6 - Hematuria And Proteinuria Flashcards
Hematuria definition?
> 3 RBC/HPF (high power field)
Warning sign of hematuria?
Gross hematuria (hmm) Sign of malignancy
Besides malignancy hematuria can be?
Urinary calculi
UTI
Carcinoma of kidney or bladder
Initial hematurea
Blood at beginning of stream
- penile/urethral source
Terminal hematuria?
Blood at end of stream
- prostatic urethral or bladder neck source
- Posterior urethral polyps
- Vascular neck tumors
Total hematuria?
Blood throughout
- bladder or upper tract source
- stone
- tumor
- TB
- nephrotic syndrome
ROS for hematuria?
Are the following symptoms present?
– Dysuria
• Painful intermittently (beginning/end of urination)
• Painful throughout
– Symptoms of bladder irritability
• frequency, urgency, etc.
– Urethral discharge?
– Fever, pain
– Trauma, menses
Get an abdominal/pelvic/rectal exam to r/o differential
Renal or extra renal?
Renal − Glomerular − Non-glomerular − Cysts − Calculi − Neoplasms
Extra-renal – Benign prostatic hyperplasia – Infections – Drugs – Calculi – Neoplasms – Blood disorders – Trauma – Pelvic radiation – Genital or anal bleeding
DDX for hematuria?
PP ON THIS
• Period • Prostate, papillary necrosis • Obstructive uropathy • Nephritic syndrome • Trauma, tumor, tuberculosis, thrombosis (renal vein) • Hematologic (blood disorder, sickle cell) • Infection/inflammation • Stones
1st thing to do w hematuria?
Urinalysis
– 1st morning void is best
– Dipstick can detect as few as 2 RBC/HPF
– If positive → get 3 samples at least 1 wk apart for
confirmation
False pos hematuria?
Myoglobinuria, hemoglobinuria, bacteria, oxidizing
agents, hydrochloric acid, concentrated urine,
menses, vigorous exercise, beets/rhubarb
False neg hematuria?
High vitamin C/ascorbic acid levels
If pos heme UA?
Confirm w microscopy
Culture and sensitivity
- ID and treat
- repeat 4-6 weeks
Cytology (if persistent)
- r/o cancer
Imaging for hematuria?
CTU
Cystoscopy (urology)
Referrals for hematuria?
Nephrology
Urology if:
- calculi
- ureteral, cystic, urethral origin
“Flow” chart?
Get it “flow”
Slide 16
Pseudohematuria?
Dipstick pos
Microscopic neg
Hemoglobinuria - black urine - (hemolysis, hemolytic
anemia, malaria) - dark from at extra-renal source
Myoglobinuria - rhabdo, trauma, sock, acute tubular necrosis
Foods
Food coloring
Drugs
Pance peral
AN OLD PERSON W/ A HISTORY OF SMOKING (esp., male) PRESENTING W/ PAINLESS HEMATURIA HAS BLADDER CANCER UNTIL PROVEN OTHERWISE!!
Definition of proteinuria?
150mg/24hrs
Microalbuminuria?
30-300
> 300 dipstick will find it
Nephrotic proteinuria?
> 3.5 g/day
Glomerular proteinuria?
Effacement of epithelial cell foot processes and; altered glomerular permeability w/ ↑ filtration fraction of normal plasma proteins; heavy proteinuria
– Diabetic nephropathy
Basically a broken glomerulus
Tubular proteinuria?
Faulty reabsorption of normally filtered proteins (i.e., beta-2-macroglobulin and immunoglobulin light chains) in proximal tubule
– ATN, toxic injury (lead, aminoglycosides), drug-induced interstitial nephritis, and hereditary metabolic disorders (Wilson disease and; Fanconi syndrome)
Broken reabsorption
Overload proteinuria?
Overproduction of circulating, filterable plasma proteins (i.e., monoclonal gammopathies = Bence Jones proteins, myoglobin, or hemoglobin)
– Multiple myeloma, rhabdomyolysis, hemolysis
You just have too much protein for the kidney to handle
Functional proteinuria
crossfitlife
Benign - stressors
- illness, exercise, orthostatic proteinuria
Microalbuminuria is important in?
Diabetics
- DM nephropathy
- annual screening
HTN and other kidney disease
Microalbuminuria is a risk factor for?
Cardiovascular disease
Dipstick testing w pos proteinuria is usually?
Incidental pos (too much protein in diet etc)
REPEAT in 24hrs w 1st morning void
- no exercise
Gold standard of proteinuria?
24hr collection
Pts will hate you
Spot samples?
UACR - urinary albumin creatine ration
- instead of 24 hr
- recommended for DM
UPCR - urinary protein creatine ration
- better for monitoring established proteinuria
Eval of proteinuria?
Quantify - urine labs Serum Chem (CMP) - GFR, BUN, creatinine, serum albumin, lipids US Urinary electrophoresis Renal biopsy
Clinical complications of proteinuria:
Acute renal failure
• Generalized edema (due to hypoalbuminemia)
• Pulmonary edema
Proteinuria pts are at a higher risk for?
– bacterial infection (including spontaneous bacterial peritonitis)
– arterial and venous thrombosis (including renal vein thrombosis [RVT])
– cardiovascular disease
Tx for proteinuria?
Goal <0.5g/day
Lower proteinuria»_space; lowering BP (CKD progression)
ACE or ARB
Baseline serum potassium and creatine
Wt loss
Protein restriction
Nephrology referral
ACE and ARBs show?
– ↓ intra-glomerular pressure
– ↓ protein excretion
– slow progression of renal disease
Wt loss effect on proteinuria?
5% wt loss can decrease proteinuria up to 20-30%
Now i lay me down to sleep, i pray to god my muscles peak
If i should die before i wake, i hope heaven has unlimited protein shakes
