Evaluation of the patient with hematuria , with recent update in Diagnosis, Evaluation, and Follow-up of asymptomatic microscopic hematuria (AMH) in Adult | american association of urology AUA guideline
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
3. Introduction
Hematuria means blood in urine.
It may be Gross or macroscopic and microscopic
hematuria
Gross hematuria is seen by naked eyes while
microscopic hematuria needs microscope.
Hematuria is defined as the presence of at
least 5 red blood cells per HPF of centrifuged
urine and/or 5 RBC per microliter in
uncentrifuged specimen
4. • Pathophysiology:
Structural disruption in the integrity of
glomerular basement membrane caused by
inflammatory or immunologic processes
Toxic disruptions of the renal tubules
Mechanical erosion of mucosal surfaces in
the genitourinary tract
12. History:
• Age: 2-5yrs: Wilms tumor
5-12yrs: PSGN
• Sex: F>>M in >1-2yrs: UTI
F>>M: SLE nephritis
M>F : X-linked form of Alport syndrome
• Race: whites: Idiopathic hypercalciuria
blacks: Sickle cell disease
13. Colour of urine:
Colour Causes
Dark yellow Normal concentrated urine
Dark brown or Bile pigments
black Homogentisic acid, melanin,
tyrosinosis, methemoglobinuria
Cola coloured Glomerular hematuria
Red or pink Extraglomerular hematuria,
urine Hemoglobin, Myoglobin,
Porphyrins, Chloroquine,
Deferoxamine, Beets, blackberries,
Rifampin, Red dyes in food, Urates
14. Characteristics of urine:
• Amount of urine: Reduced in AGN, ARF
• Clots in urine: Extraglomerular
• Frequency, Dysuria, recent enuresis : UTI
• Frothy urine: Suggests Proteinuria seen in
Glomerular diseases
• Timing: Initial stream – from urethra (Urethrorrhagia
– spotting in underwear); Terminal (with suprapubic
pain, disturbance of micturition) – from bladder
21. Investigations:
• Urine dipstick test: Based on the
peroxidase-like activity of
hemoglobin
• It can detect trace amounts
of hemoglobin and
myoglobin.
• Can detect 5-10 intact RBC
per mm3 of unspun urine
• False +ve: Urine pH >9, H2O2
• False –ve: High ascorbic acid,
formalin
• Also for urine albumin
22. Investigations:
Urine microscopy: Presence of RBCs and casts (> 5
RBCs per HPF) in centrifuged urine
Glomerular Non - glomerular
1. Brown, cola coloured or smoky 1. Bright red, pink
2. RBC casts 2.Terminal hematuria/
Passage of clots
3. Proteinuria 2+ or more 3. Proteinuria of < 2+
4. Deformed urinary RBCs 4. Normal morphology of RBCs
23. Study on Evaluation of hematuria using the urinary albumin-
to-total-protein ratio to differentiate glomerular and
nonglomerular bleeding
•N. Ohisa · R. Matsuki · H. Suzuki · H. Miura · Y. Ohisa · K. Yoshida
Department of Clinical Laboratory, Tohoku University Hospital,
Sendai, Japan
•microscopy-based differentiation is not only tedious but the sensitivity and
specificity may vary from one examiner to another. Furthermore, once
the specimen has been frozen, differentiation becomes difficult.
•A total of 143 random urine specimens from patients seen at the Division of
Nephrology, Endocrinology and Vascular Disease and the Urology Department
at Tohoku University Hospital were included in the study. The inclusion criterion
for the study was a diagnosis of glomerular disease based on clinical features
or histopathology with hematuria (5 or more RBCs per high-power fi eld). Of the
104 patients diagnosed with glomerular disease and 39 specimens from
patients with nonglomerular disease, used as controls in the study.
24. • With respect to the albumin-to-total-protein ratio,
the mean value in the glomerular disease group was
0.72 •} 0.10, whereas the mean in the
nonglomerular disease group was 0.35 •} 0.17 (P <
0.001). The distribution of the albumin-to-total-
protein ratio in the glomerular and nonglomerular
disease groups was clearly differentiated. Sensitivity
and specificity as a function of the albumin-to-total-
protein ratio. At a ratio cutoff of 0.59, sensitivity and
specificity was maximized at 96.2% and 100%,
respectively.
25. Distribution of urinary albumin-to-total-protein ratio in glomerular and
nonglomerular hematuria. The mean albumin-to-totalprotein ratio in the
glomerular disease group was signifi cantly higher than that in the nonglomerular
disease group. A cutoff of 0.59 excluded all nonglomerular disease cases, while
detecting all but three glomerular disease cases. Gl, glomerular disease; non-Gl,
nonglomerular disease; vertical axis, albumin-to-total-protein ratio; horizontal axis,
glomerular disease, nonglomerular disease
26. Urine albumin-to-total-protein ratio sensitivities and specifi ities
in differentiating glomerular and nonglomerular hematuria. At a
ratio of 0.59, sensitivity and specificity were 96.2% and 100%,
respectively.
27. Cola/ brown urine?
Proteinuria(>30mg/dl)?
RBC cast?
Acute nephritic syndrome?
