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A student post this as a discussion, please reply with 1 up to date reference. Hematuria Pathophysiology Hematuria is blood in the urine that results from structural alterations cause by injury, infection, or mass. Sometimes during the inflammatory process, the glomerular membrane can be injured causing hematuria. Also, certain medications, calculi, and chemicals can damage the mucosal layer of urinary tract causing hematuria (Saleem & Hamawy, 2021). Epidemiology Microscopic hematuria is found in single samples of 4% of school age children 0.5 % occurrence on repeat samples Gross hematuria is more common in girls Overall incidence is 0.3% (Bignall & Dixon, 2018). Physical exam findings Growth parameters: FTT or falling growth curves (chronic renal insufficiency or long-standing acidosis) Vital signs, especially low BP Malformed ears (congenital renal disease) Oliguria or anuria Edema, hypertension, and proteinuria, which are suggestive of glomerular disease Flank pain, which is suggestive of an upper tract disorder Red flags FTT Chronic anemia Complicated enuresis Prolonged, unexplained vomiting or nausea (especially in the morning), anorexia, weight loss without diarrhea Hypotension Unusual bone disease Poor school performance (Garzon et al., 2020). Differential diagnoses and rationale Wilms tumor UTI Renal calculi Neoplasm Polycystic kidney disease Lupus erythematous Anticoagulants Hemophilia Thrombocytopenia Glomerulonephritis Epididymitis Presence of pigment from various sources Trauma Viral illness Subacute bacterial endocarditis Sclerodema Sjogren syndrome Urogenital fistulas Medullary sponge kidney Henoch-Schönlein purpura (HSP) IgA nephropathy Sickle cell disease and trait (Sanjeev, 2021). Management plan to include diagnostic testing, medications if applicable, follow-up plans, and referrals if needed For gross hematuria with unclear cause referral is warranted symptomatic microscopic hematuria, or persistent asymptomatic hematuria and proteinuria as renal biopsy may be indicated. Asymptomatic hematuria requires periodic evaluation every 1 to 2 years to reevaluate for coexisting conditions or proteinuria, and to revisit family history of hematuria or hearing deficits. Diagnostics UA Urine culture and sensitivity BUN, creatinine, CMP, including eGFR CBC PT, PTT, INR Sed rate IVP Renal ultrasound Renal biopsy CT scan MRI Sickle cell assessment