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THE CHILDREN’S MEDICAL CENTER OF DAYTON Pediatric Clips Hematuria — Abiodun Omoloja, MD January 2003 • Volume 1 • Issue 1 Pediatric Clips from The Children’s CASE: 12-YEAR-OLD WITH BLOOD IN THE URINE Medical Center are quick reviews of Chris is a 12-year-old African- tea-colored urine, dysuria, fre- turia being a year ago; has no American male with a history of quency or enuresis. He has not had knowledge of the type of stone. common pediatric microscopic blood in his urine a documented urinary tract infec- Two other male siblings and conditions. for over five years and a family tion. Other than mild reactive the mother have no history of history of kidney stones. Routine airway disease, his medical history blood in the urine and don’t have yearly well examinations and is unremarkable. any medical problems. Nobody The Children’s sport physicals have documented He is actively involved in the in the immediate and extended Medical Center is the hematuria. About five years school basketball team. family has any hearing defects. the region’s pediatric ago he was evaluated by a His father has a history of Physical examination was referral center for a pediatrician; they do not recollect kidney stones for the past three unremarkable, as his blood 20-county area. the outcome of that evaluation. years but has not had any surgical pressures, weight and height As the only facility He denies back pain, facial procedure; his last episode of were within normal for age. or feet swelling, gross hematuria, abdominal pain and gross hema- in the region with a full-time commitment to pediatrics, Children’s EVALUATION/RECOMMENDATIONS offers a wide range of services in general Microscopic hematuria is one pain and gross hematuria are presence/absence of red blood pediatrics as well as of the most common reasons present. Inquiry regarding the cell (RBC) casts, proteinuria in 35 subspecialty for a nephrology referral presence of sickle cell disease or and number of RBCs are very areas for infants, with the above presentation trait in family members (including important aspects of the being typical. extended) is of utmost importance evaluation. Less than 10 RBCs children and teens. As in any medical evaluation, even in Caucasian patients. Occa- per hpf will render a low yield We welcome your obtaining a good history is key to sionally, requesting hemoglobin in any work-up. inquiries about identifying the etiology of the electrophoresis might be needed 2. A random creatinine and services available – problem. The presence and/or if the patient is adopted and calcium estimation on the urine call 937-641-3666 absence of pain at urination, skin has gross hematuria. sample is helpful and is a cost- or e-mail marketing rash, gross hematuria and hearing Absence of facial or feet effective test. A calcium to @childrensdayton.org. defects in family members are swelling suggests the absence of creatinine ratio above 0.2 is helpful information in narrowing significant proteinuria. The timing suggestive of abnormally high down the differential diagnosis and of collecting urine sample for calcium excretion in the urine, a ordering the necessary investiga- testing should always be known precondition for the formation tions. Other important family because of the possibility of of the most common type of history is the presence of hematuria exercise-induced hematuria. This kidney stones, calcium oxalate Dayton, Ohio in biological parents or siblings, is a benign condition typically seen stone and associated with history of sickle cell disease or trait. after intense physical activity microscopic hematuria. All kids need The persistence of micro- (trauma related, biking, etc.). The 3. Renal panel to assess renal special care — hematuria for five years makes the hematuria completely resolves and function. All kids need possibility of viral cystitis / UTI is of no clinical significance. 4. Renal and bladder ultrasound is Children’s. unlikely as hematuria eventually Initial workup should include the initial imaging study of resolves. The family history of the following: choice because of its non- One of America’s kidney stones is very interesting, as 1. Urine analysis (UA) on a freshly invasiveness, lack of radiation top 25 children’s a strong familial occurrence is very voided urine sample preceded and relative ease. It serves as a hospitals — common, although typically by minimal or no physical good screen to document Child magazine, 2003 intermittent colicky abdominal activity. The specific gravity, Continued on the reverse side. Continued from the front. normal genitourinary anatomy and Renal panel, C3 & C4 were normal. Based on the initial negative results, detection of renal stones. I have The UA performed on Chris showed 1+ UA on Mother’s first morning urine come across horseshoe and pelvic blood, no protein, specific gravity of sample was done. Father’s urine was kidney during evaluation of micro- 1.020 (similar to initial UA 5yrs ago), not tested, but a negative urine would scopic hematuria. Should be done if 10-20 RBCs and no RBC casts. Calcium have been significant despite the history hematuria is significant (>10 RBCs). creatinine ratio was less than 0.2. Renal of documented renal stones. 5. Complement C3 & C4 to be done if and bladder ultrasounds were normal Based on the history, physical significant hematuria or prescence of with no calcifications, normal bladder exam, laboratory and imaging studies, RBC casts as normal levels reduce the wall thickness. No abnormal anatomy the diagnosis is benign hematuria. possibility of recent post-infectious was visualized and renal sizes were glomerulonephritis, membrano- appropriate for height and age. proliferative glomerulonephritis (MPGN) and lupus nephritis. A low level could help to diagnose an asymptomatic acute post- streptococcal glomerulonephritis. Featured specialist pediatric residency at Bronx Lebanon outpatient consultations are available Hospital/Albert Einstein College of for patients with electrolyte acid Medicine in New York. He completed base and blood pressure disorders. Abiodun his research and clinical fellowships Consultation for calcium and Omoloja, in nephrology and hypertension at phosphorus disorders and blood MD, is a Cincinnati Children’s. Dr. Omoloja is pressure disorders are also provided. pediatric board certified in pediatrics and The department offers nephrol- pediatric nephrology. specialized procedures for renal ogist in Contact information: replacement therapy including the de- 937-641-3304 or nephrology@ hemodialysis, peritoneal dialysis and partment childrensdayton.org. hemo-filtration/hemodi-afiltration of ne- The department of nephrol- (CAVH/CVVH) for acute inpatients. phrology ogy at Children’s provides compre- The department works closely with at The hensive diagnostic and treatment urologic and pediatric surgeons to Children’s Medical Center of services for the entire range of provide comprehensive manage- Dayton. Dr. Omoloja received his disorders of the kidney, urinary tract ment of patients through a com- medical degree from University of and hypertension. Inpatient and bined renal-urologic clinic. Ilorin, Nigeria. He completed his Nonprofit Organization U.S. Postage Paid Permit Number 323 Dayton, Ohio For further information, The Children’s Medical Center or its One Children’s Plaza Dayton, Ohio 45404-1815 specialists at 937-641-3666 or firstname.lastname@example.org. Funding provided by: 937-256-0046 An affiliate of EMD, Inc.
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