1. Approach to red urine in children
Kamal Akl MD
Professor of Pediatrics & Pediatric Nephrology

2. Objectives Red urine is not always hematuria
Hematuria is not always renal
Focused Hx Focused PE Focused Labs & imaging- Focused management

3. Examples of Urine Color

4. Causes of red urine
Food
Medications
Others

5. Hematuria
Microscopic
Macroscopic
Definition of Microhematuria

6. Reagent Strips

7. Urine Dipstick

8. Causes of hematuria in Jordan
UTI Around 1/3rd
Glomerulopathy Around 1/3rd
Crystals & Stones Around 1/3rd
Rest: Miscellaneous

9. Causes of Hematuria in Children
Upper Urinary Tract vs Lower
Glomerular bleeding vs Nonglomerular

10. Glomerular hematuria Color Presence of proteinuria RBC morphology
RBC casts

12. RBC Cast

13. Hematuria
Painless
Painfull

14. Hematuria Importance of Medical & Diet History
Importance of Family History

15. Medical History Lower vs upper urinary tract symptoms Dietary Intake
Skin rash
History of URTI
Trauma/ Exercise
Medication intake
Geography
Prevalent conditions in the community

16. Hematuria Persistent micro Persistent micro + Proteinuria
Intermittent macro
Persistent micro OR Intemittent Macro

17. Alport Syndrome Hematuria Sensorineural Deafness Renal Failure
May diagnose by skin biopsy instead of renal biopsy Look for Epidermal staining for collagen IV

18. Dietary History Very Important Water intake
For Hyperuricosuria Not only importance of purine intake such as red meat
BUT: Fructose intake

19. Diet History Examples: Hematuria after Mansaf : Hyperuricosuria(HU)
BBQ : HU
Mulukhia: Oxalate
Tomatoes: Oxalate
Sweetened Beverages: HU

20. Family History Consanguinity Similar cases Deafness ESRF
Familial Hematuria
Stones
Gout

21. Importance of PE Complete PE + Focused on the condition
Check BP; edema
Evidence of systemic disease eg Rash

22. Presentations of Glomerular Disease
Asymptomatic Urinary Abnormalities
Hypertension
Acute Kidney Injury
Chronic Kidney Disease
Nephrotic Syndrome
Rapidly Progressive Glomerulonephritis

23. Focused Lab
Depends on
Medical History
Diet Hx
Family Hx

24. Focused Investigations
Based on Hx & PE

25. Focused Management Depends on Medical Hx Diet Hx Family Hx
Labs: Note  treat the patient not the lab

26. Conclusions
Thank you