Heme positive without RBC due to hemoglobin or myoglobin. Hemoglobinuri without hematuri can occur in hemolytic anemia. Myoglobinuri without hematuri syndrome occurs in rhabdomyolisis of muscle trauma and is generally associated with increased concentrations of creatinine kinase plasme.
Rhabdomyolis can occur due to viruses, crush injury, severe electrolyte abnormalities (hipernatremi, hypophosphatemi), hypotension, DIC and long seizures. Heme negative may appear red, the color of cola, or burgundy, depending on the type of drugs and food, dark brown (or black) can be found for a variety of urinary metabolites. heme positive: hemoglobin, myoglobin heme negative: drugs, chlorokuin, dexeroxamine, ibuprofen, iron sorbitol, metronidazole, nitrofurantoin, Phenazopyridine (Pyridium), phenolphtalen, phenothiazine, rifampin, salicylates, sulfasalazine, vegetable / fruit: beets, blackberries, food dyes, metabolites, homogenitic acid, melanin, methemoglobin, porphyrin, tyrosinosis, veining.
Upper urinary tract that causes hematuri usually derived from the nephron (glomerulus, and interstitium colektivus ductus). Lower urinary tract that causes hematuri from pelvocalyceal system, ureter, bladder and urethra. hematuri of the glomerulus is usually brown, cola color, burgundy, 100mg/dl dipstick proteinuria, red blood cell casts and RBC urine out of shape. Ductus colektivus hematuri of leukocytes is accompanied by renal tubular epithelium or cast. Lower urinary tract inverse associated with the presence of gross hematuria and terminal hematuria (gross hematuri the last jet of urine), blood clots, RBC morphology of both normal and proteinuria (dipstick) <100mg/dl. Hematuri patients usually have symptoms that lead to specific abnormalities. tea color, edema, hypertension and oliguri lead to acute nephritis syndrome, including glomerulonephritis post streptococcus infection, IgA nephropaty, Membranoproliferative glomerulonephritis, Henoch-Schonlein purpura nephritis, systemic lupus erythematosus nephritis, Wegener's granulomatosis, microscopic polyarteritis nodusa, good pasteur hemolitic uremic syndrome and syndrome. history of upper respiratory tract infections, skin and digestive lead to acute glomerulonephritis, hemolitic uremic syndrome, or HSP. rash and joint pain leads to HSP or SLE. ketch urinary frequency, dysuria and fever lead to urinary tract infections and may be a nephrolithiasia. mass in the flank area of the possibility of a hydronephrosis, cystic disease, renal vein thrombosis, or tumor. hematuri with headaches, vision changes, epistaxis or CHF leads to hypertension. riwaya patients with trauma requiring immediate evaluation. Family history also needs to be asked for the possibility of Alport syndrome, thin glomerular basement membrane disease, SLE nephritis, IgA nephropathy (Berger's disease). Other kidney disorders are hereditary include polycystic kidney disease, urolithiasis, and sickle cell disease. syndrome (Vater: Vertebral body anomalies, Anal atresia, Tracheo-esophageal fistula and Renal dysplasia syndrome). abdominal mass in the posterior urethral valves can be suspected, uretereopelvic junction obstruction, polycystic kidney disease or tumor Wilm.
The most frequent cause of hematuri
- Urinary tract infections
- Meatal stenosis
- Perineal inflammatory
- Trauma
- Urolithiasis / hypercalciuria
- Coagulopathy
- Tumor
- glomerular o Ig A nephropathy
source : Nelson
- Alport syndrome
- thin glomerular basement membrane disease
- glomerulonephritis post streptococcus infection
- HSP nephritis o SLE nephritis
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