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T or F. A few RBCs can be normal.
True
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What is the most common cause of hematuria?
UTI
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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
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UA with alkaline pH, +nitrates, & leukocytes suggest what urinary disease?
UTI
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Urine with hematuria, pyuria, and NO bacteria, what should you suspect?
STD or viral infection
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If protein in the urine, what should you rule out?
glomerulonephritis
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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
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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)
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For Proteinuria, what are some
-signs,
-PE,
-Hx,
-Diag
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
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What level of proteinuria is considered significant?
+1 or higher (30mg/dl)
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Discuss isolated proteinuria.
- -10-20yo, more likely male
- -orthostatic/postural proteinuria but normal when supine
- -persistent, asymptomatic--> common & transient
- -usually grow out of
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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
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If dipstick shows trace 1+ proteinuria & spec gravity > 1.015, what is your management?
Monthly urine rechecks for 4-6mo, if protein persists--> refer
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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
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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
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What is the management if nephritis?
- -PSGN txt is supportive, 90% resolve within 6-24mo
- -hospitalization depends on symptoms
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What is more common in kids, a lower or upper tract UTI?
Lower! (cystitis)
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What is the most common organism seen in kids w/ UTI?
E. coli
(other: klebsiella, proteus, enterococcus)
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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
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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
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