(3.2) Hematuria [DSA-Tyler]

Question 1

The presence of blood in sufficient quantity to be seen to the naked eye (>3500 RBCs present) is known as ______

Answer 1

Gross hematuria

Question 2

What is the definition of microscopic hematuria?

Answer 2

2-3 RBCs per high-power field on urine microscopy

Question 3

What are the main risk factors for bladder cancer?

Answer 3

(review)

Smoking

Occupational exposure to chemicals

Heavy phenacetin use

Cyclophosphamide

Ingestion of aristolochic acid

Question 4

What is the caveat to evaluating hematuria in older men with sx of BPH?

Answer 4

Older men with microscopic/gross hematuria are more likely to have genitourinary malignancy

Diagnostic evaluation should be pursued even in the presence of signs of BPH

Question 5

Nonglomerular causes of hematuria:

Lower urinary tract

Answer 5

Urethritis, prostatitis

BPH

Cystitis

Bladder/prostate carcinoma

Exercise-induced

Question 6

Nonglomerular causes of hematuria:

Upper urinary tract source

Answer 6

Ureteral/renal calculus

Hydronephrosis

Pyelonephritis

PKD

Hypercalciuria/hyperuricosuria w/o stones

Renal trauma

Papillary necrosis

Interstitial nephritis

Sickle cell trait/disease

Renal infarct

Renal tuberculosis

Schistosoma haematobium

Renal vein thrombosis

Question 7

Glomerular causes of hematuria:

Primary glomerulonephritis

Answer 7

IgA nephropathy

Postinfectious

Idiopathic (focal glomerulosclerosis)

Question 8

Glomerular causes of hematuria:

Secondary glomerulonephritis

Answer 8

Systemic lupus erythematosus

Wegener’s granulomatosis

Other vasculitides

Question 9

What are the alarm symptoms associated with hematuria?

Answer 9

Increased age - neoplasm

Constitutional sx (weight loss, appetite loss, malaise) - malignancy

Smoking/chemical/cyclophosphamide/aristolochic acid

+family hx of deafness or renal disease - familial disease i.e. Alport syndrome

Question 10

When the urine dipstick is positive for blood but the microscopic exam of the urine does not show RBCs, what pathologies must be considered?

Answer 10

Myoglobinuria

Hemoglobinuria

Question 11

True macroscopic hematuria is always ____

Answer 11

Pathologic

Question 12

Women may have microcopic hematuria due to what spurious causes?

Answer 12

Urinary contamination due to:

Menstruation

Sexual intercourse

Question 13

Microscopic hematuria due to transient causes such as UTI or strenuous exercise is expected to resolve after _____

Answer 13

Repeat testing after 48 hours or

Discontinuing exercise for 72 hours

Question 14

What distinguishes glomerular hematuria from non-glomerular hematuria?

Answer 14

RBC casts

Dysmorphic RBCs

New/acutely worsening HTN or proteinuria

Increased creatinine

Question 15

What are visible blood clots in the urine indicative of?

Answer 15

Lower urinary tract source or hematuria

Question 16

Essentials of diagnosing renal cell carcinoma

Answer 16

Gross/microscopic hematuria (60%)

Flank pain/mass

Fever/weight loss

Solid renal mass on imaging

Question 17

What are the main populations affected by renal cell carcinoma?

Answer 17

60s

2:1 male:female

Smokers

VHL syndrome

Question 18

What are the most valuable imaging studies for renal cell carcinoma?

Answer 18

CT

MRI scanning

Confirm character of mass, stage the lesion

Question 19

Where are the renal cell carcinomas that have the best prognosis?

Answer 19

Tumors confined to renal capsule (T1-T2)

90-100% 5-year survival after radical nephrectomy

Question 20

What is the survival rate for renal cell tumors extending beyond the renal capsule (T3-T4)?

Answer 20

50-60%

Question 21

What renal cell tumors have the worst prognosis?

Answer 21

Pts that have solitary resectable metastases (15-30%)

Node-positive tumors (0-15%)

Question 22

Who do you refer a patient with renal cell masses? If they are metastatic?

Answer 22

Solid renal masses/complex cysts => Urologist

Renal cell carcinoma => Urologic surgeon

Metastatic disease => Oncologist

Question 23

What is the most common primary glomerular disease worldwide?

Answer 23

IgA Nephropathy

Particularly in Asia

Question 24

When does hematuria present in IgA nephropathy?

Answer 24

1-2 days after mucosal viral infection (usually URI)

Question 25

What can IgA nephropathy be secondary to?

Answer 25

(review) Hepatic cirrhosis Celiac Dz HIV infection CMV

Question 26

When is gross hematuria encountered in ADPCKD?

Answer 26

Cyst rupture

Question 27

Although serum IgA levels are elevated in 50% of patients with IgA nephropathy, their sensitivity and specificity are low, so diagnosis is confirmed by \_\_\_\_\_\_\_

Answer 27

**Kidney biopsy** showing IgA depositys in the mesangium

Question 28

How is the pathology if IgA nephropathy scored?

Answer 28

Oxford IgA Nephropathy MEST: **M**esangial hypercellularity **E**ndocapillary hypercellularity **S**egmental glomerulosclerosis **T**ubular atrophy/interstitial fibrosis

Question 29

When is medullary sponge kidney usually diagnosed?

Answer 29

40s-50s

Question 30

How does a patient with medullary sponge kidney normally present?

Answer 30

**Gross/microscopic hematuria** Recurrent UTI Nephrolithiasis

Question 31

What are the most common complications of medullary sponge kidney disease?

Answer 31

Decreased urinary concentrating ability +/- Nephrocalcinosis

Question 32

What developmental malformation causes medullary sponge kidney disease?

Answer 32

Developmental malformation and cystic dilatation of renal collecting ducts - *can see on CT* *Autosomal dominant mutations in the MCKD1 or MCKD2 genes on chromosome 1 and 16 but usually sporadic and not inherited*

Question 33

Medullary sponge kidney disease is often associated with what kind of kidney stones?

Answer 33

Calcium phosphate Calcium oxalate

Question 34

What might you see on CT of a patient with medullary sponge kidney disease?

Answer 34

Cystic dilatation of distal collecting tubules Striated appearance in this area Calcifications in the renal collecting system