Síndrome de cascanueces: una causa infrecuente de hematuria / Nutcracker Syndrome: a Rare Cause of Hematuria

La hematuria en pediatría responde habitualmente a etiologías benignas. Una causa poco frecuente es el síndrome de cascanueces, que se define como la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior, que deriva en una presión elevada en la vena renal izquierda con el desarrollo de venas colaterales y dilataciones varicosas. La prevalencia de este síndrome se desconoce. Cuando es sintomático ocasiona hematuria, proteinuria y dolor pélvico crónico. En la pubertad, el crecimiento rápido y el desarrollo de los cuerpos vertebrales pueden producir un estrechamiento del ángulo entre la aorta y la arteria mesentérica superior. Se describe el caso de una adolescente con diagnóstico de carcinoma mucoepitelial metastásico óseo múltiple que presenta hematuria anemizante. Se arribó al diagnóstico de síndrome de cascanueces y se discutieron las opciones de tratamiento. Finalmente, con el uso de realce del calzado para corrección de la escoliosis, se atenuó significativamente la hematuria. (AU)

In pediatrics, hematuria usually responds to benign etiologies. A rare cause is nutcracker syndrome, defined as compression of the left renal vein between the aorta and the superior mesenteric artery, resulting in elevated pressure in the left renal vein with the development of collateral veins and varicose dilatation. The prevalence of this syndrome is unknown. When symptomatic, it causes hematuria, proteinuria, and chronic pelvic pain. At puberty, the rapid growth and development of the vertebral bodies can produce a narrowing of the angle between the aorta and the superior mesenteric artery.We describe the case of a teenage girl diagnosed with multiple metastatic mucoepithelial carcinoma of bone who presented anemia-producing hematuria. The diagnosis of nutcracker syndrome was arrived at with consideration of the therapeutic options. Finally, with shoe enhancement for scoliosis correction, hematuria was significantly lessened. (AU)

Alteraciones urinarias en niños con primera infección urinaria e infección urinaria recurrente / Urinary disorders in children with first urinary infection and recurrent urinary tract infection

Introducción: las infecciones del tracto urinario son un problema frecuente en la población pediátrica. La infección del tracto urinario recurrente tiene mayor riesgo de cicatrices renales y daño glomerular. Objetivo: describir la frecuencia de hematuria, presencia de proteínas en orina, elevación en tensión arterial y hallazgos ecográficos en pacientes pediátricos desde 1 mes hasta 14 años de edad, con diagnóstico de infección del tracto urinario. Métodos: estudio descriptivo transversal, realizado entre octubre de 2014 y febrero de 2016, en pacientes que asistieron al servicio de urgencias pediátricas del Hospital de San José, con diagnóstico de infección del tracto urinario. Resultados: se diagnosticaron 125 pacientes con infección del tracto urinario, la mediana de edad fue de 2,75 años, más frecuente en mujeres (75,2 por ciento) y la mayoría recibió tratamiento intrahospitalario (58,4 por ciento). Se observó que en el grupo de infección del tracto urinario recurrente fue más frecuente el hallazgo de hematuria, que en la infección del tracto urinario primer episodio (21,9 vs. 11,8 por ciento), al igual que las malformaciones renales (32,0 vs. 14,5 %). En la tensión arterial no se observaron grandes diferencias entre los grupos, con una frecuencia de tensión arterial elevada en hospitalizados de 19,6 por ciento para primer episodio, y 18,2 por ciento en recurrentes. La presencia anormal de proteínas en orina fue de 35,4 por ciento en el grupo de infección del tracto urinario primer episodio. Conclusiones: son frecuentes la presencia de hematuria, malformaciones renales y elevación de la tensión arterial en pacientes con infección del tracto urinario. Se encuentra una frecuencia inusual de pacientes con elevación de la presión arterial y proteínas en orina, probablemente por falsos positivos. Se debe insistir en seguimiento ambulatorio del uroanálisis y la tensión arterial, para garantizar que esta se normalice o para detectar daños permanentes(AU)

