RED URINE. 24 th June 2016 Dr Amrit Kaur

Transcription

1 RED URINE 24 th June 2016 Dr Amrit Kaur

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3 4 year old male with macroscopic haematuria 5 month h/o intermittent MaH 12 episodes, coca-cola urine Treated for UTIs, urine cultures negative Urine dipstick always negative for blood Urine dipstick positive for protein

4 Definition Macroscopic: self evident Microscopic: > 5 RBC/ml in uncentrifuged urine Urine dipsticks very sensitive, positive result requires urine microscopy to confirm presence of intact red blood cells Hbcatalysesoxidation reaction between hydrogen peroxide & tetramethylbenzidineon the stick, yellow to green colour change

5 Incidence MaH0.2% & MiH0.5-4% < 30% of children with incidental finding of MiHbeyond 6 months Routine screening in school children, Japan, Taiwan and Korea

6 Aetiology GLOMERULAR PIGN IgA nephropathy Benign familial haematuria HSP nephritis, SLE Exercise RVT Nutcracker syndrome VASCULAR Pyelonephritis Renal cystic dysplasia Sickle cell disease/trait Coagulopathy Tuberculosis TUBULOINTERSTITIAL LOWER URINARY TRACT Urolithiasis Hypercalciuria Haemorrhagic cystitis Idiopathic bulbar urethritis Tumours eg Wilms Schistosomiasis

7 Investigations: history Common in systemic illness Throat infections last days Urinary tract infections Skin rashes Joint swelling or pain, oedema Trauma or abdominal pain Travel abroad FHx or renal disease/sensorineural deafness Timing of haematuria Growth and developmnt

8 4 year old male No recent infection No UTIs Skin, joints, vision no concerns No trauma Recent trip to America Rash and facial swelling during this trip, exacerbated by sunshine No FHs renal disease/deafness Development and growth appropriate Haematuriathroughout stream

9 Extraglomerularv glomerular haematuria EXTRAGLOMERULAR GLOMERULAR Colour(if MaH) Red or pink Red, smokey brown coca-cola clots May be present absent proteinuria Usually absent May be present RBC morphology normal dysmorphic RBS casts absent May be present Urine Earlyor terminal Throughout Red cell casts Acanthocytes EM

10 Clinical evaluation MaHor symptomatic MiH Asymptomatic MiH Associated with proteinuria BP Urine microscopy & culture upcr

11 4 year old male MaH BP normal for age/height/sex Urine culture negative upcr 300 mg/mmol(raised)

12 MaHor symptomatic MiH Majority MaHare UTIs, or urinary tract trauma Differentiate between glomerular and LUT causes

13 Investigations: if Glomerular bleeding Urine microscopy & culture FBC U&Es, bone and liver function ASOT & DNAseB C3 & C4 upcr ANA/dsDNA/Igs ANCA GBM antibody titres Hb electropheresis Coagulation Urine dipstick family members Alportsscreening

14 Investigations: non-glomerular/lut Urine MC&S Renal USS Urine Ca:creat ratio Cystoscopy LOWER URINARY TRACT UTI Urolithiasis Hypercalciuria Haemorrhagic cystitis Idiopathic bulbar urethritis Tumours eg Wilms Schistosomiasis VASCULAR RVT Nutcracker Syndrome

15 Investigations: asymptomatic MiH Similar to Ix for MaH BP upcr Confirm persistent Monitor for glomerulonephritis Test family members,? Train parents to home test Refer to nephrologist if GN or >?? months

16 4 year old male, investigations Creatinine 48 µmol/l (slightly raised) ESR 18 mm/hr(raised) Nephritic screen, ANA positive upcr300 mg/mmol Serum albumin normal Asked to re-attend in 2 weeks with x3 EMU, may require renal biopsy

17 2 weeks later Repeat creatinine was normal Inflammatory markers normal upcr560, 850 & 1323 mg/mmol Serum albumin normal

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19 AlkaptonuriaAKU Black Urine Disease AR 1: people, 64 known cases in UK Severe early onset OA Lack of enzyme homogentisic dioxygenase(hgd) Unable to break down homogentisic acid (toxic acid) Accumalation of HGA causes discolouration HGA interferes with upcrassay National AKU centre, Liverpool

20 Causes of visibly red urine Haemoglobinuira Myoglobinuria Drugs eg rifampicin, nitrofurantoin, metronidazole Foods eg betalaine in beetroot, food colourings Inborn errors of metabolism egporphyria, tyrosinaemia, methaemoglobin, AKU Factitious haematuria Neonatal uratecrystals

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22 Thank you for listening