病毒感染与肉眼血尿

人一生中受到以初感染、再感染、潜伏感染、持续感染等各种形式的病毒感染。临床上可见病毒感染后一过性蛋白尿及血尿,有者成为慢性肾疾患。本文就病毒感染在肾、尿路疾病的发生和发展中所起作用加以讨论。一、人类病毒感染和肾脏损害侵入人体的病毒或直接损害脏器,或在淋巴组织增殖后,经过病毒血症再侵入与该病毒有较强亲和力的靶器官而产生病变。肾脏和尿路细胞对病毒具有很强的敏感性,加上肾脏有     

肉眼血尿外阴分泌物增多

患儿,女,10岁,因间歇肉眼血尿8年,外阴分泌物增多1个月入院。患儿2岁时因感冒后出现肉眼血尿,不伴尿路刺激征、水肿及少尿。外院予抗感染及对症治疗12d,肉眼血尿消失。8年来患儿多次于感冒后出现肉眼血尿,每次持续1～5d,均在感冒症状缓解后肉眼血尿消失,但仍有持续镜下     

肉眼血尿 肾功能进行性恶化

<正>1病历摘要患儿男,9岁。因肉眼血尿伴眼睑水肿3d收入中南大学湘雅第二医院儿科肾脏病专科病房。患儿住院前3d尿颜色加深呈洗肉水样,无血块,尿量减少(具体不详),有轻微尿痛,但无尿频尿急等症状。晨起时眼睑水肿,偶有阵发性前额痛,持续数分钟后自行缓解。当时有轻微咳嗽,     

新生儿肉眼血尿临床分析

目的 探讨新生儿肉眼血尿的发病原因及预后。方法 回顾性总结1989年8月～2006年7月收治的18例新生儿肉眼血尿患儿的临床资料。结果 18例新生儿肉眼血尿都有原发疾病。其中，重度窒息和重度硬肿症最常见，严重感染、出血症及药物所致肉眼血尿也有发生。死亡病例主要病理改变为肾静脉血栓、肾实质坏死。死亡6例中，重度窒息并多器官功能衰竭3例，重度硬肿症并DIC、肺出血2例，新生儿败血症并化脓性脑膜炎、中毒性肠麻痹、肾功能衰竭各1例。存活12例镜下血尿均在住院期间3d-2周内消失，随访均未发现慢性肾功能损害及持续血尿。结论 新生儿肉眼血尿多为继发性，严重窒息和硬肿症是常见的原因。预后与原发病有关，原发病严重、并发症多者病死率高；存活者血尿为暂时性的，随着原发病的治愈而消失，预后良好。     

肉眼血尿,心脏杂音,赘生物

患儿为学龄期女性,因发现肉眼血尿1d入院.入院后迅速完善检查,明确了系统性红斑狼疮诊断.治疗后病情好转,但病程中出现心脏杂音,行心脏彩超提示赘生物.为儿童罕见病例,经过会诊,诊断Libman-Sacks心内膜炎.总结:重视临床体检,注意病情的变化;重视多学科的合作.     

支原体肺炎并肉眼血尿1例

患儿男性,5岁．发热、痉挛性咳嗽8天,全程血屎2天。既往健康,否认肾病史。体格检查：体温385℃．脉搏124次,分,呼吸44次/分,血压13/9kPa。发育营养中等,皮肤无发绀、浮肿、皮疹及出血点。双肺部叩诊清音．可闻干湿罗音。心、肝、脾正常。辅助检查：血红蛋白102g/L,红细胞426×l^12,L,白细胞9．3×10^9/L,淋巴细胞0．61,中性粒细胞0．38,嗜酸性粒细胞60×10^6/L,血小板192×10^9/L,网织红细胞0．075,出、凝血时间正常,血沉35mm／h。肉眼血尿,蛋     

头孢拉啶致肉眼血尿16例

我院儿科1996年6月～1998年5月收治16例应用头孢拉啶后导致肉眼血尿患儿,报告如下。临床资料一、一般资料 16例均为应用头孢拉啶(头孢拉啶胶囊,江苏扬子江制药厂,批号：960513,971017。头孢拉啶针剂,深圳市制药厂,批号：960325,971216。)后出现肉眼血尿就诊,用药前均无肾脏病史,2例同时应用妥布霉素。年龄2～10 a,男10例,女6例,上呼吸道感染8例,气管炎5例,肺炎3例,4例伴呕吐,2例应用妥布霉素4～5 mg/(kg·d),qd×3。给药途径：口服7例［剂量50 mg/(kg·d)］,2例100 mg/(kg·d);静脉9例［50～100 mg/(kg·d)］,1次或2次应…     

右肾缺如左肾积水伴间断性肉眼血尿1例报告

患儿女,6岁2个月。因肉眼血尿10灭天伴上腹疼痛5天,于1985年9月29日入院。患儿同年6月初曾肉眼血尿,持续5天。9月中旬无明显诱因突然再次肉限血尿伴左上腹及脐周阵发性疼痛、恶心、呕吐10余次/日,面色苍白,故就诊。入院查体:发育尚可,呈贫血貌,血压100/60mmHg,心肺听诊无异常。腹软,左上腹外侧部可扪及约5×7cm包块,质略硬,触痛。肝脾不肿大。肠鸣音正常。四肢无畸形。实验室检查:     

