Definition of Terms Hematuria Abnormal presence of blood in the urine More than three red cells per high-power

er field on at least two occasions. Initial Hematuria: Bleeding at the start of urination - indicates urethral pathology Terminal Hematuria: Bleeding at the end of urination - Indicates pathology of the bladder neck, posterior urethra, or prostate. Total Hematuria: Bleeding throughout urination - Indicates pathology above the bladder neck Proteinuria Excessive protein excretion in the urine, generally greater than 150-160 mg/24hr in adults. Transient proteinuria : normal renal function, bland urine sediment, normal blood pressure, absence of significant edema, quantitative protein excretion of usually less then 1g/day; that is not indicative of significant underlying renal disease, and the proteinuria disappears upon repeat testing Orthostatic proteinuria thin adolescents or adults younger than 30 years (may be associated with severe lordosis); renal function is normal and proteinuria usually is less than 1g/day; overnight urine collection shows normal protein excretion ( <50 mg during 8-h period) Persistent proteinuria due to extrarenal disease Renal function is normal, urine sediment is bland, blood pressure is normal, significant edema is absent, and quantitative albumin excretion usually is less than 500 mg/day; this is not usually indicative of clinically progressive, underlying renal disease Persistent proteinuria in excess of 500 mg/day is more likely the result of significant glomerular disease Edema Generalized edema is the excessive accumulation of interstitial fluid throughout the body. Facial edema refers to either localized swelling for example, around the eyes or more generalized facial swelling that may extend to the neck Leg edema results when excess interstitial fluid accumulates in one or both legs. Methods of evaluating hematuria URINALYSIS Dip strip analysis is critically important in patients with dark or abnormal appearing urine because several substances may discolor the urine and give the appearance of hematuria. The urine dipstick test is currently one of the most useful and sensitive tools in detecting hematuria. This test is based on the peroxidase activity of hemoglobin (rather than the presence of RBCs) and myoglobin. Confirmation requires a microscopic examination of the urine for the presence of RBCs and casts. A freshly voided urine specimen should be used. Methods of evaluating proteinuria Evaluation of proteinuria by urinary dipstick primarily detects albumin and intact globulins, while overlooking positively charged light chains of immunoglobulins. These proteins can be detected by the addition of sulfosalicylic acid to the uric specimen. Precipitation indicates the presence of paraproteins. The next step is a 24-hr urine collection. A finding of greater than 150-160 mg/24 hr is abnormal, and greater than 3.5g/24 hr is consistent with nephrotic-range proteinuria. Report by Frankie Mandolang