Hematuria

Dipstick (+) Heme with RBCs on microscopy

Gross

Microscopic

(+) Trauma

(-) Trauma

Eumorphic RBCs

Dysmorphic RBCs

(+) Pain

(-) Pain Urine Ca/Cr R/O meatal stenosis Family screening

Imaging of abdomen/pelvis (helical CT, RUS, KUB) Cystoscopy

Urine Ca/Cr Urine culture Imaging for stone (RUS, CT)

Urine Ca/Cr Evaluate for familial nephritis Evaluate for HSP Hb electrophoresis if indicated

Evaluate for proteinuria Electrolytes, BUN, Cr, albumin C3, C4, ANA Streptococcal Abs ANCA CBC Evaluate for HSP and other vasculitides

Algorithm for evaluation of hematuria. ANA antinuclear antibody, ANCA antineutrophil cytoplasmic antibody, Abs antibodies, BUN blood urea nitrogen, C complement, Ca calcium, CBCcomplete blood count, Cr creatinine, CT computedtomography scan, HSP Henoch-Schonlein purpura, Hb hemoglobin, KUB kidneyureter-bladder radiograph, RBC red blood cell, R/O rule out, RUS renal ultrasonography

Alur tatalaksana BAK merah SMF Anak RSUP Fatmawati

BAK MERAH Eritrosit (-) Pigmenturia Eritrosit 5/LPB Dipstick (+) Heme

Gross

HEMATURIA
Trauma (-) GLOMERULUS Edema Ruam Hipertensi Silinder eritrosit Proteinuria +2 Dysmorphic RBCs Darah: Ureum, kreatinin, elektrolit, ASTO, C3, Protein total, albumin, kolesterol Urin: ratio Ca/Kr Urin: ratio Ca/Cr Evaluasi familial nephritis Evaluasi HSP Hb electrophoresis bila perlu

Mikroskopik NON-GLOMERULUS Disuria Demam Silinder eritrosit (-) Eumorphic RBCs Nitrit (+)

Trauma (+)

Nyeri (+)

nyeri (-)

Darah: Ureum, kreatinin, Kalsium Urin: Kultur, Ratio Ca/Kr, Ca 24 jam USG Ginjal

Urin : ratio Ca/Cr Kultur urin USG, CT scan

Ya

Pemeriksaan sesuai GNAPI

Terapi GNAPI Pencitraan abdomen/pelvis (helical CT, BNO, USG ginjal) Cystoscopy

Tidak

Penyebab belum jelas

Nefrolitiasis Hidronefrosis Trauma

ISK

Evaluasi HSP dan penyakit vaskulitis lain

NILAI NORMAL Ratio Ca/Kr urin usia: < 7 bln 0,8 7 18 bln 0,6 19 bln 6 thn 0,4 > 6 thn 0,2 Ca urin 24 jam < 4 mg/KgBB

RUJUK KE NEFROLOGI Kelainan penglihatan & Pendengaran Skrining keluarga Cek: Komplemen, ANA, Anti-dsDNA USG Ginjal

RUJUK KE UROLOGI atau NEFROLOGI ANAK

Terapi ISK

SMF Anak Divisi Nefrologi 2009