3 - Hematuria

Question 1

Gross hematuria with clots usually comes from what source?

Answer 1

lower urinary tract

Question 2

What is the gold standard test for microscopic hematuria?

Answer 2

• urine sediment

Question 3

What is the definition of hematuria from a urine sediment?

Answer 3

• 3+ RBCs/hpf

Question 4

What are 3 common reasons of false positive dipsticks?

Answer 4

• semen in urine
• alkaline urine or oxidizing agents
• myoglobinuria/hemoglobinuria

Question 5

It is important to have a repeat urine microscopy test in ___ weeks to ensure no hematuria.

Answer 5

6 weeks

*to make sure this patient does not have cancer

Question 6

If you see gross hematuria with clots what imaging study should you order?

Answer 6

CT abdomen and pelvis

Question 7

If you see gross hematuria without clots what do you suspect the source is?

Answer 7

kidneys

Question 8

Concurrent pyuria and dysuria is consistent with what diagnosis?

Answer 8

UTI

Question 9

unilateral flank pain and hematuria is consistent with what diagnosis?

Answer 9

nephrolithiasis

Question 10

RBC casts, dysmorphic appearing RBCs, and brown cola colored urine is consistent with what type of bleeding?

Answer 10

glomerular bleeding

Question 11

For neprholithiasis and hydronephrosis do you want a CT with or without contrast?

Answer 11

without!

Question 12

For renal and urothelial abnormalities do you want to order a CT with or without contrast?

Answer 12

with!

Question 13

What are the 4 contraindications for CT urography?

Answer 13

• young patients with negative non-con CT
• pregnant women
• decreased renal function
• allergic to contrast

Question 14

For what patient would a retrograde pyelography be indicated?

Answer 14

a patient who is unable to have IV contrast d/t decreased kidney function

Question 15

What is the only imaging modality to permit visualization of prostate and urethra?

Answer 15

• Cystoscopy

Question 16

If a patient has one episode of hematuria and high risk for malignancy how often do they need an urinalysis?

Answer 16

yearly urinalysis for 2 years

if both come back negative = they are done

Question 17

If a patient has persistent hematuria how often should they have an urinalysis?

Answer 17

yearly urinalysis

if persistent for 3-5 years, repeat initial urologic work up

Question 18

What is the main indication for a renal biopsy?

Answer 18

presence of glomerular hematuria (casts, dysmorphic RBCs)

Question 19

CT urography is recommended for patients with this condition.

Answer 19

unexplained hematuria