Clinical Evaluation of the Child with Hematuria Flashcards Preview

Nelson - Nephrology > Clinical Evaluation of the Child with Hematuria > Flashcards

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

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

5, uL

2

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

500,000

3

RBC excretion in urine can increase with what activities

1) Fever 2) Exercise

4

Significant hematuria is generally considered as

>50 RBCs/uL urine

5

Can cause false-negative hematuria with the use of dipstick

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

6

Can cause false-positive hematuria with the use of dipstick

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

7

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

10-15mL freshly voided and centrifuged

8

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

>10 RBCs/uL or a +1 urinary dipstick

9

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

1) Hemoglobin 2) Myoglobin

10

Upper urinary tract sources of hematuria originate where

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

11

Lower urinary tract sources of hematuria originate where

Pelvocaliceal system to urethra

12

Hematuria from the glomerulus is often associated with (4)

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

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

1) Leukocytes 2) Renal tubular casts

14

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

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

T/F Hematuria associated with glomerulonephritis is typically painless

T

16

MCC of gross hematuria

Bacterial UTI

17

Urethral bleeding in the absence of urine

Urethrorrhagia

18

Urethrorrhagia usually occurs in what age group

Prepubertal boys

19

T/F Urethrorrhagia has a mild self-limited course

T

20

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

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

21

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

F, such hematuria is often transient and benign

22

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

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

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

Ultrasonography of the urinary tract

24

Cause of Hematuria: Anemia d/t hypervolemia with dilution

ARF

25

Cause of Hematuria: Anemia d/t decreased RBC production

CRF

26

Cause of Hematuria: Anemia d/t hemolysis

HUS, chronic hemolytic anemia, SLE

27

Cause of Hematuria: Anemia d/t blood loss

Pulmonary hemorrhage ( Goodpasture syndrome)

28

Cause of Hematuria: Anemia d/t melena

HSP, HUS

29

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

HUS

30

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

SLE

31

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

F, NOT sensitive enough

32

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

F

33

A voiding cystourethrogram is indicated for patients with

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

34

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

T

35

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

True urethral stenosis is quite rare

36

Cystoscopy should be reserved for evaluating the rare child with

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

37

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

A vascular malformation or another anatomic abnormality

38

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

BP and urinalysis every 3 months until hematuria resolves

39

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

Greater than 1 yr