Introduction: urinary tract infections are a frequent problem in the pediatric population. Recurrent urinary tract infection has a higher risk of kidney scars and glomerular damage. Objective: to describe frequency of hematuria, presence of proteins in urine, increase of blood pressure, and ultrasound findings in pediatric patients from 1 month to 14 years old with a diagnosis of urinary tract infection. Methods: cross-sectional descriptive study conducted from October 2014 to February 2016, in patients who attended the pediatric emergency´s service of the Hospital of San José with a diagnosis of urinary tract infection. Results: 125 patients with urinary tract infection were diagnosed, the median age was 2.75 years, it was more frequent in women (75.2 percent) and the majority of them received intrahospital treatment (58.4 percent). It was observed that in the recurrent urinary tract infection group the finding of hematuria was more frequent, than in the group of urinary tract infection as a first episode (21.9 vs. 11.8 percent), as well as the renal malformations (32,0 vs. 14.5percent). In blood pressure, there were no large differences among the groups, with a rate of high blood pressure frequency in hospitalized patients of 19.6 percent for first episode, and 18.2 percent in recurrent patients. The abnormal presence of proteins in urine was of 35.4 percent in the group of urinary tract infection first episode(AU) Conclusions: the presence of hematuria, renal malformations and increase of blood pressure in patients with urinary tract infection are frequent. There is an unusual frequency of patients with high blood pressure and proteins in the urine, probably due to false positives. It must be addressed the ambulatory monitoring of urinalysis and blood pressure to ensure that it normalizes or to detect permanent damage

El análisis de orina como herramienta diagnóstica en casos de malaria grave / Urinalysis as a diagnostic tool in severe malaria

Resumen La malaria produce complicaciones y muerte especialmente en poblaciones con acceso limitado a la atención en salud. La malaria grave puede reconocerse tempranamente mediante la detección en la orina de hallazgos como la hematuria, la coluria y la proteinuria. Se hizo una revisión narrativa basada en estudios sobre malaria grave y el empleo del análisis de orina mediante la consulta de 91 publicaciones. Mediante el análisis de la orina, se pueden detectar alteraciones metabólicas y lesiones en distintos órganos. En estudios recientes en Colombia se ha confirmado su utilidad como apoyo en el diagnóstico de la disfunción renal, la disfunción hepática y la anemia asociada con hemólisis, las cuales son complicaciones frecuentes en la malaria. El examen constituye una herramienta de fácil aplicación en la consulta ambulatoria y en pacientes hospitalizados para reconocer tempranamente casos complicados, y permite la detección oportuna de diferentes lesiones en el paciente con malaria, contribuyendo así a la reducción de la morbilidad grave y la mortalidad.

Abstract Malaria accounts for a significant morbidity and mortality rate around the world, especially in communities with limited access to healthcare. Some clinical signs in urine, like haematuria, coluria and proteinuria, help for the early diagnosis of severe malaria cases. A narrative review was conducted by analyzing 91 publications on studies about severe malaria cases and the use of urinalysis. A urinalysis can detect metabolic disturbances and organ injury. Its diagnostic utility for frequent complications caused by malaria, such as hepatic injury, kidney dysfunction and hemolysis, has been confirmed by recent Colombian studies. This test is an easy-to-use tool in outpatient clinics and with hospitalized patients to promptly recognize complicated cases, allowing the timely identification of different lesions in patients with malaria, thus contributing to the reduction of severe morbidity and mortality.

Hemoglobinuria paroxística nocturna. el rol de la anhidrasa carbónica-i urinaria en la hemólisis intravascular / Peroxysmal nocturnal hemoglobinuria: the role of urinary carbonic anhydrase-I in intravascular haemolysis

La Hemoglobinuria Paroxística Nocturna (HPN) se caracteriza por hemólisis intravascular crónica mediada por complemento. Cuando se produce la hemolisis se libera a circulación Anhidrasa Carbónica- I (AC-I), una enzima que se halla en alta concentración en el eritrocito y por su bajo peso molecular filtra por el glomérulo. El objetivo del presente trabajo fue detectar la excreción de la AC-I en orina de pacientes con HPN por Electroforesis Bidimensional de Utilidad Clínica (2D UC), y compararla con otras causas de hemólisis, de origen renal y postrenal. Se evaluaron 8 pacientes con HPN sin tratamiento con eculizumab un inhibidor del C5 del complemento, y 5 de ellos postratamiento, 12 orinas de pacientes con nefritis lúpica y 10 orinas de pacientes con hemólisis postrenal. La AC-I puede estar presente en la orina, en los tres grupos, sin embargo la relación AC-I/Hemoglobina en la hemólisis intravascular está invertida en comparación con la hemolisis glomerular y post-renal. Los pacientes con HPN tratados con eculizumab no presentan AC-I, y sería de utilidad en el seguimiento de los pacientes tratados con el inhibidor del C5, para evidenciar posibles escapes hemolíticos.

