-Menorrhagia,endometriosis,hematospermia
--Strenous physical exercise
Urinalysis --Fabricated or induced illness (by proxy)
Glomerular Non-Glomerular
hematuria hematuria
Investigations
Serum:Creatinine,C3,C4,ASOT /ADB,albumin
Urine protein(upcr 24h collection)
Case :4
12 years old boy presented with h/o passing cola coloured urine
which was painless. Mother has also found that the child has
been having similar complaints for the past 2 yrs following each
episode of RTI . She also gives h/o similar complaints in
maternal uncle.
What is the possible diagnosis you would think ?
a) RSD.
b) IgA Nephropathy
c) Thin basement membrane & disease
d) PIGN
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Further Evaluation:
How do we proceed ?
S. Creatinine - 0.7 mg/dl
S. Electrolytes – Normal
S. Albumin – 3.6g/ dL
S. Cholesterol – 180 mg/dl
S. C3 - Normal
Urine albumin - 2 +
Pus cells – 2 to 3
RBC – Field full
Renal biopsy - Shows IgA deposits in Mesangial matrix
Investigations:
Renal biopsy:
Indications -
Significant proteinuria (3+ or more) or nephrotic
syndrome
Gross hematuria >4wks (Microscopic >2yrs)
Abnormal renal function, Persistent HTN
Low C3 level persist beyond 12 weeks.
Serologic abnormalities (abnormal ANA or dsDNA
levels)
A family history of end stage renal disease or evidence
of Chronic renal disease
Systemic disease with significant proteinuria
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Case :5
Investigations :
Urinalysis
Albumin 1+
Pus cell 6-8/hpf
RBC plenty
Normal RFT
Ultrasound abdomen
LK 7.6cm. A calculus measuring 6 mm in the left renal calyx
RK 7.8cm. Two calculus measuring 3 & 5 mm in right renal
calyx
Bilateral normal renal echoes
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Diagnosis
Summary
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Management:
According to cause:
Reassurance and F/U
Treat cystitis, pyelonephritis, AGN: As per protocol
Supportive treatment: Diuretics, Fluid and salt
restriction, Antihypertensives
Monitoring – BP, I/O, weight, Urine R/M
Treat Hyperkalemia, AKI, CHF, acidosis, fluid overload,
HTN and its complications
ACE inhibitors useful in proteinuria
Immunosuppressive therapy: Depending on cause
Management:
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TAKE HOME MESSAGE
Asymtomatic Microscopic Hematuria in children is rarely associated
with clinically important renal disease.
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