1. Hurricane Katrina Aug 29, 2005

5. Gross Hematuria Presenting to ER UTI50% Perineal/Urethral Irritation18% Trauma7% Acute Nephritis4% Coagulopathy3% Stone2% No etiology identified 10% Don’t forget about tumors (Wilms)

6. Asymptomatic Gross Hematuria No identifiable cause36% Hypercalciuria22% IgA Nephropathy16% Post-strep glomerulonephritis7% Other glomerular (thin b.m.)2% Congenital anomalies2% Sickle cell1%

7. Evaluation (H&P!!!) Trauma: CT Scan S/S of malignancy? – Wilm’s – Neuroblastoma

8. Evaluation Post-infectious Acute Glomerulonephritis (strep) – 10 days post pharyngitis – 21 days post impetigo – Edema, HTN (85%) – Strep antibody titers – Low C3

9. Evaluation IgA – Most common presentation recurrent hematuria – 5 days post URI – Can be associated with edema, HTN, renal insufficiency – Dx: Kidney biopsy

10. Anatomic Abnormalities and Hematuria

12. UPJ Obstruction Blockage (often partial) of urine flow where ureter enters kidney. Both congenital and acquired Most common pathologic cause of antenatally detected hydronephrosis Intrinsic narrowing (most common) Extrinsic compression (10%) aberrant renal a.

13. UPJ Obstruction: Presentation Fetal/neonatal: Fetal U/S, palpable abd mass, UTI, hematuria, FTT Children: Intermittent flank pain, hematuria with minor trauma, calculi, HTN

14. UPJ Obstruction: Treatment Asymptomatic: Watchful waiting Symptomatic: Surgery

15. ADPKD Most common hereditary kidney dz Presents from neonate to 5 th decade Hematuria, B flank pain, abdominal masses, HTN, UTI Cysts in liver, pancreas, spleen, ovaries Mitral valve prolapse 12% of peds pts Intracranial aneurysms (adults) Dx by U/S, bilateral macrocysts Tx: Supportive

16. ARPKD Infantile PKD Neonatal B flank mass, oligohydramnios, pulm hypoplasia, potter facies Severe hepatic cirrhosis and portal HTN 30% die as neonates If survive 1 st year, 10 year survival 80% ESRD >50%