Thursday, June 14, 2012

Hematuria in children ( part 3)

Hematuria can be of glomerular or nonglomerular origin. Brown-colored urine, RBC casts, and dysmorphic (small deformed, misshapen, sometimes fragmented) RBCs and proteinuria are suggestive of glomerular hematuria. Reddish or pink urine, passage of blood clots, and eumorphic (normal sized, biconcavely shaped) erythrocytes are suggestive of a nonglomerular bleeding site.
Potential causes of hematuria in children include the following:
1- Glomerular hematuria
o    Thin basement membrane disease (benign familial hematuria)
o    Alport syndrome
o    Postinfectious glomerulonephritis
o    Membranoproliferative glomerulonephritis
o    Lupus nephritis
o    Anaphylactoid purpura (Henoch-Schönlein purpura)

2- Nonglomerular hematuria
o    Fever
o    Strenuous exercise
o    Mechanical trauma (masturbation)
o    Menstruation
o    Foreign bodies
o    Urinary tract infection
o    Hypercalciuria/urolithiasis
o    Sickle cell disease/trait
o    Coagulopathy
o    Tumors
o    Drugs/toxins (nonsteroidal anti-inflammatory drugs [NSAIDs], anticoagulants, cyclophosphamide, ritonavir, indinavir)
o    Anatomic abnormalities (hydronephrosis, polycystic kidney disease, vascular malformations)
o    Hyperuricosuria



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