Hematuria By Dr. Nadeem Khawer

HEMATURIA
Nadeem Khawar
Definition
lGross
lBlood in the urine visible to the naked eye

lMicroscopic
lMore than 5 RBCs / hpf on a centrifuged urine
Imposters of Hematuria
lHeme Positive
lHemoglobinuria
lMyoglobinuria
lHeme Negative
lFoods (beets,berries,dyes)
lDrugs (rifampicin,metronidazole)
Causes
ü UTI
ü Glomerulonephritis
ü Stones
ü Trauma
ü Anatomic
ü Coagulopathies
ü Vascular
ü Exercise
ü Drugs
ü Factitious
Evaluation
lHistory
ü Gross / Microscopic
ü Symptomatic / Asymptomatic
ü Upper / Lower urinary tract

ü Onset / Number of episodes
ü Family history
ü Drugs


lExamination
ü General
ü Blood pressure
ü Abdomen
ü Renal punch (gentle!)
lPhysical examination of the kidneys
lBy Urinalysis
–Blood,protein,pus cells,casts,crystals
Gross Hematuria
Symptomatic
1. Stones
2. UTI
3. HSP
Asymptomatic
1. Glomerulonephritis
2. Coagulopathies
3. Anatomic
i. Investigation
Ø Carried out on the basis of history and examination findings
Ø Urine examination in every case
i. RBC morphology points to upper or lower urinary tract origin
ii. Protienurea points to glomerular or tubular origin
iii. Casts suggests nephritis
iv. Pus cells suggests UTI
v. Crystals suggests stones
Ø Urine Tests
Ø Microscopy

Ø Culture

Ø 24 hour urine
i. Protein
ii. calcium
Ø Blood Tests
i. Full blood count
ii. Urea / Creatinine
iii. ASO titer
iv. Coagulation profile
v. Calcium
vi. C3 level
vii. ANF

§ Renal Imaging
§ Ultrasound
a. (stones 84% vs. plain film 54%)
§ IVP
§ DTPA
§ MCUG

§ Renal biopsy
Acute Poststreptococcal Glomerulonephritis
Ø Second most common glomerular cause of gross hematuria
Ø Group A beta hemolytic streptococci-nephritogenic strains
o Throat or skin infections
Ø Immune complex mediated


Clinical Features
o Classic example of acute nephritic syndrome
o Most common age: 5 – 12 years
o Onset
o Throat infection:1-2 weeks
o Skin infection: 3-6 weeks
o Clinical course
§ Mild asymptomatic hematuria to acute renal failure
o Duration: upto 8 weeks



Investigations
A. Throat swab
B. FBC
C. Rising antibody titer: ASO (throat) , Dnase B (skin)
D. C3 level
E. Renal function
F. Urinalysis
Management
lTreat renal failure
lTreat Hypertension
lPenicillin 10 days
lTreat family members with antibiotic if throat culture positive

lThank You