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Renal > 3.6: Haematuria > Flashcards

3.6: Haematuria Flashcards

1
Q

What is haematuria?

A

Blood in the urine

Can be macroscopic or microscopic

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2
Q

What is frank haematuria?

A

Macroscopic Haematuria (Visible)

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3
Q

When do we diagnose haematuria?

A

If there a presence of 5 or more red blood cells in high powered field in three or more consecutive specimens

Can also be diagnosed from urine dipstick

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4
Q

What are the two types of haematuria?

A

Visible Haematuria - Macroscopic/Gross/Frank

Not visible - Microscopic (Dipstick Positive)

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5
Q

Symptomatic microscopic haematuria suggests..?

What symptoms would they have?

Asymptomatic haematuria suggests..?

A

Asymptomatic = Incidental finding (should it be investigated?)

Symptomatic

Needs investigation

  • Lower urinary tract = Hesistancy, frequency, dysuria. urgency
  • Upper urinary tract = Renal Colic
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6
Q

What can contaminate a urine sample and make it look red?

A

Menstrual Blood

Food (Beetroot, Blackberries, Rhubarb)

Myoglobin - Rhabdomyolisis, Crush Syndrome

Drugs (Chloroquine, Rifampicin)

Toxins (Lead, Mercury)

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7
Q

What can contaminate a urine sample and make it look brown?

A

Urobilonogen (By product of bilirubin)

Porphyria (Rare disease, abnormal metabolism of haemoglobin)

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8
Q

Describe the affect of blood thinners (Eg: Warfarin) and bleeding disorders on the urine?

A

Can cause bleeding

May present with blood in urine

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9
Q

What percent of those who present with frank haematuria have cancer (estimate)?

A

20-30%

This explains why frank haematuria is investigated thoroughly

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10
Q

What percent of people who have microscopic haematuria and are asymptomatic have cancer?

A

Approx 2.6%

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11
Q

Risk factors for urinary tract cancer?

A

Smoking

Occupational risk factors - dye, chemicals

Age > 40 Years

History of urinary tract problems (infections, irritations, disease)

Analgesia Abuse

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12
Q

Causes of haematuria?

A

Benign

Malignant

Trauma

Other - Infection, Inflammation

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13
Q

Name the infective conditions that cause haematuria?

A

Urethritis

Prostatitis

Cystitis (Bladder)

Ureteritis

Pyleonephritis

Glomerulonephritis

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14
Q

What does this show?

What symptoms would there be?

A

Inflammed bladder

Haematuria

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15
Q

Do renal stones cause haematuria?

A

Some can by scratching urinary tract as they pass down

20% of those with renal stones can present with frank haematuria

Higher percent have microscopic haematuria

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16
Q

Do renal tumours cause haematuria?

Other symptoms?

A

50-60% of patients with renal tumours present with haematuria

Also pain and abdominal mass

17
Q

Do tumours of the urinary tract cause haematuria?

Other symptoms?

A

Yes

About 75% of urinary tract cancers present with haematuria

Retention, Pain, Loin Pain

18
Q

What are the two tumours of the urinary tract?

A

Renal Cell Cancer

Transitional Cell Cancer

19
Q

Describe sports haematuria?

Describe joggers haematuria?

A

Contact sports (rugby players) may present with haematuria due to trauma to kidney

Joggers is in non contact sport - mainly long distant runners. Present with haematuria after long distant running. Resolves about 1 week later

20
Q

Describe decompression haematuria?

A

Seen in patients with urinary retention after drainage with a large catheter

Rapid drainage damages the blood vessels called decompression haematuria

21
Q

Describe some non urinary tract causes of haematuria?

A

Malignancy of other places

Gynaecological problems

Previous surgery

Foreign body

22
Q

Urinary tract cancer is more common in YOUNG/ELDERLY?

Urinary tract infections more common in MALES/FEMALES?

A

Urinary tract cancer more common in elderly

Urinary Tract infections more common in females (shorter urethra)

23
Q

Dark blood with clots suggests?

Fresh red blood in urine suggests?

A

Dark blood with thick clots suggest old blood - old problem that has resolved

Fresh red blood suggests acute ongoing problem

24
Q
  • Loin Pain
  • Passing clots that are long like worms

Where is this problem originating from?

A

Upper Urinary Tract

(Clots are long and thin which is the same anatomy as the Upper Urinary Tract. The colic also suggests clots are being passed)

25
Q

Describe some occupational risk factors for urinary tract cancers?

Where will the cancer develop?

A

Oil Industry (Chemicals)

Rubber Industry (Chemicals)

Hairdressers (Dyes)

Lower Urinary Tract

26
Q

What is Schistosomiasis?

What can this progress to?

A

Urinary tract infection caused by parasitic worm

Common in those who go swimming in tropical africa, egypt, south america

Can present with haematuria

Can predeceed squamous cell carcinoma

27
Q

Drug abuse causes haematuria. Name the drug?

What can this progress to?

A

Phenacetin

Progresses to transitional cell cancer

28
Q

Upper urinary tract symptoms?

A

Loin Pain

Fever

Sickness

Nauseau

Vomiting

Diarrhoea

Shivering

29
Q

Lower urinary tract symptoms?

A

Frequency

Dysuria

Haematuria

General feeling of unwellness

Back Pain/Pubic Pain

30
Q

Investigation of haematuria?

A

Urinalysis

Abdominal Exam

Blood Tests

Culture and sensitivities

Ultrasound

Flexible Cystoscopy

CT Urography

PR Exam

31
Q

What does this photo show?

A

All the causes of haematuria

32
Q

Diagnosis?

  • 24 year old female

Frank Haematuria

Smoker

  • Large white cells
  • Single
  • Sexually active
  • USS normal
  • Cytoscopy red patch
  • Cytology normal
A

UTI

33
Q

Diagnosis?

  • 45 year old female

Frank Haematuria

Urinary Urgency and Frequency

Smoker

  • Paraplegic
  • Bladder Stones
  • USS normal
  • Cytoscopy Normal
  • Cytology Normal
A

Squamous Cell Cancer of bladder

Can develop due to lots of urinary infections

34
Q

60 year old female

Smoker

Frank Haematuria

Cytoscopy Red patch

Cytology suspicious

Ultrasound shows hydronephrosis

A

Bladder Tumour

Renal (34 decks)

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