Sickle cell trait and gross hematuria

Kiryluk, K.; Jadoon, A.; Gupta, M.; Radhakrishnan, J.
April 2007
Kidney International;Apr2007, Vol. 71 Issue 7, p706
Academic Journal
A 35-year-old African-American woman with sickle cell trait presented to our medical center with severe gross hematuria. The patient reported having had dark urine for at least 2 months, but after a recent 2 h and 30 min air travel, her urine became bright red and she began passing dark clots. In addition, she started experiencing generalized fatigue, weakness, and mild dizziness. The patient had experienced several episodes of gross hematuria in the past. One such episode, 15 years ago, resulted in a prolonged hospitalization and transfusion of 5U of blood. Another episode took place 11 years ago lasting for approximately 2 weeks, but symptoms resolved spontaneously. The etiology of her hematuria had never been established. Other medical problems included chronic right knee osteoarthritis and degenerative lumbar disk disease. She denied chronic use of non-steroidal anti-inflammatory agents, but admitted to frequent use of acetaminophen for arthritic pain. Upon presentation, the patient appeared comfortable. Her blood pressure was 130/60, and heart rate was 80/min. Head, neck, lung, and heart examinations were unremarkable. The abdomen was soft and non-tender and liver span was normal. The tip of the spleen was palpable. There was no pedal edema. Her laboratory values were significant for mild anemia with hematocrit of 33% (normal 34-44%). The platelet count was 313 × 109/l (normal 165-415 ×109/l) and white blood cell count was 6.5 ×109/l (normal 3.5-9.0 × 109/l). Her coagulation parameters were normal. The serum electrolytes were also within normal range. Her renal function was preserved with a creatinine of 0.9 mg/dl (normal 0.5-0.9 mg/dl) and a blood urea nitrogen of 7 mg/dl (normal 7-20 mg/dl). Urine analysis revealed 3 + hemoglobin and no protein. Urine microscopy showed 182 red blood cells per high powerfield. Urine cultures were negative. Renal ultrasound measured the right kidney length at 11.7 cm; the left kidney was 11.9 cm in length; there was no hydronephrosis or calculus in either kidney. The urinary bladder was unremarkable. Magnetic resonance imaging confirmed that both kidneys were of normal size and signal, and no solid enhancing lesion was identified. Diagnostic cystoscopy and ureteroscopy were performed. Blood was visualized effluxing from the right ureteral orifice. Upon inspection of the collecting system, the posterior middle pole calyx was found to have a stenotic infundibulum. Endoinfundibulotomy was performed to enter the calyx, where there appeared to be a sloughed ischemic papilla with an accompanying hemorrhage (Figure 1). The papilla was fully fulgurated in an attempt to stop the bleeding. The remaining calyces and the renal pelvis were also inspected and found to be free of disease. Although the bleeding ceased in the immediate post-procedure period, it reappeared later that day.


Related Articles

  • Massive Hematuria in a Young Adolescent with Sickle Cell Trait. Asnes, Russell S.; Migel, Peter F.; Wisotsky, David H. // Clinical Pediatrics;Feb1983, Vol. 22 Issue 2, p150 

    The article reports a case of massive hematuria in a 13-year old boy with sickle cell trait. Hematuria occurs in approximately six per cent of persons with sickle cell hemoglobin, the incidence being much more frequent with sickle cell trait than with sickle cell anemia. Most of these episodes...

  • Renal Mass in an Otherwise Healthy Man. Rubinas, Tara C.; Flanigan, Robert C.; Picken, Maria M. // Archives of Pathology & Laboratory Medicine;Jan2004, Vol. 128 Issue 1, pe19 

    Presents a case report of epithelioid angiomyolipoma in a man with a history of microhematuria and renal mass. Radiology report for the man; Characteristics of angiomyolipoma; Epithelioid variant of angiomyolipoma; Description of renal epithelioid oxyphilic neoplasms.

  • Genetic heterogeneity of Alport syndrome. Feingold, Josué; Bois, Etienne; Chompret, Agnès; Broyer, Michel; Gubler, Marie-Claire; Grünfeld, Jean-Pierre // Kidney International;Apr1985, Vol. 27 Issue 4, p672 

    Forty-one families have been studied with stringent diagnostc criteria of Alport syndrome: proven renal disease with hematuria affecting at least two relatives, neural hearing loss in at least one affected individual, and evolution to renal failure in at leastone affected individual. The...

  • Renal Papillary Necrosis Unmasking Sickle Cell Disease. Voulgarelis, Michalis; Ziakas, Panayiotis D. // New England Journal of Medicine;3/24/2005, Vol. 352 Issue 12, p1237 

    Presents the images in clinical medicine feature showing an image of a 26-year-old healthy women evaluated due to new-onset hematuria. Unremarkable physical examination; Laboratory tests and results; Pyelography which was performed with the use of contrast material that showed bilateral...

  • Renal Medullary Carcinoma: A Case Report and Brief Review of the Literature. Shetty, Aditya; Matrana, Marc R. // Ochsner Journal;Summer2014, Vol. 14 Issue 2, p270 

    Background: Renal medullary carcinoma (RMC) is an aggressive form of non-clear cell kidney cancer that typically affects young adults and is almost exclusively associated with sickle cell trait. Typical RMC patients tend to be young black males (2:1 male to female predominance) with sickle cell...

  • Evaluation of Hematuria in Adults. Riesenberg, Don; Sutton, James M. // JAMA: Journal of the American Medical Association;5/9/90, Vol. 263 Issue 18, p2475 

    Discusses the diagnosis of hematuria in adults. Definition and demographics of microscopic hematuria (MH); Laboratory examinations to test for MH; Recommendations for evaluation of patients with MH.

  • New markers for analyzing the cause of hematuria. Janssens, Pim M. W. // Kidney International Supplement;Nov1994, Issue 47, pS-115 

    Discusses the new markers for analyzing the cause of hematuria. Description and prevalence of hematuria; Usability of proteinuria; Localization of Tamm Horsfall glycoprotein in the kidney; Development of an immunocytochemical staining technique; Use of material from kidney transplantation...

  • Magnetic resonance urography of renal papillary necrosis. Schroeder, Jennifer; Thacker, Paul; Purves, Todd // Pediatric Radiology;Apr2014, Vol. 44 Issue 4, p491 

    The article presents a case study of a 17-year-old previously healthy African-American girl presented with a 3-day history of gross hematuria. The patient underwent magnetic resonance (MR) urogram which revealed unsuspected sickle cell trait. She was diagnose with renal papillary necrosis. It...

  • Painless Hematuria in a 14-Year-Old Boy. Ziai, Mohsen // Clinical Pediatrics;Dec1974, Vol. 13 Issue 12, p1083 

    The article presents a case study about painless hematuria in a 14-year-old boy. 14-year old white boy was admitted to Children's Hospital of San Francisco for evaluation of painless hematuria. He reportedly had been in good health until one month previously, when he was struck in the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics