![]() ![]() VS: T 36.4, P 68, BP 146/80, R 20, 100% O2 Gen: no distress HEENT: no peri-orbital edema, MMM Chest: CTA b/l CV: RRR, no murmur Abd: soft, NTND Ext: slight erythema in skin folds, no edema Simckes and Spitzer, Ped in Review, 1995.ħ Physical Exam in ED Wt 60kg (↑ over last 6 mos) Combination of both increases risk of renal disease Hypertension Can be a symptom of fluid overload warranting diuresis and further observation PMD sends patient to the ED…. Proteinuria may be due to notable hematuria, BUT. URINALYSIS: + hematuria, + proteinuria HTN with hematuria, proteinuria implies glomerular origin so need to admit – if only isolate hematuria or isolated proteinuria, would be ok to observe – also think about admitting if there is a story of castsĥ A Word on Urinalysis UA with >/= 5 RBC/hpf on 3 samples over several weeks = HEMATURIA Only UA can distinguish between confounders: Myoglobin, hemoglobin, toxins, foods/coloring BUT, if you have hematuria and proteinuria, higher likelihood of having renal disease – although you can see this with infection alone………need to look at rest of UA Massengill, Peds In Review, 2008Ħ A Word on Disposition Hematuria AND proteinuria Hypertension ![]() PMD notes elevated BP, weight gain, and then orders one key test………. PMH + OCD No known family history Not yet menstruating.Ĥ Case Presentation Orange urine persists x 4 days, so mom makes appointment with PMD. No real symptoms – no dysuria, no abd pain, no urgency but some frequency. Work-up based on Differential Discussion of Pathophysiology Treatment and Prognosis Take Home Pointsģ Case Presentation 12 y/o F with OCD develops “orange” urine with sediment. 2 Overview Case Presentation Indications for Referral/Admission
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