Hematuria Evaluation of the child with hematuria Causes of hematuria in children

Evaluation Step 1: all patients CBC U/C Serum creatinine level 24-hr urine collection for Cr Protein Ca Serum C3 level Ultrasonography or IVP

Evaluation Step 2: selected patients DNase titer or Streptozyme test if hematuria is of <6mo duration Skin or throat cultures ANA titer Urine erythrocyte morphology Coagulation studies/platelet count Sickle cell screen in all black patients VCUG when infection or when a lower tract lesion is suspected

Evaluation Step 3: invasive procedures Renal biopsy indicated for Persistent high-grade microscopic hematuria Microscopic hematuria + any of the following Diminished renal function Proteinuria>150mg/24hr(0.15g/24hr) Hypertension 2nd episode of hematuria Cystoscopy indicated for Pink or red hematuria, dysuria, and sterile U/C

Causes (1) Glomerular Diseases Recurrent gross hematuria syndrome IgA nephropathy Idiopathic(benign familial) hematuria Albort syndrome Acute PSGN Membranous glomerulopathy SLE MPGN Nephritis of chronic infection RPGN Goodpasture disease Anaphylactoid purpura Hemolytic-uremic syndrome

Causes (2) Infection Bacterial Tuberculosis Viral Hematologic Coagulopathies Thrombocytopenia Sickle cell disease Renal vein thrombosis

Causes (3) Stones and Hypercalciuria Anatomic Abnormalities Congenital anomalies Trauma Polycystic kidneys Vascular abnormalities Tumors Exercise Drugs