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An Evidence-Based Approach To The Management Of Hematuria In Children In The Emergency Department
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An Evidence-Based Approach To The Management Of Hematuria In Children In The Emergency Department - $39.00

Publication Date:

September 2014 (Volume 11, Number 9)

CME

This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP Category 1 credits, 4 AAP Prescribed credits, and 4 AOA Category 2A or 2B CME credits.

Authors

Kathryn H. Pade, MD
Fellow, Division of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, CA

Deborah R. Liu, MD
Fellowship Director, Division of Emergency Medicine, Children’s Hospital Los Angeles, Assistant Professor of Pediatrics, USC Keck School of Medicine, Los Angeles, CA

Abstract

Hematuria is defined as an abnormal number of red blood cells in urine. Even a tiny amount of blood (1 mL in 1000 mL of urine) is sufficient to make urine appear pink or red. In the pediatric population, the majority of etiologies are benign and often asymptomatic. However, hematuria may also be a sign of renal pathology, local infection, or systemic disease. Hematuria can be differentiated into 2 categories: macroscopic hematuria (visible to the naked eye) and microscopic hematuria (> 5 red blood cells/high-powered field on urinalysis). This review will outline the current literature regarding evaluation and management of pediatric patients who present to the emergency department with hematuria. Obtaining a thorough history and the appropriate diagnostic tests will be discussed in depth.

Exerpt from Issue

A 12-year-old adolescent boy presents to the emergency department with a chief complaint of urine the color of brown soda. He reports a recent upper respiratory infection. On physical examination, his blood pressure is 145/72 mm Hg, and you note periorbital edema. Urine dipstick is positive for blood and 2+ protein. You consider any emergent laboratory work you need to perform to confirm the diagnosis and wonder if this child requires admission to the hospital…

A 15-year-old adolescent girl is brought in by her parents with a chief complaint of pink urine. Review of systems is significant for muscle soreness, which she attributes to running a half-marathon for her cross-country team the day prior to presentation. Urine dipstick is positive for large occult blood. As you begin initial management, you consider other laboratory work that should be performed…

A previously healthy 5-year-old girl presents to the emergency department with pink urine after visiting her grandmother for the weekend. Review of systems is otherwise negative, and the patient does not take any medications. The physical examination is nonfocal, including the genitourinary examination. Urine dipstick is negative for blood or protein. You wonder what other questions you should ask to confirm the diagnosis. Does she require a repeat urine dipstick and microscopic urinalysis with her pediatrician?

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