24 Non-Glomerular Hematuria Flashcards
1
Q
Non-Glomerular Causes of Hematuria:
DDx & Work-up
A
- DDx
- Cancer – until proven otherwise
- Trauma
- Stones
- Infection
- Iatrogenic
- Miscellaneous
- Work-up
- Urinalysis
- Upper vs. lower tract
- CT scan
- (-) Contrast or (+/-) contrast
- [Historical: Intravenous pyelogram (IVP)]
- Cystoscopy
- Retrograde urethrogram and cystogram
- 90% of work up will be negative
- Urinalysis
2
Q
Hematuria of Cancer
A
- Gross hematuria common
- Work-up as indicated and urine cytology
- Bladder cancer- Transitional cell –Urothelial cell
- Renal carcinoma
- Detected incidentally, not usually from hematuria
- Prostate cancer
- Dectected by PSA and rectal exam, not hematuria
- Urethral cancer
- Only GU cancer more common in females
- Urothelial cancer in proximal urethra
- Squamous cancer in distal
3
Q
Hematuria from Trauma
A
- Blunt and penetrating renal trauma
- Ureteral trauma
- Blunt and penetrating bladder trauma
- Rupture of the membranous urethra
- Straddle trauma to the bulbar urethra
- Injury to the penile urethra
4
Q
Blunt Renal Trauma
- Etiology
- Grade
- W/ microscopic hematuria
- CT
- Treatment
A
- Etiology
- Motor vehicle accident’s
- Falls
- Contact sports
- Graded I - V
- W/ microscopic hematuria
- Work-up not necessary if hemodynamically stable
- Except children or clinical suspicion
- CT usually done for other injuries
- Treatment
- Observation
- Until urine clear
- Surgery
- Grade V
- Thrombosis of the main renal artery
- Multiple major lacerations
- Avulsion of the main renal artery and/or vein
- Observation
5
Q
Penetrating Renal & Bladder Trauma
A
- Both
- Stab or gun shot wound
- Renal
- 88% associated with other organ injury
- After stabilization, surgical exploration
- Rare to study
- Bladder
- Diagnostic studies only if stable
- Surgical repair
6
Q
Ureteral Trauma
A
- Rare
- Deceleration injury or penetrating trauma
- Iatrogenic causes
- Incidental congenital anomalies
- Uretero-pelvic junction obstruction
- Surgical repair
7
Q
Blunt Bladder Trauma
A
- Motor vehicle accident’s, deceleration injuries
- Gross hematuria typically present
- Types
- Contusion
- Extraperitoneal rupture
- 10% of pelvic fracture
- Treatment: bladder drainage
- Intraperitoneal rupture
- Surgical repair
- Retrograde urethrogram first
8
Q
Rupture of the Membranous Urethra
A
- 10% pelvic fractures in males
- GROSS BLOOD AT MEATUS
- Retrograde urethrogram
- Operative realignment
- Open or endoscopic
9
Q
Straddle Trauma to the Bulbar Urethra
A
- Butterfly hematoma
- Treatment: extended drainage
- Long term: stricture disease
10
Q
Injury to the Penile Urethra
A
- Penetrating trauma or sexual activity
- Fractured penis
- Gross blood
- Retrograde urethrogram
- Open surgical repair
11
Q
Kidney Stones:
Calculus Disease
A
- One of the most common renal diseases of the Western World
- Present in Egyptian mummies dated to 4800 B.C.
- 2 to 4% of the American population are at risk of at least one stone episode
during his/her life time - 50% of those will experience at least one further episode of stone formation over the ensuing 10 years
- Stone disease accounts for 1 of every 1000 hospitalizations
- 200,000 hospitalizations per year
- Exceeding $400 million dollars annually
12
Q
Kidney Stones:
3 Theories of Stone Formation
A
- Matrix Theory
- Organic matrix compounds present in all stones are causally related to stone formation
- Inhibitor Theory
- Deficiency in the urine of substrates which normally inhibit crystallization and growth
- Crystalloid or Precipitation-Crystallization Theory
- Supersaturation with respect to the stone-forming constituents
- Reality: likely due to a combination of these theories
13
Q
Kidney Stones:
Calcium Oxalate Monohydrate or Dihydrate:
Pathogenesis / Risk Factors
A
- Idiopathic
- Metabolic defects
- Alkaline urine pH
- Hypercalciuria
- Hyperoxaluria
- Hyperuricosuria
- Family history
- Dehydration
- Diet or medications
- Vitamins A, D, C
- Acetazolamide
- Antacid abuse
14
Q
Kidney Stones:
CaOx Features
A
- Accounts for about 85% of all stones
- Male to female ratio is 3-4:1
- High incidence of stones in the South Eastern United States = Stone Belt [Texas to Virginia and south]
- Hypercalciuria
- > 300 mg/24 hr in males
- > 250 mg/24 hr in females
- Calcium homeostasis requires
- Hormones: 1,25 vitamin D, PTH
- Organs: bone, kidney, gut
15
Q
Kidney Stones:
Hypercalciuria
A
- Increased gut absorption of calcium
- Increased 1,25 vit D (sarcoid, primary hyperparathyroidism)
- Dietary calcium excess
- Idiopathic
- Increased bone reabsorption
- Primary hyperparathyroidism
- Distal RTA
- Idiopathic
- Increased renal excretion
- Hypercalcemia of any cause
- Distal RTA
- Dietary sodium or protein excess
- Idiopathic hypercalciuria
- Renal leak
