Hematuria in Children: Model Clinical case and Viva Q&A

Clinical Case of Hematuria in Children

Clinical Case: Gross Hematuria in a 7-year-old Boy

A 7-year-old boy presents to the pediatric clinic with his mother, who reports noticing blood in her son's urine for the past two days. The urine appears bright red, and the boy complains of mild discomfort while urinating. There is no history of trauma, recent illness, or medication use.

Past Medical History:

• No significant medical conditions
• Normal growth and development
• Up-to-date on vaccinations

Family History:

• Maternal grandfather with history of kidney stones
• No known hereditary renal diseases

Physical Examination:

• Vital signs: Temperature 37°C, Heart rate 88 bpm, Respiratory rate 18/min, Blood pressure 110/70 mmHg
• General: Alert, cooperative, no acute distress
• Abdomen: Soft, non-tender, no masses or organomegaly
• Genitourinary: Normal external genitalia, no signs of trauma
• Skin: No rashes or petechiae
• Musculoskeletal: No edema or joint swelling

Initial Diagnostic Steps:

1. Urinalysis: Positive for blood, protein 1+, no casts
2. Urine culture: Pending
3. Complete blood count: Within normal limits
4. Serum creatinine and BUN: Within normal range

Based on these findings, further evaluation is needed to determine the underlying cause of hematuria in this child.

Clinical Presentations of Hematuria in Children

Varieties of Clinical Presentations of Hematuria in Children

1. Asymptomatic Microscopic Hematuria

   Detected incidentally during routine urinalysis, with no visible blood in urine and no other symptoms. Often transient and benign.

2. Gross Hematuria with Dysuria

   Visible blood in urine accompanied by pain or burning sensation during urination. May indicate urinary tract infection or bladder inflammation.

3. Hematuria with Flank Pain

   Blood in urine associated with severe pain in the side or back. Could suggest kidney stones or ureteropelvic junction obstruction.

4. Hematuria Following Upper Respiratory Tract Infection

   Occurs 1-2 weeks after a sore throat or skin infection. May indicate post-streptococcal glomerulonephritis.

5. Exercise-Induced Hematuria

   Blood in urine noticed after intense physical activity, often resolving with rest. Generally benign but requires evaluation to rule out other causes.

6. Hematuria with Edema and Hypertension

   Blood in urine accompanied by swelling (particularly around the eyes and ankles) and high blood pressure. May suggest nephrotic syndrome or acute glomerulonephritis.

7. Painless Gross Hematuria

   Visible blood in urine without pain or other symptoms. Can be alarming and may indicate various conditions from benign causes to more serious issues like tumors.

8. Hematuria with Abdominal Mass

   Blood in urine associated with a palpable abdominal mass. Warrants immediate evaluation for potential Wilms' tumor or other renal malignancies.

9. Hematuria with Recent Trauma

   Blood in urine following injury to the abdomen, pelvis, or genitourinary tract. May indicate renal contusion, laceration, or urethral injury.

10. Hematuria with Family History of Renal Disease

    Blood in urine in a child with family members affected by conditions like Alport syndrome, polycystic kidney disease, or other hereditary nephropathies.

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

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