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Hurricane Katrina Aug 29, 2005

Hurricane Katrina Aug 29, 2005. Gross Hematuria Presenting to ER. UTI 50% Perineal /Urethral Irritation 18% Trauma 7% Acute Nephritis 4% Coagulopathy 3% Stone 2% No etiology identified 10% Don’t forget about tumors ( Wilms ). Asymptomatic Gross Hematuria.

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Hurricane Katrina Aug 29, 2005

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  1. Hurricane Katrina Aug 29, 2005

  2. Gross Hematuria Presenting to ER • UTI 50% • Perineal/Urethral Irritation 18% • Trauma 7% • Acute Nephritis 4% • Coagulopathy 3% • Stone 2% • No etiology identified 10% • Don’t forget about tumors (Wilms)

  3. Asymptomatic Gross Hematuria • No identifiable cause 36% • Hypercalciuria 22% • IgA Nephropathy 16% • Post-strep glomerulonephritis 7% • Other glomerular (thin b.m.) 2% • Congenital anomalies 2% • Sickle cell 1%

  4. Evaluation (H&P!!!) • Trauma: CT Scan • S/S of malignancy? • Wilm’s • Neuroblastoma

  5. Evaluation • Post-infectious Acute Glomerulonephritis(strep) • 10 days post pharyngitis • 21 days post impetigo • Edema, HTN (85%) • Strep antibody titers • Low C3

  6. Evaluation • IgA • Most common presentation recurrent hematuria • 5 days post URI • Can be associated with edema, HTN, renal insufficiency • Dx: Kidney biopsy

  7. Anatomic Abnormalities and Hematuria

  8. UPJ Obstruction • Blockage (often partial) of urine flow where ureter enters kidney. • Both congenital and acquired • Most common pathologic cause of antenatally detected hydronephrosis • Intrinsic narrowing (most common) • Extrinsic compression (10%) aberrant renal a.

  9. UPJ Obstruction: Presentation • Fetal/neonatal: Fetal U/S, palpable abd mass, UTI, hematuria, FTT • Children: Intermittent flank pain, hematuria with minor trauma, calculi, HTN

  10. UPJ Obstruction: Treatment • Asymptomatic: Watchful waiting • Symptomatic: Surgery

  11. ADPKD • Most common hereditary kidney dz • Presents from neonate to 5th decade • Hematuria, B flank pain, abdominal masses, HTN, UTI • Cysts in liver, pancreas, spleen, ovaries • Mitral valve prolapse 12% of peds pts • Intracranial aneurysms (adults) • Dx by U/S, bilateral macrocysts • Tx: Supportive

  12. ARPKD • Infantile PKD • Neonatal B flank mass, oligohydramnios, pulmhypoplasia, potter facies • Severe hepatic cirrhosis and portal HTN • 30% die as neonates • If survive 1st year, 10 year survival 80% • ESRD >50%

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