4. Haematuria Flashcards
What are the different classifications of haematuria?
Visible haematuria: blood is visible in the urine colouring it red, pink or dark brown.
Non-visible haematuria: blood is present in urine on urine analysis, but not visible.
What are classifications of non-visible haematuria?
Symptomatic: presents with associated symptoms e.g, suprapubic pain
Asymptomatic: no associated symptoms
when is Haematuria a normal finding?
HAEMATURIA IS NEVER A NORMAL FINDING
What is pseudohaematuria?
Red or brown urine that is not secondary to the presence of haemoglobin
What are the cause of pseudohaematuria?
- medication: rifampicin, methyldopa
- hyperbilirubinuria
- myoglobinuria
- foods: beetroot or rhubarb
What are different urological causes of haematuria?
- infection: cystitis, pyelonephritis, prostatitis
- malignancy: urothelial carcinoma, prostate adenocarcinoma
- BPH
- renal calculi
- trauma or recent surgery
- radiation cystitis
- parasitis, most commonly schistosomiasis
- glomerulonephritis
- drugs
what are the most common causes?
urinary tract infection (UTI), urothelial carcinoma, stone disease, adenocarcinoma of the prostate, and benign prostatic hypertrophy (BPH).
how can causes of Haematuria be divided?
- urological
- upper tract
- lower tract - non-urological
- medical
- pseudohaematuria
What drugs can cause haematuria?
- cyclophosphamide (haemorrhagic cystitis)
- naproxen
- nitrofurantoin
- penicillin
- blood thinners (not typically the underlying cause)
What characteristics of the haematuria are important?
- degree of haematuria (red vs dark red)
- presence of blood clots
- timing in the stream
What does the timing of the blood in the stream suggest?
- initial: urethral cause
- total haematuria: bladder or upper urinary tract cause
- terminal haematuria: potential severe bladder irritation (e.g. bladder stones)
What associated symptoms may be present?
- Lower Urinary Tract Symptoms (LUTS),
- fevers or rigors,
- suprapubic pain, flank pain, or
- weight loss, or
- recent trauma
What part of the social history is very important?
Smoking status
- strong association with urological malignancies
Why is occupational history important?
Any exposure to industrial carcinogens (increased risk of bladder cancer)
Why is travel history important?
Risk of schistosomiasis
Where is schistosomiasis found?
South American, Africa, Middle East, Southeast Asia. Intermediate host: Snails.
What physical examination should be done?
Abdominal examination, alongside potential digital rectal examination and / or examination of the external genitalia depending on the presentation.
What investigations would you do?
- Urinalysis
- Baseline bloods (FBCs, U&E, Clotting)
- PSA if indicated
- urinary protein levels (spot albumin:creatinine ratio or protein:creatinine ratio) in those with deranged renal function
What are the NICE guidelines for urgent urological referral?
Aged ≥45yrs with either:
- Unexplained visible haematuria without urinary tract infection
- Visible haematuria that persists or recurs after successful treatment of urinary tract infection
Aged 60yrs with have unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test.
Patients with asymptomatic non-visible haematuria on two out of three tests should also be referred for further investigation.
What special investigations can be done?
- Flexible cystoscopy is the gold standard investigation for assessing the lower urinary tract
Upper Urinary tract:
- US KUB (typically for non-visible)
- CT (typically for visible )