化验尿液中乳酸脱氢酶鉴别上、下尿路感染

乳酸脱氢酶(LDH)以几种同功酶的形式存在于体内。肾脏感染时其同功酶4、5于肾髓质中的浓度很高,并移行于尿液中。正常情况下,血清和尿液中这两种同功酶的含量均不高,当尿中LDH的同功酶4、5增高时,则提示上尿路感染。该项检验包括     

Evaluation of gross hematuria

Gross hematuria in children is a common complaint that often leads patients to seek urgent care. The diagnostic evaluation can be chosen based on specific patient history and physical examination. When a patient is asymptomatic, hypercalciuria and mild forms of glomerulonephritis are common causes of gross hematuria. Although they are less common in children, special care should be taken to investigate for renal and bladder tumors.     

Clinical spectrum of gross hematuria in pediatric patients

Although isolated gross hematuria is a disturbing symptom, there have been few studies of this finding in pediatric patients. Therefore, this study was performed to examine the associated symptoms and causes of gross hematuria in children and adolescents who presented with this problem as their major clinical manifestation. It also determined the long-term outcome of patients in whom no etiology was found. A retrospective review was performed on the medical records of 100 consecutive patients referred for evaluation of gross hematuria between 1992 and 1999. The etiology was determined based on standard urinalysis methods, clinical laboratory tests, and imaging studies. Patients with gross hematuria in whom an etiology was not found were followed up through 2001. Of the 100 patient records reviewed, 18 were excluded because the clinical evaluation was incomplete. The remaining 82 patients (59 M: 23 F) had a mean age of 9.2 +/- 5.0 years. Glomerular gross hematuria was found in 24 patients. A cause was found in all of these patients, most commonly immunoglobulin A (IgA) nephropathy (n=13) and Alport syndrome (n=6). Nonglomerular gross hematuria was found in 56 patients, and the most common etiologies were hypercalciuria (n=9), urethrorrhagia (n=8), and hemorrhagic cystitis (n=7). No etiology was found in 26 patients with nonglomerular gross hematuria. No diagnosis was made in the case of 2 patients whose hematuria could not be defined as glomerular or nonglomerular. Telephone follow-up was performed in 18 of these children 4.0 +/- 3.2 years (range: 1-9 years) after the initial evaluation and showed that only 3 of these patients had had recurrences of gross hematuria. They and all of the other patients remained otherwise well. The urinalysis, including microscopic examination, was the most important diagnostic test in a patient with isolated gross hematuria. Nonglomerular problems were more than twice as common as glomerular diseases as a cause of isolated gross hematuria in pediatric patients The distribution of the etiologies of gross hematuria was consistent with previous studies. Although nearly half of the patients with nonglomerular gross hematuria could not be given a diagnosis, their long-term prognosis appeared to be good.     

The clinical significance of asymptomatic gross and microscopic hematuria in children

BACKGROUND: The development of asymptomatic gross or microscopic hematuria is relatively common in children. OBJECTIVE: To evaluate the clinical importance of hematuria in children and the necessity for such an evaluation using a defined diagnostic protocol. DESIGN: The protocol included a personal and family history, physical examination and blood pressure determination, and a set of comprehensive laboratory and radiological examinations. RESULTS: Of 342 children with microscopic hematuria, no cause was uncovered in 274 patients. The most common cause discovered was hypercalciuria (16%), followed by post-streptococcal glomerulonephritis (1%). Of 228 children with gross hematuria, no cause was uncovered in 86 patients. The most common cause discovered was hypercalciuria (22%). Ten patients had clinically important structural abnormalities. Fifty-three patients qualified for renal biopsy; 36 had IgA nephropathy. CONCLUSIONS: Our results suggest that diagnostic evaluation for potential causes of asymptomatic microscopic hematuria in children may not be necessary. Because microscopic hematuria can, rarely, be the first sign of occult renal disease, long-term follow-up is mandatory. As clinically important abnormalities of the urinary tract are commonly discovered in children with asymptomatic gross hematuria, a thorough diagnostic evaluation is warranted.     

Leukemic infiltration of the urinary bladder presenting as uncontrollable gross hematuria in a child with acute lymphoblastic leukemia

Acute leukemia can result in leukemic infiltration of many organs, but leukemic infiltration of the bladder is rare. The authors describe an 8-year-old girl with acute lymphoblastic leukemia who, during marrow relapse, had uncontrollable gross hematuria secondary to leukemic infiltration of the bladder. Cystoscopic biopsy confirmed the diagnosis. Literature review revealed 13 cases of acute leukemia with bladder involvement. Although leukemic infiltration of the bladder is rare, it should be considered in patients with acute leukemia and hematuria. Urine cytology might help detect bladder involvement.