1 / 29

HEMATURIA

HEMATURIA. Dr. Shreedhar Paudel April, 2009. HEMATURIA. Microscopic hematuria more than three erythrocytes per high-power field HEME-POSITIVE    -- Hemoglobin    -- Myoglobin. HEMATURIA……. Artificial food coloring Beets Berries Chloroquine Furazolidone Hydroxychloroquine

nira
Download Presentation

HEMATURIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. HEMATURIA Dr. ShreedharPaudel April, 2009

  2. HEMATURIA • Microscopic hematuria • more than three erythrocytes per high-power field • HEME-POSITIVE    --Hemoglobin   --Myoglobin

  3. HEMATURIA…….. • Artificial food coloring • Beets • Berries • Chloroquine • Furazolidone • Hydroxychloroquine • Nitrofurantoin • Phenazopyridine • Phenolphthalein • Rifampin

  4. HEMATURIA…. • CAUSES OF HEMATURIA:- • A. RENAL • GLOMERULAR • RENOVASCULAR • B. HEMATOLOGICAL • C. URETERIC • D. PKCD, UTI, TUMOR

  5. HEMATURIA….. • CAUSES OF HEMATURIA:- • Severe dehydration--- Renal vein thrombosis • Myocardial infarction-- Renal artery embolus or thrombus • Atrial fibrillation--- Renal artery embolus or thrombus • Hypertension Glomerulosclerosis-- with or without proteinuria

  6. HEMATURIA…….. • EVALUATION OF PATIENT WITH HEMATURIA:- • H/O passage of clots → extraglomerular cause of hematuria • H/O recent trauma to the abdomen → hydronephrosis • H/O early-morning periorbital puffiness, weight gain, oliguria, the presence of dark-colored urine, and the presence of edema or hypertension suggests a glomerular cause.

  7. HEMATURIA…….. • EVALUATION OF PATIENT WITH HEMATURIA…. • Painless hematuria due to glomerular causes • H/O recent throat or skin infection → post infectious glomerulonephritis • H/O joint pains, skin rashes, and prolonged fever in adolescents → collagen vascular disorder

  8. HEMATURIA…….. • EVALUATION OF PATIENT WITH HEMATURIA…. • The presence of anemia cannot be accounted for by hematuria alone → in a patient with hematuria and pallor, other conditions such as systemic lupus erythematosus and bleeding diathesis should be considered • H/O fever, abdominal pain, dysuria, frequency, and recent enuresis in older children → UTI as the cause of hematuria

  9. HEMATURIA…….. • EVALUATION OF PATIENT WITH HEMATURIA…. • Skin rashes and arthritis → HSP and SLE • Information regarding exercise, menstruation, recent bladder catheterization, intake of certain drugs or toxic substances, or passage of a calculus may also assist in the differential diagnoses.

  10. HEMATURIA…….. • EVALUATION OF PATIENT WITH HEMATURIA…. • familial, Alport syndrome, collagen vascular diseases, urolithiasis, or PCKD • PHYSICAL EXAMINATION • INVESTIGATION

  11. HEMATURIA…….. • Indications of kidney biopsy in patients with hematuria:- • Significant proteinuria • Abnormal renal function • Recurrent persistent hematuria. • Serologic abnormalities (abnormal complement, ANA, or dsDNA levels). • Recurrent gross hematuria. • A family history of end-stage renal disease

  12. ACUTE GLOMERULNEPHRITIS (AGN) • CONDITIONS PRESENTING AS AGN • POST INFECTIOUS—streptococci, hepatitis B and C, bacterial endocarditis • SYSTEMIC VASCULITIS – HSP, SLE, Polyarteritis nodosa • MEMBRANOPROLIFERATIVE GN • IGA NEPHROPATHY • ALPORT SYNDROME

  13.  Acute Poststreptococcal Glomerulonephritis • Sudden onset of • Gross hematuria • Edema • Hypertension • renal insufficiency • most common glomerular causes of gross hematuria in children

  14. Acute Poststreptococcal Glomerulonephritis……… • Etiology:- • throat or skin infection by certain “nephritogenic” strains of group A β-hemolytic streptococci. ↓ streptococcal pharyngitis (serotype 12) streptococcal skin infections or pyoderma (serotype 49)

