Hematuria The approach to

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Hematuria The approach to
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Definition

• Macroscopic (gross) Hematuria
• any discolored urine visible to the human eye
• Microscopic Hematuria
• gt5 RBC/hpf seen under microscope

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Urine Dipstick

• Detects Hgb, myoglobin
• Detects protein

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Epidemiology

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Hematuria

• Upper urinary tract
• glomerulus
• collecting tubules
• interstitium

• Lower urinary tract
• calyx
• pelvis
• ureter
• bladder
• urethra

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• Lower tract
• terminal hematuria clots
• normal morphlogy
• lt 2 proteinuria in absence of gross bleeding

• Upper tract
• brown or coca cola colored
• gt2 protein,
• cast,
• leukocyte,
• deformed RBC and tubular epithelial cells

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Extraglumerular glomerular
Color Red or pink Red brown or cola colored
Clots May be present Absent
Proteinuria Usually absent May be present
Morphology Normal Dysmorphic
Rbc casts absent May be present
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Extraglomerular Hematuria

• UPPER URINARY TRACT
• pyelonephritis
• ATN
• papillary necrosis
• nephrocalcinosis
• thrombosis
• malformation
• SCD
• tumor
• PCKD

• LOWER URINARY TRACT
• cystitis
• urethritis
• urolithiasis
• trauma
• coagulopathy
• heavy excersise
• UPJ obstruction
• ureterocele
• Munchausen, MBP

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Glomerular Hematuria

• RENAL
• IgA nephropathy
• Alport syndrome
• Thin glomerular BM disease
• Post infectious
• MPGN
• hypercalciuria

• MULTI-SYSTEM
• SLE nephritis
• HSP nephritis
• Wegener syndrome
• Goodpasture syndrome
• HUS
• Sickle cell Disease
• Hiv nephritis
• Infective endocarditis

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Persistent hematuria

• Asymptomatic isolated microscopic hematuria
• Asymptomatic microscopic hematuria with
  proteinuria
• Symptomatic microscopic hematuria

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Asymptomatic isolated microscopic hematuria

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Asymptomatic isolated microscopic hematuria

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Gross or symptomatic microscopic hematuria

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• drug-induced hemorrhagic cystitis

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Historical clues

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Physical examination

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Evaluation

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Primary Evaluation

• CBC
• C3, C4
• antistreptolysin-O titer, streptozyme titer
• serum electrolytes, BUN, serum Cr, serum albumin
• test for lupus
• Hep B
• antinuclear cytoplasmic antibody titer
• imaging

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Advanced evaluation

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• ?????????? IVP
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Indications for renal biopsy

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Pathogenesis of glomerulonephritis

• Immunologic damage
• In most of these disorders humoral immune
  response with immune complex caused by in situ
  binding of antibodies to antigens localized
  within the glomeruli.
• Secondary processes
• Complement system
• Coagulation system
• Leukocyte recruitment
• Glomerular cells

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• ?????? ????? ?????? ????? - PIGN

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Post inf. Glomerulonephritis

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  (3-6 ??????).
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  (NAPIr,SPE B) ???? ?????????? ?????? ?? ?????????
  ????????in situ .

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????? ????? ?? PSGN

• Membranoproliferative glomerulonephritis (MPGN) -
  persistent nephritis and hypocomplementemia
  beyond four to six weeks
• IgA nephropathy - shorter time between the
  antecedent illness and hematuria, history of
  prior episodes of gross hematuria.
• Secondary causes of glomerulonephritis - Lupus
  nephritis and Henoch-Schönlein purpura.

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IgA nephropathy

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  ?????.
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  ?????, ????? ? HIV ????.
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Hereditary nephritis (Alport)

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  ????? ?????? ??? IV.

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Causes of Hematuria in the Newborn 

• Renal vein thrombosis (Asphyxia, dehydration,
  shock)
• Renal artery thrombosis
• Autosomal recessive polycystic kidney disease
• Obstructive uropathy
• Urinary tract infection
• Bleeding and clotting disorders
• Trauma
• Bladder catheterization
• Cortical necrosis (Hypoxic/ischemic perinatal
  insult)
• Nephrocalcinosis (Frusemide in premature

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