Hematuria and Hypercalciuria
also see Vin-rose urine
Differential of Hematuria without proteinuria
Thin basement membrane disease
Sickle cell disease or trait
Renal cystic disease
Renal anatomic abnormalities
Differential of hematuria with proteinuria
Other forms ofglomerulonephritis
Familial causes of hematuria:polycystic kidney disease, thin basement membrane disease, sickle cell disease or trait, Alport syndrome, hypercalciuria with family history of nephrolithiasis
Workup of persistent hematuria
Consider a urine culture, sickle cell prep in African-Americans, urinary Ca/Cr ratio, serum creatinine, C3, streptozymetiter
Consider kidney/bladder ultrasound to r/o polycystic kidney dz, tumor, UPJ obstruction, and stones
Consider a CBC, C3, C4, ASO titer, streptozyme titer, electrolytes, BUN, Cr, albumin, SC prep, quantitative protein excretion
Consider tests for SLE, Hep B, antinuclear cytoplasmic antibody titer
Screening urinalysis on first-degree family members
Renal biopsy if etiology remains unclear
Discussion of some conditions in the differential dx
- Benign familial hematuria (BFH) should be considered in any child who has hematuria. Therefore, family members should have their urine tested for blood. In general, BFH is considered a diagnosis of exclusion.
- Any form of renal cystic disease may
cause RBCs to appear in the urine. However, multicystic kidney dysplasia (MKD)
is a rare cause of hematuria in infants. This congenital malformation
almost always is unilateral and most frequently is detected on routine
ultrasonographic screening during pregnancy. Ultrasonography will reveal
multiple cysts scattered throughout the renal parenchyma, with marked
echogenicity of the parenchyma, indicating nonspecific renal
dysplasia. A renal scan will distinguish between hydronephrosis and MKD.
There is no treatment for MKD.
- The most common renal tumor of childhood is Wilms tumor. In general, affected children will have a large abdominal mass that often is detected initially by a parent. There may be abdominal pain if the mass extends throughout the abdomen. However, Wilms tumor is an unusual cause of RBCs in the urine in children.
- The complete urinalysis required to evaluate urine for the presence of RBCs offers other potentially diagnostic indices, including the presence of protein, white blood cells (WBCs), and nitrites. Protein in the urine may indicate renal disease, and in conjunction with RBCs suggests renal parenchymal injury. The presence of many WBCs, RBCs, and nitrites in the urine is highly suggestive of a urinary tract infection.
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