Upper Urinary Tract Causes of Hematuria

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Chapter 513 Upper Urinary Tract Causes of Hematuria

513.1 Interstitial Nephritis

See Chapter 526.

513.2 Toxic Nephropathy

See Chapter 527.

513.3 Cortical Necrosis

See Chapter 528.

513.4 Pyelonephritis

See Chapter 532.

513.5 Nephrocalcinosis

See Chapter 541.

513.6 Vascular Abnormalities

Craig C. Porter, Ellis D. Avner

Hemangiomas, hemangiolymphangiomas, angiomyomas, and arteriovenous malformations of the kidneys and lower urinary tract are rare causes of hematuria. They can manifest with microscopic hematuria or gross hematuria with clots. Cutaneous vascular malformations, when present, can offer a clue to these underlying causes of hematuria. Renal colic can develop if the upper tract is involved. The diagnosis may be confirmed by angiography or endoscopy.

Unilateral bleeding of varicose veins of the left ureter, resulting from compression of the left renal vein between the aorta and superior mesenteric artery (mesoaortic compression), is referred to as the nutcracker syndrome. Patients with this syndrome typically present with persistent microscopic hematuria (occasionally, recurrent gross hematuria) that may be accompanied by proteinuria, lower abdominal pain, flank pain, or orthostatic hypotension. Diagnosis is confirmed by Doppler ultrasonography, CT, phlebography of the left renal vein, or magnetic resonance angiography.

Guthrie SO, Rhodes M, Janco R, et al. An infant with Kassbach-Merritt syndrome with associated renal hematoma and intussusception. J Perinatol. 2005;25:143-145.

Pratap A, Tiwari A, Pandey SR, et al. Giant cavernous hemangiolymphangioma of the bladder without cutaneous hemangiomatosis causing massive hematuria in a child. J Pediatr Urol. 2007;3:326-329.

Wang L, Yi L, Liu Z, et al. Diagnosis and surgical treatment of nutcracker syndrome: a single-center experience. Urology. 2009;73:871-876.

513.7 Renal Vein Thrombosis

Craig C. Porter, Ellis D. Avner

Epidemiology

Renal vein thrombosis (RVT) occurs in 2 distinct clinical situations. In newborns and infants, RVT is commonly associated with asphyxia, dehydration, shock, sepsis, congenital hypercoagulable states, and maternal diabetes. In older children, RVT is seen in patients with nephrotic syndrome, cyanotic heart disease, inherited hypercoagulable states, and sepsis and following kidney transplantation and following exposure to angiographic contrast agents.

Pathogenesis

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