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-Red/ smoky brown/cola colored / faint pink
-Benzidine or guaiac test

Important causes: -

  1. Acute GN, Alport syndrome. Membrano proliferative GN
  2. Renal vein thrombosis, Renal calculi* Idiopathic hypercalciuria
  3. Hemorrhagic cystitis, DIC. Polycystic Kidneys, Wilms tumor
  4. Urinary tract infection, trauma 

Glomerular - Dysmorphic RBCS are seen where as in bleeding from renal pelvis or lower urinary tract, the RBC’s are of normal morphology.

Presence of significant proteinuria and/or red cell casts also suggest Glomerular disease


Idiopathic hypercalciuria
  1. A family history of hematuria or urolithiasis. The diagnosis of hypercalciuria is confirmed by a 24-hour urinary calcium excretion exceeding 4mg/kg/d.
    1. Urinary calcium to creatinine ratio in spot urine samples serve as a screening test. A urine calcium to creatinine ratio (mg/mg) exceeding 0.2 suggests hypercalciuria, although normal ratios may be as high as 0.8 in infants younger than 7 mo of age.
    2. Blood level of calcium is normal
  2. Dietary sodium restriction is important because calcium excretion parallels that of sodium excretion. Importantly, dietary calcium restriction is not recommended because of the obligate requirement for growth and lack of evidence demonstrating a reduction in urinary calcium levels. Oral thiazide diuretics may normalize urinary calcium excretion by stimulating calcium reabsorption in the distal tubule. 



The presence of protein in the urine is abnormal.


Fever, dehydration and heavy exercise may cause transient proteinuria that is usually mild.


Important causes of asymptomatic proteinuria:

  1. Orthostatic proteinuria          
  2. Chronic glomerular diseases        
  3. Reflux nephropathy      
  4. Renal hypoplasia

In orthostatic proteinuria protein is absent in urine specimen collected after overnight recumbence.


II. Glomerulopathies-


The five main primary glomerulopathies are-
  1. Acute nephritic syndrome              
  2. Nephrotic syndrome      
  3. Chronic glomerulonephritis.
  4. Rapidly progressive glomerulonephritis(subacute glomerular inflammation)
  5. Asymptomatic abnormalities of urinary sediment(hematuria, proteinuria)

Nephritic Syndrome- This is characterised by development over days of azotemia, hypertension, edema, hematuria, proteinuria and oliguria. RBC cast are present in the urine. If these manifestations occur within weeks to months it is known as rapidly progressive glomerulonephritis.

  1. Acute Poststreptococcal GN
    It is most common cause of GN in childhood. Nephritis develops 1 –3 weeks after pharyngeal or cutaneous infection with ‘nephritogenic’ strains of group A beta – hemolytic streptococci.
    Diagnosis depends on a positive pharyngeal or skin culture, rising antibody titers and hypocomplementemia. Renal biopsy reveals diffuse proliferative GN.
    Treatment consists of correction of fluid and electrolyte imbalance
    In most cases the disease is self – limited, although the prognosis is less favorable and urinary abnormalities are more likely to persist in adults.   
  2. Goodpasture’s Syndrome
    1. This is characterized by lung hemorrhage, GN, and circulating antibody to basement membrane,   
    2. usually in young men. Hemoptysis may precede nephritis.
    3. Rapidly progressive renal failure is typical
    4. Circulating anti – glomerular basement membrane (GBM) antibody and linear immuno –
    5. fluorescence on renal biopsy establishes the diagnosis
    6. Plasma exchange may produce remission.  
  3. Henoch – Schönlein Purpura
    1. It is generalized vasculitis causing GN, purpura, arthralgias and abdominal pain, occurring
    2. mainly in children.
    3. Renal involvement is manifested by hematuria and proteinuria.
    4. Serum IgA is increased in half of patients
    5. Treatment is symptomatic.  
  4. IgA Nephropathy (Berger’s Disease)
    1. This is the most common form of primary glomerular disease in the world
    2. It progresses to end stage renal disease in 20 to 40% of patients affected over a 20 years period.
    3. Gross, intermittent hematuria, which is glomerular, is the presenting symptom.
    4. There is presence of abnormal proteinuria
    5. Mesangial IgA is present, serum compliment is normal.
    6. No therapeutic regimen has been shown to clearly affect outcome in IgA nephropathy.

Diseases Associated with IgA Nephropathy Q


Idiopathic (majority)


Renal – limited or as component of Henoch – Schönlein purpura

In associated with systemic diseases or drugs

  • Liver : Chronic liver disease with involvement of biliary tree
  • Gastrointestinal : Celiac disease, Crohn’s disease, adenocarcinoma
  • Respiratory : Idiopathic interstitial pneumonitis, obstructive bronchiolitis, adenocarcinoma
  • Skin : Dermatitis herpetiformis, mycosis fungoides, leprosy
  • Eyes : Episcleritis, anterior uveitis
  • Miscellaneous : Ankylosing spondylitis, relapsing polychondritis, Sjögren’s syndrome,monoclonal IgA gammopathy, schistosomiasis

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