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Pediatric Clips (PDF)


									                         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
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    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.
                                                 his research and clinical fellowships       Consultation for calcium and
                                                 in nephrology and hypertension at           phosphorus disorders and blood
                                  MD, is a
                                                 Cincinnati Children’s. Dr. Omoloja is       pressure disorders are also provided.
                                                 board certified in pediatrics and                The department offers
                                                 pediatric nephrology.                       specialized procedures for renal
                                  ogist in
                                                      Contact information:                   replacement therapy including
                                  the de-
                                                 937-641-3304 or nephrology@                 hemodialysis, peritoneal dialysis and
                                  of ne-
                                                      The department of nephrol-             (CAVH/CVVH) for acute inpatients.
                                                 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

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                                                                                                         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

           Funding provided by:

937-256-0046              An affiliate of
                           EMD, Inc.

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