Hematuria & Proteinuria
1.You are seeing a 9-year-old boy for red-tinted urine for several days. He has no abdominal pain. He has had intermittent fevers for the past week. His past medical history is significant for a similar episode several years ago that self-resolved. He is well-appearing. His blood pressure is 100/65 mmHg. He has a normal physical exam. Urinalysis shows numerous RBCs but no casts. His serum complement level is normal.
1. Define hematuria. What are some common causes of gross and/or microscopic hematuria?
2. How would you evaluate a patient presenting with gross hematuria?
3. In any patient with hematuria, what history, physical exam, and laboratory findings are concerning for renal disease?
4. What is the most likely diagnosis in the case detailed above?
2. A 3-year-old boy presents to your office with several days of swelling of the face and extremities. On exam, you appreciate a happy child with facial swelling and pitting edema in all extremities. The remainder of his physical exam is normal. His vital signs are normal. Urinalysis shows 4+ proteinuria and 5 RBCs per high-power field.
1. What is the most likely diagnosis?
2. What findings would you expect on histologic examination of this patient’s kidney?
3. How would you treat this patient?
4. Name several other expected laboratory and exam findings in a patient with this condition.
5. What are some other conditions associated with nephrotic syndrome?
6. Name some indications for renal biopsy.
Case by Dr. Julie Schneider