Hematuria (Blood in Urine)

Kumud P Mehta
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Investigations of Hematuria
Urine
- color
- dipstick to detect blood / benzedine test (+ve with Hb / myoglobin and proteinuria)
- microscopy of urine for RBC's
- Wright's stain / phase contrast microscopy / Coulter counter can detect source of bleeding from glomerular or non glomerular source

Investigations should be phased in such a way as to rule out common causes.
Phase 1
- Acute post infections glomerulonephritis- ASO titre, serum C3 level, HBsAg
- Acute pyelonephritis - Urine Culture, Colony Count
- Hypercalciuria - Urinary Calcium/Creatinine ratio, 24 hours urinary calcium excretion
- Ultrasonography to rule out stones, tumors, hydronephrosis, cystic kidney disease

If urine examination reveals < 5 RBC's / HPF on monthly examination, then urine examination should be repeated at least 3 times before it is considered normal.

Phase 2
If hematuria is persistent in school age, then the following should be done:
- Family members should be screened for hematuria
- ANA, Anti dsDNA, C3 levels
- Renal function tests
- Audiometry for nerve deafness
- Renal biopsy to rule out IgA nephropathy. If biopsy is normal then in case of positive family history, it is familial benign nephropathy

Indications for renal biopsy (Light immunoflourescent and electron microscopy)
- Asymptomatic hematuria for more than 1 year
- Hematuria with positive family history
- Hematuria + moderate to severe proteinuria, hypertension or elevated BUN, S.creatinine lasting for 2-3 weeks (atypical features in acute post streptococcal GN)
- Deafness
+ve serology for hepatitis B or SLE

* Alport's syndrome can be diagnosed only if EM is done. IgA nephropathy can be diagnosed only if IF is done. If EM and IF is not possible, light microscopy alone can give final diagnosis in all condition except Alport's syndrome and IgA nephropathy


Hematuria (Blood in Urine) Hematuria (Blood in Urine) 01/03/2001
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