An office approach to hematuria and proteinuria sciencedirect. You must only pay if you wish to access the post test following the webcast, in order to earn cme credit. Microhematuria is often asymptomatic and has a prevalence of 45% in routine. Hematuria is blood in your urine from an injury or medical condition. The blood can come from two places, either the kidneys or the lower structures such as the ureters, bladder or urethra. Nonglomerular hematuria approach to patients with asymptomatic nonglomerular hematuria. Blood or red blood cells can enter and mix with urine at multiple anatomical sites. Hematuria may originate from the glomeruli, renal tubules and interstitium, or urinary tract including collecting systems, ureters, bladder, and urethra.
Hematuria on a ua should be reported as 0 to 3 rbchpf, 4 to 10 rbchpf, 11 to 25 rbchpf, 26 to 50 rbchpf, 50 rbchpf, or gross hematuria. Microscopic hematuria is defined as presence of three or more red blood cells rbcs per highpower field. Appreciate when consultation with a pediatric nephrologist is necessary. History the evaluation of hematuria should always begin with a detailed history. It can present as macroscopic hematuria or microscopic hematuria due to either glomerular or nonglomerular disorders. Acute hematuria discharge care what you need to know. If you see blood in your urine, you should call your healthcare provider.
Approach to hematuria systemic lupus erythematosus organ. Haematuria is defined as evidence of blood in the urine. Neoplasms are unusual causes of hematuria in children. In contrast, proteinuria is suggestive of kidney disease in patients with diabetes mellitus, hypertension, primary renal disease, or other systemic illnesses. Gross hematuria gross hematuria means that you can see blood with the naked eye because the urine is pink, red, purplishred, brownishred, or teacolored. Symptoms, causes, diagnosis and treatment hematuria, or blood in the urine, can be either gross visible or microscopic blood cells only visible through a microscope. An evidencebased approach to the management of hematuria. Although hematuria is a common finding in the unselected population of children, the approach to evaluation is quite variable. Asymptomatic microscopic hematuria amh, the presence of 3 or more red blood cells on urinalysis in the absence of genitourinary gu symptoms, is highly prevalent, with populationbased studies estimating that up to 40. Approach to hematuria resident teaching rounds steve radke.
Having blood in your urine doesnt always mean you have a medical problem. Approach to diagnosis and management of hematuria springerlink. Clinical presentation and urine microscopy can differentiate glomerular from nonglomerular hematuria. The us and canadian guidelines take a pragmatic approach here. Microscopic hematuria mh, often discovered incidentally, has many causes, including benign processes, kidney disease, and genitourinary malignancy. A practical primary care approach to hematuria in children. Causes of hematuria in children glomerular diseases recurrent gross hematuria iga. Approach to hematuria and proteinuria all webcasts are free to view. Hematuria and proteinuria in children american academy of.
Approach to hematuria and proteinuria webcast details osu. Diagnostic tests and algorithms used in the investigation of haematuria. The summary roc approach models test accuracy, defined. Approach to hematuria free download as powerpoint presentation.
Algorithmic approach to microscopic hematuria in adults. It can be caused by a bleeding disorder or certain medications, or by stones, infection, or tumor. Assessment of microscopic hematuria in adults aafp. Costeffectiveness of common diagnostic approaches for. An 8yearold white girl is referred for evaluation of hematuria, proteinuria, and hypertension. Most adolescents who are diagnosed with proteinuria through screening urinalysis do not have renal disease, and the proteinuria will usually resolve on repeat testing. Microscopic hematuria is a common finding on urine dipstick examination with a prevalence rate between 1% and 2% for two or more positive samples in children from 6 to 15 years of age. The presence of microscopic hematuria has a low predictive value for bladder cancer, even in highrisk elderly patients, and there is currently no evidence that early detection improves prognosis. The causes of hematuria include urinary tract infection uti, bladder or kidney stones, kidney disease, use of certain medications, strenuous exercise, and trauma. Primary care approach to proteinuria american board of. The timing of hematuria in the urinary stream is important.
Changes in the practice of primary care medicine in the united states mandate an approach to common office problems that is practical and realistic. Proteinuria is a common finding in primary care practice. This article will discuss the differential diagnosis of haematuria from a urological perspective, important investigations to determine the cause, and resultant management. The various causes of hematuria in children are listed in table 102. Asymptomatic microscopic hematuria is, on the average, 10fold as prevalent as gross hematuria 1. Obtaining a thorough history and the appropriate diagnostic tests will be discussed in depth.
