#13 Press - Evaluation of Hematuria

Question 1

LR comes in with red urine. The results show no red sediment and the dipstick heme returns positive. The plasma color is clear. What is the diagnoses and possible cause?

Answer 1

myoglobinuria ; rhabdomyolysis

Question 2

What are the signs of glomerular hematuria?

Answer 2

lack of blood clots
dysmorphic appearance of RBC
Brown, cola-colored urine
RBC casts
Protein excretion exceeding 500 mg/day

Question 3

The United States Preventative Services Task Force does/does not recommend screening for disease by tests for hematuria?

Answer 3

does NOT

Question 4

LO is a 55 year old male and has been a heavy smoker. His IVP, CT, urine cytology and US came back negative. What test would you order next?

Answer 4

Cytoscopy

Question 5

HU comes in with cola colored urine and protein excretion exceeding 500 mg/day. There is also a dysmorphic appearance of the RBCs. Which nephritic syndromes are you thinking?

Answer 5

Post-infectious GN
Lupus nephritis
RPGN
HUT-TTP

Question 6

IP comes in with red cell casts, lack of blood clots and brown colored urine. What hereditary renal diseases may cause this glomerular hematuria?

Answer 6

Hereditary renal disease

• IgA nephropathy
• Alport’s
• Thin basement membrane disease

Question 7

RH has had reddish pink urine and has come in for an exam. The results come back with normal RBC morphology and no RBC casts. What type of hematuria is present? Causes?

Answer 7

Extraglomerular Hematuria:
Tubular 
Vascular
Familial
Metabolite
Interstitial nephritis
Papillary necrosis

Question 8

65 year old male comes in with persistent hematuria but there is no cause from history. Results come back and there are no red cell casts or other evidence of glomerular disease. What is your ddx?

Answer 8

Malignancy

Question 9

You have received the file for a new patient. After looking at the file, you not that he has suffered from persistant hematuria for over 4 years. What is your ddx?

Answer 9

IgA nephropathy

Thin basement membrane disease

Question 10

You need to justify the need for a cystoscopy for one of your patients to the insurance company. You have recommended the cystoscopy due to the following risk factors?

Answer 10

Male over age 50
Heavy smoker
Prolonged heavy phenacetin use (old analgesic)
Exposure to dyes (analine)
long-term administration of cyclophosphamide
Analgesic abuser

Question 11

LO comes in with red urine. The results show no red sediment and the dipstick heme returns positive. The plasma color is red. What is the diagnoses and possible cause?

Answer 11

Hemoglobinuria; hemolytic anemia

Question 12

TR comes in with red urine. The results show no red sediment and the dipstick heme returns negative. What are the possible causes?

Answer 12

Medication - phenazopyridine, doxyrubicin, chloroquine, deferoxamine, ibuprofen, iron sorbitol
Food dyes - beets, blackberries, food coloring
Matebolites - bile pigments, Porphyria

Question 13

Patient comes in with pyuria and dysuria. What are the likely diagnoses?

Answer 13

UTI

Bladder malignancy

Question 14

Patient comes in with a history of a recent upper respiratory infection complaining of hematuria. What are the likely diagnoses?

Answer 14

Post-infectious glomerulonephritis

IgA nephropathy

Question 15

Patient comes in with hematuria and a positive family history of renal disease. What are the likely diagnoses?

Answer 15

Hereditary nephritis
ADPKD
Sickle Cell

Question 16

Patient comes in with flank pain from ureteral obstruction. What are the likely diagnoses?

Answer 16

Calculus
Blood clot
Malignancy

Question 17

Patient comes in with hesitancy and dribbling. What is the likely diagnosis?

Answer 17

BPH

Question 18

Your patient has persistent idiopathic microscopic hematuria. What is your follow-up plan?

Answer 18

6, 12, 24, and 36 month urine cytology

or another US and cystoscopy at one year