[58] Haematuria Flashcards
What is haematuria?
The presence of blood in the urine
What are the possible causes of haematuria?
- UTI
- Glomerular pathology
- Urinary tract stones
- Trauma
- Other renal pathology
- Vascular causes
- Haematological causes
- Drug induced
- Exercise induced
What glomerular pathology can cause haematuria?
- Post-infectious glomerulonephritis
- Henoch-Schonlein purpura
- IgA nephropathy
- SLE
- Hereditary glomerular pathologies
What hereditary glomerular pathologies can cause haematuria?
- Thin basement membrane
- Alport’s syndrome
What other renal pathologies can cause haematuria?
- Renal tract tumour
- Polycystic kidney disease
What are the vascular causes of haematuria?
- Renal vein thrombosis
- Arteritis
What are the haematological causes of haematuria?
- Coagulopathy
- Sickle cell disease
What drugs can cause haematuria?
Cyclophosphamide
What questions should be asked when taking a history of haematuria?
- Have they had any UTI symptoms?
- Have they had any renal stone symptoms?
- Have they had any symptoms of glomerular pathology?
- Have they had any signs of coagulopathy?
- Have they had any recent trauma?
- Any family history?
What UTI symptoms should be asked about?
- Fever
- Frequency
- Dysuria
What is a symptom of renal stones?
Colicky abdominal pain
What are some symptoms of glomerular pathology?
- Sore throat
- Rashes
What is a sign of coagulopathy?
Easy bruising
What family history should be asked about?
- Haematuria
- Deafness
- Sickle cell disease
What should be looked for on examination when a patient presents with haematuria?
- Abnormal BP
- Palpable mass on abdomen
- Rashes on skin
- Pain or swelling in joints
What urine tests should be performed?
- MCS
- Protein:creatinine ratio
- Calcium:creatinine ratio
What is suggestive of nephritis on MCS?
Casts
What bloods should be performed?
- U&E’s
- FBC
- Clotting
- Complement - C3/4
- ANA/anti-dsDNA
When might a renal biopsy be indicated?
- Significant persistent proteinuria
- Recurrent macroscopic haematuria
- Renal function is abnormal
- Complement levels are persistently abnormal
What additional tests can be performed if needed?
- Renal tract USS
- Urinalysis of parents
What are some other causes of red urine?
- Haemoglobinuria/myoglobinuria
- Foods e.g. beetroot
- Rifampicin
- Urate crystals
- External source e.g. menstrual blood loss
How is haematuria managed?
- Treat any obvious cause
- Refer to paediatric nephrology if complex
- Monitor if no obvious cause or worrying symptoms and if no resolution in 6 months refer to nephrology