Paroxysmal Nocturnal Hemoglobinuria (PNH) is characterized by chronic complement mediated haemolysis. In these conditions it might be expected that carbonic anhydrase-I (AC-I) would be liberated into the plasma and excreted in the urine, by its high concentration in the erythrocyte and low molecular weight. The objective of the present study was to detect the urinary excretion of AC-I from patients with PNH by wodimensional clinical utility electrophoresis (2D UC) and to compare it with other causes of renal and post-renal haemolysis. We evaluated 8 patients with PNH without eculizumab, a complement C5 inhibitor, 5 of them posttreatment, 12 urine of patients with lupus nephritis and 10 urine of patients with post-renal hemolysis. AC-I may be present in the urine, in all three groups, however, the AC-I/Haemoglobin ratio in intravascular haemolysis is reversed compared to glomerular and post-renal haemolysis. Patients with PNH treated with eculizumab do not have AC-I and would be useful in monitoring patients treated with the C5 inhibitor to evidence possible haemolytic leaks.

Embolização vesical superseletiva para tratamento de hematúria maciça por cistite actínica / Selective vesical artery embolization for treatment of gross hematuria due to actinic cystitis

Os autores relatam o caso de uma paciente de 46 anos de idade, que, após ter sido submetida a tratamento radioterápico por neoplasia de colo uterino, desenvolveu cistite actínica com episódios frequentes de hematúria franca. A paciente necessitou ser submetida a repetidos cateterismos vesicais por retenção urinária, hemotransfusões e internacões hospitalares. As medidas conservadoras e as tentativas de hemostasia por cistoscopia não foram bem-sucedidas no controle do sangramento. A paciente foi então submetida a tratamento endovascular com embolização superseletiva das artérias vesicais e outros pedículos vasculares, que se demonstraram associados ao sangramento. O procedimento foi bem-sucedido e a paciente vem sendo acompanhada há nove meses sem a necessidade de novas hemotransfusões nem de novas internações hospitalares. De acordo com a revisão da literatura, o uso dessa técnica ainda não havia sido descrito em trabalhos brasileiros.

This article describes the case of a 46-year-old female patient who had been treated with radiotherapy for cervical cancer. She developed actinic cystitis with frequent episodes of severe hematuria. She required repeated catheterization to manage urinary retention, blood transfusions and hospital admissions. Conservative measures and attempts to achieve hemostasis by cystoscopy were unsuccessful at controlling bleeding. The patient therefore underwent endovascular treatment with superselective embolization of the vesical arteries and other vascular pedicles found to be linked with the bleeding. The procedure was successful and the patient has been in follow-up for 9 months with no need for further blood transfusions or admission to hospital. According to a review of the literature, use of this technique has not previously been described in Brazil.

Proteinuria predicts relapse in adolescent and adult minimal change disease

OBJECTIVE: This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients. METHODS: We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >13 years and had minimum 1-year follow-ups. RESULTS: Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease. CONCLUSIONS: In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day.

Litiasis recidivante en cachorro Schnauzer miniatura: reporte de un caso / Recurrent urolithiasis in a miniature Schnauzer puppy: case report

La formación de cálculos urinarios es un problema clínico importante en perros. Existen diferencias en la tendencia de presentar litiasis entre diversas razas. Se presenta un caso de litiasis recidivante en un cachorro, macho,Schnauzer miniatura, que a los dos meses de edad presentó hematuria y disuria por obstrucción de vías urinarias asociada a etiología litiásica. El cachorro expulsó urolitos en dos ocasiones, a los tres y siete meses de edad. El análisis morfológico de estos cálculos mostró que el primero estaba formado por Carbapatita (fosfato de calcio carbonatado cristalizado) correspondiente al tipo morfológico IVa1 y los cálculos del segundo episodio presentaban una combinación del tipo IVa1 + IIa, este último tipo morfológico formado por Weddellita (oxalato de calcio dihidratado). Los análisis de orina mostraron pH 6 a 7,5, con bacterias y cristales de fosfato triple en dos muestras y de oxalato de calcio en una muestra del total de seis analizadas. Se administró antibióticos para controlar infecciones urinarias en ambos episodios litiásicos. El manejo nutricional consistió en alimentación con balanceado especial para perros con litiasis desde los 2 hasta los 7 meses de edad. Luego del segundo episodio litiásico se evitaron los balanceados y se alimentó al cachorro con pollo hervido y verduras. Desde la instauración del nuevo régimen nutricional, hace ya más de un año, no se han observado cristales en las muestras de orina, ni se refieren síntomas urinarios en el cachorro hasta la fecha.

