hurricane katrina aug 29, 2005. gross hematuria presenting to er uti50% perineal/urethral...
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Gross Hematuria Presenting to ER
• UTI 50%• Perineal/Urethral Irritation 18%• Trauma 7%• Acute Nephritis 4%• Coagulopathy 3%• Stone 2%• No etiology identified 10%• Don’t forget about tumors (Wilms)
Asymptomatic Gross Hematuria
• No identifiable cause 36%• Hypercalciuria 22%• IgA Nephropathy 16%• Post-strep glomerulonephritis 7%• Other glomerular (thin b.m.) 2%• Congenital anomalies 2%• Sickle cell 1%
Evaluation
• Post-infectious Acute Glomerulonephritis (strep)– 10 days post pharyngitis– 21 days post impetigo– Edema, HTN (85%)– Strep antibody titers– Low C3
Evaluation
• IgA– Most common presentation recurrent hematuria– 5 days post URI– Can be associated with edema, HTN, renal
insufficiency– Dx: Kidney biopsy
UPJ Obstruction
• Blockage (often partial) of urine flow where ureter enters kidney.
• Both congenital and acquired• Most common pathologic cause of antenatally
detected hydronephrosis• Intrinsic narrowing (most common)• Extrinsic compression (10%) aberrant renal a.
UPJ Obstruction: Presentation
• Fetal/neonatal: Fetal U/S, palpable abd mass, UTI, hematuria, FTT
• Children: Intermittent flank pain, hematuria with minor trauma, calculi, HTN
ADPKD
• Most common hereditary kidney dz• Presents from neonate to 5th decade• Hematuria, B flank pain, abdominal masses, HTN,
UTI• Cysts in liver, pancreas, spleen, ovaries• Mitral valve prolapse 12% of peds pts• Intracranial aneurysms (adults)• Dx by U/S, bilateral macrocysts• Tx: Supportive