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Childhood Diseases

Question
Posted by: Cindy | 2018/02/18

Q.

Hematuria 6 yr old - update after renal doppler

Hello again! Still stumped regarding my daughter. Basically the only symptom she has is persistent microscopic hematuria and gross hematuria occurs after some kind of physical effort (running, jumping, etc). Tests conducted: 4 x ultrasounds; cystography (during voiding), scintigraphy; renal doppler. 2 weeks ago (after jumping around at home) there was a case of gross hematuria....2 hrs later, a blood clot was passed. This prompted another follow up and ultrasound - nothing found apart from bilateral hydronephrosis. During one test, the left ureter was visibly dilated and in another ultrasound, the right ureter was dilated. No protein in urine. There were dysmorphic RBC in the urine but no more. There were WBC in the urine but no more. Amount of RBC in urine has declined from 250 to 25 since initial case in September. NO infections found, no bacteria, no pain, no fever, on fatigue, no loss of appetite. Kidneys seem to be slightly hypotonic - paediatric nephrologist suggests this is from birth. Vit D deficiency and currently on D3 supplements. Urine flow looked normal on all tests, kidney function good - both kidneys functioning about the same. Doppler revealed normal blood flow to and from kidneys. This suggests no renal or arterial obstructions or constriction (Nutcracker Syndrome eliminated as per specialist). Child has NOT had so much as a cold since June or July last year. She only NOW has a bit of a runny nose but she has been 100% healthy apart from the ongoing hematuria. Blood tests have been done extensively and they even checked her DNA and immunology. Could there be a correlation between physical effort (even walking quickly for 15 minutes) and gross hematuria? Since we have done SO many tests already.....would a CT be appropriate at this point? Would a CT show us anything that the other tests did not? Baring in mind that the cystography was only focused on the bladder and the renal scan (scintigraphy) seemed to focus more on the kidney function, urine production, and flow from kidneys to the bladder. Left kidney has double renal pelvis BUT I'm not sure to what extent. I don't think that there is an additional ureter....it's just the upper portion that has duplicated. Apart from my CT question, I wonder how would we be able to detect bleeding inside the smaller veins that are not visible on your average ultrasound? Are there any other tests we can consider before putting her through a biopsy?

Expert's Reply

A.

Paediatrician
- 2018/02/20

The answer to your question is indeed 'yes'. There is a very well recognised condition called Sports hematuria that can occur even without any trauma. Look this up on Google: 'Exercise-induced hematuria' Please print out some of the information and take it to the paediatric nephrologist. The good news is that in most cases sports hematuria is a self limiting condition that clears up by itself.

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