The formation of urinary stones represents an important clinical issue in canines. There are differences in the trend to present urolithiasis among breeds. This is a case of recurrent lithiasis in a Miniature Schnauzermale puppy that presented hematuria and dysuria caused by a urinary tract obstruction associated to lithiasis. The puppy eliminated uroliths at the age of three and seven months old. The morphological analysis of this urinary calculus showed that the first consisted of carbapatite (crystallized carbonated apatite) classified as morphological type IVa1 and the second calculus presented a combination of type IVa1 + IIa. Morphological type IIa is formed by Weddellite (dihydrate calcium oxalate). Urine analysis of six samples showed a pH value from 6 to 7,5 with presence of bacteria and triple phosphate crystals in two samples and calcium oxalate crystals in one sample. Antibiotic therapy was applied to treat urinary infection in both lithiasic episodes. Dietary therapy consisted initially in feeding the puppy with balanced food special for dogs with lithiasis from two to seven months old. After the second lithiasic episode, the puppy was fed with boiled chicken and vegetables avoiding the balanced dog food. Since the implementation of the latter nutritional plan, more than a year ago, nor crystals have been detected in urine samples neither clinical signs of urolithiasis were observed in the puppy up to now.

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

Study of kidney function in asphyxiated full term newborn

Renal impairment in the neonates usually occurs following complicated labor and delivery with perinatal asphyxia, and it is usually in form of tubular insult. [Al Fred, 1996]. The clinical presentations of renal impairment in neonates is often subtle, lack of recognition of its occurrence has made this especially true when renal impairment follows perinatal asphyxia. To study kidney function in full term asphyxiated neonates. 24 asphyxiated FT newborn and 12 control were subjected to comprehensive history and renal function evaluation study. Routine urinalysis of cases, with perinatal hypoxia revealed proteinuria in 41.7% in patients. Many epithelial cells were found in 53.5% of the cases with perinatal asphyxia. Mean urine analysis for R.B.Cs of patients [6.33 RBCs/HPF +/- 4.02 RBCs/HPF]' which was significantly higher than that of controls [4.16 RBCs/HPF +/- 2.69 RBCs/HPF]. Mean urine analysis for pus cells of patients [2.84 pus cells/HPF +/- 1.59 pus cells/HPF] which was not significantly different than that of controls [3.08 pus cells/HPF + 3.87 pus cells/HPF]. Mean urinary beta 2 micro globulin concentration in patients [218.30 ng/ml +/- 100.93 ng/ml] was significantly higher than that of controls [144.316 ng/ml +/- 126.3 ng/ml] which is specific for tubular renal insult in renal impairment. Mean urinary urea in patients was [7.727 + 3.16 meq/l] which was not significant in relation to controls 96.80 +2.907 meq/l]. Mean urinary creatinine in patients was [1.30 +1.4 meq/l] which was not significantly different than controls [1.22 +1.09 meq/l]. Renal function must be evaluated in all asphyxiated newborn serum cratinine and heamaturia are sensitive indicators while urinary beta2 microlobin is more specific

Differentiation of glomerular from non-glomerular hematuria by three different methods of microscopic examinations of erythrocytes in urine

Morphological examinations of urinary erythrocytes can be of diagnostic value in initial evaluation of hematuria. Dysmorphic urinary red blood cells are known to indicate a glomerular origin of bleeding. We examined the clinical usefulness of this test in a population complained of hematuria by use of three different light microscopy, phase contrast microscopy, and Wright staining and compared their sensitivity and specificity. The study included 169 patients with hematuria [89 glomerular and 80 non-glomerular]. The urine specimens were collected before invasive procedures such as biopsy and cystoscopy. In each urine sample, 100 urinary erythrocytes were examined. Statistical analysis was performed using Student's t test, correlation coefficient, and x. Reliability parameters including sensitivity, specificity and predictive values of negative and positive tests were also evaluated. Dysmorphic red cells were recorded as acanthocytes, doughnut-like cells, yeast like cells with more than one blebs and ghost forms. Isomorphic erythrocytes had uniform size and shape. Significant difference was found in the number of urinary dysmorphic red cells between the two groups of patients. Statistical analysis showed that by using percentage of glomerular type erythrocytes and setting the cut-off at 20-25%, the specificity for three procedures was almost the same [? 97.5%]. But sensitivity for light microscopy, phase contrast microscopy, and Wright staining was in different ranges as 70.7%, 89.8%, and 86.5% respectively. It was concluded that with some limitations, these simple, non-invasive techniques were useful in identifying the source of bleeding in the work up of hematuria by considering that sensitivity of the methods were in the order of phase contrast microscopy, Wright staining, and light microscopy

