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T or F. A few RBCs can be normal.
What is the most common cause of hematuria?
Identify some causes of gross hematuria. Microscopic hematuria.
Gross: trauma, infection, SCD, renal calculi, abnormalities of lower urinary tract
Microscopic: Infection, inflammation, hypercalciuria, perineal trauma, exercise, SLE, postinfectious glomerulonephritis
UA with alkaline pH, +nitrates, & leukocytes suggest what urinary disease?
Urine with hematuria, pyuria, and NO bacteria, what should you suspect?
STD or viral infection
If protein in the urine, what should you rule out?
What are 7 situations to refer hematuria?
- 1. Urologic trauma
- 2. Recurrent UTIs
- 3. Suspected glomerulonephritis
- 4. Thrombocytopenia
- 5. suspected renal calculi
- 6. Fx Hx of malignancy
- 7. Persistant hematuria w/ HTN, proteinuria
T or F. Proteinuria has high false positives due to exercise, fever, dehydration, alkaline urine.
True ( but can be a sign of kidney disease from DM or HTN)
For Proteinuria, what are some
you might see.
- Signs: typcially asymptomatic, some edema (periorbital, feet, hands, abdomen)
- PE: HTN, edema, failure to thrive (nephrotic syndrome)
- HX: strenuous physical activity, Viral symptoms
- Diag: Single UA
What level of proteinuria is considered significant?
+1 or higher (30mg/dl)
Discuss isolated proteinuria.
- -10-20yo, more likely male
- -orthostatic/postural proteinuria but normal when supine
- -persistent, asymptomatic--> common & transient
- -usually grow out of
Discuss Transient or Functional Proteinuria.
Discuss Glomerular proteinuria & tubulointerstitial proteinuria.
- Transient -Exercised induced or fever- resolves after fever state
- -Other: seizure, HF, infection, cold
- exposure--> resolves in 1-2 weeks
- -Glomerular--> less common and HIGH levels
- -Tubo--> less common, high levels
If dipstick shows trace 1+ proteinuria & spec gravity > 1.015, what is your management?
Monthly urine rechecks for 4-6mo, if protein persists--> refer
If dipstick shows >1+, what should your proteinuria management be?
- -2-3 random urines suggest persistent
- --> get UA upon rising, if (-) or trace, then probably orthostatic BUT if (+)--> get 12-24hr urine protein excretion checked
What are 4 classic findings of nephritis? What is the most common form in childhood?
- 1. HTN
- 2. Edema (often periorbital)
- 3. Proteinuria
- 4. Hematuria
**PSGN (strep w/in 2 weeks), peak age 7yo
What is the management if nephritis?
- -PSGN txt is supportive, 90% resolve within 6-24mo
- -hospitalization depends on symptoms
What is more common in kids, a lower or upper tract UTI?
What is the most common organism seen in kids w/ UTI?
(other: klebsiella, proteus, enterococcus)
What is suggested for kids and their first UTI (in boys & 2nd in girls)?
-Refer for U/S to rule out abnormality, should start prophylatic antibx until VCUG completed
What is the pharm recommendations for UTI in kids?
1. <24 mo--> cefuroxime 20-30mg/kg/day in 2 doses (7-14 days if febrile)
2. >24mo--> Bactrim 6-12mg/kg/day in 2 doses x 10days
3. >6yo Pyridium for dysuria
**can also use augmentin & cephalosporin