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Hematuria :
Sunil Agrawal
1st year
MD Pediatrics, IOM
Contents:
Introduction
Pathophysiology
Causes
History
Examination
Investigations
Management
Introduction
Hematuria means blood in urine.
It may be Gross or macroscopic and microscopic
hematuria
Gross hematuria is seen by naked eyes while
microscopic hematuria needs microscope.
Hematuria is defined as the presence of at
least 5 red blood cells per HPF of centrifuged
urine and/or 5 RBC per microliter in
uncentrifuged specimen
Pathophysiology:
Structural disruption in the integrity of
glomerular basement membrane caused by
inflammatory or immunologic processes
Toxic disruptions of the renal tubules
Mechanical erosion of mucosal surfaces in
the genitourinary tract
Causes of Hematuria:
A) Glomerular hematuria
No Normal
+Hearing test, +USG, Yearly Urine R/M,
+X-Ray KUB examination, BP
Management:
According to cause:
Reassurance and F/U
Treat cystitis, pyelonephritis, AGN: Antibiotics
Supportive treatment: Diuretics, Fluid and salt
restriction, Antihypertensives
Monitoring BP, I/O, weight, Urine R/M
Treat Hyperkalemia, ARF, CHF, acidosis, fluid
overload, HTN and its complications
ACE inhibitors useful in proteinuria
Immunosuppressive therapy: Depending on cause
(Steroids, cyclophosphamide)
Management:
Idiopathic Hypercalciuria: Hydrochlorothiazide, Potassium
citrate, Sodium restriction
Calculi: Plenty of water
ESRD: Dialysis, Renal transplantation
Correct thrombocytopenia, anemia, coagulation factor
deficiency
Renal vein thrombosis: Anticoagulant therapy or
thrombectomy may be needed
Surgical correction: Calculi, PUJ obstruction, Posterior
urethral valves, Wilms tumour
References:
Nelson Textbook of Pediatrics, 19th Ed
Nelson Essentials of Pediatrics, 6th Ed
O.P. Ghai Essential pediatrics, 7th Ed
Pediatric Nephrology, Shrivastava, Bagga,
4th Ed
Japanese Society of Nephrology 2007
Indian J Pediatrics 1999; 66 : 207-214
Various Websites