Uroanalisis: mas que un examen de rutina / Uroanalisis: more than a routine examination

Un uroanálisis (citoquímico de orina) completo incluye el exámen físico, químico y microscópico. La muestra ocasional de orina es útil en la mayoría de los casos, pero esta muestras deben ser evaluadas dentro de las dos primeras horas después de haber sido recogidas. La orina turbia frecuentemente es el resultado de cristales de fosfatos precipitados en orinas alcalinas, aunque también puede estar causado por piura. Un olor fuerte puede ser el resultado más de la concentración de la orina que el efecto de una infección del tracto urinario. Puede ser útil la evaluación de la orina por medio de tirillas, pero se debe recordar que también pueden ocurrir los falsos positivos y negativos con éste método. La gravedad específica provee una gran información sobre el estado de hidratación del paciente. La microhematuria tiene una gran gama de causas, desde las benignas hasta las que ponen en peligro la vida del paciente. Las causas glomerulares, renales o urológicas de la microhematuria pueden ser fácilmente diferenciadas por otros elementos del uroanálisis. Aunque la proteinuria transitoria típicamente es una condición benigna, la proteinuria persistente requiere evaluaciones más complejas. Las infecciones del tracto urinario no complicadas diagnosticadas por estereasa leucocitaria positiva o nitritos positivos pueden ser tratadas sin la necesidad del cultivo.Palabras clave: uroanálisis, citoquímico de orina, orina.

Effectiveness of routine urine analysis of patient attending rural health centers in Abbottabad

Renal diseases may be discovered accidentally during routine urinalysis. This study was done to see the significance of urinalysis and study the magnitude of abnormal urinalysis in patients with no symptoms of renal disease. From 15th February to 16th March 2005, a total of 1000 samples of urine were collected from the patients attending three rural health centers of Abbottabad. Dipstick Method was used for urinalysis. there were 600 males and 400 female patients. The age ranged from 1 to 55 years. Proteinuria was present in 2.3%, hematuria in 4.8% patients, pyuria in 10.2% and glycosuria in 2% patients. In our setup routine urine analysis should be performed in all patients to identify the presence of unrecognized renal diseases which may benefit from simple therapeutic measures

Renal failure in asphyxiated neonates.

A prospective case controlled study was conducted in the NICU of a tertiary level referral teaching hospital to determine the incidence of renal failure in asphyxiated neonates and to correlate severity and type of renal failure with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. Ninety-eight neonates were enrolled 70 asphyxiated babies and 28 healthy controls. Renal functions were assessed using urinary output, urine microscopy, biochemical parameters and sonographic findings. Babies having renal failure were managed on a protocolised plan and followed up till 6 months of age to detect any residual impairment. Blood urea and serum creatinine were significantly higher in asphyxiated babies compared to the control group. Biochemical derangements correlated well with HIE staging and Apgar scores. There was no significant difference in urine output in the control and the study group as significant oliguria was seen in only 7 of the 70 asphyxiated babies and the output did not correlate with severity of asphyxia. Serum sodium level and fractional excretion of sodium showed significantly different values in the asphyxiated babies compared to control. Of the 70 asphyxiated babies 33 (47.1 %) had renal failure, which was of the non-oliguric type in 78 % cases and oliguric type in 22 % cases. Sonographic abnormalities were seen more often in oliguric babies and was associated with a bad prognosis. Renal parameters normalized in all neonates by 6 months of age. Mortality was higher in babies with oliguric renal failure. We conclude that renal failure is a significant problem in asphyxiated neonates with majority of babies having nonoliguric failure. Severity of renal function abnormality correlates well with degree of asphyxia. Oliguria, hyponatremia and abnormal sonographic scan are bad prognostic signs in renal failure secondary to birth asphyxia.

