APROACH TO

HEMATURIA

Conformation of hematuria by microscopic

examination of the urine requires the
identification of more than 5RBC/hpf
Goals for primary care physician in the
management of child with hematuria
1- To recognize and confirm the finding of
hematuria
2-To identify the common etiologies
3-To identify patients with significant urinary
system disease that might require further
expertise in either diagnosis & treatment

Causes of Hematuria

Glomerular diseases: acute post infectious

glomerulonephritis, IgA nephropathy,
Beningn familial hematuria, Systemic
infections(malaria leptospirosis, infective
endocarditis, MPGN, FSGN ,SLE, HUS,HSP,
Alports syndrome,Goodpastures disease
Non-glomerular causes-Nephrolithiasis
,Hypercalciuria ,Viral hemorhagic cystitis,
UTI, Vascular abnormilities renal vein or
artery thrombosis ,A-V malformation ,
Trauma, Tumors, Hydronephrosis, Renal

Medications :NSAIDs , anticoagulants,

cyclophosphamide , ritonavir,
indinavir,
T.B.
Mnchausen syndrome

 TABLE IICauses of Hematuria in the

Newborn
Renal vein thrombosis
Renal artery thrombosis
Autosomal recessive polycystic kidney disease
Obstructive uropathy
Urinary tract infection
Bleeding and clotting disorders
Trauma, bladder catheterization

TABLE IIIAgents that may Color Urine

Red or pink urine
Red cells, free hemoglobin, myoglobin,
Urates
Drugs: chloroquine, phenazopyridine
Beets, red dyes in food
Porphyrins
Dark yellow or orange
Normal concentrated urine
Rifampicin, pyridium
Dark brown or black
Bile pigments
Methemoglobinemia
Homogentesic acid

Distinguishing Features of Glomerular and nonglomerular Hematuria

Features

Glomerular diseases

non-glomerular
diseases

Dysuria

+ in urthritis and cystitis

Systemic complaints

Edema,fever,pharyngtis, Fever with uti , Pain with

rash,arthralgia
calculi

Family history

Deafness,hematuria in
alports syndrome

May be + with
calculi&hypercalcemia

Hypertension,edema

Usually present

Less common

Abdominal mass

+ in wilms
tumour,obstructive
uropathy

Rash ,arthritis

HSP,Lupus
erythematosus

Absent unless part of

drug induced interstitial
nephrirts

Color of urine

Brown ,tea, cola

Bright red , clots may be

present

Proeinuria

2+ or more

<2+

Dysmorphic RBCs

More than 20%

Not common ,<15%

Microscopy of urinary sediment.

Typical
appearance in non-glomerular
hematuria:
RBCs are uniform in size and
shape, along with
numerous polymorphs

Microscopy of urinary
sediment. Typical
appearance of RBCs in
glomerular hematuria:
RBCs are small and vary in
size, shape, and
hemoglobin content

RED URINE
URINALYSIS

> 5 RBCs
Hematuri
a

Glomerular
KFT,SE,ASLO,C3,Total
protien,albumin,cholest
erol,Urine spot Pr./Cr.
Tests consistant
with PIGN
Ye
s
Supportive
Rx
HT,Hypercalemia
,Azotemia

NO RBCs
Pigmenturia
Non-glomerular

Urine C&S,KFT,USG
abdo,sr. Ca+,U Ca: Cr ratio,
24 hr U Ca
NO

No obvious
cause

Refer pediatric
nephrologist(F/H/O,h
earing & visual
defect,C4,ANA,anti
Ds
DNA,ANCA,USG&Biop

Nephrolithiasis,tra
uma,Hydronephro
sis

UTI
Treat as
per
protocol

Refer pediatric
surgeon/urologist in
consultation with pediatic
nephrology