Microhematuria pdf this document was amended in july 2016 to reflect literature that was released since the original publication of this content in may 2012. Plan a practical and systematic approach to the evaluation of hematuria. Bilirubin or excessive ingestion of carotene or other food pigments can cause discoloration of urine similar to that seen in hematuria. Ppt hematuria powerpoint presentation free to download. The dipstick relies on oxidation of an organic peroxide on the test strip by the peroxidaselike activity of hemoglobin. The clinician, therefore, must decide how intensively to investigate the source of mh and select which tests to order and referrals to make, aiming not to overlook serious conditions while simultaneously avoiding unnecessary tests. Padmaja assistant professor professor and chief dr. Pdf evaluation and management of hematuria researchgate. Downloaded from the american family physician web site at. Approach to a child with hematuria d d authorstream. Vcug voiding cystourethrogram c 3 serum complement concentration. Hematuria is defined as 25 rbcs per hpf in urine microscopy.
In the majority, a good clinical examination and basic investigations including a urine microscopic. It is a common symptom of both benign and malignant conditions. For evaluation of renal disease, us offers an accurate, noninvasive approach to rule. Additional points of emphasis include when to refer to a pediatric nephrologist or. Numerous consensus guidelines from varying societies have outlined preferred imaging pathways for the patient with unexplained urologic causes of hematuria. Review the presentation and differential diagnosis of glomerular hematuria. Hematuria defined as the presence of blood or red blood cells in the urine. The most important test in the evaluation of hematuria is a microscopic examination of the urine.
The red diaper syndrome is caused by serratia marcescens colonization of the gastrointestinal tract. Approach to hematuria kidney urinary tract infection. The first episode occurred a few days after the onset of a uri. Razan haj definition presence of rbc in urine either. Approach to hematuria identify origin of the blood glomerular hematuria nonglomerular hematuria micro or macroscopic micro or macroscopic abnormal morphology normal morphology proteinuria, active sediment isolated finding may be familial check first degree relatives look for hearing loss glomerular hematuriacharacteristics acanthocytes. Approach to hematuria identify origin of the blood glomerular hematuria nonglomerular hematuria micro or macroscopic micro or macroscopic abnormal morphology normal morphology proteinuria, active sediment isolated finding may be familial check first degree relatives look for hearing loss glomerular hematuria characteristics acanthocytes. Some common causes of hematuria are bladder infection, kidney stone, trauma to the kidneys or bladder, and some medications. Hematuria at the start of urination suggests a problem with the distal urethra.
Acute means the problem starts suddenly, worsens quickly, and lasts a short time. Hematuria is one of the alarming manifestations of a renal disease. The blood can come from two places, either the kidneys. An evidencebased approach to the management of hematuria in. Hematuria and proteinuria are common findings in primary care practice. Assessment of asymptomatic microscopic hematuria in adults. Hematuria is when there is an unusual amount of red blood cells in the urine, as a small number of blood cells is considered normal. Hematuria or blood in urine hematuria is blood in the urine. With repeated evaluations, the prevalence of asymptomatic microscopic hematuria decreases to less than 0. The word hematuria comes from the latin heme, for blood and uria for urine.
This is usually undertaken by a combination of clinical examination, cystoscopic evaluation, and urinary tract imaging. Ppt approach to hematuria powerpoint presentation free to. Haematuria is defined as evidence of blood in the urine under microscopy. Microscopic hematuria was present in all of the patients prior to renal biopsy and was. Gross hematuria can vary widely in appearance, from light pink to deep red with clots. Limited evaluation of microscopic hematuria in pediatrics. An organized practical approach for the pediatrician to use in evaluating a child with hematuria or proteinuria emphasizes common conditions and stepwise laboratoryradiologic investigations. The purpose of this article is to describe the current consensus guidelines for nonimaging triage and ultimate preferred imaging approach for the patient with unexplained hematuria. Racgp macroscopic haematuria a urological approach. A practical approach is to determine whether the hematuria is of glomerular or nonglomerular origin. Pdf causes of hematuria can range from benign conditions such as urinary tract infection to serious.
Approach to hematuria welcome to association of physicians of. It may be due to injury to the kidneys, urinary tract, prostate, or genitals. There is consensus that visible haematuria may be a sign of serious underlying disease, including malignancy, and warrants a thorough diagnostic evaluation. Additional points of emphasis include when to refer to a pediatric nephrologist or urologist and when to consider renal biopsy. Although the american academy of pediatrics eliminated routine urine screening from its preventive care guidelines a decade ago, many pediatricians continue to use screening urinalysis ua as part of their health supervision visits. Recognize that hypercalciuria can be symptomatic even in the absence of a kidney stone. An anatomical framework is helpful in developing a comprehensive differential diagnosis.