Diagnostico topografico de las hematurias en pacientes pediatricos mediante el porcentaje de hematies dismorficos / Topographic diagnosis of hematurias in pediatric patients by means of a percentage of dimorphic red cells

Se realizo un estudio para fijar el porcentaje de hematies dismorficos que sirva de punto de corte optimo para el diagnostico topografico de las hematurias en pacientes pediatricos. Se utilizaron datos clinicos y de laboratorio de 77 pacientes con hematuria glomerular y 15 con hematuria no glomerular. Mediante una metodologia estadistica se obtuvo 14 por ciento como valor del punto, con lo que se asigna al grupo de las hematurias glomerulares todo paciente que presente una cifra de hematies dismorficos igual o superior. El area bajo la curva ROC (Receiver Operating Characteristic) asociada a este test fue 0,9597, lo que indica una elevada exactitud para la prueba, basntante cercana del valor idal, 1,0 que indica una discriminacion perfecta

Cytological examination of urine of patients suffering from cystitis and hematuria

A sample of 390 patients with a mean age of 40.4 years presented with hematuria, cystitis or suspected bladder mass were evaluated clinically and by US and urine cytology [voided and irrigation]. The results were compared with those of cystoscopy and bladder biopsy. Bladder tumors were found in 23.5% of all screened patients [SQ. CC 11.8%, TCC 11% and adenocarcinoma 0.8%]. Urine cytology was positive in 17.7% inconclusive in 17.8% and negative in 64.5%. Sensitivity was 86% and specificity 99%. According to tumor type [SQ. CC, TCC and adenocarcinoma] cytology was positive in 58.7%, 88.3% and 100%, respectively. Low grade tumors, especially SQ. CC and voided urine samples give less positive results than high grade tumors and bladder irrigation urine sampling. It is concluded, that urine cytology is sensitive in detecting bladder tumors. Accuracy increases with high risk and symptomatic patients. Frequent screening of the groups is recommended

Propedêutica sequencial da urina nas suspeitas de hematúria / Sequential approach of the urine in the suspected hematuria

Os autores apresentam um caso de hemoglobinúria paroxística noturna cuja suspeita diagnóstica surgiu a partir da análise seqüencial da urina de coloração vermelho-acastanhada em paciente com história de hematúria recorrente. Sugerem que a urinálise pelo nefrologista aumenta as chances de acerto diagnóstico em situações semelhantes, assim como evita a realização desnecessária de exames complementares, como ilustrado no caso apresentado.

The authors present a case of paroxysmal nocturnal haemoglobinuria suspected when the urine was sequentially analyzed in a patient with history of recurrent hematuria. They suggest that the urinalysis done by nephrologists rises the chances of acorrect diagnosis in clinical situations like the one presented, as well as avoid that unnecessary tests to be done, as in the discussed case.

Hipercalciuria idiopática en pediatria: experiencia de 5 años / Idiopathic hypercalciuria in pediatrics: experience of 5 years

El estudió de la hipercalciuria idiopática en pediatría requiere contar con información local. Se presentan los resultados de la medición de excresión urinaria de calcio en 97 niños sanos, medido a través del índice calciuria creatininuria, resultando un promedio de 0,13 y una mediana de 0,08. Se evalúa igualmente la relación entre calciuria así determinada y la excresión urinaria de sodio (n:47), demostrándose una correlación estadísticamente significativa, r de 0,41, p<0,01. La validez del índice calcio/creatinina en orina aislada frente al calcio en orina de 24 horas (n:44) se confirmó al obtener una alta correlación (r:0,89, p<0.001) entre ambos. Al comparar la eficacia de la prueba de restricción y sobrecarga de calcio con la restricción simple de calcio en el diagnóstico diferencial de las hipercalciurias idiopáticas (n:78) absortiva y renal, se observó que la exactitud del ensayo de restricción simple es mayor

Orina de color y cantidad anormal / Urine of abnormal color and quantity

Siempre que sea posible es aconsejable observar la orina como parte del examen físico (micción en el pañal, micción espontánea en el lactante, muestra ex profeso y datos de información anamnésticos en el niño mayor). Normalmente la orina es de color amarillo ámbar más o menos pálido con variaciones del matiz por circunstancias diversas. Recién emitida es límpida y transparente