Yes NO
Glomerular hematuria Extraglomerular hematuria
• CBC Step 1
• Electrolytes,Ca • Urine culture
• BUN/Cr Step 2
• Serum protein/albumin • Urine Ca/Cr
• Cholesterol • Renal/ bladder USG
• C3/C4 Step 3
• ASO/Anti-DNase B • Urinalysis: siblings, parents
• ANA • Serum electrolytes, Cr, Ca
• Antineutrophil antibody • If crystalluria, urolitiasis or
nephrocalcinosis:
• Throat/ skin culture
24-hr urine for Ca, Cr, Uric acid, oxalate
• 24-hour urine total protein
creatinine clearance • If hydronephrosis/pyelocaliectasis:
cystogram, renal scan
28. Investigations:
• Urine C/S
• RFT: Blood urea nitrogen/serum creatinine, Na/K (↓Na in
AGN, ↑K in ARF)
• Complete blood counts (CBC): Hb - ↓ in bleeding, HUS, SLE,
CRF; Abnormal TC, DC in infections, HUS, ↓ in SLE;
• Platelet counts and Coagulation studies: (history suggestive
of bleeding disorder, HUS), Sickle cell (Hemoglobin
electrophoresis)
• PBS: Microangiopathic hemolytic anemia
• ESR, CRP - Infections
• 24 hr urinary protein, Spot urinary protein: Creatinine ratio,
Serum albumin and cholesterol if associated proteinuria
(Nephrotic syndrome)
• Urine calcium: Hypercalciuria is a relatively common finding
in children.
– 24-hour urinary calcium (>4 mg/kg/d), or
– Spot urine calcium-creatinine ratio >0.21
29. Investigations:
• Imaging Studies
– Renal and bladder sonography: Urinary tract anomalies,
such as hydronephrosis, hydroureter, nephrocalcinosis,
tumor, and urolithiasis, Renal parenchymal disease
– X-Ray KUB: calculi
– Doppler study of renal vessels and IVC: Renal vein
thrombosis
– Intravenous urography
– Spiral CT scan - Urolithiasis, Wilms tumor and polycystic
kidney disease, Renal trauma
– Micturating cystourethrograms - Urethral and bladder
abnormalities (eg, cystitis), in recurrent UTI to r/o VUR,
anomalies
– Radionuclide studies – Renal function and perfusion
– Angiogram
– Chest X-Ray (Pulmonary oedema, CHF)
30. Investigations:
• Renal biopsy:
Relative indications -
• Significant proteinuria (3+ or more) or nephrotic
syndrome +
• Recurrent persistent hematuria (Microscopic
>2yrs)
• Abnormal renal function, Persistent HTN
• Hematuria, Proteinuria, diminished renal function,
low C3 level persist beyond 2 mo of onset of AGN
• Absence of evidence of streptococcal infection
• Serologic abnormalities (abnormal ANA or dsDNA
levels)
• A family history of end stage renal disease or
evidence of Chronic renal disease in patient
31. Dx Histology Clinical Lab
IgA IgA deposition in the Gross, No specific
Nephro- mesangium, glomerular intermittent, changes,
pathy sclerosis, proliferative changes, painless although
crescents in severe cases hematuria increased serum
IgA levels
observed in some
patients
HSP Same as IgA nephropathy Purpura, joint No specific
pains, laboratory data
abdominal
pain,
hematuria, etc
SLE Mild glomerulitis, proliferative Hematuria, Abnormal C3, C4,
changes, immune complex proteinuria, ANA, dsDNA,
deposition, crescents, hypertension, anemia,
immunoglobulin deposition joint pains, thrombocytopeni
rashes, etc a, etc
32. Dx Histology Clinical Lab
Alport Some thinning of basement Sensorineural No
Syndrome membranes, "basket weave" hearing loss, corneal specific
changes in the glomerular abnormalities, changes
basement hematuria, renal
membrane on electron failure
microscopy
Thin Average glomerular basement Persistent No
Basement membranes thin (reported to microscopic or gross specific
Membrane be 100-200 nm) hematuria, changes
disease significant family
history
Mesangio- Glomerular lobulations, Hematuria, C3 levels
proliferative thickening of the mesangial proteinuria, may be
GN matrix and glomerular hypertension low
basement membranes,
crescents, etc
33. Investigations:
• Cystourethroscopy: Terminal hematuria,
disturbances of micturition, suprapubic pain
(Only if strong suspicion of bladder ulceration,
tumours)
• Screening of first degree relatives in persistent
hematuria
38. For Asymptomatic, isolated
microscopic hematuria:
Isolated microscopic
hematuria
Repeat urinalysis weekly x 2 Negative F/U Urine R/M with
(No exercise x 48hrs) examination
Persistent hematuria
Test parents for Positive Benign Familial
hematuria Hematuria
No Yes
Family h/o calculi Urine Ca/Cr ratio
No Normal
+Hearing test, +USG, Yearly Urine R/M,
+X-Ray KUB examination, BP
39. Management:
• According to cause:
– Reassurance and F/U
– Treat cystitis, pyelonephritis, AGN: Antibiotics
– Supportive treatment: Diuretics, Fluid and salt
restriction, Antihypertensives
– Monitoring – BP, I/O, weight, Urine R/M
– Treat Hyperkalemia, ARF, CHF, acidosis, fluid
overload, HTN and its complications
– ACE inhibitors useful in proteinuria
– Immunosuppressive therapy: Depending on cause
(Steroids, cyclophosphamide)
40. Management:
– Idiopathic Hypercalciuria: Hydrochlorothiazide, Potassium
citrate, Sodium restriction
– Calculi: Plenty of water
– ESRD: Dialysis, Renal transplantation
– Correct thrombocytopenia, anemia, coagulation factor
deficiency
– Renal vein thrombosis: Anticoagulant therapy or
thrombectomy may be needed
– Surgical correction: Calculi, PUJ obstruction, Posterior
urethral valves, Wilms tumour
41. References:
• Nelson Textbook of Pediatrics, 19th Ed
• Nelson Essentials of Pediatrics, 6th Ed
• O.P. Ghai Essential pediatrics, 7th Ed
• Pediatric Nephrology, Shrivastava, Bagga,
4th Ed
• Japanese Society of Nephrology 2007
• Indian J Pediatrics 1999; 66 : 207-214
• Various Websites
