Hematuria

Dipstick (+) Hemewith RBCs onmicroscopy

• Urine Ca/Cr• Evaluate for familial nephritis• Evaluate for HSP• Hb electrophoresis if indicated

• Urine Ca/Cr• Urine culture• Imaging for stone (RUS, CT)

• Evaluate for proteinuria• Electrolytes, BUN, Cr, albumin• C3, C4, ANA• Streptococcal Abs• ANCA• CBC• Evaluate for HSP and other vasculitides

• Urine Ca/Cr• R/O meatal stenosis• Family screening• Imaging of abdomen/pelvis

(helical CT, RUS, KUB)• Cystoscopy

Gross Microscopic

(+) Trauma (-) Trauma

(+) Pain (-) Pain

Eumorphic RBCs Dysmorphic RBCs

Algorithm for evaluation of hematuria. ANA antinuclear antibody, ANCA antineutrophil cytoplasmic antibody, Abs antibodies, BUN blood urea nitrogen, C complement, Ca calcium, CBCcomplete blood count, Cr creatinine, CT computedtomography scan, HSP Henoch-Scho¨nlein purpura, Hb hemoglobin, KUB kidneyureter-bladder radiograph, RBC red blood cell, R/O rule out, RUS renal ultrasonography

HEMATURIA

Eritrosit ≥ 5/LPBDipstick (+) Heme

• Urin: ratio Ca/Cr• Evaluasi familial nephritis• Evaluasi HSP• Hb electrophoresis bila perlu

• Urin : ratio Ca/Cr• Kultur urin• USG, CT scan

Evaluasi HSP dan penyakit vaskulitis lain

• Pencitraan abdomen/pelvis (helical CT, BNO, USG ginjal)• Cystoscopy

Gross

Eritrosit (-) Pigmenturia

Trauma (+) Trauma (-)

Nyeri (+) nyeri (-)

Terapi ISK

Mikroskopik

BAK MERAH

GLOMERULUS• Edema• Ruam• Hipertensi• Silinder eritrosit• Proteinuria ≥ +2• Dysmorphic RBCs

NON-GLOMERULUS• Disuria• Demam• Silinder eritrosit (-)• Eumorphic RBCs• Nitrit (+)

• Darah: Ureum, kreatinin, elektrolit, ASTO, C3, Protein total, albumin, kolesterol• Urin: ratio Ca/Kr

Pemeriksaan sesuai GNAPI

Ya

TidakTerapi GNAPI

• Darah: Ureum, kreatinin, Kalsium• Urin: Kultur, Ratio Ca/Kr, Ca 24 jam• USG Ginjal

Penyebab belum jelas ISK• Nefrolitiasis• Hidronefrosis• Trauma

RUJUK KE NEFROLOGI• Kelainan penglihatan & Pendengaran• Skrining keluarga• Cek: Komplemen, ANA, Anti-dsDNA• USG Ginjal

RUJUK KE UROLOGI atauNEFROLOGI ANAK

Alur tatalaksana BAK merahSMF Anak RSUP Fatmawati

SMF Anak Divisi Nefrologi 2009

NILAI NORMAL• Ratio Ca/Kr urin usia: < 7 bln 0,8 7 – 18 bln 0,6 19 bln – 6 thn 0,4 > 6 thn 0,2• Ca urin 24 jam < 4 mg/KgBB