I have a difficult case to share with you. My patient 2 months old, since 2 weeks has been experiencing blood when changing diapers first thing in the morning. I've attached a photo.
The only connection is he has been crying heavily a day before, screaming.
What to do next? Is there a need to consult with urologist? Or just watchful waiting?
No other signs. Everything is ok, growth ok, breastfeeding, genitalia clear, no inflammation.
Blood in stools?or urine?if stools require urgent ultrasound to rule out malrotation of gut with volvulous,needs testing for bleeding diathesis,vit k injection,even if ultrasound is normal ct angio for abnormal blood vessels.if from urine also requires ultrasound to rule out wilms tumour.
Ultrasound revealed nothing, everything is ok, except for crystals in bladder and kidney. The urine analysis was negative for blood including microscopic examination.
The supposed coloring is from urine and not stool, early in morning only, Now, since one week, everything is normal, the diapers are clean, just normal urine.
Do you think we should go for normal ct-angio for abnormal vessels after evaluating this scenario?
Thank you.
Helo,crystals of size mam?any calcium like deposition.if so idiopathic familial hypercalciuria is a possibility.please check for u.calcium creat ratio.if it is normal.wait and watch.and please rule out bleeding diathesis with pt,ptt,inr
Thank you very much for your input. I too was thinking about running PT, PTT, and INR although his pediatrician did not confirm so far. Crystals were tiny and not measurable. They were defined as urate.
Urate crystals( combination of calcium and urate) also called brik stain crstal.
First few weeks baby can pass this crystals and diaper become red stain if baby is dehydrated or slightly dry where baby is breast feed and mom's milk supply less is than adequate. Not to worry.
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