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- Susan F. Massengill, MD*
- *Director, Pediatric Nephrology, Levine Children's Hospital at Carolinas Medical Center, Charlotte, NC
Objectives
After completing this article, readers should be able to:
Define hematuria.
List the common conditions associated with hematuria.
Identify the important elements of the history and physical examination that suggest serious renal disease.
Plan a practical and systematic approach to the evaluation of hematuria.
Appreciate when consultation with a pediatric nephrologist is necessary.
Case Study
An 8-year-old white girl is referred for evaluation of hematuria, proteinuria, and hypertension. She has had recurrent episodes of gross hematuria. The first was at 3 years of age and was attributed to a urinary tract infection, but a urine culture was negative. She was treated with 10 days of antibiotics, and the symptoms resolved. The second episode, at age 5 years, was attributed to acute poststreptococcal glomerulonephritis, although an antistreptolysin O (ASO) titer was normal, and complement studies were not ordered. Blood pressure at that time was 120/80 mm Hg (normal for age and height is 94/54 mm Hg). The girl was lost to follow-up and presents 3 years later with blood pressure at the 95th percentile, gross hematuria, and generalized edema. Urinalysis of tea-colored urine shows too-numerous-to-count dysmorphic red blood cells (RBCs), white blood cells, proteinuria, and RBC casts. The differential diagnosis includes immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, and hereditary nephritis, although the latter condition is unusual in a female. She is admitted for additional evaluation.
Introduction
Hematuria is a common finding in children and often comes to the attention of the pediatrician as a result of a routine screening urinalysis, as an incidental finding when evaluating urinary tract symptoms, or when a child has gross hematuria. Although the differential diagnosis for hematuria is extensive, most cases are isolated and benign. Generally, hematuria is a medical rather than a urologic issue. Only the rare child or adolescent who has hematuria needs initial screening radiographic imaging …
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