HEMATURIA and PROTEINURIA (Pediatrics )

HEMATURIA   Asymptomatic Microscopic Hematuria 5% of school aged children on single test but < 1% on repeated testing ...

HEMATURIA

 

Asymptomatic Microscopic Hematuria

1. 5% of school aged children on single test but < 1% on repeated testing
2. usually found on routine screening
3. 5-10 RBCs per hpf of centrifuged urine; dipsticks are very sensitive
4. but have a high false positive rate
5. benign recurrent hematuria in 2/3 of cases
   • sporadic or familial
   • no associated proteinuria

 

Gross Hematuria

o upper urinary tract source

• cola/tea-coloured urine, casts, proteinuria, dysmorphic RBC's,associated symptoms (i.e. edema, azotemia, HTN)

o lower urinary tract source

• bright red urine, initial and terminal stream hematuria, clots, normal RBC morphology, < 2+ proteinuria, no casts

o very large renal bleeding can look like a lower urinary tract bleed

PROTEINURIA

 

1. definition: qualitative: 1+ on dilute, 2+ on concentrated urine (specific gravity>1.015); quantitative: 4mg/kg/h on timed urine (>40 mg/kg/hr is nephrotic range)
2. transient: due to fever, dehydration, exercise, seizures, stress
3. persistent
   • orthostatic (more common in adolescents)
   • increased plasma protein concentration
   • glomerular (e.g. nephrotic syndrome, glomerulonephritis)
   • tubulointerstitial (e.g. Fanconi's syndrome, ATN)
   • structural abnormalities of urinary tract (e.g. hydronephrosis)