Clinical Evaluation of the Child with Hematuria Flashcards Preview

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Flashcards in Clinical Evaluation of the Child with Hematuria Deck (39)
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1
Q

Hematuria is defined as the presence of at least ___ RBCs per ___ of urine

A

5, uL

2
Q

Normal children can excrete more then ___ RBCs per 12hr period

A

500,000

3
Q

RBC excretion in urine can increase with what activities

A

1) Fever 2) Exercise

4
Q

Significant hematuria is generally considered as

A

> 50 RBCs/uL urine

5
Q

Can cause false-negative hematuria with the use of dipstick

A

1) Formalin 2) High concentrations of ascorbic acid >2000 mg/day

6
Q

Can cause false-positive hematuria with the use of dipstick

A

1) Alkaline urine (pH >8) 2) Contamination with oxidizing agents such as H2O2

7
Q

Amount of urine essential for microscopic analysis to confirm presence of RBCs

A

10-15mL freshly voided and centrifuged

8
Q

Presence of RBC in urine is suggested by presence of how many RBCs

A

> 10 RBCs/uL or a +1 urinary dipstick

9
Q

Clinically significant heme-positive urine without RBCs may be caused by the presence of

A

1) Hemoglobin 2) Myoglobin

10
Q

Upper urinary tract sources of hematuria originate where

A

Within the nephron (glomerulus, tubular system, or insterstitium)

11
Q

Lower urinary tract sources of hematuria originate where

A

Pelvocaliceal system to urethra

12
Q

Hematuria from the glomerulus is often associated with (4)

A

1) Brown, cola- or tea-colored, or burgundy urine 2) Proteinuria >100 mg/dL via dipstick 3) Urinary microscopic findings of RBC casts 4) Deformed urinary RBCs (particularly acanthocytes)

13
Q

Hematuria originating within the tubular system may be associated with the presence of

A

1) Leukocytes 2) Renal tubular casts

14
Q

Lower urinary tract sources of hematuria may be associated with (5)

A

1) Gross hematuria that is bright red or pink 2) Terminal hematuria 3) Blood clots 4) Normal urinary RBC morphology 5) Minimal proteinuria on dipstick

15
Q

T/F Hematuria associated with glomerulonephritis is typically painless

A

T

16
Q

MCC of gross hematuria

A

Bacterial UTI

17
Q

Urethral bleeding in the absence of urine

A

Urethrorrhagia

18
Q

Urethrorrhagia usually occurs in what age group

A

Prepubertal boys

19
Q

T/F Urethrorrhagia has a mild self-limited course

A

T

20
Q

Recurrent episodes of gross hematuria suggest what clinical entities (3)

A

1) IgA nephropathy 2) Alport syndrome 3) Thin GBM disease

21
Q

T/F Asymptomatic patients with isolated gross hematuria should undergo extensive diagnostic evaluation

A

F, such hematuria is often transient and benign

22
Q

Initial evaluation for the child with completely asymptomatic isolated microscopic hematuria that persists on at least 3 urinalyses observed over a minimum of a 2 wk period

A

1) Urine culture 2) Spot urine for hypercalciuria 3) If culture-negative, do calcium:creatinine ratio 4) If African-American, sickle cell screen 5) UA of all first-degree relatives if all of the above are normal

23
Q

Test that is most informative in patients presenting with gross hematuria, abdominal pain, flank pain, or trauma

A

Ultrasonography of the urinary tract

24
Q

Cause of Hematuria: Anemia d/t hypervolemia with dilution

A

ARF

25
Q

Cause of Hematuria: Anemia d/t decreased RBC production

A

CRF

26
Q

Cause of Hematuria: Anemia d/t hemolysis

A

HUS, chronic hemolytic anemia, SLE

27
Q

Cause of Hematuria: Anemia d/t blood loss

A

Pulmonary hemorrhage ( Goodpasture syndrome)

28
Q

Cause of Hematuria: Anemia d/t melena

A

HSP, HUS

29
Q

Cause of hematuria presenting with peripheral blood smear that might reveal a microangiopathic process

A

HUS

30
Q

Cause of hematuria presenting with (+) Coombs’ test, (+) ANA, leukopenia, and multisystem disease

A

SLE

31
Q

T/F Urinary RBC morphology is sensitive enough to unequivocally delineate the site of hematuria

A

F, NOT sensitive enough

32
Q

T/F Coagulation studies should be routinely obtained in all cases of hematuria

A

F

33
Q

A voiding cystourethrogram is indicated for patients with

A

1) UTI 2) Renal scarring 3) Hydroureter 3) Pyelocaliectasis

34
Q

T/F Cystoscopy is an unnecessary and costly procedure in most pediatric patients with hematuria

A

T

35
Q

The diagnosis of “possible urethral stenosis” as an indication for cystoscopy should be viewed with a high degree of suspicion, because

A

True urethral stenosis is quite rare

36
Q

Cystoscopy should be reserved for evaluating the rare child with

A

1) Bladder mass on UTZ 2) Urethral abnormalities caused by trauma, posterior urethral valves, or tumor

37
Q

Finding of unilateral gross hematuria localized by cystoscopy is rare, but it can indicate what

A

A vascular malformation or another anatomic abnormality

38
Q

Surveillance for children with persistent asymptomatic isolated hematuria and a completely normal evaluation

A

BP and urinalysis every 3 months until hematuria resolves

39
Q

Referral to a pediatric nephrologist should be considered for patients with persistent asymptomatic hematuria of what duration

A

Greater than 1 yr