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Renal and Urologic Disorders in Children

Creatinine is commonly used as an approximation of GFR. Creatinine clearance corrected for surface area is approximately 40 mL/min/1.73 M2 in the full term newborn.

GFR increases during the first 2 years of life more rapidly than body size and reaches adult norms/1.73 M2 at the end of this time. Subsequently GFR and body size increase proportionately and thus GFR/1.73 M2 remains stable throughout the remainder of

Plasma creatinine concentration alone is not an adequate measure of renal function. Renal Urologic Disorders Hematuria Acute Post-streptococcal Glomerulonephritis Hemolytic Uremic Syndrome Anaphylactoid Purpura (Henoch-Schonlein) Nephritis Proteinuria IgA Nephropathy (Berger's Disease)

Maximum urinary concentrating capacity is less in the newborn; 600-700 milliosmoles/kg water in the full-term newborn, and approximately 400 milliosmoles/kg water in seven month gestation newborns. Maximum urinary concentration of 1200-1400 mOsm/kg water is characteristically achieved in children by

Hematuria

Clinical Evaluation of Hematuria

Physical Examination. Height, weight, blood pressure, optic fundi, presence or absence of mass, skin appearance, genitalia, edema, complete physical examination.

Laboratory. Urinalysis, urine culture, CBC, serum BUN, creatinine, calcium, streptozyme, serum complement (Cs as screen), quantitative urinary protein, calcium and creatinine, nephrosonogram.

Differential Diagnosis of Red Urine

Red Urine, No Blood Present on Dipstick, No Red Cells on Microscopic Examination

Hematuria not present

Red color is probably caused by dyes or 

Hematest Positive, No RBC on Microscopic Examination

Hemoglobinuria

Glucose-6-phosphate dehydrogenase deficiency

Paroxysmal hemoglobinuria

Mismatched blood transfusion

Fresh water drowning

RBC present on microscopic examination, but No casts: Exercise, fever, sickle hemoglobin, hypercalciuria, stones, familial, coagulopathy, trauma, drugs (eg, Cytoxan), tumors, cysts, hydronephrosis, interstitial nephritis, lower urinary tract infection.

Microscopic Hematuria with Casts, but No Proteinuria

IGA nephropathy: Proliferative glomerulonephritis (familial or non-familial)