  15.  Acute Poststreptococcal Glomerulonephritis……… • Pathology:- • kidneys → symmetrically enlarged • light microscopy → enlarged glomeruli • Immunofluorescence → granular deposits of IgG • electron microscopy • Lumpy deposits on the subepithelial side of the capillary basement membrane

  16.  Acute Poststreptococcal Glomerulonephritis……… • Clinical Manifestations:- • 5–12 yr and uncommon before the age of 3 yr. • acute nephritic syndrome 1–2 wk after an antecedent streptococcal pharyngitis or 3–6 wk after a streptococcal pyoderma. • asymptomatic microscopic hematuria with normal renal function to acute renal failure

  17. Acute Poststreptococcal Glomerulonephritis……… • Clinical Manifestations:- • Edema (puffiness around eyes and pedal edema) • Hypertension • Oliguria (cola colored urine) • encephalopathy and/or heart failure owing to hypertension or hypervolemia • malaise, lethargy, abdominal or flank pain, and fever are common

  18. Acute Poststreptococcal Glomerulonephritis……… • Clinical Manifestations:- • The acute phase generally resolves within 6–8 wk • urinary protein excretion and hypertension usually normalize by 4–6 wk after onset • persistent microscopic hematuria may persist for 1–2 yr after the initial presentation

  19.  Acute Poststreptococcal Glomerulonephritis……… • Diagnosis:- • Urinalysis → • red blood cells (RBCs) • RBC casts • proteinuria(1+ to 2+) • polymorphonuclear leukocytes (indicative of glomerular inflammation) • mild normocytic anemia (due to hemodilution)

  20.  Acute Poststreptococcal Glomerulonephritis……… • Diagnosis:- • ↓ed serum C3 level • ↑ed antistreptolysin O (ASO) • ↑ ed serum urea and creatinine (reflecting degree of renal impairment)

  21. Acute Poststreptococcal Glomerulonephritis……… • Complications:- • Hypertension • Acute renal dysfunction • Hypertensive encephalopathy • Heart failure • Hyperkalemia • Hyperphosphatemia • Hypocalcemia • Acidosis • Seizures • Uremia

  22. Acute Poststreptococcal Glomerulonephritis……… • Treatment:- • Patient with mild oliguria and normal BP → can be managed at home • Close monitoring of Blood pressure and dietary intake • 10-day course of systemic antibiotic therapy with penicillin (once AGN occurred penicillin treatment has no effect on course of disease----may be given if active pharyngitis or pyoderma present)

  23. Acute Poststreptococcal Glomerulonephritis……… • Treatment:- • DIET • Protein, sodium and potassium restricted till serum urea reduce to normal and urinary output increases • Fluid intake restricted to amount equal to insensible loss + urinary loss • Overhydration-- ↑es HTN and precipitates LVF

  24. Acute Poststreptococcal Glomerulonephritis……… • Treatment:- • WEIGHT • Weighed daily • Should lose about 0.5 % BW/ Day – due to endogenous catabolism • Gain in weight requires– fluid restriction • DIURETICS • Not indicated (since edema is rarely massive and comes to normal with return of renal function) • Used in presence of pulmonary edema (iv frusemide)

  25. Acute Poststreptococcal Glomerulonephritis……… • Treatment:- • HTN • Mild—controlled by salt and water restriction • Malignant HTN – prompt treatment ( iv nitroprusside) • LVF • Control HTN • iv frusemide • Prognosis:- • Complete recovery occurs in 95% of cases

  26. Henoch-Schönlein Purpura • Small vessel vasculitis • Mild renal involvement– microscopic hematuria, mild proteinuria • Clinical features:- • purpuric rash ( extensor surface) • Arthritis • abdominal pain • Rarely presents with nephritic or nephrotic syndrome, HTN, azotemia

  27. Henoch-Schönlein Purpura…

  28. Henoch-Schönlein Purpura…

  29. Henoch-Schönlein Purpura…. • TREATMENT:- • Most patients recover without any specific treatment • Long-term observation– to detect insidious renal damage • Combination of steroids and azathioprine recommended • But long-term outcome may not be satisfactory

More Related