Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam...
-
Upload
gervais-fisher -
Category
Documents
-
view
213 -
download
0
Transcript of Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam...
![Page 1: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/1.jpg)
Paediatrics 4 Microteaching:Haematuria in children
Zara GallVictoria Hopkinson
Shahid Islam(Previous presentation by Satish Maddenini and Lynsey McHugh)
September 2011
![Page 2: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/2.jpg)
MCQs
1) Macroscopic haematuria is more common than microscopic haematuria in children
2) Around half of children with macroscopic haematuria will have a UTI
3) Red coloured urine can be caused by food colouring
4) Absence of RBC casts on urine microscopy excludes glomerulonephritis as the cause of haematuria
5) Cystoscopy is a first line investigation of non-glomerular haematuria in children
![Page 3: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/3.jpg)
Causes of haematuria in children
• Frank (visible) haematuria• Causes most concern but often benign and usually short lived• Uncommon – 1:1000 visits to doctor• Around 50% will have UTI
• Microscopic (non-visible) haematuria • Prevalence of around 1.5% in children and adolesents• Thus more common, but often more difficult to define
Causes of urine mimicking haematuria:
Dipstick (heme) positive:Haemoglobinuria, myoglobinuria, bacterial peroxidases, povidone, hypochlorite
Dipstick negative, red urine:Drugs (nitrofurantoin, salicylates), foods (beetroot, food colouring), metabolites
(porphyrin)
![Page 4: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/4.jpg)
Causes of haematuria in children
• Microscopy positive for Eumorphic cells:
• Hypercalcuria• Present in approx 30% of children with noninfected urine
with non-glomerular haematuria• Nephrolithiasis• Nephrocalcinosis• UTI• Trauma• Exercise• Cystic kidney disease• Tumour• Haemangioma
![Page 5: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/5.jpg)
Causes of haematuria in children
Microscopy positive for Dysmorphic RBC/RBC casts
• Proteinuria present• Poststreptococcal GN (early)• IgA nephropathy• Alport syndrome• HSP• Haemolytic uraemic syndrome• Membranoproliferative GN• Focal segmental GN• Diffuse proliferative GN• SLE• Sickle cell disease or trait• Hep B-associated GN
• Proteinuria not present• Family history of haematuria
• Alport syndrome (if FH of hearing loss/renal failure)
• Thin basement membrane disease
• Sickle cell disease or trait• No FH of haematuria
• IgA nephropathy• Poststreptococcal GN
(late)
![Page 6: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/6.jpg)
Investigations
• Thorough history, examination (inc. BP check) and family history• Presence of haematuria must be confirmed by both dipstick and
microscopic evaluation• Microscopy particularly important
• Are RBC present?• RBC casts?• Dysmorphic RBC?
• Hallmark of glomerular bleeding has been RBC casts +/- proteinuria• But many children with glomerular or renal parenchymal disease have
neither RBC casts nor proteinuria• One study showed that if 10% RBC show dysmorphism, diagnosis
is GN with 94% specificity and 92% sensitivity
![Page 7: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/7.jpg)
Investigations
No RBC casts/dysmorphic RBC
• Investigate further if
• Micro haematuria >5 RBC/hpf in 2 out of 3 urinalyses in asymptomatic child, or in single sample in symptomatic child
• Macroscopic haematuria
• Investigations directed towards finding non-glomerular or urological cause of haematuria
• Urine culture
• Renal USS
• Other Ix depending on the results of these – eg DMSA, MCUG
• And if these are normal
• Cystoscopy
• Esp if macroscopic haematuria
RBC casts/dysmorphic RBC present• ?proteinuria present
• Spot albumin/creatinine ratio• Abnormal if >10mg/mmol in children
• Proteinuria confirmed• Refer to a nephrologist for Ix such as:
albumin, cholesterol, FBC, U+E, C3, C4, ASO, ANCA etc
• No proteinuria• Repeat urine microscopy 3 times over
2 months• If negative reassure• If positive
• Sickle prep • USS• Screen for hypercalcuria
If tests negative and haematuria persists
• Refer to nephrologist
![Page 8: Paediatrics 4 Microteaching: Haematuria in children Zara Gall Victoria Hopkinson Shahid Islam (Previous presentation by Satish Maddenini and Lynsey McHugh)](https://reader036.fdocuments.net/reader036/viewer/2022070418/5697c00d1a28abf838cc9724/html5/thumbnails/8.jpg)
MCQs
1) Macroscopic haematuria is more common than microscopic haematuria in children F
2) Around half of children with macroscopic haematuria will have a UTI T
3) Red coloured urine can be caused by food colouring T
4) Absence of RBC casts on urine microscopy excludes glomerulnephritis as the cause of haematuria F
5) Cystoscopy is a first line investigation of non-glomerular haematuria in children F