Heamaturia

Dr.Badi AlEnazi

Consultant pediatric endocrinologest and diabetologest

• Haematuria may occur as an isolated symptom or as part of a systemic disorder.

• It may be visible to the naked eye (frank or macroscopic haematuria) or be detected only on microscopic analysis of the urine.

• The source of the blood may be anywhere from glomerulus to urethra

• most cases in childhood are due to UTI or primary glomerular disease.

DDx

• Urinary tract infection (UTI).• Glomerulonephritis (post-streptococcal,

Henoch-Schonlein purpura, familial).• IgA nephropathy.• Acute haemorrhagic cystitis. Viral

(adenovirus 11 and 21).• drugs (cyclophosphamide).• Calculus.

DDX

• Trauma.• Exercise-induced. Usually after severe

exercise and• resolves within 48 hours.• Tumours. Wilms’ tumour (uncommon

presentation),• bladder tumours (rare in children).

DDX

• Subacute bacterial endocarditis.

• Infections, e.g. tuberculosis, schistosomiasis.

• Coagulopathies.

• Sickle cell disease. Sickling within the renal medulla leads to local papillary infarcts.

DDX

• Renal vein thrombosis. Gross haematuria and palpable renal mass in a newborn infant.

• Factitious haematuria. As part of the Munchausen by proxy spectrum

Clinical Features

• The urine is usually pink or brown in colour because of the presence of the oxidized haem pigment.

• In post-streptococcal GMN the urine is often described as smoky.

Clinical Features

• If the urine is bright red with or without clots then a lower urinary tract source should be suspected.

• Haematuria may be an isolated finding or be associated with symptoms of a systemicdisorder, e.g. Henoch-Schbnlein purpura (rash, joint pains).

Clinical Features

• Hypertension and oliguria are features of acute GMN.

• Frequency and dysuria suggest a UTI which may be accompanied by microscopic haematuria, but presentation with frank haematuria is rare.

Clinical Features

• Loin pain or renal colic suggests the presence of a calculus.

• SBE, sickle cell disease and coagulation disorders are infrequent cause

Clinical Features

• ther causes of dark urine should be excluded:

• Bile pigments.

• Haemoglobinuria, myoglobinuria.

• Foods, e.g. beetroot.

• Drugs, e.g. rifampicin.

• Urate crystals may appear pink in the nappy of young infants

• Urinary dipsticks are very sensitive and are therefore not very reliable.

• They are also positive for myoglobin and

free haemoglobin

Urine microscopy

• should always be performed to confirm

• the presence of red cells (a fresh specimen is important since red cells lyse on standing).

• The presence of red cell casts indicates an intrarenal cause (either glomerular or tubular)

Urine microscopy

• Glomerular casts indicate a glomerular cause.

• Pyuria and bacteriuria point to an infective cause which should be confirmed by culture.

• Urine culture will confirm a bacterial infection.

• CBC and coagulation tests. To

exclude coagulopathies and sickle cell disease.

acute nephritis

• Causes of acute nephritis : Post-infectious (including streptococcus)

• Vasculitis (Henoch-Schönlein purpura or, rarely, SLE, Wegener's granulomatosis, microscopic polyarteritis, polyarteritis nodosa)

• IgA nephropathy and mesangiocapillary glomerulonephritis

• Anti-glomerular basement membrane disease (Goodpasture's syndrome) - very rare

acute nephritis

• Acute nephritis in childhood usually follows a streptococcal sore throat or skin infection. Streptococcal nephritis is a common condition in the developing world

• In acute nephritis, increased glomerular cellularity restricts glomerular blood flow and therefore filtration is decreased. This leads to: decreased urine output and volume overload

• hypertension, which may cause seizures • oedema, characteristically around the eyes • haematuria and proteinuria.

• .

acute nephritis

• Management is by attention to both water and electrolyte balance and the use of diuretics when necessary. Rarely, there may be a rapid deterioration in renal function (rapidly progressive glomerulonephritis). This may occur with any cause of acute nephritis, but is uncommon when the cause is post-streptococcal. If left untreated, irreversible renal failure may occur over weeks or months, so renal biopsy and treatment with immunosuppression and plasma exchange should be undertaken promptly