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Hematuria in Children
Aka: Hematuria in Children, Pediatric Hematuria, Brick-Red Diaper dumping Syndrome- See Also
- Epidemiology: Hematuria Incidence
- Microscopic Hematuria
- Gross Hematuria
- More commonly found in girls
- Overall Incidence: 0.13%
- Definition
- Gross Hematuria
- Pink, red or brown color visible to naked eye
- Confirm by dipstick and sediment exam
- Microscopic Hematuria significant values
- Urine Red Blood Cells: 0.5 - 2.4 Million/day
- Spun urine: 5-10 Red Blood Cells/hpf (50/ul)
- Confirmed on repeat Urinalysis after 1 month
- Gross Hematuria
- Differential Diagnosis of Gross Hematuria
- See Gross Hematuria
- Causes (Mneumonic: ABCDEFGHI)
- Anatomy
- Ureteropelvic junction obstruction
- Renal Cysts (Simple, Polycystic Kidney Disease)
- Vaginal source of bleeding
- Boulders
- Cancer
- Drugs
- Exercise
- Fictitious Causes
- Munchausen's Syndrome
- Betadine contaminant
- Brick-Red Diaper dumping Syndrome
- Salmon-red color on diaper may appear to family as Gross Hematuria
- Diaper absorbant material reacts with urate crystals in concentrated urine to form color
- Benign cause and resolves with hydration
- Familial
- Foreign Body
- Glomerulonephritis
- Post-Streptococcal Glomerulonephritis
- Henoch-Schonlein Purpura (HSP)
- Systemic Lupus Erythematosus (SLE)
- IGA Nephropathy
- Alport's Syndrome
- Hemoglobinopathies (Sickle Cell Anemia)
- Hematologic disorders (Platelet disorders)
- Infection
- Anatomy
-
Family History
-
Renal Failure
- Renal transplant
- Dialysis
- Systemic Lupus Erythematosis
- Familial Heamturia
-
Renal Failure
- History
- Abdominal Pain
- Bloody Diarrhea
- Arthralgias
- Vigorous Exercise
- Jogging
- Biking
- Snow boarding
- Child Abuse history
- Abdominal, back or Flank Pain
- Bruising
- Urinary Tract Infection, cystitis, or Hypercalciuria
- Medications
- Aspirin
- NSAIDs
- Antibiotics
- Methyldopa
- Signs
- Blood Pressure
- Edema
- Skin rash
- Labs: Indicated for persistant Hematuria >1 month
- Repeat Urinalysis
- Urine Culture
- Urine Calcium to Creatinine Ratio (normal <0.2-0.25)
- Collect 24 hour Urine Collection
- Urine Calcium Excretion (normal <4 mg/kg/day)
- Urinalysis of a Family Member
- Chemistry panel (Chem 10)
- Sickle Cell Screen
- Complement level (C3)
- Anti-streptolysin O titer (ASO Titer)
- Antinuclear Antibody (ANA)
- Imaging
- Diagnostic Studies
- Audiogram to assess for Alport's Syndrome
- Shows bilateral Sensorineural Hearing Loss
- Audiogram to assess for Alport's Syndrome
- Referral Criteria
- Concurrent systemic signs
- Elevated Renal Function testing (BUN, Creatinine)
- Coexistant Proteinuria
- Episodes of Gross Hematuria
- Family History
- Glomerulonephritis
- Deafness
- Renal Failure
- Renal Transplant
- Parental anxiety
- Follow-up
- After negative work-up, rescreen urine every 6-12 month
- References