Kamal Akl MD Professor of Pediatrics amp Pediatric Nephrology Objectives Red urine is not always hematuria Hematuria is not always renal Focused Hx Focused PE Focused Labs amp imaging Focused management ID: 998687
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1. Approach to red urine in childrenKamal Akl MDProfessor of Pediatrics & Pediatric Nephrology
2. ObjectivesRed urine is not always hematuriaHematuria is not always renalFocused Hx Focused PE Focused Labs & imaging- Focused management
3. Examples of Urine Color
4. Causes of red urineFoodMedicationsOthers
5. HematuriaMicroscopicMacroscopicDefinition of Microhematuria
6. Reagent Strips
7. Urine Dipstick
8. Causes of hematuria in JordanUTI------------------------------- Around 1/3rd Glomerulopathy-------------- Around 1/3rd Crystals & Stones -------------Around 1/3rd Rest: Miscellaneous
9. Causes of Hematuria in ChildrenUpper Urinary Tract vs LowerGlomerular bleeding vs Nonglomerular
10. Glomerular hematuriaColorPresence of proteinuriaRBC morphologyRBC casts
11.
12. RBC Cast
13. HematuriaPainlessPainfull
14. HematuriaImportance of Medical & Diet HistoryImportance of Family History
15. Medical HistoryLower vs upper urinary tract symptomsDietary IntakeSkin rash History of URTI Trauma/ ExerciseMedication intakeGeographyPrevalent conditions in the community
16. HematuriaPersistent microPersistent micro + ProteinuriaIntermittent macroPersistent micro OR Intemittent Macro
17. Alport SyndromeHematuriaSensorineural DeafnessRenal FailureMay diagnose by skin biopsy instead of renal biopsy Look for Epidermal staining for collagen IV
18. Dietary HistoryVery ImportantWater intakeFor Hyperuricosuria Not only importance of purine intake such as red meatBUT: Fructose intake
19. Diet HistoryExamples: Hematuria after Mansaf : Hyperuricosuria(HU) BBQ : HU Mulukhia: Oxalate Tomatoes: Oxalate Sweetened Beverages: HU
20. Family HistoryConsanguinitySimilar casesDeafnessESRFFamilial HematuriaStonesGout
21. Importance of PEComplete PE + Focused on the conditionCheck BP; edemaEvidence of systemic disease eg Rash
22. Presentations of Glomerular DiseaseAsymptomatic Urinary AbnormalitiesHypertensionAcute Kidney InjuryChronic Kidney DiseaseNephrotic SyndromeRapidly Progressive Glomerulonephritis
23. Focused LabDepends on Medical HistoryDiet HxFamily Hx
24. Focused InvestigationsBased on Hx & PE
25. Focused ManagementDepends on Medical HxDiet HxFamily HxLabs: Note treat the patient not the lab
26. ConclusionsThank you