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題名 | 兒童血尿之快速評估與高尿鈣症之臨床診斷=The Rapid Evaluation of hematuria and Diagnosis of Hypercalciuria in Children |
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作者 | 陳遠浩; 林長興; | 書刊名 | 醫學研究 |
卷期 | 15:4 1995.01[民84.01] |
頁次 | 頁231-244 |
分類號 | 417.5744 |
關鍵詞 | 血尿; 紅血球形態; 高尿鈣; Hematuria; RBC morphology; Hypercalciuria; |
語文 | 中文(Chinese) |
中文摘要 | 以尿液中紅血球形態改變之分析,是身為一現代醫生對血尿來源作揖簡單、快捷且不具任何傷害性篩檢方式應有之認識,因它不僅是血尿來源檢查方向及正確診斷之提供的重要指標,也因此可節省相當之醫療浪費,更可減少因該腎臟疾病延誤診治所導致的慢性腎疾甚至於尿毒症的發生。而面對一位僅有單純性血尿之病患(童),當由尿液中紅血球形態分析而排除了腎絲球血尿之情況後,在沒有任何可被查證到的原因時,尿液中鈣排泄的檢查應是首先要被考慮而不可疏漏者。一旦高尿鈣與血尿的相關性被證實時,則口服鈣負荷試驗為進一步瞭解其高尿鈣所屬型式之另一重要檢查,當最後之診斷一經確立,則應給以適當的治療以及長時間的追蹤,如此不但可減少結石形成的危險,對預防結石所造成的腎臟衰竭也不失為另一重大之貢獻。 |
英文摘要 | Hematuria, the prerence of red blood cells (RBCs) in the urine whether gross or microscopic, is of concern to patients, parents and pediatricians. The pediatrician is confronted with the task of planning a cost-effective workup to identify serious or treatable disease. The purpose of this review is to outline such an approach for patients with hematuria. The shape of the RBCs in the urine are found helpful to localize source of the bleeding. RBCs with blebs or burrs (dysmorphic) indicate that the blood is originated from the glomerulus. RBCs that are normal in shape and size (eumophic) or slightly small with a serrated edge (crenated) generally originated somewhere other than the glomerulus and indicative of lower urinary tract bleeding. The shape of RBCs in the urine are examined in 38 children with hematuria by light microscopy to determine the probable site of bleeding in the urinary tract. The sensitivity and specificity of this test are 93.3% and 100% respectively in the 38 children with hematuria. It is suggested that the light microscopic examination of RBCs morphology in the urine is a single, inexpensive and noninvasive screening test to permit an accurate distinction of bleeding originating either in glomerulus or in noglomerulus. If hematuria is isolated and there is no significant history, the urinary calcium excretion should be measured. A spot urine calcium/creatinine ratio can rapidly rule out hypercalciuria as a cause of hematuria (<0.21 is normal). Oral calcium loading test should be taken to make differentiation between abosorptive hypercalciural and renal hypercalciuria. On account of the requirement of calcium to grow, dietary calcium restriction is not recommended. Except encouraged fluid intake, a small dose of hydrochlorothiazide (0.5-1.0 mg/kg/day) should be the other choice to treat the patients with hypercalciuria. To prevent the risk of hypercalcemia and stone formation of urinary tract, the long-term follow up is still needed. |
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