HAEMATURIA

Dr. Shaman Rajindrajith

Causes of Haematuria

• Glomerulour Diseases– Recurrent gross H’urea– Post streptococcal nephritis– Membranous– SLE– HSP– HUS– Goodpasture syndrome

• Infections– UTI– Tuberculosis

Causes of Haematuria Cont…

• Haemtological– Coagulopathies– Thrombocytopaenia

• Others– Hypaercalciuria– Stones– Trauma– PKD– Renal vein

thrombosis– Tumours– Drugs– Exercise

Causes of Dark Colour Urine

• RED– Blood– Haemoglobin– Myoglobin– Porphyrins– Food colourings– Drugs– Urates

• BROWN/BLACK– Blood– Homogentisic acid– Melanin– Methaemoglobim

Evaluation

• History

• Examination

Evaluation

• History– Infections

(Skin/Throat/GI)– Urinary symptoms– Skin rashes– Joint involvement– Drugs– Trauma– Family history

• Examination– Oedema– Rashes– Joints– Renal masses– Genitalia– BP

Investigations• Basic Investigations

– UFR+- Culture– FBC– Renal function– USS abdomen & pelvis

• Others– Evidence of Streptococcal infection– C3 levels– 24 hour urine collection for – protein, creat, Ca– Coagulation screen

• Invasive Procedures– Biopsy– Cystoscopy

Post-Streptococcal Glomerulonephritis

Aetiology• Commonest cause of Nephritic syndrome in

children• Components of Nephritic syndrome

– Haematurea– Oedema– Hypertension– Renal insufficiency

• Lansfield’s Group A Streptococci• Nephritogenic strains

– Serotype 12- Throat infection– Serotype 49- Skin infection– Serotype 4 &25

Pathogenesis

• Precise mechanism is not known

• ? Circulating immune complexes

• ? Complement activation

Pathology

• All glomeruli enlarged

• Diffuse mesangial cell proliferation

• PMN infiltration

• Crescents formation

• Immuno-histochemistry– Deposition of C3 & Ig

Clinical Picture

• Antecedent Streptococcal infection 1-3 wk• Peri-orbital oedema• Low urine output• Red colour urine• Lethargy• Flank pain• Mild temperature

Investigations

• Urine microscopy– Red cells– Granular casts– White cells– Protein

• Renal functions– Electrolytes– Urea/Creatinine

• Evidence of Strep. Infection– ASOT– Anti Dnase B

• Immunological– Low C3

Management• Monitoring

– Temperature chart– Daily weight– BP– Intake –output chart– Daily urine protein

• Antibiotics– Oral penicillin for 10 days

• Investigations• Control Blood pressure• Other aspects

– ? Restriction of activity

Complications

• Acute Renal Failure

• Hypertensive Encephalopathy

• Pulmonary Oedema

Management of Complications

• Acute Renal Failure– Fluid restriction– Protein restriction– Monitoring– Electrolyte balance– Dialysis

• Encephalopathy– Intensive care– Control BP– Sedatives/

anticonvulsants

Prognosis

• Complete recovery > 95%

• May progress to ‘crescent nephritis’

• Haematurea may persist for 1-2 years

• Recurrences – extremely rare

Other Causes of Glomerulonephritis

• Membranous

• SLE nephritis

• Mesangiocapillary nephritis

• Goodpasture Syndrome

• Haemolytic- Uraemic syndrome

Crescent Nephritis

• Rapidly progress to renal failure

• Crescents in glomeruli

• Aetiology– Post-streptococcal– SLE– HSP– Vasculitic syndromes